Dunn C, Olabode-Dada O, Whetstone L, Thomas C, Aggarwal S, Nordby K, Thompson S, Johnson M. Mindful eating and weight loss, results from a randomized trial. J Fam Med Community Health. 2018; 5(3): 1152.

MAIN FINDINGS: Participants who completed Eat Smart, Move More,

Weigh Less had a significantly larger increase in their mindfulness scores than those in the waitlist control group. Study results suggest that there is a beneficial association between mindful eating and weight loss.

Dailey R, Romo L, Myer S, Thomas C, Aggarwal S, Nordby K, Johnson M, Dunn C. The Buddy Benefit: Increasing the Effectiveness of an Employee-Targeted Weight-Loss Program Through Communication. Journal of Health Communication. 2018;23(3):272-280.

MAIN FINDINGS: Participants who found a caring, attentive “buddy” that encouraged them to keep their goals were more likely to reduce their BMI and waist size while participating in the Eat Smart, Move More, Weigh Less program.

Thompson S, Dunn C, Aggarwal S, Tchwenko S, Wang A, Rushing J, Thomas C, Nordby K, Allison C. Behaviors predictive of weight loss maintenance: Six-month follow up of an online weight management program. Obes Open Access. 2016;2(3).

MAIN FINDINGS: The program implements evidence-based behaviors associated with weight loss maintenance, including limiting portion sizes, eating vegetables, and mindfulness of healthy eating and physical activity.

Dunn C, Olabode-Dada O, Whetstone L, Thomas C, Aggarwal S, Nordby K, Thompson S, Johnson M, Allison C. Using synchronous distance education to deliver a weight loss intervention: a randomized trial. Obesity. 2016;24(1):44-50.

MAIN FINDINGS: Participants who completed

the program lost significantly more weight than those in the wait-list control group and had a greater reduction in BMI. Weight loss was maintained at 6 months.

Eat Smart, Move More, Weigh Less Is Evidence-Based

Central Journal of Family Medicine & Community Health

Cite this article: Dunn C, Olabode-Dada O, Whetstone L, Thomas C, Aggarwal S, et al. (2018) Mindful Eating and Weight Loss, Results from a Randomized Trial. J Family Med Community Health 5(3): 1152.

Abstract

More than one-third of the US adult population is obese. Mindful eating is a possible strategy for weight management. The purpose of the current study was to examine the effectiveness of Eat Smart, Move More, Weigh Less (ESMMWL) in increasing mindful eating as measured by the Mindful Eating Questionnaire (MEQ). The secondary objective was to investigate the relationship between mindful eating and weight loss. Participants were part of a randomized controlled trial that evaluated the effectiveness of ESMMWL, a real-time online, 15-week weight management program. A total of 80 state employees and teachers in North Carolina (intervention group = 42, wait-list control group = 38) participated in the study. The primary outcome was mindful eating as measured by the MEQ, a 28-item questionnaire that assesses five domains of mindful eating. All analyses were performed using SPSS software. Independent samples t-tests and X2 tests were used to compare baseline measures for intervention and waitlist control groups. Analyses of covariance with baseline measure as covariates were conducted to compare change in mindfulness scores between the two groups. Mean mindfulness scores were analyzed using repeated measures ANOVA with Greenhouse-Geisser correction for violations of sphericity. The relationship between weight loss and mindfulness was analyzed with Pearson correlations. Results indicated that ESMMWL participants lost more weight than participants in the waitlist control group. For all subscales and the summary score, participants who completed ESMMWL had a significantly larger increase in their mindfulness scores than those in the waitlist control group. Study results suggest that there is a beneficial association between mindful eating and weight loss. This study contributes to the mindfulness literature as few studies have employed rigorous methodology to examine the effectiveness of an intervention on mindful eating.

*Corresponding authorCarolyn Dunn, Department of Agricultural and Human Sciences, North Carolina State University, NCSU Campus Box 7606, Raleigh, NC 27695-7606, USA, Tel: 919-515-9142; Email:

Submitted: 21 April 2018

Accepted: 30 May 2018

Published: 01 June 2018

ISSN: 2379-0547

Copyright

© 2018 Dunn et al.

