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Implementing federal food service guidelines in federal and private worksite cafeterias in the United States leads to improved health outcomes and is cost saving

Journal of Public Health Policy volume 43, pages 266–280 (2022)Cite this article

Abstract

Poor diet increases cardiometabolic disease risk, yet the impact of food service guidelines on employee health and its cost effectiveness is poorly understood. Federal food service guidelines (FFSG) aim to provide United States (U.S.) government employees with healthier food options. Using microsimulation modeling, we estimated changes in the incidence of cardiometabolic disease, related mortality, and the cost effectiveness of implementing FFSG in nationally representative model populations of government and private company employees across 5 years and lifetime. We based estimates on changes in workplace intake of six FFSG dietary targets and showed lifetime reductions of heart attacks (− 107/million), strokes (− 30/million), diabetes (− 134/million), ischemic heart disease deaths (− 56/million), and stroke deaths (− 8/million). FFSG is cost saving overall, with total savings in discounted healthcare costs from $4,611,026 (5 years) to $539,809,707 (lifetime) $U.S. This study demonstrates that FFSG improves health outcomes and is cost saving.

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References

  1. Onufrak SJ, Zaganjor H, Moore LV, et al. Foods Consumed by US Adults From Cafeterias and Vending Machines: NHANES 2005 to 2014. Am J Health Promot. 2019;33(5):666–74.

  2. Onufrak SJ, Zaganjor H, Pan L, et al. Foods and beverages obtained at worksites in the United States. J Acad Nutr Diet. 2019;119(6):999–1008.

    Article  Google Scholar 

  3. Hales CM, Carroll MD, Fryar CD, et al. Prevalence of obesity and severe obesity among adults: United States, 2017–2018. NCHS Data Brief. 2020;360:1–8.

    Google Scholar 

  4. Bureau of Labor Statistics. Labor Force Statistics from the Current Population Survey, 2017. Washington, D.C.: United States Department of Labor. Contract No. March 4.

  5. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015–2020 Dietary Guidelines for Americans. 8th Edition. December 2015.

  6. Korre M, Tsoukas M, Frantzeskou E, et al. Mediterranean diet and workplace health promotion. Curr Cardiovasc Risk Rep. 2014;8(12):1–7.

    Article  Google Scholar 

  7. Raulio S, Roos E, Prättälä R. School and workplace meals promote healthy food habits. Public Health Nutr. 2010;13(6A):987–92.

    Article  Google Scholar 

  8. Food Service Guidelines Federal Workgroup; Department of Health and Human Services. Washington, DC: Food Service Guidelines for Federal Facilities. 2017.

  9. FedScope Employment Cube: December 2017. 2017. https://www.opm.gov/data/index.aspx.

  10. D’souza, V. Federal food service operations: implementation of the HHS/GSA Health and Sustainability Guidelines. Washington, DC: United States Government Accountability Office. 2014.

  11. Micha R, Peñalvo JL, Cudhea F, et al. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the united states. JAMA. 2017;317(9):912–24.

    Article  Google Scholar 

  12. Micha R, Shulkin ML, Penalvo JL, et al. Etiologic effects and optimal intakes of foods and nutrients for risk of cardiovascular diseases and diabetes: Systematic reviews and meta-analyses from the Nutrition and Chronic Diseases Expert Group (NutriCoDE). PLoS ONE. 2017;12(4):e0175149.

    Article  Google Scholar 

  13. Vernooij RWM, Zeraatkar D, Han MA, et al. Patterns of red and processed meat consumption and risk for cardiometabolic and cancer outcomes: a systematic review and meta-analysis of cohort studies. Ann Intern Med. 2019;171(10):732–41.

    Article  Google Scholar 

  14. Moran A, Lederer A, Johnson Curtis C. Use of nutrition standards to improve nutritional quality of hospital patient meals: findings from New York City’s Healthy Hospital Food Initiative. J Acad Nutr Diet. 2015;115(11):1847–54.

    Article  Google Scholar 

  15. Rice L, Benson C, Podrabsky M, et al. The development and adoption of the first statewide comprehensive policy on food service guidelines (Washington State Executive Order 13–06) for improving the health and productivity of state employees and institutionalized populations. Transl Behav Med. 2019;9(1):48–57.

    Article  Google Scholar 

  16. Mckinnon RA, Siddiqi SM, Chaloupka FJ, et al. Obesity-related policy/environmental interventions: a systematic review of economic analyses. Am J Prev Med. 2016;50(4):543–9.

    Article  Google Scholar 

  17. Pandya A, Sy S, Cho S, et al. Validation of a cardiovascular disease policy microsimulation model using both survival and receiver operating characteristic curves. Med Decis Making. 2017;37(7):802–14.

    Article  Google Scholar 

  18. United States Census Bureau. Number of establishments with corresponding employment change by employment size of the enterprise for the United States and all states, totals: 2015–2016. Washington, DC: United States Census Bureau; 2019.

