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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

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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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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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.

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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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Keywords

  • Diet
  • Government
  • Health policy
  • Workplace