OPEN ACCESS

Keywords•Obesity; Overweight; Weight management; Distance-

education; Mindful eating; Online

Research Article

Mindful Eating and Weight Loss, Results from a Randomized TrialCarolyn Dunn1*, Olusola Olabode-Dada2, Lauren Whetstone3, Cathy Thomas2, Surabhi Aggarwal1, Kelly Nordby1, Samuel Thompson2, and Madison Johnson1

1Department of Agricultural and Human Sciences, North Carolina State University, USA2Division of Public Health, Community and Clinical Connections for Prevention and Health Branch, USA 3Nutrition Education and Obesity Prevention Research and Evaluation Unit, University of California, USA

INTRODUCTION In the United States, obesity affects more than one-third of the

adult population [1]. Being categorized as overweight or obese increases the risk of chronic disease including hypertension, type 2 diabetes, and cardiovascular disease [2,3]. Evidence suggests that weight loss in individuals who are overweight or obese may prevent or reduce many of the risk factors for chronic illness [4-10].

There are a number of weight loss strategies that may be employed including caloric restriction, physical activity, pharmacotherapy, or weight loss surgery. Public health guidelines recommend a combination of reducing caloric intake, increasing physical activity, and behavior modification therapy for successful weight management [11]. Specifically, various public health organizations support the small changes approach [12], which emphasizes the combination of diet and physical activity and suggest incremental reductions in energy intake and increases in energy expenditure to prevent gradual weight gain and/or promote gradual weight reduction [13]. In recent years, mindful eating, including increasing one’s awareness and focus on eating, paying attention to hunger and satiety cues, planning meals and snacks, and eating as a singular activity, has been introduced as a possible strategy for weight management.

Within the past decade, there has been an increase in the literature associating mindfulness with reduction in obesity as well as mindfulness as a component of eating disorder treatment [14]. The practice of mindfulness has also been applied to the reduction of food cravings [15,16], portion control [17], and reduction in BMI [18-22] and weight [18,19,21,22]. Mindfulness refers to the learned ability to be open, accepting, and attentive to the moment and, in relation to eating, it refers to an individual maintaining a “non-judgmental awareness of [one’s] physical and emotional sensations while eating or in a food-related environment” [23]. An increase in mindful eating is stated to increase sensitivity to the physiological signs of hunger, satiety cues, pace of eating, the food environment, and food characteristics [17,23,24]. Furthermore, when examining the change in mindfulness, studies found that participants who scored high in mindfulness also had lower problematic eating behaviors [15] and reported fewer serving sizes of energy dense foods [17]. The evidence suggests that mindfulness-based weight loss interventions had an impact on reducing weight and BMI [18-22] but there is a need for additional research. Specifically, there is a need for more published studies that examine the relationship between a validated measure of mindfulness and weight change [25].

The Buddy Benefit: Increasing the Effectiveness of anEmployee-Targeted Weight-Loss ProgramRENE DAILEY1, LYNSEY ROMO2, SARAH MYER2, CATHY THOMAS3, SURABHI AGGARWAL2, KELLY NORDBY2,MADISON JOHNSON2, and CAROLYN DUNN2

1University of Texas at Austin2North Carolina State University3North Carolina Division of Public Health

It is well known that significant others (particularly romantic partners) can influence people’s weight management efforts. However, whatconstitutes effective support—and from which type of individual (e.g., romantic partner, family member, friend)—is unclear. Thus, framedby confirmation theory, we assessed the effectiveness and types of communication of a weight-loss “buddy” through reports of 704individuals enrolled in a 15-week synchronous online weight-loss program. Roughly 54% of participants chose buddies; and those who didlost more weight and waist inches than those who were involved in the program without buddy support. We also found that a combinationof high accepting and high challenging messages from buddies was associated with the greatest decrease in body mass index (BMI) as wellas the greatest reduction in waist size. Furthermore, the support by romantic partners paralleled support by other types of buddies. Having asupportive buddy who was not a romantic partner was just as effective as turning to a romantic partner for assistance. This studyunderscores the important role of a buddy in supporting weight-loss program involvement and encourages individuals to consider enlistingthe help of a buddy, as opposed to losing weight alone, in order to maximize weight management effectiveness.

Two-thirds of US adults are overweight or obese (Ogden, Carroll,Kit, & Flegal, 2014), a major public health concern, as carryingexcess weight is associated with such physical, psychological, andsocial consequences as increased risk of cancer (Key, Spencer, &Reeves, 2010), Type 2 diabetes, high blood pressure, high choles-terol (Mokdad et al., 2003), depression, low self-esteem, anxiety,eating disorders, social isolation (Schwimmer, Burwinkle, & Varni,2003), stigma (e.g., Puhl & Brownell, 2001), and death (BerringtonDe Gonzalez et al., 2010). Consequentially, medical providers andhealth officials urge Americans to achieve and maintain a healthyweight, and increasingly employers are offering weight-loss pro-grams to aid employees in their weight-loss efforts. A systematicreview of worksite nutrition and physical activity programs indi-cates that these programs are associated with a reduction of weightand BMI across workplace settings and sexes (Anderson et al.,2009).

