Nutritional Interventions in at the Office: Comparison
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Workplace nutrition interventions have garnered attention as a pivotal component of employee well-being and organisational productivity. The narrative synthesis has demonstrated that behavioural and mixed (cognitive-behavioural) interventions are more effective rather than solely cognitive ones. Apart from the employees, employers also should be engaged into designing interventions as well. 

  • workplace nutrition
  • employee well-bein
  • employers

1. Introduction

The concept of well-being comprises health, happiness, and prosperity, including feeling mentally well, being satisfied with life, having a sense of purpose, and managing stress effectively [1]. Proper nutrition and a healthy diet are fundamental to good health and well-being. A balanced diet provides the necessary energy for daily activity as well as essential nutrients for growth and repair, promoting strength and health. It also facilitates the prevention of diet-related illnesses. An increasing body of research indicates that diet and nutrition have a substantial impact on mood and mental well-being, as well as on work performance [2].
Workplace well-being activities have a long history. Formal corporate well-being programs date back to the 1950s [4,5][3][4] and have observed rapid growth since the 1970s, mainly in the United States. Employers, wishing to reduce losses due to sickness absence, presenteeism (attendance at work despite illness) [6][5] or compensations, introduced preventive measures in the workplace. These measures resulted from the peculiarities of the US healthcare system, which does not entail public health insurance coverage; thus, healthcare costs are passed on to citizens and employers [7][6]. Initially, the implementation of well-being and health programs (e.g., as part of Employee Assistance Programs) aimed to prevent work-related illness and accidents. Over time, they also began to shape an employer-focused corporate culture oriented towards health promotion, enhancing the company’s brand and market position [8][7]. This became important in order to attract employees, whose expectations are constantly increasing; to create a company brand that is perceived as responsible and supportive of the employee; or to position the company through the awards given to top employers. This is also a result of the growing popularity of CSR (corporate social responsibility) and ESG (environment, social responsibility, and corporate governance). Over time, such an approach became recognised world-wide, and well-being initiatives have become a permanent part of the corporate culture of many companies [9,10,11][8][9][10].
Due to increased global health needs (staff shortages, challenges in obtaining healthcare services, aging population), for several years now, the World Health Organisation has identified the workplace setting as crucial for health promotion. The average employee spends one-third of the day in the workplace; thus, measures taken just in this environment seem reasonable and relatively easy to implement [12,13][11][12]. Currently, health-related benefits such as private health insurance, fitness perks, fruit and vegetable delivery to the office or lunch subsidies are among the most frequently offered, and their scope is steadily increasing. The reason for this is both the employers’ aspirations to distinguish themselves and the steadily rising employee expectations [9,11][8][10].
When undertaking activities to promote health in the workplace, it is necessary to clearly define the target group, as well as the purpose and form of the activities (interventions) to be undertaken. Office workers are one of the most frequently addressed group of employee-directed health-related activities [10][9]. This is due to a number of factors that facilitate the design, implementation and evaluation of such interventions, e.g., a fixed pattern of work—work at similar times of the day and for a comparable amount of time, making most employees available at roughly the same place and time; or a similar range of duties—typically sedentary work that does not require the extra effort associated with, for example, having to stand for long periods of time or carrying objects. In addition, office workers in most cases are not shift workers, which has a huge impact on their circadian rhythm, meal times, eating habits and associated health risks.
Another important step is to determine the purpose and form of the intervention. Overall, interventions can be divided into three main categories. The first category comprises cognitive interventions, which aim to increase nutritional knowledge and awareness of the impact of nutrition on health, e.g., through education, training or lectures. The second category comprises behavioural interventions, which are skill-giving interventions, i.e., interventions that focus on the recipient (e.g., through workshops or prevention programs) or that implement the changes needed to alter eating behaviour, as well as environmental interventions that focus on changes in access to or labelling of foods, e.g., providing fruit in the office or the colour-coding of cafeteria meals based on their nutritional value. The third category comprises mixed interventions, which combine cognitive and behavioural interventions. The cognitive interventions group may include, e.g., lectures (onsite and online) and e-learning courses. Behavioural interventions include, e.g., changing the availability of certain foods (limiting sweets in vending machines or providing fresh fruit and vegetables to the office), labelling healthy meals in the employee cafeteria with colours or symbols [15,16][13][14] or financial incentives for choosing healthy products [17][15]. Mixed interventions involve both components and may consist of workshops with a health care professional (doctor, nurse, nutritionist, public health specialist health educator, etc.), well-being programs combining lectures, workshops, exercise and dietary change, or, for example, diabetes prevention programs targeting the prevention and treatment of a particular disease [18,19,20][16][17][18].
The evaluation of the effectiveness of workplace nutrition interventions is a crucial component of their implementation [21][19]. Effectiveness can be measured using various indicators and methods. Cognitive interventions often involve pre- and post-intervention knowledge tests. The effectiveness of behavioural and mixed interventions can be assessed using work environment and economic indicators (e.g., absenteeism, presenteeism, costs) or health-related indicators (e.g., BMI, glucose levels, cholesterol levels, disease exacerbation, consumption of specific food groups). These indicators may be combined to provide a more comprehensive evaluation of the impact of interventions.

