Lifestyle Interventions for the Treatment of Obesity in Workers: An Integrative Review

Abstract

Background: Obesity is a multifactorial disease with significant physical, psychological, and economic impacts on individuals and society. Workers are particularly vulnerable, as obesity is associated with reduced productivity, absenteeism, and premature mortality. Lifestyle interventions combining dietary, physical activity, and behavioural strategies have been investigated as therapeutic approaches in this population. Objective: We aimed to conduct an integrative review assessing the effectiveness of workplace-based obesity treatment models involving dietary interventions, physical activity, and behavioural change. Methods: A search was conducted in PubMed for studies published between 2006 and 2024, with no language restrictions. Eligible studies included experimental or quasi-experimental longitudinal designs involving adult workers. After screening 95 articles, 18 were evaluated in full, and 8 met all inclusion criteria. Data extraction covered study design, intervention type, comparators, outcomes, and methodological quality, assessed using the Newcastle–Ottawa Scale. Results: Half of the included studies reported no significant reduction in body mass index after 6 or 12 months, while the others showed only modest decreases. Nevertheless, all interventions demonstrated improvements in dietary habits (reduced sugar-sweetened beverage intake, increased fruit, vegetable, and fibre consumption), physical activity (increased walking, reduced sedentary behaviour), and behavioural domains (adherence to healthy routines, self-monitoring, and family or employer support). Conclusions: Lifestyle-based workplace interventions for obesity show limited long-term effectiveness in weight reduction but promote healthier lifestyle habits, cardiometabolic health, and more supportive work environments. Future research should include diverse socioeconomic settings, particularly in developing countries, and apply robust designs, longer follow-ups, and innovative strategies to enhance adherence and outcomes.

1. Introduction

Obesity is a chronic and multifactorial disease that challenges clinical care and remains one of the most neglected public health issues in both developed and developing countries [1]. In 2022, more than 2.5 billion adults and older individuals were overweight or obese, corresponding to approximately 43% of men and 44% of women worldwide [2]. This major cardiometabolic risk factor has a multifactorial origin and entails physical, psychological, and economic impacts for both individuals and society [2].

Behavioral, environmental, sociocultural, and psychological conditions, combined with genetic factors, contribute to the development of obesity [3]. The main cause is related to an environment that favors a chronic imbalance between energy intake and expenditure [4]. Thus, sedentary lifestyle and the consumption of hypercaloric diets are key determinants of the increasing prevalence of overweight and obesity [5].

Evidence indicates that lifestyle-directed interventions can be effective in controlling the progression of obesity and preventing comorbidities [6]. Strategies aiming to create a negative energy balance, through physical activity combined with caloric restriction, promote body weight reduction and improvements in cardiometabolic risk factors [7]. Moreover, obesity is associated with unemployment, social exclusion, reduced productivity [4], higher absenteeism, and an increased risk of premature mortality among workers [8].

Despite the growing recognition of lifestyle modification as a cornerstone in obesity management, the translation of these interventions into occupational settings remains poorly systematized. Workers represent a population particularly vulnerable to obesogenic environments, given the combined influence of long working hours, limited opportunities for physical activity, stress-related eating behaviors, and organizational factors that limit adherence to healthy routines. However, few studies have summarized and critically analyzed how lifestyle interventions, encompassing dietary modification, structured physical activity, and behavioral therapy, have been implemented and evaluated among working populations. This gap represents a relevant scientific problem, as understanding the effectiveness of such interventions in workers could support the design of tailored, feasible, and sustainable strategies for obesity prevention and treatment in the workplace.

The impact of obesity on work productivity has already been documented [9]; however, the scientific literature still lacks reviews that systematize evidence regarding lifestyle interventions in the context of workers.

Therefore, this study aimed to conduct an integrative review to identify, summarize, and critically evaluate the therapeutic effects of lifestyle-based obesity treatment models, including dietary interventions, physical activity, and behavioral modifications, in adult workers.

2. Materials and Methods

An integrative literature review was conducted, which allows the gathering, evaluation, and synthesis of available scientific evidence on a given phenomenon based on primary studies. Six steps were followed in its operationalization: (1) formulation of the guiding question; (2) literature search or sampling; (3) data collection; (4) critical analysis of the included studies; (5) discussion of results; and (6) presentation of the integrative review [10].