    Google Scholar 

  19. National Health and Nutrition Examination Dietary Data (NHANES). Hyatsville, MD: Department of Health and Human Services, Centers for Disease Control and Prevention, 2009–2016. Department of Health and Human Services, Centers for Disease Control and Prevention. 2009–2016. https://wwwn.cdc.gov/nchs/nhanes/Search/DataPage.aspx?Component=Dietary.

  20. Penalvo Jose, L, Micha, R, Smith Jessica, D, et al. Do worksite wellness programs improve dietary behaviors and adiposity? A systematic review and meta-analysis (Abstract MP005). Circulation 2017;135(suppl_1):AMP005–AMP.

  21. National Health and Nutrition Examination Dietary Data (NHANES). Hyatsville, MD: Department of Health and Human Services, Centers for Disease Control and Prevention, 2009–2014. Department of Health and Human Services, Centers for Disease Control and Prevention. 2009–2014. https://wwwn.cdc.gov/nchs/nhanes/Search/DataPage.aspx?Component=Dietary.

  22. Odoms-Young AM, Kong A, Schiffer LA, et al. Evaluating the initial impact of the revised Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food packages on dietary intake and home food availability in African-American and Hispanic families. Public Health Nutr. 2014;17(1):83–93.

    Article  Google Scholar 

  23. National Research Council Panel to Evaluate the USDA’S methodology for estimating eligibility participation for the W. I. C. Program. Estimating Eligibility and Participation for the WIC Program: Final Report. Estimating Eligibility and Participation for the WIC Program: Final Report. 2003.

  24. Lassen AD, Beck A, Leedo E, et al. Effectiveness of offering healthy labelled meals in improving the nutritional quality of lunch meals eaten in a worksite canteen. Appetite. 2014;75:128–34.

    Article  Google Scholar 

  25. French SA, Harnack LJ, Hannan PJ, et al. Worksite environment intervention to prevent obesity among metropolitan transit workers. Prev Med. 2010;50(4):180–5.

    Article  Google Scholar 

  26. National Health and Nutrition Examination Survey Data (NHANES). Hyatsville, MD: Department of Health and Human Services, Centers for Disease Control and Prevention, 2009–2016. Department of Health and Human Services, Centers for Disease Control and Prevention. 2009–2016. https://wwwn.cdc.gov/nchs/nhanes/default.aspx.

  27. Lee Y, Mozaffarian D, Sy S, et al. Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: a microsimulation study. PLoS Med. 2019;16(3):e1002761.

    Article  Google Scholar 

  28. Mozaffarian D, Liu J, Sy S, et al. Cost-effectiveness of financial incentives and disincentives for improving food purchases and health through the US Supplemental Nutrition Assistance Program (SNAP): a microsimulation study. PLOS Med. 2018;15(10):e1002661.

    Article  Google Scholar 

  29. Rehm CD, Peñalvo JL, Afshin A, et al. Dietary intake among US adults, 1999–2012. JAMA. 2016;315(23):2542–53.

    Article  Google Scholar 

  30. Micha R, Kalantarian S, Wirojratana P, et al. Estimating the global and regional burden of suboptimal nutrition on chronic disease: methods and inputs to the analysis. Eur J Clin Nutr. 2012;66(1):119–29.

    Article  Google Scholar 

  31. Weinstein MC, Russell LB, Gold MR, et al. Cost-effectiveness in health and medicine. Oxford: Oxford University Press; 1996.

    Google Scholar 

  32. U.S. Department of Labor. The Bureau of Labor Statistics’ Consumer Price Index 2017. https://www.bls.gov/data/#prices.

  33. U. S. Government Accountability Office (GAO). Appropriations Law Forum (2008): GAO Fact Sheet: No Cost Contracts 2008. https://docslib.org/gao-fact-sheet-no-cost-contracts.

  34. U.S. General Services Administration. 2018 Agency Financial Report. U.S. Government; 2018. https://www.gsa.gov/reference/reports/budget-performance/annual-reports/2018-agency-financial-report.

  35. Concannon K. In: Agriculture, DO, editor. Federal Register: Nutrition Standards in the National School Lunch and School Breakfast Programs, Final Rule. Washington, D.C.: Food and Nutrition Service (FNS), USDA; January 26, 2012.

  36. U.S. Office of Personnel Management (OPM). Federal employees guide me: insurance 2017. https://www.opm.gov/healthcare-insurance/Guide-Me/Federal-Employees/Health/How-much-do-I-pay-for-coverage/#url=Overview.

  37. Neumann PJ, Sanders GD, Russell LB, et al. Cost-effectiveness in health and medicine. Oxford: Oxford University Press; 2016.

    Book  Google Scholar 

  38. Hipple, SF. People who are not in the labor force: why aren't they working? Beyond the Numbers: Employment and Unemployment, vol. 4, no. 15 U.S. Bureau of Labor Statistics.

