A 3-year 4-arm small-to-medium employer-randomized control trial is proposed based on interest across DHHS in confronting mounting overweight/obesity and at CDC in identifying cost-effective Interventions that can improve workers' health. The study will gauge relative effectiveness-compared to Standard worksite wellness (SWW) which features no deliberate overweight and obesity control and prevention (OO/CP) components-of three Standard-plus (SpWW) models: Individual per se (Ips), Environmental per se (Eps), Integrated environmental-individual (lei). Interventions will seek to modify employee behaviors that contribute to overweight/obesity, Ips by providing health services to subsets of employees, Eps by altering worksite and surrounding settings affecting all employees, lei by integrating the two approaches. Each will feature distinct health promotion/disease prevention (around food choices, physical activity, alcohol, tobacco) but common design/implementation (employer/employee program delivery collaboration) components. The test period will last 30 mos, enlist 32 employers. In phase 1 (4 mos) baseline measures will be taken of relevant employer and employee characteristics and Test site program delivery (PD) teams will be constituted to work with the study team a) to tailor Interventions by selecting general Worksite wellness and specific OO/CP components (study-defined range, fixed minimum) and b) to design Protocols by which PD teams with study personnel will guide phase 2 (26 mos) Interventions. Primary outcomes include morbidity: weight (overweight/obesity = BMI >25/>30), waist circumference (overweight=WC >35 [w], >40 [m]), lipids (total cholest, HDL-cholest), blood glucose; disability: work limitations (WLQ); health-related quality of life: physical, mental health status (SF-36); productivity: absenteeism (rate), productivity (WLQ); cost: employer, employee cost (health-related). Test site are expected to report significantly more positive outcome than Control site, lei significantly more positive outcomes than Ips or Eps, Ips no more or less positive outcomes than Eps employers.