Significant others, including friends, family members, orromantic partners, can influence people’s weight-loss efforts(e.g., Kumanyika et al., 2009; Markey, Markey, & Gray, 2007;Wing & Jeffery, 1999), either through coparticipation in aweight-loss intervention (e.g., Wing & Jeffery, 1999) or byproviding social support, which is associated with healthy eatingand exercise behaviors (e.g., Tucker & Mueller, 2000;Verheijden, Bakx, vanWeel, Koelen, & van Staveren, 2005).

Although the provision of social support is generally viewedas beneficial (cf., Hogan, Linden, & Najarian, 2002), even in thecontext of workplace programs (e.g., Wang, Pbert, & Lemon,2014), the quality or type of the support also matters. It isunclear, however, what constitutes better social support andwhether health-related social support is more effective comingfrom spouses, friends, or family members (Hogan et al., 2002).It is also uncertain how involved family or spouses should be inproviding support (McLean, Griffin, Toney, & Hardeman,2003). Thus, through an analysis of an employee-targetedweight management program, the goal of the current studywas to assess the effectiveness of having a designated significantother or “buddy” and the support they provide. This investiga-tion is framed by using confirmation theory, which focuses on acombination of types of support.

Support from Significant Others

Across a variety of contexts, structural support (someone’savailability to provide support) is critical in managing weightand health concerns (Hogan et al., 2002). For instance, a studyof school employees participating in a weight gain preventionintervention revealed that social support from family, friends,and coworkers was positively associated with weight manage-ment; friend and coworker support for healthy eating and familysupport for physical activity were related to weight loss.Conversely, social undermining (e.g., criticizing weight-lossefforts, encouraging unhealthy behaviors) was associated with

Address correspondence to Rene Dailey, Department ofCommunication Studies, University of Texas at Austin, E-mailrdailey@austin.utexas.edu

Journal of Health Communication, 00: 1–9, 2018Copyright © Taylor & Francis Group, LLCISSN: 1081-0730 print/1087-0415 onlineDOI: https://doi.org/10.1080/10810730.2018.1436622

Sci Forschen

O p e n H U B f o r S c i e n t i f i c R e s e a r c h

Obesity: Open AccessOpen Access

Copyright: © 2016 Thompson S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Volume: 2.3Research Article

Behaviors Predictive of Weight Loss Maintenance: Six-Month Follow up of an Online Weight Management ProgramSam Thompson1*, Carolyn Dunn2, Surabhi Aggarwal2, Samuel Tchwenko1, Alice Wang3, Jill Rushing1, Cathy Thomas1, Kelly Nordby2 and Christine Allison4

1North Carolina Division of Public Health, Raleigh, North Carolina, USA2North Carolina State University, Raleigh, North Carolina, USA3University of North Carolina, Gillings School of Global Public Health, Chapel Hill, North Carolina, USA4North Carolina State Health Plan for Teachers and State Employees, Raleigh, North Carolina, USA

Received date: 29 Aug 2016; Accepted date: 02 Nov 2016; Published date: 08 Nov 2016.

Citation: Thompson S, Dunn C, Aggarwal S, Tchwenko S, Wang A, et al. (2016) Behaviors Predictive of Weight Loss Maintenance: Six-Month Follow up of an Online Weight Management Program. Obes Open Access 2(3): doi http://dx.doi.org/10.16966/2380-5528.124

Copyright: © 2016 Thompson S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

*Corresponding author: Sam Thompson, North Carolina Division of Public Health, Raleigh, North Carolina 27699-1915, USA, Tel: (919) 707-5238; E-mail: sam.thompson@dhhs.nc.gov

IntroductionBehaviors associated with weight loss maintenance six months after

completing an online weight management program were identified from responses to a follow-up survey of participants in Eat Smart, Move More, Weigh Less (ESMMWL), a 15-week, evidence-based adult weight management program [1]. This inquiry contributes to existing literature on behaviors that support weight loss maintenance, particularly after online interventions. These findings have potential to inform intervention curricula regarding the promotion of behaviors that support weight loss maintenance, as well as further investigation into the relationships between specific behaviors and weight loss maintenance. These findings may also help public health practitioners identify obesity prevention strategies that support behaviors proven to foster weight loss maintenance.