This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines to ensure methodological transparency and replicability. The guiding question was formulated based on the PICO strategy: P (population) = workers; I (intervention) = lifestyle changes (dietary interventions, physical activity, and behavioral modification); C (comparison) = experimental groups versus controls; O (outcomes) = anthropometric and clinical indicators such as body mass index (BMI), waist circumference, and body weight reduction.

Operational definitions were established to standardize the concepts used in this review. “Dietary interventions” were defined as structured modifications in food intake, including caloric restriction, macronutrient redistribution, or nutritional counseling. “Physical activity interventions” referred to planned, repetitive, and structured movement programs designed to improve physical fitness or energy expenditure, following the American College of Sports Medicine (ACSM) principles. “Behavioral modification interventions” encompassed psychological or educational strategies aimed at changing eating habits, self-monitoring, motivation, or adherence, according to the behavior change framework described by the World Health Organization (WHO).

2.1. Search Strategy

The bibliographic search was conducted in the PubMed database, including publications between 2006 and 2024, with no language restrictions, in May 2024. MeSH descriptors combined with Boolean operators were used:

“lifestyle” AND “health promotion” AND “obesity” AND “exercise” AND “diet” AND “worker’s health”;

“obesity” AND “worksite” AND “behavioral intervention” AND “incentives”;

“health promotion” AND “weight control” AND “construction workers” AND “physical activity” AND “dietary behavior”;

“occupational health” AND “worker’s health” AND “body mass index” AND “obesity”.

Although only one database (PubMed) was used, this choice was based on its comprehensive coverage of biomedical and health sciences literature. To minimize bias, the search combined MeSH terms and non-indexed keywords, adjusted to the PubMed thesaurus. This limitation was acknowledged and discussed in Section 4.

2.2. Eligibility Criteria

We included primary studies with experimental or quasi-experimental and longitudinal designs that investigated interventions targeting obesity treatment in adult workers, involving diet, physical activity, and/or behavioral modification, with or without a comparison group. Excluded studies comprised reviews, protocols, commentaries, editorials, institutional guidelines, and position statements; purely descriptive observational studies; case reports, dissertations, theses, and book chapters.

2.3. Selection and Extraction Process

A total of 99 articles were identified from the four search strategies. After removing duplicates (n = 4), 95 studies remained. Of these, 75 were excluded after title and abstract screening, and 2 could not be retrieved. Thus, 18 articles were assessed in full text, of which 10 were excluded for not addressing the outcomes of interest. In the end, 8 studies met the eligibility criteria and were included in the review (Figure 1).

Two independent reviewers conducted all phases of the review process (search, screening, data extraction, and quality assessment). In cases of disagreement, consensus was reached through discussion or consultation with a third reviewer. The extracted data included study identification (author, year, country), population characteristics, type of intervention (dietary, physical activity, behavioral, or combined), comparators, duration, outcomes assessed, and main results.

2.4. Methodological Quality Assessment

The quality of the included studies was analyzed using the Newcastle-Ottawa Scale, adapted for intervention studies, considering selection, comparability, and outcome criteria. Only studies that achieved a minimum score of 5 points were included.

Considering the diversity of study designs, complementary tools, ROBINS-I (for non-randomized studies) and the Joanna Briggs Institute (JBI) Critical Appraisal Tools, appropriate to each design, were used to support the interpretation of findings, in accordance with recommendations for integrative reviews.

As this was a review of previously published studies, no ethical approval was required. No human subjects or identifiable data were involved. Accordingly, a sample size calculation was not applicable to this design.

3. Results

The search yielded 95 publications after removing duplicate records from the four search strategies. After screening titles and abstracts, 75 articles were excluded, and 2 could not be retrieved. Thus, 18 articles were assessed in full text, of which 10 were excluded for not addressing the outcomes of interest. Therefore, this integrative review was based on the remaining eight publications (Table 1).

Most of the studies included in this review (n = 5) involved North American workers [11,12,13,14,15], two studies assessed Dutch workers [16,17], and one study included a sample of employees from Australia [18]. The participants were employed in different occupational settings: construction industry [16], transportation sector [11,12], a casino [18], medium- and large-sized companies [13,17], a healthcare network [14], and a manufacturing, research, and development company [15].

