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
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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.
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© 2022 by the Academy of Nutrition and Dietetics.