Online interactive technology interventions have been demonstrated to help participants lose or maintain weight, including maintaining clinically significant weight loss ( ≥ 5% of bodyweight) for a large proportion of participants [2,3]. Participants who completed ESMMWL lost significantly more weight than those in the wait-list control group and had a greater reduction in BMI [4]. Reductions in BMI, weight, and waist circumference were greater for online ESMMWL participants than those attending in-person classes [5]. Internet-based programs reach large numbers of participants in dispersed work settings and lead to improvements in eating habits, as well as moving individuals into the normal weight category [2]. However, the long-term effectiveness of web-

based weight loss interventions is uncertain [6]. A systematic review of web-based weight loss programs could not reach conclusions on their long-term effectiveness [7]. Computer-delivered interventions have demonstrated sustained improvements in health behaviors outcomes at the first post-intervention assessment [8]. However, the long-term effect of these behaviors on participants’ weight is unknown [8].

This study hypothesizes that ESMMWL online participants who adopted specific healthy eating and physical activity behaviors and continued them after the program ended will be more likely to have

a) maintained positive program outcomes (weight loss or maintenance) and

b) lost additional weight

at six-month follow-up when compared against their counterparts who did not adhere to the same behaviors.

MethodsStudy design

The study uses a retrospective cohort design. Responses to follow-up surveys completed between October 2013 and July 2014 were analyzed to identify behaviors that respondents reported adopting and continuing as a result of ESMMWL that were associated with weight loss maintenance six months after the program ended. Study participants were members of the North Carolina State Health Plan for Teachers and State Employees.

ISSN 2380-5528

AbstractIntroduction: The study identifies behaviors associated with weight loss maintenance six months after completing an online weight

management program. The findings have potential to inform the promotion and ongoing support of behaviors that foster weight loss maintenance.

Methods: A retrospective cohort design was employed for responses submitted between October 2013 and July 2014 to a follow-up survey of participants in an online weight management program. Participants’ weights at the start of the program (W1), at the end of the program (W2) and six months after the program (W3) were used to create three outcome subgroups: Maintenance (W3 ≤ W2 ≤ W1), Post-program loss (W3<W2 ≤ W1) and Clinically significant maintenance (W3 ≤ W2 ≤ W1 where W3 ≤ 0.95W1). Chi-squared tests were used to determine associations (p<.05) between these outcome subgroups and behaviors adopted and continued as a result of the program.

Results: Eight of 15 weight management behaviors assessed were associated with one or more outcome subgroups while four behaviors (limiting portion sizes, eating vegetables, and mindfulness of healthy eating and physical activity) were associated with all three outcome subgroups.

Conclusion: Study findings identify behaviors that should be fostered as part of a sustained response to overweight and obesity. The identified mindfulness and healthy eating behaviors should be emphasized throughout a weight management curriculum to encourage participants to adopt behaviors that will contribute to their sustained success.

Keywords: Weight loss maintenance; Weight management; Mindfulness; Obesity; Nutrition; Physical activity; Internet

Dunn C, Whetstone LM, Kolasa KM, Jayaratne KSU, Thomas C, Aggarwal S, Nordby K, Riley K. Using synchronous distance-education technology to deliver a weight management intervention. JNEB. 2014;46(6):602-609.

MAIN FINDINGS: The program, delivered in real-

time, online distance education format supported with personalized e-mail, expands the reach of nonclinical weight management. The online delivery produces similar impacts when compared to in-person delivery and achieves positive outcomes related to weight, healthy eating, physical activity behaviors and has the potential to reduce health care costs.

Dunn C, Whetstone LM, Kolasa KM, Jayaratne KSU, Thomas C, Aggarwal S, Herget C, Rogers AB. Delivering a behavior-change weight management program to teachers and state employees in North Carolina. Am J Health Prom. 2013;27(6):378-383.

MAIN FINDINGS: The program demonstrates the feasibility of implementing a behavior change-based weight management program at the worksite to achieve positive outcomes related to weight, blood pressure, healthy eating and physical activity behaviors and has the potential to reduce health care costs.