2. Nutritional Interventions in at the Office

There are more and more employee well-being initiatives introduced by employers. They embrace a wide range of health- and wellness-related aspects, e.g., physical activity, mental health, substance abuse prevention, and guidelines for proper nutrition. The issue is increasingly important and interventions are expected to be undertaken, especially for office workers (white-collar professionals). Nevertheless, public health specialists and practitioners implementing them face a substantial challenge to design them in such way so that they are effective, evidence-based and cost-effective/cost-efficient.
The narrative synthesis has demonstrated that behavioural and mixed (cognitive-behavioural) interventions are more effective rather than solely cognitive ones. Therefore, it seems reasonable to promote those interventions that involve comprehensive well-being programs, personalised consultations and environmental interventions, such as menu modifications or improving access to healthy snacks at the workplace. A properly designed intervention needs to account for the needs and characteristics of its future participants. When designing workplace nutrition interventions, it is also important to consider employee diversity. Factors such as employee sex, religion, economic or social status, among others, may influence the overall participation and effectiveness. The analysis of employee needs and abilities should also be taken into consideration when designing interventions so that they are prepared ‘with’ the employees instead of just ‘for’ them.
Apart from the employees, employers also should be engaged into designing interventions as well. After all, they are the ones who make the final decision and provide financial coverage for the intervention which may offer better access to healthy products or improve consumption patterns of the employees. This may further improve employee health and limit the costs of healthcare providers as well as build better workplace organisational culture. Then, either as a continuation or a separate intervention, it may be beneficial to reduce access to snacks such as sweets, crisps and sweetened beverages found in vending machines or canteens, and replace them with fruit and vegetables for the employees.
In recent years, an increase in overweight and obesity rates has been observed, especially after the COVID-19 pandemic [45][20]. This is particularly noticeable among office workers with sedentary jobs which may contribute to the development of diseases of affluence such as diabetes or the metabolic syndrome. Therefore, the implementation of disease prevention programs in the workplace may improve employee health. As it was observed, these programs featured comprehensive approaches to those diseases and combined the aspects of nutrition, physical activity and counselling [18,30,31][16][21][22]. They are considered to be slightly effective but with no major improvement. Nevertheless, the obtained results are still insufficient to properly assess the effectiveness, as flaws can be found both in the design of the interventions themselves as well as in data quality.
As cognitive interventions mainly include education in the form of lectures or individual consultations, they are not considered effective if they do not involve behavioural change [41,42][23][24]. This is because dietary choices are determined by a number of factors, rather than just knowledge, and include environmental factors (e.g., availability of food, social and cultural practices, price and advertising of food), intrapersonal factors (e.g., beliefs, attitudes), interpersonal factors such as friends and family relations, experience with food, and biologically determined behavioural predispositions [46][25]. Therefore, it is difficult to imagine that solely offering knowledge will profoundly alter one’s dietary choices. Cognitive interventions are very often cost-effective, easier to organise and implement. Moreover, they do not require special tools, buying and transporting food to the workplace, and there are also fewer people involved in the execution of such an intervention. In most cases, it is enough to involve one employee and one speaker to run the lecture or consultations. Nonetheless, it has been suggested that for cognitive interventions to be more effective, they should be a part of comprehensive solutions and not performed on their own [18][16].
In order to properly evaluate the effectiveness of behavioural interventions, they should be categorised into person-oriented and environmental interventions. The first group comprises individual counselling, workshops, behavioural prevention programs or financial incentives. As for workshops and counselling, there is no sufficient data to fully confirm their effectiveness [17,30][15][21]. This is because the effects may vary from person to person, as each employee has different needs and meeting them all may be challenging. The intervention should be performed by a specialist who understands the basics of nutritional education and counselling not only in the field of nutrition, but also in the field of social psychology, health education, anthropology and economics [46][25]. Financial incentives such as lower prices for healthy food or discounts for healthy snacks are relatively new and less commonly used interventions, as they require considerable financial coverage by the employer. Therefore, there is limited information to assess their effectiveness [17][15]. Nonetheless, they may be promising in the following years, especially when, with more and more employees underscoring the financial aspect of shaping their nutritional habits and benefits at the workplace that would satisfy them, as well as the fact that prices of healthy food are much higher compared to unhealthy food, this possibly becomes a significant barrier for the employees to buy healthy food themselves [47,48][26][27].
