Community Guide Recommendations and CDC's Promising Practices

To help employers respond to the current obesity epidemic, the Centers for Disease Control and Prevention (CDC) conducted a systematic review of the literature on worksite health promotion programs and identified promising practices to prevent and control obesity. The research findings from the The Guide to Community Preventive Services (Community Guide)* recommendation and promising practices established the foundation for the CDC's LEAN Works! Web site.

The Guide to Community Preventive Services (theCommunity Guide) summarizes what is known about the effectiveness, economic efficiency, and feasibility of interventions to promote community health and prevent disease. The Task Force on Community Preventive Services makes recommendations for the use of various interventions based on the evidence gathered in the rigorous and systematic scientific reviews of published studies conducted by the review teams of the Community Guide (see Task Force on Community Preventive Services).

The Task Force on Community Preventive Services recommends worksite programs intended to improve diet and/or physical activity behaviors based on strong evidence of their effectiveness for reducing weight among employees.²⁰¹

Promising practices highlight emerging interventions that have preliminary evidence of effectiveness and complement the Community Guide obesity recommendation. Promising practices are strategies delivered to employees through their employer which demonstrate a reduction in a weight-related outcome (i.e. weight, Body Mass Index (BMI), body fat, waist circumference, waist-to-hip ratio) or prevalence of individuals who are overweight or obese.²⁰⁸

CDC's Division of Nutrition, Physical Activity, and Obesity Promising Practices
Environmental and Policy	Informational and Educational	Behavioral Interventions
Enhanced access to opportunities for physical activity combined with health education	Multicomponent educational practices Exercise prescriptions alone	Weight loss competitions and incentives Behavioral interventions with incentives Behavioral interventions without incentives

Environmental and Policy Strategies

Environmental and policy strategies address the entire workforce or populations (not individuals) and targeted physical and organizational structures through developing worksite and public policies that support healthy behaviors. They are likely to be sustained for a longer period of time than individually oriented strategies.⁴²

Promising Practice #1: Enhanced access to opportunities for physical activity combined with health education
Enhanced access to opportunities for physical activity combined with health education are practices that enable or facilitate access to physical activity programs, workshops, classes, and other resources in a worksite setting. Such practices can include developing walking trails, building a fitness center at the worksite, or creating a par course (fitness trail).

For more, see Environmental and Policy Strategies.

Informational and Educational Strategies

Informational and educational strategies focus on the provision of information designed to increase awareness and knowledge as a requisite to motivate behavioral change. These strategies present both general health information, including information about weight loss and maintenance, chronic disease prevention and risk reduction, and specific information about physical activity and nutrition. These strategies do not include any environmental and policy strategies.

Promising Practice #2: Exercise prescriptions alone
Exercise prescription involves a planned or structured physical activity regimen given to an individual or group that includes specific recommendations for the frequency, intensity, and type of exercise. The practices reviewed involved recruiting participants into voluntary groups at the worksite. After completing physical fitness evaluations, participants are placed in exercise training programs of mild, moderate, or vigorous intensity.

Promising Practice #3: Multicomponent educational practices
Multicomponent educational practices are aimed at providing information, with the curriculum/modules addressing health promotion programs (e.g., healthy lifestyles, physical activity, and nutrition) and risk reduction programs (e.g., weight management, cardiovascular [CVD] risks, and diabetes risks). In addition to health education sessions, these studies incorporated components such as (1) exercise prescription, (2) nutrition prescription, and (3) small media (e.g., brochures, pamphlets, electronic messages).

Based on the program description and what was reported by the author, these multicomponent practices all offered a health education class combined with exercise prescription and nutrition prescription and small media. These practices were evaluated together because it was not possible to separate health education from other components.

For more, see Health Educational Strategies.

Behavioral Strategies

Behavioral strategies for obesity and prevention control focus on teaching behavioral management skills and structuring the social environment to provide support for people trying to initiate or maintain weight change. Strategies often include individual or group behavioral counseling and will often involve coworkers, family members, and other intermediaries who are part of an individual's social environment.

Behavioral methods may involve modeling or demonstration, participatory skill development, individual benchmarking (i.e., goal-setting and achievement), providing feedback, providing incentives or disincentives, or providing materials necessary to enhance the desired behavior (e.g., pedometer, food journals).

Promising Practice #4: Weight-loss competitions and incentives
Competitions and incentives consist of rewards for weight loss and behavioral change to increase physical activity or improve nutrition. The rewards can be in-kind, financial, or the honor or pride of winning. The incentives can vary in size and by type and can be used for screening, enrollment, compliance (i.e., staying in the program), completing the program, and maintenance of the changes after completing the program.
*These practices do not include teaching behavioral management skills, modeling or demonstration, or participatory skill development.

Promising Practice #5: Behavioral practices with incentives
Behavioral practices teach behavioral management skills, modeling or demonstration, participatory skill development, and individual benchmarking (i.e., goal-setting and achievement), and provide feedback and building social support for behavioral patterns. Such practices are complemented by in-kind or financial incentives, typically given for participation and completing the program.

Promising Practice #6: Behavioral practices without incentives
These programs teach participants specific behavioral skills that enable them to incorporate physical activity and improve their nutrition through modeling or demonstration, participatory skill development, individual benchmarking (i.e., goal-setting and achievement), feedback, and building social support for behavioral patterns. These programs did not offer incentives. The typical behavioral practice consisted of one-on-one or group consultations with personalized goals or plan of action to improve employees' nutrition, increase their physical activity, or help them lose weight.

For more, see Behavioral Strategies.

Also in This Section

• Expert Interview

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* Links to non-Federal organizations found at this site are provided solely as a service to our users. These links do not constitute an endorsement of these organizations or their programs by CDC or the Federal Government, and none should be inferred. CDC is not responsible for the content of the individual organization Web pages found at these links.