Dunn C, Kolasa K, Vodicka S, Schneider L, Thomas C, Smith C, Lackey C. Eat Smart, Move More, Weigh Less a weight management program for adults—revision of curriculum based on first-year pilot. J of Extension. 2011;49(6):6TOT9.

MAIN FINDINGS: The program uses the Theory

of Planned Behavior and strategies identified in the professional literature that are associated with healthy eating, physical activity, and achieving and maintaining a healthy weight.

Whetstone L, Kolasa K, Dunn C, Jayaratne J, Vodicka S, Schneider L, Thomas C, vanStaveren M, Aggarwal S, Lackey C. Effects of a behavior-based weight management program delivered through a state cooperative extension and local public health department network, North Carolina, 2008–2009.

Preventing Chronic Disease. 2011;8(4):A81: www.cdc.gov/pcd/issues/2011/jul/10_0160.htm.

MAIN FINDINGS: Eat Smart, Move More, Weigh Less is an effective weight management program that is associated with decreased weight and increased confidence in healthy eating and physical activity.

Young S, Halladay J, Plescia M, Herget C, Dunn C. Establishing worksite wellness programs for North Carolina government employees, 2008. Preventing Chronic Disease. 2011;8(2):A48: www.cdc.gov/pcd/issues/2011/mar/10_0069.htm.

MAIN FINDINGS: Partnerships are essential to guide worksite wellness programs. State health plans and public health agencies each play a role.

December 2011Volume 49 Number 6Article Number 6TOT9

Return to Current Issue

Eat Smart, Move More, Weigh Less a WeightManagement Program for Adults—Revision of

Curriculum Based on First-Year PilotCarolyn Dunn

Professor and Nutrition SpecialistNorth Carolina Cooperative Extension

North Carolina State UniversityRaleigh, North Carolina

Carolyn_Dunn@ncsu.edu

Kathryn M. KolasaProfessor

Brody School of MedicineEast Carolina University

University Healthy Systems of Eastern CarolinaGreenville, North Carolina

KolasaKA@ecu.edu

Sheree VodickaHealthy Weight Communications Coordinator

Physical Activity and Nutrition BranchNorth Carolina Division of Public Health

Raleigh, North CarolinaSheree.Vodicka@ncmail.net

Lori SchneiderPhysical Activity Specialist

Physical Activity and Nutrition BranchNorth Carolina Division of Public Health

Raleigh, North CarolinaLori.Schneider@ncmail.net

Cathy ThomasBranch Head

Physical Activity and Nutrition BranchNorth Carolina Division of Public Health

Raleigh, North CarolinaCathy.Thomas@ncmail.net

Eat Smart, Move More, Weigh Less a Weight Management Program for Adults—Revision of Curriculum Based on First-Year Pilot12/19/11 09:09:25

1/6

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

VOLUME 8: NO. 4, A81 JULY 2011

Suggested citation for this article: Whetstone LM, Kolasa KM, Dunn C, Jayaratne KSU, Vodicka S, Schneider L, et al. Effects of a behavior-based weight management pro-gram delivered through a state cooperative extension and local public health department network, North Carolina, 2008-2009. Prev Chronic Dis 2011;8(4):A81. http://www.cdc.gov/pcd/issues/2011/jul/10_0160.htm. Accessed [date].

PEER REVIEWED

Abstract

IntroductionEat Smart, Move More, Weigh Less (ESMMWL) is an adult weight management program developed in response to North Carolina Obesity Plan recommendations to make weight management interventions accessible to under-served populations. ESMMWL was designed to be deliv-ered through the North Carolina Cooperative Extension and North Carolina Division of Public Health. Program coursework included content on evidence-based eating and physical activity behaviors and incorporated mindful eat-ing concepts. The objectives of this study were to describe participant changes in weight and behaviors and to docu-ment the effectiveness of the program.

MethodsIn this prospective pilot study, courses were delivered and data collected from January 2008 through June 2009.

Instructors provided feedback about implementation. For participants, height, weight, and waist circumference were measured at baseline and completion. Participants com-pleted a questionnaire about changes in their eating and physical activity behaviors, changes in their confidence to engage in weight management behaviors, and their satis-faction with the course.

ResultsSeventy-nine instructors delivered 101 ESMMWL courses in 48 North Carolina counties. Most of the 1,162 com-pleters were white women. Approximately 83% reported moving toward or attaining their goal. The average weight loss was 8.4 lb. Approximately 92% reported an increase in confidence to eat healthfully, and 82% reported an increase in confidence to be physically active. Instructors made suggestions for program standardization.

