Project Summary

Environmental Approaches to Obesity Prevention and Management at The Dow Chemical Company
The Dow LightenUP Project

Project Brochure

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Overview

Employers are seeking innovative and evidence-based interventions that can be implemented at the workplace to address the growing epidemic of obesity that adversely impacts worker health and productivity. In a five year project funded by the National Heart, Lung and Blood Institute (NHLBI), the Emory University Institute for Health and Productivity Studies partnered with Thomson Reuters, the University of Georgia, the National Business Group on Health, and The Dow Chemical Company (Dow) to design, implement, and evaluate an environmental and ecological intervention program aimed at preventing and managing overweight/obesity in the workplace.

The Problem

About two-thirds of all Americans are overweight or obese¹, and obesity is a risk factor for chronic disease conditions including type-2 diabetes, cardiovascular disease, musculoskeletal disorders, certain cancers, depression, and other preventable diseases.^2,3 The national medical cost burden attributable to obesity and overweight is estimated to be $117 billion⁴ (in direct and indirect costs). For employers, the annual excess medical costs for obese or overweight employees are 21% higher than for those not overweight.⁵ Obesity is estimated to cause 39 million lost workdays and 239 million restricted activity days.⁶

Business leaders are becoming increasingly aware of the human and economic burden that poor health imposes on their workers and their companies' competitiveness. Many employers have invested in health promotion and disease prevention programs aimed at reducing the prevalence of obesity in the workplace through encouragement of physical activity, healthy diet, and improved management of health risk factors.^7,8 Employers continue to seek innovative and evidence-based interventions that can be imported into the workplace to address this growing public health epidemic that also adversely affects worker productivity.

The Situation at Dow

Dow's Health Strategy plans include the need for innovative preventive health interventions directed at obesity and overweight. Like other businesses, Dow's employee population has high rates of overweight and obesity. Thomson Reuters conducted a return-on-investment (ROI) analysis illustrating that a 1% annual decrease in overall health risks (including obesity) among Dow employees would save the company approximately $62 million over 10 years (adjusted for inflation) in health care costs alone.⁹ This figure would be even more significant if indirect productivity costs were acknowledged.

The LightenUP Study at The Dow Chemical Company

The overall project goals/objectives of this study were to:

1. Design and demonstrate the feasibility of implementing moderate-intensity and high-intensity environmental and ecological interventions directed at overweight and obesity prevention at The Dow Chemical Company.
   
   
2. Test the multifaceted hypothesis that, relative to individual interventions alone, environmental interventions combined with individual interventions: a) reduce the prevalence of obesity and overweight, b) reduce the prevalence of other weight-related risk factors, c) improve health, and reduce healthcare utilization and expenditures, and; d) improve an array of indicators known to be related to employee productivity.
   
   
3. Test whether savings outweigh program expenses, thus producing a positive return on investment.

Twelve Dow Chemical manufacturing and research/development locations in Louisiana, Texas, New Jersey and West Virginia served as study sites (a total of 10,618 eligible employees). Moderate intensity interventions were offered at four company sites. These interventions included inexpensive environmental changes such as environmental prompts that encouraged employees to make healthy food choices and be physically active; this included point of choice messages to encourage healthy eating and physical activity, such as the use of signs strategically located in front of stairwells, vending machines, and cafeterias. Additional moderate intensity interventions included healthy food offerings in cafeterias, a weight management tracking program, labels denoting healthy vending machine items and individual level rewards/recognition. High intensity interventions (above and beyond moderate level interventions) were offered at five company sites. These interventions included engagement of senior managers in the development of a worksite culture that is broadly supportive of improved health among Dow employees, the development of site goals tied to health improvement, senior leadership training, and workgroup and team leadership rewards/recognition. Three locations served as control groups which only received Dow's existing core health promotion program consisting of individually-oriented interventions.

The study employed a quasi-experimental pre-post design comparing high intensity, moderate intensity and control sites. Process and outcome measures were collected at three milestones: baseline, year 1 and year 2.

Study Impact

By pursuing these study aims, the research will help corporate executives, health promotion program managers, scientists, and policymakers engaged in the development and implementation of successful interventions. Additionally, specialists in organizational development will gain a better understanding of the successful environmental interventions that are available and that will appeal to employers and their employees.

Findings

First-year results revealed that environmental changes to the workplace can achieve modest improvements in employees' health risks, including weight and BMI measures, in one year.¹⁰ After one year of intervention, a modest treatment effect was observed for weight and BMI largely because the control group subjects gained weight while the intervention group subjects maintained their weight; however, no effect was observed for overweight and obesity prevalence. Other risk factors (tobacco use, high blood pressure, and systolic and diastolic blood pressure values) decreased significantly, although blood glucose (high risk prevalence and values) increased.

These overall patterns for weight and BMI were sustained after two years of intervention. Thus, while no additional weight change was achieved after an additional year of intervention, the intervention group participants were able to maintain their weight and BMI two years in a row while the control group participants gained weight over time. These are encouraging findings. Given that national obesity rates are on the rise, and that people tend to gain weight as they age, the small but significant effects of environmental interventions at the worksite are notable. Helping people avoid weight gain is as important as supporting their weight loss efforts. The final results are still being analyzed and will undergo further peer review before being finalized.

Conclusion

Environmental and social ecological interventions often require engaging leadership support and modifying organizational policies which can involve lengthy administrative processes before approval is gained for such activities. Thus, the full effects of environmental interventions may not be observable within even a two-year time horizon. Additional research, with more worksites and longer follow-up periods, may be necessary in order to attain a better understanding of environmental interventions on employee health risks.

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¹ Task Force on Community Preventive Services. Proceedings of The Task Force Meeting: Worksite Reviews. Task Force on Community Preventive Services; 2007
² Must A, Spadano J, Coakley EH, Field AE, Colditz G, Dietz WH. The disease burden associated with overweight and obesity. JAMA. 1999;282:1523-1529
³ Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults: The evidence report. National Heart Lung and Blood Institute. Obes. Res. 1998;6(Suppl 2):51S-209S.
⁴ National Center for Health Statistics. Overweight and Obesity Prevalence. http:ww.cdc.gov/nchs/overwt.htm; 2003.
⁵ Erfurt J, Foote A, Heirich M. Worksite wellness programs: Incremental comparisons of screening and referral alone, health education, follow-up counseling, and plant organization. Am J Health Promot. 1991;5:438-448
⁶ Department of Health and Human Services (DHHS). Prevention Makes Good Cents. 2003. Available at: http://aspehhsgov/health/prevention/#N_62_.
⁷ Ozminkowski RJ, Ling D, Goetzel RZ, Bruno JA, Rutter KR, Isaac F, Wang S. Long-term impact of Johnson & Johnson's health & wellness program on health care utilization and expenditures. J Occup Environ Med. 2002;44:21-30
⁸ Ozminkowski RJ, Dunn RL, Goetzel RZ, Cantor RI, Murnane J, & Harrison M. A return on investment evaluation of citibank, n.A. Health management program. Am J Health Promot. 1999;14:31-43
⁹ Goetzel R, Ozminkowski, RJ, Baase, CM, Billotti, GM. Estimating the return-on-investment from changes in employee health risks on The Dow Chemical Company's health care costs. J Occup Environ Med. 2005;47:759-768
¹⁰ Goetzel RZ, Baker KM, Short ME, et al. First-year results of an obesity prevention program at The Dow Chemical Company. J Occup Environ Med. 2009;51:125-138.