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Obesity: Worksite Programs


What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 47 studies (search period 1966 – 2005).

The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to obesity prevention and control.

Summary of Results

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 1.22 MB].

The review included 47 studies and reported 3 measures: body mass index (BMI), weight, and percent body fat.

  • Intervention groups had favorable results on all 3 reported measures when compared with control groups (31 studies).
  • Effects were greater for groups who received more intensive versus less intensive interventions (9 studies).
  • In randomized controlled trials, participating employees lost an average of 2.8 pounds (9 studies) and reduced their average BMI by 0.5 (6 studies) when compared with control groups after 12 months.
  • No single focus, diet or physical activity, or combination of both appeared to be better than others in terms of effects on weight loss.

Summary of Economic Evidence

Detailed results from the systematic review are available in the published evidence review pdf icon [PDF - 1.22 MB].

  • In 3 studies, cost-effectiveness estimates varied from $1.44 to $4.16 per pound of weight lost (reported in 2005 dollars).
  • One study conducted a cost-effectiveness analysis of a worksite weight-loss program that offered 3-team competitions in business or industrial settings. Participants got a behavioral treatment manual at each weigh-in.
    • Intervention costs for the 3 competitions were $6149, $1377, and $762, respectively. This included material costs and personnel time for management, employees, and program staff who organized and supervised the program.
    • The cost per pound of weight loss was $4.16 for a 12-week program with employees of three banks. The costs were $2.19 for a 13-week program and $1.60 for a 15-week program with employees of two manufacturing companies. The lower costs per pound lost were due to decreased organizational expenses.
  • One study analyzed the cost effectiveness of team competitions and estimated a cost of $1.45 to lose 1% of body weight.
    • Costs included paid time for the committee that planned, coordinated, and administered the program; employee time; and costs of photocopying manuals and printing posters.
  • One study assessed the cost effectiveness of a 3-month education-based program that included competition and emphasized self-responsibility.
    • The campaign cost was $25,376 and the study reported a cost of $1.77 per pound of weight lost.
  • One study reported costs for a program in which each participant received information about how to start a safe weight-loss program. Costs included personnel time and materials for typesetting and printing flyers and posters.
    • The intervention cost was $2634 excluding volunteer time and $3966 including 166 hours of volunteer time valued at $8.04 per hour.
    • Cost-effectiveness ratios were $2.17 and $1.44, respectively, per pound of weight lost with or without the cost of volunteer time. The follow-up period for this study was shorter than that required for the effectiveness review.
  • One study reported a reduction in disability and major medical costs of $1023 per participant at a worksite physical fitness program for a 1-year period, excluding costs of maternity- or obstetrics-related claims.
    • The intervention costs of $75,750 included the first-year budget for operating expenses, annual cost of laboratory tests and physical examinations, and annual cost of capital investment in equipment amortized more than 20 years.
    • Although the study did not report any change in employee weight, there was a significant decline in the percentage of body fat.
    • The intervention returned $1.59 for every dollar invested in the program, resulting in a net saving of $0.59 per $1.00.


The CPSTF finding should be applicable to a white-collar workforce where both overweight and other chronic disease risk conditions exist.

Evidence Gaps

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

  • Which employee populations benefit the most from worksite health promotion interventions focused on weight loss?
  • Do those at greatest risk benefit more or less than others?
  • What are program effects on individuals’ weight loss, and what percent of participants have clinically meaningful weight loss (i.e., >5% or >10% body weight loss)?
  • What are intervention effects at the population-level?
  • How does effectiveness vary by blue- or white-collar job status, race, or ethnicity?
  • How effectiveness are individual program components or combinations of components?
  • How feasible is it to set up programs in very small or very large worksite settings?

Study Characteristics

  • The most common intervention strategies included informational and behavioral skills components (32 studies).
  • Four studies looked at policy and environmental changes in the worksite.
  • Half the studies were conducted in the United States; remaining studies were conducted in Europe, Australia, New Zealand, Japan, Canada, India, and Iceland.
  • The purpose of the interventions, as stated by study authors, included cardiovascular disease risk reduction (34%); weight control (26%); and physical fitness (19%).
  • The behavioral focus of each intervention included diet and physical activity behaviors (57%); diet only (21%); and physical activity only (21%).
  • Study participants were coded as white-collar or blue-collar workers based on descriptions in the studies and nature of the company. In 19 studies, this could not be determined; in 25 studies, most participants (80%) held white-collar jobs; in the remaining 4 studies, the participants held blue-collar jobs.
  • Among studies that reported gender of participants, most included both men and women (64%).
  • Among 46 of 47 included studies, the median sample size was 141. The final study, a WHO multi-country trial, had a sample size of 63,732.
  • Of the 39 studies reporting attrition, the median attrition rate was 17%.