ConclusionThis study demonstrated the effectiveness, diffusion, and implementation of a theoretically based weight manage-ment program through a state extension and local public health department network. Study of the sustainability of changes in eating and physical activity behaviors is needed.

Introduction

Eat Smart, Move More North Carolina is a statewide

Effects of a Behavior-Based Weight Management Program Delivered Through a State Cooperative Extension and Local

Public Health Department Network, North Carolina, 2008-2009

ORIGINAL RESEARCH

Lauren MacKenzie Whetstone, PhD; Kathryn M. Kolasa, PhD, RD, LDN; Carolyn Dunn, PhD; K. S. U. Jayaratne, PhD; Sherée Vodicka, MA, RD, LDN; Lori Schneider, MA, PAPHS; Cathy Thomas, MAEd;

Meg van Staveren, MPH, RD; Surabhi Aggarwal, MHSc, MPH; Carolyn Lackey, PhD

www.cdc.gov/pcd/issues/2011/jul/10_0160.htm • Centers for Disease Control and Prevention 1

Journal of Nutrition Education and Behavior

VOLUME 8: NO. 2 MARCH 2011

Establishing Worksite Wellness Programs for North Carolina Government

Employees, 2008

COMMUNITY CASE STUDY

Suggested citation for this article: Young S, Halladay J, Plescia M, Herget C, Dunn C. Establishing worksite well-ness programs for North Carolina government employees, 2008. Prev Chronic Dis 2011;8(2). http://www.cdc.gov/pcd/issues/2011/mar/10_0069.htm. Accessed [date].

PEER REVIEWED

Abstract

BackgroundState employee health plans sometimes provide worksite wellness programs to reduce the prevalence of chronic diseases among their members, but few offer the compre-hensive range of interventions recommended by the Task Force on Community Preventive Services.

Community ContextNorth Carolina’s State Health Plan for Teachers and State Employees provides health coverage for approxi-mately 665,000 state employees, teachers, retirees, and dependents. Health claims indicate that the prevalence of having at least 1 chronic disease or of being obese is approximately 32% among state employees.

MethodsThe State Health Plan created a partnership with North Carolina’s Division of Public Health, Office of State Personnel, and other key state agencies to identify bureau-cratic obstacles to providing worksite wellness programs for state employees and to develop a state policy to address them. The Division of Public Health established a model worksite program to guide development of the worksite wellness policy and pilot wellness interventions.

OutcomeThe state’s first worksite wellness policy created an employee wellness infrastructure in state government and addressed administrative barriers to allow effective work-site wellness interventions. For example, the policy led to pilot implementation of a subsidized worksite weight management program. Positive results of the program helped generate legislative support to expand the weight management program throughout state government.

InterpretationStrong interagency partnership is essential to guide work-site wellness policy and program development in state gov-ernment. State health plans, public health agencies, and personnel agencies each play a role in that partnership.

Background

One objective of Healthy People 2010 was for at least 75% of worksites to offer comprehensive worksite wellness programs for their employees (1). Worksite programs are part of a public health strategy to address the increase in chronic diseases, which are predicted to cost the US health care system an estimated $4.2 trillion annually by 2023 (2). The Task Force on Community Preventive Services recommends 18 components of an effective comprehensive worksite wellness program that fall into 4 categories: insurance benefits, policies, programs, and communications (3). Worksite programs shown to be most effective were those that used evidence-based interven-tions to help employees lose weight, increase physical activity, reduce tobacco use, and have better access to influenza vaccination (3).

Suzanna Young, MPH; Jacquie Halladay, MD, MPH; Marcus Plescia, MD, MPH; Casey Herget, MSW, MPH; Carolyn Dunn, PhD

www.cdc.gov/pcd/issues/2011/mar/10_0069.htm • Centers for Disease Control and Prevention 1

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Weight Control

Delivering a Behavior-Change Weight Management Programto Teachers and State Employees in North CarolinaCarolyn Dunn, PhD; Lauren MacKenzie Whetstone, PhD; Kathryn M. Kolasa, PhD, RD, LDN;K. S. U. (Jay) Jayaratne, PhD; Cathy Thomas, MA, Ed; Surabhi Aggarwal, MHSc, MPH, RD;Casey Herget, MSW, MPH; Anne B. Rogers, RN, BSN, MPH

Abstract

Purpose. To ascertain the effectiveness of a behavior-change weight management program offered toteachers and state employees in North Carolina (NC).