All studies had a longitudinal design, with duration ranging from 24 weeks to two years. Only one of them did not include randomization of the sample [14], in which the authors selected employees from different sectors of the same company as experimental and control groups, both undergoing the same intervention, with the only difference being the use or non-use of pedometers.

Table 1. Studies Included in the Review.

Reference	Population	Intervention	Comparison	Remarks
Viester et al. (2017) [16]	Construction workers in the Netherlands with overweight or obesity. EG (n = 162) CG (n = 152)	Single-blind randomized trial with workplace intervention conducted during working hours. D—Calorie guide, recipes, individual plan. PA—Pedometer and individualized exercise prescription. C—Stages of change; knowledge tests.	EG vs. CG (general health guidance) after 6 and 12 months.	The EG showed positive changes in vigorous physical activity and in the consumption of sugar-sweetened beverages compared with the CG, although the effects on body weight were modest. A significant reduction in BMI was observed after 6 months.
Olson et al. (2016) [11]	Transport company workers in the United States, BMI ≥ 27. EG (n = 247) CG (n = 225)	Randomized controlled trial with internet-based instructions. D (Diet): Guidance for reducing the consumption of high-calorie foods, reducing portion sizes, increasing fruit and vegetable intake, and an individualized meal plan. PA (Physical Activity): Pedometer, guidance to increase walking, and self-monitoring. C (Counseling/Behavioral): Motivational guidance, informational booklet, goal setting, prize-based competition, sleep recommendations, and follow-up with coaches.	EG vs. CG (general information and rewards for participation in assessments) after 6 months.	The EG showed significant reductions in BMI and body weight, in addition to increased fruit and vegetable consumption and a higher number of days per week of physical activity.
Atlantis et al. (2006) [18]	Casino workers in Australia, sedentary, with no BMI restriction. EG (n = 19) CG (n = 23)	Randomized controlled trial. D (Diet): Monthly individual consultations with a nutritionist, guidance on reducing fast food and sweets. PA (Physical Activity): Individualized prescription of moderate-to-high intensity aerobic exercises and resistance training, 3 times per week. C (Counseling/Behavioral): Health education, participation in seminars, individual counseling, and adherence-based rewards.	EG vs. CG (general information) after 24 weeks.	The EG showed a reduction in waist circumference and improvement in aerobic fitness compared with the CG; however, there was no statistically significant change in BMI.
Verweij et al. (2012) [17]	Workers from medium- and large-sized companies in the Netherlands with increased health risk (overweight or obesity, and/or elevated waist circumference, and/or sedentary lifestyle, and/or inadequate eating behavior). EG (n = 274) CG (n = 249)	Single-blind randomized controlled trial. D (Diet): Reduced price of healthy foods, strategies to promote healthy options in the cafeteria, guidance to reduce fast-food intake, encouragement to increase fruit consumption, and completion of a food diary. PA (Physical Activity): Installation of bicycle racks, promotion of physical activity, pedometer, and informational leaflets. C (Counseling/Behavioral): Guidance and sessions on behavior change, individual cognitive-behavioral therapy sessions.	EG vs. CG (general information) after 6 months.	After 6 months, the EG showed a significant reduction in workplace sedentary behavior and an increase in fruit consumption. However, no changes were observed in overall physical activity level, snack consumption, or BMI.
