1. Worksite Health Promotion Principles and Tools of the Trade
John B. Bartholomew
The University of Texas at Austin

2. Obesity Trends* Among U.S. Adults BRFSS, 1985
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

3. Obesity Trends* Among U.S. Adults BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

4. Obesity Trends* Among U.S. Adults BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

6. Obesity Trends* Among U.S. Adults BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

7. Obesity Trends* Among U.S. Adults BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

9. Obesity Trends* Among U.S. Adults BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

10. Obesity Trends* Among U.S. Adults BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

11. Obesity Trends* Among U.S. Adults BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

12. Obesity Trends* Among U.S. Adults BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

13. Obesity Trends* Among U.S. Adults BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19%

14. Obesity Trends* Among U.S. Adults BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

15. Obesity Trends* Among U.S. Adults BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

16. Obesity Trends* Among U.S. Adults BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

17. Obesity Trends* Among U.S. Adults BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% ≥20

18. Obesity Trends* Among U.S. Adults BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% %–24% ≥25%

19. (*BMI 30, or ~ 30 lbs overweight for 5’4” person)
Obesity Trends* Among U.S. Adults BRFSS, 2002
(*BMI 30, or ~ 30 lbs overweight for 5’4” person)
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)
No Data <10% %–14% %–19% %–24% ≥25%
Source: Behavioral Risk Factor Surveillance System, CDC

20. Obesity Trends* Among U.S. Adults BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% %–14% %–19% %–24% ≥25%

21. Obesity Trends* Among U.S. Adults BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
No Data <10% %–14% %–19% %–24% ≥25% 21

22. Obesity Trends* Among U.S. Adults BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
No Data <10% %–14% %–19% %–24% %–29% ≥30% 22

23. Obesity Trends* Among U.S. Adults BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
No Data <10% %–14% %–19% %–24% %–29% ≥30% 23

24. Obesity Trends* Among U.S. Adults BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% %–14% %–19% %–24% %–29% ≥30%

25. 25

26. Stages of Change Pre-contemplator Contemplator Preparation Action
Maintenance
Not interested
Thinking about it
Planning to do it
Doing it!

27. Stages of Change Attitudes Self-efficacy Cons > Pros low SE
Not interested:
Thinking about it:
Planning to do it:
Doing it!
Pros = Cons low SE
Pros > Cons mod SE
Pros > Cons high SE

28. Stages of Change How does this help me?
Must recognize that everyone does not realize a direct benefit from exercise
For many, the costs outweigh the benefits
Much of what we do is to add value or reduce
the cost associated with physical activity

29. Rewards and punishment for exercise
Benefits / rewards:
(1) improved health, (2) fitness, (3) weight management
(4) reduced stress (5) increased energy (6) fun activities
(7) social interaction (8) successful aging (9) eat more
Costs / punishments:
(1) financial cost (2) loss of time (3) pain / soreness
(4) fear of injury (5) boredom (6) frustration with plateau
(7) feeling uncoordinated & self-conscience
(8) smell / look bad (9) fatigue

30. Reports of beginning exercisers
Benefits / rewards:
(1) improved health, (2) fitness, (3) weight management
(4) reduced stress (5) increased energy (6) fun activities
(7) social interaction (8) successful aging (9) eat more
Costs / punishments:
(1) financial cost (2) loss of time (3) pain / soreness
(4) fear of injury (5) boredom (6) frustration with plateau
(7) feeling uncoordinated & self-conscience
(8) smell / look bad (9) fatigue

31. Reports of experienced exercisers
Benefits / rewards:
(1) improved health, (2) fitness, (3) weight management
(4) reduced stress (5) increased energy (6) fun activities
(7) social interaction (8) successful aging (9) eat more
Costs / punishments:
(1) financial cost (2) loss of time (3) pain / soreness
(4) fear of injury (5) boredom (6) frustration with plateau
(7) feeling uncoordinated & self-conscience
(8) smell / look bad (9) fatigue

32. Reinforcement Schedule for Exercise
Choice is
Rewarded
Choice is
Punished
Exercise Sessions
Is it surprising that 50% of people drop out of exercise programs in the first few months?

33. What to do? Shift the curve to the left
Reduce barriers / punishments associated with exercise
Increase benefits / rewards
Individualize information by targeting different stages of change or readiness to exercise