Design. Fifteen-week weight management program with premeasures and postmeasures.

Setting. State agencies and public K-12 schools in five NC counties.

Subjects. A total of 2574 NC state employees enrolled in 141 classes.

Intervention. Eat Smart, Move More, Weigh Less (ESMMWL) is a 15-week weight managementprogram delivered by trained instructors. Lessons inform, empower, and motivate participants to livemindfully as they make choices about eating and physical activity.

Measures. Height, weight, body mass index (BMI), waist circumference, blood pressure, confidence inability to eat healthy and be physically active, changes in eating, and physical activity behaviors.

Analysis. Descriptive statistics, t-tests, v2 tests, and analyses of variance.

Results. Data are reported for 1341 participants in ESMMWL who completed the program, submittedan evaluation, and had not participated in the program in the past; 89% were female and mean age was48.8 years. Average BMI and waist circumference decreased significantly. Confidence in eating healthfullyand being physically active increased significantly. The percentage of participants with a BMI, 30 kg/m2

increased from 40% to 45% and those with a normal blood pressure increased from 23% to 32.5%.Participants reported being more mindful of what and how much they ate (92%), being more mindful ofhow much daily physical activity they got (88%), and eating fewer calories (87.3%).

Conclusion. This project demonstrated the feasibility of implementing a behavior change–based weightmanagement program at the worksite to achieve positive outcomes related to weight, blood pressure, healthyeating, and physical activity behaviors. Programs such as this have the potential to provide health care costsavings. (Am J Health Promot 2013;27[6]:378–383.)

Key Words: Weight Management, Worksite, Mindfulness, Behavior Change, PreventionResearch. Manuscript format: research; Research purpose: intervention testing, programevaluation; Study design: quasi-experimental; Outcome measure: behavioral, biometric;Setting: workplace; Health focus: weight control, nutrition, physical activity; Strategy:education, skill building, behavior change; Target population: adults; Target populationcircumstances: all education levels, all income levels, all races/ethnicities

PURPOSE

Overweight and obesity continue tobe the most pressing public healthproblems of our time.1,2 North Carolinahas the 14th highest adult obesity ratein the country.3 In 2010, nearly two-thirds (65%) of adults in North Caro-lina were either overweight or obese.4

North Carolina, like many other states,has a state plan to prevent overweight,obesity, and related chronic diseases.5

To achieve the goals of the state plan,an easily accessible, affordable, inter-disciplinary weight management pro-gram was needed. The Eat Smart, MoveMore, Weigh Less (ESMMWL) programwas created in response to this need.ESMMWL was developed by a team ofinteragency professionals with expertisein nutrition, physical activity, and be-havior change, and the program coversa range of topics that address healthyeating, physical activity, and mindful-ness about eating and physical activityin their daily lives. ESMMWL is anevidence-based, 15-week weight man-agement program for adults that uses

Carolyn Dunn, PhD, and Surabhi Aggarwal, MHSc, MPH, RD, are with North Carolina Cooperative Extension, North Carolina State University,Raleigh, North Carolina. Lauren MacKenzie Whetstone, PhD, and Kathryn M. Kolasa, PhD, RD, LDN, are with the Brody School of Medicine,East Carolina University, Greenville, North Carolina. K. S. U. (Jay) Jayaratne is with North Carolina State University, Raleigh, North Carolina.Cathy Thomas, MA, Ed, is with the North Carolina Division of Public Health, Department of Health and Human Services, Raleigh, NorthCarolina. Casey Herget, MSW, MPH, and Anne B. Rogers, RN, BSN, MPH, are with the State Health Plan for Teachers and State Employees,Raleigh, North Carolina.

Send reprint request to Carolyn Dunn, PhD, Department of 4H Youth Development and Family and Consumer Sciences, North Carolina CooperativeExtension, NCSU Campus Box 7606, North Carolina State University, Raleigh, NC 27695-7606; carolyn_dunn@ncsu.edu.

This manuscript was submitted February 21, 2012; revisions were requested May 29 and August 3, 2012; the manuscript was accepted for publication August 24, 2012

Copyright � 2013 by American Journal of Health Promotion, Inc.0890-1171/13/$5.00 þ 0DOI: 10.4278/ajhp.120221-QUAN-101

378 American Journal of Health Promotion July/August 2013, Vol. 27, No. 6

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