Understanding Pathways to Weight Loss among Employees and Organizations Enrolled in the WAY to Health Worksite-based Weight Loss Study

Li, Jiang

Understanding Pathways to Weight Loss among Employees and Organizations Enrolled in the WAY to Health Worksite-based Weight Loss Study

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March 20, 2019

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Li, Jiang
- Affiliation: Gillings School of Global Public Health, Department of Health Behavior

Abstract

The focus of this dissertation is to understand how worksite-based multilevel weight loss interventions influence employees and worksites enrolled in the WAY to Health research study. Paper 1 uses the RE-AIM framework to evaluate the public health impact of the minimal-intensity worksite-based environmental change intervention called The Winner's Circle Dining Program (i.e., WC). In Paper 2, I conducted a theory-guided mediational analysis to examine motivations and self-efficacy as pathways in the relationship between the web-based weight loss program/cash incentives, healthy eating, physical activity and weight change among employees enrolled in the weight loss study. Methods: A total of 1004 overweight employees from 17 community colleges in North Carolina were randomly assigned to one of three interventions: WC only, WC +Web-based Weight Loss Program (WC+WEB), or WC + Web-based Weight Loss Program + Incentives (WC+WPI). Descriptive statistics were summarized for RE-AIM measures-Reach, Adoption and Implementation of WC. To examine the Effectiveness, the interactions between WC and the individual level interventions as well as their main effects on changes in individual's weight (or healthy eating) were estimated using a 2-level hierarchical linear model. A structural equation model analysis was used to test the proposed mediators on the path to weight change for Paper 2. Results: Paper 1 found that 62% of participants reported that they used the food services on campus thus were reachable by the WC. All campuses adopted at least one component of the WC to provide access and highlight healthy foods. Nine out of 17 community colleges (53%) placed WC stickers at cafeteria and/or vending machines over a 12-month period; 32.5%-48% of the employees reported that they purchased items with the WC logo. Moreover, placing WC stickers at the cafeteria or vending machines significantly enhanced the effects of the WPI on weight loss at the 12-month follow-up. Paper 2 revealed that the relationship between WC+WPI intervention and weight loss was mediated by autonomous motivation to participate in a weight loss program; as was the relationship between the WC+WPI intervention and total calories. Conclusions: This dissertation provides insights on how to maximize the intervention effects on weight loss.

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