Abstract
Background
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.
Objective
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).
Design
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/setting
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.
Results
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.
Conclusions
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
US Bureau of Labor Statistics. Economic News Release: American Time Use Survey: 2019 results. https://www.bls.gov/news.release/archives/atus_06252020.pdf. Accessed May 20, 2021.
- Foods and beverages obtained at worksites in the United States.J Acad Nutr Diet. 2019; 119: 999-1008
- Work conditions and the food choice coping strategies of employed parents.J Nutr Educ Behav. 2009; 41: 365-370
- The impact of shift work on eating patterns and self-care strategies utilised by experienced and inexperienced nurses.Chronobiol Int. 2018; 35: 811-820
- Work hours, overtime, and break time of registered nurses working in medium-sized Korean hospitals.Workplace Health Saf. 2018; 66: 588-596
- Skipping breakfast is associated with overweight and obesity: a systematic review and meta-analysis.Obes Res Clin Pract. 2020; 14: 1-8
- Genome-wide association study of breakfast skipping links clock regulation with food timing.Am J Clin Nutr. 2019; 110: 473-484
- Breakfast skipping is associated with increased risk of type 2 diabetes among adults: a systematic review and meta-analysis of prospective cohort studies.J Nutr. 2019; 149: 106-113
- Breakfast skipping and the risk of type 2 diabetes: a meta-analysis of observational studies.Public Health Nutr. 2015; 18: 3013-3019
- Skipping breakfast and the risk of cardiovascular disease and death: a systematic review of prospective cohort studies in primary prevention settings.J Cardiovasc Dev Dis. 2019; 6: 30
- Association between skipping breakfast and risk of cardiovascular disease and all cause mortality: a meta-analysis.Clin Nutr. 2020; 39: 2982-2988
- Breakfast size is associated with daily energy intake and diet quality.Nutrition. 2020; 75-76: 110764
- Meal timing and frequency: implications for cardiovascular disease prevention: a scientific statement from the American Heart Association.Circulation. 2017; 135: e96-e121
- The effect of breakfast type on total daily energy intake and body mass index: results from the Third National Health and Nutrition Examination Survey (NHANES III).J Am Coll Nutr. 2003; 22: 296-302
- Trends in breakfast consumption of US adults between 1965 and 1991.J Am Diet Assoc. 1996; 96: 464-470
- The effects of skipping a meal on daily energy intake and diet quality.Public Health Nutr. 2020; 23: 3346-3355
- Relationship between eating behavior and obesity among Chinese adults.. 2020; 41: 1296-1302
- A 2-phase labeling and choice architecture intervention to improve healthy food and beverage choices.Am J Public Health. 2012; 102: 527-533
- Traffic-light labels and choice architecture: promoting healthy food choices.Am J Prev Med. 2014; 46: 143-149
- A traffic light food labeling intervention increases consumer awareness of health and healthy choices at the point-of-purchase.Prev Med. 2013; 57: 253-257
- Design of ChooseWell 365: randomized controlled trial of an automated, personalized worksite intervention to promote healthy food choices and prevent weight gain.Contemp Clin Trials. 2018; 75: 78-86
- Automated behavioral workplace intervention to prevent weight gain and improve diet: ChooseWell 365 randomized clinical trial.JAMA Netw Open. 2021; 4e2112528
- Dietary Guidelines for Americans, 2010.US Government Printing Office, Washington, DC2010
- Association of worksite food purchases and employees’ overall dietary quality and health.Am J Prev Med. 2019; 57: 87-94
- Automated self-administered 24 hour dietary assessment tool.
