Abstract
INTRODUCTION: Most Americans spend half their waking hours at work and consume food acquired there. The hypothesis was that the healthfulness of worksite food purchases was associated with employees' overall diet and health. METHODS: Participants were 602 hospital employees who regularly used worksite cafeterias and enrolled in a health promotion study in 2016-2018. All cafeterias used traffic-light labels (green=healthy, yellow=less healthy, red=unhealthy). A Healthy Purchasing Score was calculated for each participant by summing weighted proportions of cafeteria items purchased over a 3-month observation period (red=0, yellow=0.5, green=1; range, 0-1). Healthy Eating Index scores (range, 0-100) were calculated based on two 24-hour dietary recalls. BMI, blood pressure, and HbA1c were measured. Hypertension and prediabetes/diabetes diagnoses were determined by self-reported and clinical data. Regression analyses examined dietary quality and diagnoses by tertile of Healthy Purchasing Score (T1=least healthy purchases, T3=most healthy), adjusting for demographics. All data were collected before the start of the intervention and were analyzed in 2018. RESULTS: Mean age was 43.6 years (SD=12.2), 79% were female, and 81% were white. Mean BMI was 28.3 kg/m(2) (SD=6.5); 21% had hypertension, and 27% had prediabetes/diabetes. Mean Healthy Eating Index was 60.4 (SD=12.5); mean Healthy Purchasing Score was 0.66 (SD=0.15). Healthier purchases were associated with healthier Healthy Eating Index scores (T1=55.6, T2=61.0, T3=64.5, p<0.001) and lower obesity prevalence (T1=38%, T2=29%, T3=24%, p<0.001); similar patterns were observed for hypertension and prediabetes/diabetes. CONCLUSIONS: Worksite food purchases were associated with overall dietary quality and cardiometabolic risk. Interventions to increase healthfulness of food choices at work may improve employees' health.