Wilson et al. (2014) [12]	Railway maintenance workers in the United States, with participation encouraged for those with BMI ≥ 27. EG (n = 227) CG (n = 135)	Randomized trial. D (Diet): Self-monitoring of food intake, consultation with a nutritionist, goal of reducing 7% of initial body weight, posters, and healthy menus. PA (Physical Activity): Self-monitoring of physical activity, recommendation of 150 min of physical activity per week. C (Counseling/Behavioral): Manual with simplified language, awareness of health behaviors, individual counseling, educational material for families, and a website with family support strategies.	EG vs. CG (general health information provided as part of the company’s usual operations) after 12 months.	The EG showed better weight and BMI outcomes compared to the CG, mainly because CG participants gained weight, while EG participants lost a small amount of weight (not reaching the target goal). Nevertheless, the EG developed strategies for weight control and engagement in physical activity.
Almeida et al. (2015) [13]	Workers from medium- and large-sized companies in the United States, with BMI ≥ 25. EG (n = 789) CG (n = 1001)	Randomized controlled trial, internet-based instructions. D (Diet): Low-fat, high-fiber diet with emphasis on fruits and vegetables, replacement of sugar-sweetened beverages with water, individualized meal plan. PA (Physical Activity): Guidance to perform 150 min per week, electronic coach. C (Counseling/Behavioral): Behavioral strategies via email, website support, financial incentives.	EG vs. CG (general information on healthy eating and physical activity) after 6 months.	Both groups showed a small reduction in BMI after 6 months. Participants also increased fruit and fiber intake and physical activity levels, while reducing saturated fat and cholesterol consumption. However, no statistically significant differences were observed between EG and CG.
LaCaille et al. (2016) [14]	Employees of a medium-sized healthcare system in the United States, with BMI ≥ 25. EG (n = 361) CG (n = 81)	Quasi-experimental study with a non-equivalent, non-randomized control group. Duration: 12 months. D (Diet): Food labeling with calorie information, number of steps required to burn them, and “traffic light” symbols based on energy density; changes in utensil size; increased availability of low-energy-density foods; reduced portion sizes of high-calorie foods; information on energy balance; health messages in the workplace. PA (Physical Activity): Pedometers to monitor steps, encourage walking, and promote self-monitoring. C (Counseling/Behavioral): Health-related behavior change strategies, “influential” employees trained to reinforce healthy messages, influence positive attitudes, and increase colleagues’ self-efficacy, financial incentives.	EG (hospital employees) vs. CG (clinic employees from the same administration, who received the same guidance and financial incentives but no pedometers), assessed at 6 and 12 months.	No statistically significant differences were observed between groups regarding BMI, body weight, or waist circumference over 12 months. The EG increased walking time compared with the CG, although overall physical activity levels were not altered. Moreover, fruit and vegetable consumption decreased, and fat intake remained unchanged.
Fernandez et al. (2015) [15]	Employees of a manufacturing, research, and development company in the United States, with BMI ≥ 25. EG (n = 1547) CG (n = 1068)	Randomized study with a qualitative phase (Phase 1) and a quantitative phase (Phase 2). D (Diet): Phase 1: exploration of the social and cultural role of food. Phase 2: actions to reduce energy intake and control portion sizes, sessions with nutritionists. PA (Physical Activity): Phase 1: exploration of the social and cultural role of physical activity. Phase 2: actions to increase energy expenditure, pedometers, and partnerships with gyms. C (Counseling/Behavioral): Actions to raise awareness and build capacities, workplace health promotion interventions, workshops, and financial incentives.	EG vs. CG (no intervention) after 2 years.	After 2 years of intervention, a favorable trend toward BMI reduction was observed among EG participants. Environmental changes implemented in the workplace increased employees’ exposure to an adequate energy balance.

