Obesity and its associated mortality and morbidity are a national health crisis. It is estimated that American employers spend more than $900 billion dollars annually on medical expenditures and that obesityattributable medical expenditures to be $75 billion dollars. Interventions to reduce or prevent obesity that are aimed at the individual level have been studied extensively. On the other hand, data from theory-based research using institutional-level (environmental) approaches are seriously lacking. Yet, institutional-level approaches have the potential to reach large numbers of persons at substantially lower costs than approaches based on individuals and are therefore of critical interest.
The specific aim of this randomized, controlled trial is to test the effectiveness of an institutional-level intervention to prevent or reduce obesity at small manufacturing companies in Kentucky. As secondary aims we will determine whether the intervention increases health promoting behaviors, decreases cardiovascular and diabetic risk factors, and reduces productivity costs related to absences and work limitations. Small manufacturing companies in Kentucky were chosen to target because many of the workers are of Appalachian descent and low socioeconomic status, are at increased risk for heart disease and diabetes, and perform sedentary jobs. Although the work environments in manufacturing provide unique opportunities to address obesity, the literature lacks evidence of successful interventions from rigorous worksite trials. This proposal addresses the RFA's request to test a cost-effective health intervention using the synergy created through partnerships among academia, public health, and industry. The investigators and health planners will use the Social Ecological model and Diffusion of Innovations Theory to plan and test a year-long, company-wide campaign at three companies. The institutional-level components include tailored strategies to change knowledge, attitudes, and behavior. Three hundred randomly selected employees at the intervention and control worksites will be followed at baseline, 3, 6, and 12 months for anthropometric measures, lifestyle behaviors, absences, and work performance. Since the number of employees who worked in manufacturing in the United States in 2003 was estimated to be 14,701,000 (BLS, 2004), and since overweight and obesity affects up to 66 % of the working population, this project will make a significant contribution to the growing efforts to address the obesity epidemic in the United States.
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