Employee weight management through health coaching

Pilot Feasibility Study of Incorporating Whole Person Care Health Coaching Into an Employee Wellness Program

Prior research supports positive health coaching outcomes, but there is limited literature on the integration of employer-sponsored health coaching into employee wellness strategy. The aim of our mixed methods study was to assess feasibility, acceptability, and preliminary efficacy of incorporating a whole-person care model of health coaching into an employee wellness program (i.e., weight loss, smoking cessation) that is made available by an employer-sponsored health plan. For the quantitative study, eligible employees and covered spouses (n = 39) from Loma Linda University Health were recruited into a novel, 12-week, whole person care intervention that combined health coaching and health education and examined outcomes from surveys detailing the participants' experience and biometric data from the intervention and maintenance periods. For the qualitative study, data were collected through key informant interviews from three health coaches and six intervention participants who were recruited via random sampling. Health coaching was well-received by the participants, and led to a slight albeit positive behavioral change for obesity. A significant decrease in body mass index occurred over 12 weeks of intervention (−0.36 kg/m², p = 0.016), that did not continue during the maintenance phase (−0.17 kg/m², p = 0.218). Qualitative findings indicated improved personal health awareness, accountability, motivation, and self-efficacy along with goal setting and barrier overcoming skills among the key themes. Our pilot study findings identify positive behavior change effects of an employee health intervention based on a whole person care model of health coaching with integrated health education, and also identify the need for methods to maintain behavior change (i.e., mHealth, peer-support) post-intervention. Further investigation in randomized controlled trials is the next step in this research.

Relationship of Weight-Related Eating Behaviors and Weight Loss of Participants Enrolled in a Proprietary Weight Loss Program

Background: There is a need for improving long-term success in meal replacement programs and identifying the variables that affect weight loss and maintenance in a proprietary weight loss program that includes health coaching. Objective: The aim of this study is to evaluate weight-related eating behaviors of participants with clinically significant weight loss (CSWL) in a proprietary weight loss program. Study Design, Setting, and Participants: A cross-sectional sample of participants (n=1,454) enrolled in a proprietary weight-loss program that includes meal replacements and health coaching were queried via an on-line survey for weight-related eating behaviors and weight history. Main Outcome Measures and Analysis: Weight-related eating behaviors of routine restraint (RR), compensatory restraint (CR), susceptibility to external cues (SEC), and emotional eating (EE) were assessed using the Weight Related Eating Questionnaire. CSWL was defined as having achieved a weight loss greater than 10% of starting weight. Participants were dichotomized into those with CSWL (n=973) and with no CSWL (n=481). The relationship between CSWL (controlling for age and sex) as the dependent variable and weight-related eating behaviors (RR, CR, SEC, and EE) as the independent variables was assessed using logistic regression (Stata/SE 14). Results: Those with CSWL have higher odds of having RR (OR: 1.3, p<0.05) and CR (OR: 1.1, p<0.05) and lower odds of SEC (OR: 0.7, p<0.05) and EE (OR: 0.8, p<0.05) eating behaviors than those without CSWL. Conclusions: Weight-related eating behaviors of participants in proprietary meal replacement weight-loss programs who have successfully lost weight differ compared to those who have not. Knowledge of the relationship between CSWL and weight-related eating behaviors can be used by coaches to assist participants in reinforcing those behaviors that support weight-loss. These results are limited to participants who self-select for proprietary meal-replacement weight-loss programs and cannot be generalized to other weight-loss or maintenance programs.

Implementing Patient-Reported Outcomes to Improve the Quality of Care for Weight of Patients with Schizophrenia

"Enhancing QUality of Care In Psychosis" (EQUIP) was an eight-site clustered controlled trial of the implementation and effectiveness of patient-reported outcomes to support evidence-based practice and improve care for schizophrenia. Implementation sites chose to improve care for weight. Implementation included monitoring patient-reported outcomes using kiosks, patient and staff education, quality improvement teams, and phone care management. Qualitative and quantitative methods compared implementation and effectiveness between sites for 13 months. Eighty percent of 801 randomly selected patients were overweight. Two hundred one clinicians varied in competency. Baseline use of behavioral weight services was low. At implementation sites, patients became 2.3 times more likely to use weight services compared with control sites (95% CI, 1.5-3.6; χ² = 14.4; p < 0.01). There was no effect on the weight gain liability of medications prescribed. Controlling for baseline, patients' final weight at control sites was 5.9 ± 2.7 kg heavier than at implementation sites (F = 4.8, p = 0.03). Patient-reported outcomes can inform implementation of evidence-based practice and improvement in outcomes.

Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13), cardiovascular diseases (n = 8), and diabetes (n = 6). Intervention strategies included instructional education/counseling (n = 20), workplace environmental change (n = 6), physical activity (n = 10), use of technology (n = 10), and incentives (n = 13). Self-reported data (n = 21), anthropometric measurements (n = 17), and laboratory tests (n = 14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

The impact of telephonic wellness coaching on weight loss: A "Natural Experiments for Translation in Diabetes (NEXT-D)" study

OBJECTIVE

To evaluate the impact of a population-based telephonic wellness coaching program on weight loss.