EG: experimental group; CG: control group; D: dietary intervention; PA: physical activity intervention; C: behavioral intervention; BMI: body mass index.

Table 1. Studies Included in the Review.

Reference	Population	Intervention	Comparison	Remarks
Viester et al. (2017) [16]	Construction workers in the Netherlands with overweight or obesity. EG (n = 162) CG (n = 152)	Single-blind randomized trial with workplace intervention conducted during working hours. D—Calorie guide, recipes, individual plan. PA—Pedometer and individualized exercise prescription. C—Stages of change; knowledge tests.	EG vs. CG (general health guidance) after 6 and 12 months.	The EG showed positive changes in vigorous physical activity and in the consumption of sugar-sweetened beverages compared with the CG, although the effects on body weight were modest. A significant reduction in BMI was observed after 6 months.
Olson et al. (2016) [11]	Transport company workers in the United States, BMI ≥ 27. EG (n = 247) CG (n = 225)	Randomized controlled trial with internet-based instructions. D (Diet): Guidance for reducing the consumption of high-calorie foods, reducing portion sizes, increasing fruit and vegetable intake, and an individualized meal plan. PA (Physical Activity): Pedometer, guidance to increase walking, and self-monitoring. C (Counseling/Behavioral): Motivational guidance, informational booklet, goal setting, prize-based competition, sleep recommendations, and follow-up with coaches.	EG vs. CG (general information and rewards for participation in assessments) after 6 months.	The EG showed significant reductions in BMI and body weight, in addition to increased fruit and vegetable consumption and a higher number of days per week of physical activity.
Atlantis et al. (2006) [18]	Casino workers in Australia, sedentary, with no BMI restriction. EG (n = 19) CG (n = 23)	Randomized controlled trial. D (Diet): Monthly individual consultations with a nutritionist, guidance on reducing fast food and sweets. PA (Physical Activity): Individualized prescription of moderate-to-high intensity aerobic exercises and resistance training, 3 times per week. C (Counseling/Behavioral): Health education, participation in seminars, individual counseling, and adherence-based rewards.	EG vs. CG (general information) after 24 weeks.	The EG showed a reduction in waist circumference and improvement in aerobic fitness compared with the CG; however, there was no statistically significant change in BMI.
Verweij et al. (2012) [17]	Workers from medium- and large-sized companies in the Netherlands with increased health risk (overweight or obesity, and/or elevated waist circumference, and/or sedentary lifestyle, and/or inadequate eating behavior). EG (n = 274) CG (n = 249)	Single-blind randomized controlled trial. D (Diet): Reduced price of healthy foods, strategies to promote healthy options in the cafeteria, guidance to reduce fast-food intake, encouragement to increase fruit consumption, and completion of a food diary. PA (Physical Activity): Installation of bicycle racks, promotion of physical activity, pedometer, and informational leaflets. C (Counseling/Behavioral): Guidance and sessions on behavior change, individual cognitive-behavioral therapy sessions.	EG vs. CG (general information) after 6 months.	After 6 months, the EG showed a significant reduction in workplace sedentary behavior and an increase in fruit consumption. However, no changes were observed in overall physical activity level, snack consumption, or BMI.
Wilson et al. (2014) [12]	Railway maintenance workers in the United States, with participation encouraged for those with BMI ≥ 27. EG (n = 227) CG (n = 135)	Randomized trial. D (Diet): Self-monitoring of food intake, consultation with a nutritionist, goal of reducing 7% of initial body weight, posters, and healthy menus. PA (Physical Activity): Self-monitoring of physical activity, recommendation of 150 min of physical activity per week. C (Counseling/Behavioral): Manual with simplified language, awareness of health behaviors, individual counseling, educational material for families, and a website with family support strategies.	EG vs. CG (general health information provided as part of the company’s usual operations) after 12 months.	The EG showed better weight and BMI outcomes compared to the CG, mainly because CG participants gained weight, while EG participants lost a small amount of weight (not reaching the target goal). Nevertheless, the EG developed strategies for weight control and engagement in physical activity.
Almeida et al. (2015) [13]	Workers from medium- and large-sized companies in the United States, with BMI ≥ 25. EG (n = 789) CG (n = 1001)	Randomized controlled trial, internet-based instructions. D (Diet): Low-fat, high-fiber diet with emphasis on fruits and vegetables, replacement of sugar-sweetened beverages with water, individualized meal plan. PA (Physical Activity): Guidance to perform 150 min per week, electronic coach. C (Counseling/Behavioral): Behavioral strategies via email, website support, financial incentives.	EG vs. CG (general information on healthy eating and physical activity) after 6 months.	Both groups showed a small reduction in BMI after 6 months. Participants also increased fruit and fiber intake and physical activity levels, while reducing saturated fat and cholesterol consumption. However, no statistically significant differences were observed between EG and CG.
LaCaille et al. (2016) [14]	Employees of a medium-sized healthcare system in the United States, with BMI ≥ 25. EG (n = 361) CG (n = 81)	Quasi-experimental study with a non-equivalent, non-randomized control group. Duration: 12 months. D (Diet): Food labeling with calorie information, number of steps required to burn them, and “traffic light” symbols based on energy density; changes in utensil size; increased availability of low-energy-density foods; reduced portion sizes of high-calorie foods; information on energy balance; health messages in the workplace. PA (Physical Activity): Pedometers to monitor steps, encourage walking, and promote self-monitoring. C (Counseling/Behavioral): Health-related behavior change strategies, “influential” employees trained to reinforce healthy messages, influence positive attitudes, and increase colleagues’ self-efficacy, financial incentives.	EG (hospital employees) vs. CG (clinic employees from the same administration, who received the same guidance and financial incentives but no pedometers), assessed at 6 and 12 months.	No statistically significant differences were observed between groups regarding BMI, body weight, or waist circumference over 12 months. The EG increased walking time compared with the CG, although overall physical activity levels were not altered. Moreover, fruit and vegetable consumption decreased, and fat intake remained unchanged.
Fernandez et al. (2015) [15]	Employees of a manufacturing, research, and development company in the United States, with BMI ≥ 25. EG (n = 1547) CG (n = 1068)	Randomized study with a qualitative phase (Phase 1) and a quantitative phase (Phase 2). D (Diet): Phase 1: exploration of the social and cultural role of food. Phase 2: actions to reduce energy intake and control portion sizes, sessions with nutritionists. PA (Physical Activity): Phase 1: exploration of the social and cultural role of physical activity. Phase 2: actions to increase energy expenditure, pedometers, and partnerships with gyms. C (Counseling/Behavioral): Actions to raise awareness and build capacities, workplace health promotion interventions, workshops, and financial incentives.	EG vs. CG (no intervention) after 2 years.	After 2 years of intervention, a favorable trend toward BMI reduction was observed among EG participants. Environmental changes implemented in the workplace increased employees’ exposure to an adequate energy balance.