Environmental interventions are employed when aiming to induce behavioural changes and focus on food accessibility, e.g., more access to healthy foods such as fruit and vegetables and less access to unhealthy snacks in canteens or vending machines; food labelling, e.g., using colours to highlight nutritional value and encourage healthier choices; or collecting something, e.g., like stamps or points, to document health-promoting behaviours. Offering a special diet in the workplace (e.g., ready-to-consume meals, changing the menu in the canteen) may be effective, but has its limits. After all, employees do not spend their entire day at work and their nutritional habits are shaped in other settings as well. Still, there is not enough evidence to fully confirm or deny the effectiveness of these interventions [16][14]. The same principle applies to providing fruit and vegetables in the workplace. Their consumption may increase on-site, but not elsewhere. Thus, ensuring access to healthy snacks may be even more important with the steadily growing costs of food [48][27]. There is more research needed in this area, with special attention placed on intervention design and employer education [15,30][13][21].
As for mixed interventions, many components bear resemblance to those in cognitive and behavioural interventions. Nonetheless, mixed interventions also focused on some issues that may bring new light to workplace interventions, i.e., the use of technology in self-control and self-regulation health interventions in the workplace as well as focus on specific groups of employees.
Technological advancements and possibility of their implementation, e.g., in the form of video-consultations, wearable devices (e.g., smart watches, smart phones, sensors) or nutrition apps, draw from the self-control intervention model which facilitates the change of dietary habits. Wearables and apps appear to be effective tools, as one can always have them close; however, there is no collective agreement or guidelines on this matter. Nonetheless, this could pose a challenge, especially to employees with little or no digital competence, such as the elderly employees near retirement or other employees vulnerable to digital exclusion. This field being relatively novel, there is little theoretical research addressing such issues, which makes it worth exploring, especially with the growing popularity of end-user apps and devices [20,49][18][28].
Another action that may form a part of complex interventions is addressing the specific needs of particular groups of employees. As it turns out, in female-only groups addressing their specific needs and offering social support are more important than the focus on the intervention itself. Furthermore, the interpersonal and teaching skills of the instructor are key factors determining the effectiveness of the intervention.
All that being said, most factors contributing to the effectiveness of nutrition interventions can be categorised into three aspects: the setting, the design and the group. The setting is mainly the place where the intervention is about to take place, with all of the tools needed to implement it. Starting from the office, the office kitchen or open space, it is important to adapt the surroundings to the needs of the employees and plans of the instructor. The requirements for the intervention should be taken into account, e.g., a laptop and a projector for the lecture, labels for the meals in the canteen, or a complete kitchen and supplies for cooking. It appears that the most effective settings are the ones nearest to the employees, e.g., wearables and apps, the canteen and the office, where they spend most of their working hours [16,20,29][14][18][29].
Intervention design should consider the type of intervention (cognitive, behavioural or mixed), timeframe and anticipated budget. As previously stated, behavioural and mixed interventions are considered more effective than just cognitive ones [18][16]. The assumed timeframe should enable the employees to benefit from the intervention fully; that is, the interventions should not be planned in summer months when most employees are on vacation or during important, e.g., national events. Also, the form (onsite, online) should be adjusted to the type of work in a particular office. Longer prevention programs might be more effective due to their extended length and increased availability [18,31][16][22]. The budget should be tailored to the employer’s financial resources and their specific needs. When there is sufficient funding for such interventions, it is considerably easier to design complex programs with many activities. However, low-cost and effective interventions can be found, such as food-labelling or changing the menu available in the canteen [17][15].
Focus on the background and specific needs of the target group is another crucial factor which may strongly influence the effectiveness of workplace nutrition interventions. The nutritional education model accounts for factors determining the motivation for change and action, i.e., past behaviours, demographics and the cultural context, food preferences and prior experience with food, personality, moods and emotions, media exposure, and other individual differences. All of these factors should be carefully considered and used for the proper design of the intervention to ensure its maximum effectiveness [46,52][25][30].

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