- Dietary intake measured from a self-administered, online 24-hour recall system compared with 4-day diet records in an adult US population.J Acad Nutr Diet. 2012; 112: 1642-1647
- The Automated Self-Administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National Cancer Institute.J Acad Nutr Diet. 2012; 112: 1134-1137
- Dietary Assessment Primer: learn more about usual dietary intake.(Published 2021. Accessed May 24, 2021)
- Update of the Healthy Eating Index: HEI-2015.J Acad Nutr Diet. 2018; 118: 1591-1602
- A population’s distribution of Healthy Eating Index-2005 component scores can be estimated when more than one 24-hour recall is available.J Nutr. 2010; 140: 1529-1534
- Healthy Eating Index-2015: SAS Code.(Published 2021. Accessed May 24, 2021)
- Dietary Guidelines for Americans, 2015.8th edition. US Government Printing Office, Washington, DC2015
- What We Eat in America/National Health and Nutrition Examination Survey, 2013-2014: Healthy Eating Index-2015.(Published 2018. Accessed May 24, 2021)
- 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.Circulation. 2021; 143: e72-e227
- White coat syndrome and its variations: differences and clinical impact.Integr Blood Press Control. 2018; 11: 73-79
- 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2020.Diabetes Care. 2020; 43: S14-S31
- Stata Statistical Software [computer program]. StataCorp LLC,
College Station, TX2017Version: Release 15
- Alternative dietary indices both strongly predict risk of chronic disease.J Nutr. 2012; 142: 1009-1018
- Applications of the Healthy Eating Index for surveillance, epidemiology, and intervention research: considerations and caveats.J Acad Nutr Diet. 2018; 118: 1603-1621
- Do breakfast skipping and breakfast type affect energy intake, nutrient intake, nutrient adequacy, and diet quality in young adults? NHANES 1999-2002.J Am Coll Nutr. 2010; 29: 407-418
- Prospective study of breakfast eating and incident coronary heart disease in a cohort of male US health professionals.Circulation. 2013; 128: 337-343
- Employees’ perceptions of the impact of work on health behaviours.J Health Psychol. 2013; 18: 887-899
- Proximity of snacks to beverages increases food consumption in the workplace: a field study.Appetite. 2016; 103: 244-248
- A qualitative study to investigate the drivers and barriers to healthy eating in two public sector workplaces.J Hum Nutr Diet. 2013; 26: 85-95
- Exploring the dynamics of a free fruit at work intervention.BMC Public Health. 2016; 16: 839
- Long-term sustainability of a worksite canteen intervention of serving more fruit and vegetables.Public Health Nutr. 2010; 13: 1647-1652
- Factors influencing employees’ eating behaviours in the office-based workplace: a systematic review.Obes Rev. 2019; 20: 1771-1780
- Use of workplace foodservices is associated with reduced meal skipping in Korean adult workers: a nationwide cross-sectional study.PLoS One. 2020; 15e0243160
- Having lunch at a staff canteen is associated with recommended food habits.Public Health Nutr. 2004; 7: 53-61
- The effect of shift work on eating habits: a systematic review.Scand J Work Environ Health. 2019; 45: 7-21
- Hospital staff nurses’ work hours, meal periods, and rest breaks: a review from an occupational health nurse perspective.AAOHN J. 2010; 58: 489-497
- Factors influencing the eating practices of hospital nurses during their shifts.Workplace Health Saf. 2018; 66: 331-342
- Temporary workers’ skipping of meals and eating alone in South Korea: the Korean National Health and Nutrition Examination Survey for 2013-2016.Int J Environ Res Public Health. 2019; 16: 2319
- Biobehavioral factors that shape nutrition in low-income populations: a narrative review.Am J Prev Med. 2017; 52: S118-S126
- Meet the low-wage workforce.https://www.brookings.edu/research/meet-the-low-wage-workforce/Date accessed: September 8, 2021
- Low-socioeconomic status workers: their health risks and how to reach them.J Occup Environ Med. 2011; 53: 132-138
- Health care use and spending patterns vary by wage level in employer-sponsored plans.Health Aff (Millwood). 2017; 36: 250-257
- Association of wage with employee participation in health assessments and biometric screening.Am J Health Promot. 2018; 32: 440-445
- Intermittent fasting interventions for treatment of overweight and obesity in adults: a systematic review and meta-analysis.JBI Database System Rev Implement Rep. 2018; 16: 507-547
- Morning diurnal preference and food intake: a Mendelian randomization study.Am J Clin Nutr. 2020; 112: 1348-1357
Biography
J. L. McCurley, is a postdoctoral fellow, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Biography
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.
Biography
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.
Biography
E. Gelsomin, is a senior clinical nutritionist, Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, MA.
Biography
E. Anderson, is a clinical research coordinator, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.
Biography
R. Sonnenblick, is a clinical research coordinator, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA.
Biography
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.
Biography
A. N. Thorndike, is an associate professor, Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA.
Article Info
Publication History
Published online: August 31, 2021
Accepted:
August 26,
2021
Received:
February 17,
2021
Footnotes
Supplementary materials: Tables 2 and 3 are available at www.jandonline.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT This work was funded by the NIH R01 grants HL125486 and DK114735 . The project was also supported by NIH grant No. 1UL1TR001102 .
AUTHOR CONTRIBUTIONS A. N. Thorndike, E. B. Rimm, and D. E. Levy designed the research; A. N. Thorndike, D. E. Levy, E. Gelsomin, E. Anderson, and J. L. McCurley conducted research; J. L. McCurley, A. N. Thorndike, and D. E. Levy analyzed data; J. L. McCurley and A. N. Thorndike wrote the manuscript; R. Sonnenblick critically reviewed and synthesized literature to guide manuscript development; A. N. Thorndike had primary responsibility for final content. All authors read and approved the final manuscript.
Identification
Copyright
© 2022 by the Academy of Nutrition and Dietetics.
