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Hospital employees are what they eat ... at work. A new in the American Journal of Preventive Medicine finds that hospital employees who purchased the least healthy food in the cafeteria were more likely to have an unhealthy diet outside of work, be overweight and/or obese, and have risk factors for diabetes and cardiovascular disease when compared to employees who made healthier purchases.Employees' health can affect an organization's bottom line in multiple ways. Prior research shows obesity contributes to higher absenteeism, lower productivity, and higher healthcare expenses for employers.

With this in mind, healthcare leaders can help their employees and their organizations by shaping worksite wellness programs that improve long-term health outcomes and reduce costs."Employer-sponsored programs to promote healthy eating could reach millions of Americans and help to curb obesity, a worsening epidemic that too often leads to diabetes, cardiovascular disease, and cancer," lead investigator Anne N. Thorndike, MD, MPH, division of general internal medicine, department of medicine, Massachusetts General Hospital, and Harvard Medical School, said in a news release.

Healthy food, healthy employee

Researchers studied 602 Massachusetts General Hospital employees who regularly used the hospital's cafeterias and were enrolled in a health promotion study in 2016 to 2018. They analyzed worksite food purchases from cash register data, food consumption reports from surveys, cardio-metabolic test results, diagnoses, and medication information. After developing a Healthy Purchasing Score (HPS) to rate the dietary quality of employees' overall purchases, the investigators compared participants' HPS to the quality of their overall diet. They also assessed measures of obesity, diabetes, high blood pressure, and high cholesterol.

Employees with the lowest HPS had the lowest overall dietary quality and the highest risk for obesity, diabetes, and high blood pressure. Healthier purchases were associated with higher dietary quality and lower prevalence of obesity, hypertension, and prediabetes/diabetes.

Employers can support good health

Most Americans spend about half their waking hours at work and consume food acquired at work so there is a strong potential for employers to positively influence their workers' health.

"Workplace wellness programs have the potential to promote lifestyle changes among large populations of employees, yet to date there have been challenges to developing effective programs. We hope our findings will help to inform the development of accessible, scalable, and affordable interventions," said study investigator Jessica L. McCurley, PhD, MPH, postdoctoral fellow at the department of medicine, Massachusetts General Hospital and Harvard Medical School. For example, as part of the hospital's "" program, foods and beverages in its cafeterias have "traffic light" labels to indicate their healthfulness:

• Green is healthy
• Yellow is less healthy
• Red is unhealthy

To reduce unhealthy impulse purchases, healthier choices are placed in the direct line of sight on food displays while unhealthy foods are made less accessible. "Simplified labeling strategies provide an opportunity to educate employees without restricting their freedom of choice. In the future, using purchase data to provide personalized nutritional feedback via email or text messaging is another option to explore to encourage healthy eating," Thorndike said.

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