Association of Employees’ Meal Skipping Patterns with Workplace Food Purchases, Dietary Quality, and Cardiometabolic Risk: A Secondary Analysis from the ChooseWell 365 Trial

Published:August 31, 2021DOI:



      Employed adults may skip meals due to time or financial constraints, challenging work schedules, or limited workplace food choices. Little is known about the relationship between employees’ meal skipping patterns and workplace dietary choices and health.


      To examine whether hospital employees’ meal skipping patterns were associated with workplace food purchases, dietary quality, and cardiometabolic risk factors (ie, obesity, hypertension, and prediabetes/diabetes).


      This is a secondary cross-sectional analysis of baseline data from the ChooseWell 365 randomized controlled trial. Employees reported meal-skipping frequency in a baseline survey. The healthfulness of workplace food purchases was determined with a validated Healthy Purchasing Score (HPS) (range = 0 to 100 where higher scores = healthier purchases) calculated using sales data for participants’ purchases in the 3 months before study enrollment. Dietary quality was measured with the 2015 Healthy Eating Index (range = 0 to 100 where higher score = healthier diet) from two 24-hour recalls. Cardiometabolic risk factors were ascertained from clinic measurements.


      Participants were 602 hospital employees who regularly visited workplace cafeterias and enrolled in ChooseWell 365, a workplace health promotion study in Boston, MA, during 2016-2018.

      Main outcome measures

      Primary outcomes were HPS, 2015 Healthy Eating Index, and cardiometabolic risk factors.

      Statistical analyses

      Regression analyses examined differences in HPS, 2015 Healthy Eating Index, and cardiometabolic variables by meal skipping frequency, adjusting for demographic characteristics.


      Participants’ mean (standard deviation) age was 43.6 (12.2) years and 478 (79%) were women. Overall, 45.8% skipped breakfast, 36.2% skipped lunch, and 24.9% skipped dinner ≥ 1 day/week. Employees who skipped breakfast ≥ 3 days/week (n = 102) had lower HPS (65.1 vs 70.4; P < 0.01) and 2015 Healthy Eating Index score (55.9 vs 62.8; P < 0.001) compared with those who never skipped. Skipping lunch ≥ 3 days/week and dinner ≥ 1 day/week were associated with significantly lower HPS compared with never skipping. Employees who worked nonstandard shifts skipped more meals than those who worked standard shifts. Meal skipping was not associated with obesity or other cardiometabolic variables.


      Skipping meals was associated with less healthy food purchases at work, and skipping breakfast was associated with lower dietary quality. Future research to understand employees’ reasons for skipping meals may inform how employers could support healthier dietary intake at work.


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      J. L. McCurley, is a postdoctoral fellow, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.


      D. E. Levy, is an associate professor, Mongan Institute Health Policy Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.


      H. S. Dashti, is a postdoctoral fellow, Center for Genomic Medicine and Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.


      E. Gelsomin, is a senior clinical nutritionist, Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, MA.


      E. Anderson, is a clinical research coordinator, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.


      R. Sonnenblick, is a clinical research coordinator, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.


      E. B. Rimm, is a professor, Department of Nutrition, Harvard T.H. Chan School of Public Health, Harvard University; Channing Division of Network Medicine, Department of Medicine, Brigham and Woman’s Hospital, Boston, MA.


      A. N. Thorndike, is an associate professor, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.