METHODS

Individual-level segmented regression analysis of interrupted time series data comparing the BMI trajectories in the 12 months before versus the 12 months after initiating coaching among a cohort of Kaiser Permanente Northern California members (n = 954) participating in The Permanente Medical Group Wellness Coaching program in 2011. The control group was a 20:1 propensity-score matched control group (n = 19,080) matched with coaching participants based on baseline demographic and clinical characteristics.

RESULTS

Wellness coaching participants had a significant upward trend in BMI in the 12 months before their first wellness coaching session and a significant downward trend in BMI in the 12 months after their first session equivalent to a clinically significant reduction of greater than one unit of baseline BMI (P < 0.01 for both). The control group did not have statistically significant decreases in BMI during the post-period.

CONCLUSIONS

Wellness coaching has a positive impact on BMI reduction that is both statistically and clinically significant. Future research and quality improvement efforts should focus on disseminating wellness coaching for weight loss in patients with diabetes and those at risk for developing the disease.

Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis

BACKGROUND

In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals.

METHODS

An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I².

RESULTS

Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose.

CONCLUSIONS

Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.

An evaluation of a comprehensive, incentivized worksite health promotion program with a health coaching component

Purpose

– The use of lifestyle coaches in a worksite setting to improve weight, nutrition, physical activity, and smoking behavior among at risk individuals is a relatively new area of research in the field of health promotion. The purpose of this paper is to assess the effectiveness of an accountability-based worksite telephonic health coaching program that incorporates financial incentives, a personal wellness profile (PWP) assessment tool, and biometric testing.

Design/methodology/approach

– A retrospective cohort study was conducted based on data from four midsize companies in Utah (USA), 2007-2010. Individuals with high-risk biometric scores were required to work with a health coach.

Findings

– Participants had fewer healthcare claims and lower costs than nonparticipants, which became more pronounced over the study period. Health risks and PWP results significantly improved, more so in those in poorer health at baseline that worked with a health coach. Mean difference between health age and potential achievable age significantly decreased, more so for men than women and among those with the greatest need for improvement.

Originality/value

– Health coaching effectively improved biometric scores among high-risk individuals and narrowed the difference between current health age and achievable age, more so among those with the greatest health risks at baseline who worked with a health coach.

A small business worksite wellness model for improving health behaviors

OBJECTIVES

To evaluate the effectiveness of a wellness program delivered by WellSteps, LLC, aimed at improving employee health behaviors in small companies that lack the resources to independently develop and manage a wellness program.

METHODS

Analyses are based on 618 employees from five diverse companies that completed an initial personal health assessment.

RESULTS

Exercise and dietary behaviors significantly improved across the five companies. Significant improvements in health perception and life satisfaction also resulted and were associated with improvements in health behaviors. Three of the five companies, each with fewer than 50 employees, were most effective in influencing positive health behaviors, health perceptions, and life satisfaction.

CONCLUSIONS

The worksite wellness program effectively improved health behaviors, health perceptions, and life satisfaction.

A focus group assessment to determine motivations, barriers and effectiveness of a university-based worksite wellness program

BACKGROUND

This study explores university employee perceptions and under-standing about its Worksite Health Promotion Program (WHPP). The WHPP included a Health Risk Appraisal (HRA), biometric screening, publicity for on-campus health programs and facilities, and health coaching.

METHODS

A qualitative design was used based on a grounded theory ap-proach. Four 90 minutes focus groups with 6-8 participants in each were conducted within a two 2 week period among employees, representing fac-ulty/participants, fac-ulty/nonparticipants, staff/participants, and staff/nonparticipants. Responses to questions about motivations, barriers, and perceived health benefits that impacted participation in the WHPP were digi-tally recorded, transcribed and coded for themes.

RESULTS

Incentives effectively motivated participation. Biometric screening had the largest impact on behavior change, followed by the information learned from the HRA. However, despite two-thirds of the employees partici-pating in the pro-gram, lack of a full understanding of WHPP benefits and services lowered partici-pation in follow-up services and supplemental pro-grams.

CONCLUSIONS

Biometric screening and HRAs effectively motivate program par-ticipation. Communication of benefits and services are important when providing WHPPs.

Health coaching integration into primary care for the treatment of obesity

Obesity (and its related comorbidities) is one of the fastest-growing health concerns facing the United States and shows no sign of abating.¹ The Centers for Disease Control and Prevention calculated that nearly 36% of American adults were obese in 2010 and estimates that this number will reach 44% by 2018.

The current standard of care for the management of patients with obesity in primary care is often a general recommendation by the physician to lose weight through improved nutrition and increased physical activity. Educational materials may be provided along with a referral to a dietician, nutritionist, or weight management program. Health coaching as an obesity intervention has yet to be fully integrated into primary care practice but has proven to be effective in corporate wellness and behavioral weight loss programs.^2–5