Bibliographic reference
Peñalvo JL, et al. Effectiveness of workplace wellness programs for dietary habits, overweight, and cardiometabolic health: a systematic review and meta-analysis. doi.org/10.1016/S2468-2667(21)00140-7
In summary
A recent systematic review and meta-analysis summarized and assessed the effectiveness of 121 multicomponent worksite wellness programs on dietary habits, anthropometrics, and cardiometabolic risk. The study was based on scientific evidence collected from interventional trials over the past 30 years.
Background
Adults spend most of their weekday waking hours at work. For this reason, the workplace offers a unique opportunity to promote health. In fact, both the World Health Assembly in 2004 and the United Nations meeting on the prevention and control of non-communicable diseases in 2011 urged the private sector to promote environments and worksite wellness programs that encourage healthy behavior among workers. In 2017, the World Health Organization stated that workplace wellness programs are one of the best options to prevent and control non-communicable diseases, including mental health.
The characteristics of the study
This study was conducted following the PRISMA guidelines. It involved a systematic search in the leading databases for studies, published between January 1, 1990 and June 30, 2020, that included controlled evaluation designs to assess multicomponent workplace wellness programs. Such kinds of programs should be based on two or more intervention components aimed at improving health, for example: educational messages, cafeteria or vending machine interventions, promotion of stair use, financial incentives, changes to health insurance policies, improved accessibility or discounts for gym memberships. Outcomes were dietary factors, anthropometric measures, and cardiometabolic risk factors. The combined effects were calculated through an inverse-variance random-effects meta-analysis. Possible study biases and sources of heterogeneity were evaluated.
Results
Of the 121 interventional studies meeting the inclusion and exclusion criteria, 68% were randomized controlled trials and 32% were quasi-experimental trials. Most studies were published from 2010 onwards. Workplace wellness program interventions were compared to either a base case (usual care) control or a less intensive intervention. Pooled estimates of the effect of workplace wellness programs on dietary habits, anthropometric measurements, and clinical parameters showed: increased intake of total fruit; decreased intake of total fat and saturated fat; a reduction of BMI, bodyweight, and waist circumference. Significant improvements were seen in all cardiometabolic risk factors. The multivariate meta-regressions, which were corrected for multiple comparisons, indicated that modifications towards healthier food environments appear to be a suitable intervention component for improvements in blood lipids, particularly in LDL cholesterol. Assessment of bias scores were not shown to be a significant source of differential effects or a source of heterogeneity. Potential small-study effects or publication bias were found regarding fruit and vegetable intake (considered both together and individually), saturated fat, BMI, bodyweight, systolic blood pressure, LDL cholesterol, triglycerides, and total cholesterol. After adjusting for small-study effects or publication bias, through the trim-and-fill method, only the estimated change in intake of fruit, BMI, and bodyweight remained significant.
Limits of the study
The quality of the study was assessed using a previously established scoring system based on five criteria: study design, assessment of exposure, assessment of outcome, control for confounding variables, and evidence of selection bias. Therefore, quality assessment might differ from standardized methods such as GRADE or the Cochrane risk of bias tool. The research was limited to scientific literature published in English; therefore, results might be less applicable to non-English socioeconomic settings, and potentially relevant evidence in other languages might have been missed.
What is new?
This systematic review and meta-analysis suggests that workplace wellness programs can improve specific dietary, anthropometric, and cardiometabolic risk indicators. These findings support the use of workplace wellness programs and prompt further investigation into whether they are effective strategies for improving cardiometabolic health.
Perspectives
These new findings serve as a benchmark and could be helpful for developing new, more virtual workplace wellness programs that address the changing nature of work, particularly remote work, after the pandemic.
Edited by Elisabetta Bravini and Carmela Rinaldi