  39. Ai B, Hair E, Harris Brewer K, et al. The HHS Hubert H. Humphrey Building Cafeteria Experience: Incorporation of the Dietary Guidelines for Americans, 2010 into Federal Food Service Guidelines. Prepared by NORC at the University of Chicago. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, Washington, DC; May, 2012 May, 2012.

  40. Neumann PJ, Rosen AB, Weinstein MC. Medicare and cost-effectiveness analysis. N Engl J Med. 2005;353(14):1516–22.

    Article  Google Scholar 

  41. Neumann PJ, Cohen JT, Weinstein MC. Updating cost-effectiveness—the curious resilience of the $50,000-per-QALY threshold. N Engl J Med. 2014;371(9):796–7.

    Article  Google Scholar 

  42. Hatswell AJ, Bullement A, Briggs A, et al. Probabilistic sensitivity analysis in cost-effectiveness models: determining model convergence in cohort models. Pharm Econ. 2018;36(12):1421–6.

    Article  Google Scholar 

  43. Wise, R. Employment and Wages, Annual Averages 2017. Washington, DC: U.S. Bureau of Labor Statistics; 2017.

  44. Employee Tenure Summary [Press Release]. Washington, DC: U.S. Bureau of Labor Statistics; 2018.

  45. Geaney F, Kelly C, Greiner BA, et al. The effectiveness of workplace dietary modification interventions: a systematic review. Prev Med. 2013;57(5):438–47.

    Article  Google Scholar 

  46. Price S, Hartwell H, Hemingway A, et al. Workplace foodservice; perception of quality and trust. Appetite. 2016;97:169–75.

    Article  Google Scholar 

  47. Wickramasekaran RN, Robles B, Dewey G, et al. Evaluating the potential health and revenue outcomes of a 100% healthy vending machine nutrition policy at a large agency in Los Angeles county, 2013–2015. J Public Health Manag Pract. 2018;24(3):215–24.

    Article  Google Scholar 

  48. Ubago-Guisado E, Rodríguez-Barranco M, Ching-López A, et al. Evidence update on the relationship between diet and the most common cancers from the European Prospective Investigation into Cancer and Nutrition (EPIC) study: a systematic review. Nutrients. 2021. https://doi.org/10.3390/nu13103582.

    Article  Google Scholar 

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Funding

This research was supported by the NIH, the National Institutes of Health, National Heart, Lung, and Blood Institute (R01 HL130735, PI Micha), Washington, DC. The funders did not contribute to design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Author notes

  1. Renata Micha and Thomas Gaziano—co-senior authors.

Authors and Affiliations

  1. Department of Health Policy and Management, Center for Health Decision Science, Harvard T. H. Chan School of Public Health, 718 Huntington Avenue, Boston, MA, 02115, USA

    Shafika Abrahams-Gessel, Stephen Sy & Thomas Gaziano

  2. Friedman School of Nutrition Science and Policy, Tufts University, Jaharis Building - 150 Harrison Avenue, Boston, MA, 02111, USA

    Parke Wilde, Fang Fang Zhang, Junxiu Liu, Dariush Mozaffarian & Renata Micha

  3. National Institute of Allergy and Infectious Disease, Vaccine Research Center, National Institutes of Health, 5601 Fishers Lane, Rockville, MD, 20852, USA

    Lauren Lizewski

  4. School of Medicine, Tufts University School of Medicine, 136 Harrison Ave, Boston, MA, 02111, USA

    Mengyuan Ruan

  5. Department of Food and Nutrition, Myongji University, 116 Myongji-ro, Cheoin-gu, Yongin-si, 17058, Gyunggi-do, Korea

    Yujin Lee

  6. Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115, USA

    Thomas Gaziano

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  1. Shafika Abrahams-Gessel
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Corresponding author

Correspondence to Thomas Gaziano.

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Conflict of interest

S. Abrahams-Gessel, S. Sy, P. Wilde, FF. Zhang, L. Lizewski, L. Liu, M. Ruan, Yujin Lee, and T. Gaziano report no conflict of interest. Dr. Micha reports research funding from Bill & Melinda Gates Foundation, Nestle and Danone, and personal fees from Bunge, and Development Initiatives for serving as the co-chair of the Global Nutrition Report—all outside the submitted work, and D. Mozaffarian from Boston Heart Diagnostics, Haas Avocado board, Astra Zeneca, GOED, DSM, Life Sciences Research Organization, and UpToDate, outside of the submitted work.

Human subjects protection

The Partners Institutional Review Board issued an exemption for this study as it used only de-identified data from publicly available resources and did not involve any human participation.

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Abrahams-Gessel, S., Wilde, P., Zhang, F.F. et al. Implementing federal food service guidelines in federal and private worksite cafeterias in the United States leads to improved health outcomes and is cost saving. J Public Health Pol 43, 266–280 (2022). https://doi.org/10.1057/s41271-022-00344-y

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  • DOI: https://doi.org/10.1057/s41271-022-00344-y

Keywords

  • Diet
  • Government
  • Health policy
  • Workplace