EG: experimental group; CG: control group; D: dietary intervention; PA: physical activity intervention; C: behavioral intervention; BMI: body mass index.

The dietary interventions proposed in the studies included nutritional planning or consultation with a nutritionist [11,12,13,15,16,18], guidance for reducing caloric intake and increasing the consumption of healthy foods [11,13,14,15,17,18], use of food diaries [17], provision of supportive materials to promote healthy eating in the workplace or cafeteria [12,14,17], and modifications in utensil size [14]. Regarding physical activity, most protocols (n = 5) involved the use of pedometers to encourage workers to increase daily steps [11,14,15,16,17]. Other strategies included individualized exercise prescriptions [16,18], installation of bicycle racks [17], informational leaflets [17], guidance to achieve at least 150 min per week of physical activity [12,13], and partnerships with gyms [15]. The main motivational approach adopted in the studies was financial incentives or rewards for adherence or goal achievement [11,13,14,15,18]. Behavioral interventions also included identification of stages of change [16], knowledge tests [16], lectures or informational materials on behavior change [11,12,14,15,17,18], individual counseling [12,17,18], family support strategies [12], workplace health promotion interventions [14,15], and digital support [13].

Two of the eight studies incorporated digital tools [11,13], in which participants received instructions and feedback through a dedicated website. Despite the range of interventions proposed, half of the studies did not observe reductions in BMI in the experimental group after 6 [17,18] or 12 months [12,14]. However, three studies reported significant reductions in BMI after 6 months of intervention [11,13,16], and the longest trial showed a trend toward BMI reduction after 2 years [15]. Improvements in eating behavior were also observed, such as decreased consumption of sugar-sweetened beverages [16], increased intake of vegetables, fruits, or fiber [11,13,17], and reduced consumption of saturated fats and cholesterol [13]. A reduction in waist circumference was reported in one study [18]. Regarding physical activity, positive changes included improvements in practice, increased walking time or aerobic fitness [13,14,16,18], reductions in workplace sedentary behavior [17], and the development of effective weight control strategies [12].

4. Discussion

The aim of this study was to investigate the effectiveness of obesity treatment through dietary interventions, physical activity, and behavioural change in workers. Overall, the studies reviewed showed modest or no reductions in body mass index (BMI) after 6 to 12 months of intervention, confirming the challenges of achieving clinically significant weight loss in workplace-based programmes. Lifestyle-based interventions generally rely on well-established guidelines for dietary and physical activity planning. However, our findings highlight that adherence and long-term engagement are major determinants of success, frequently compromised by personal and organizational barriers [19,20].

Across the reviewed studies, improvements in dietary habits were more consistent than changes in anthropometric indicators. For example, the reduction in sugar-sweetened beverage intake reported by Viester et al. [16] represents a preventive action against weight gain, as these beverages—along with processed and refined foods, high-fat cheeses, and fast food—are considered potentially obesogenic [21]. Increased consumption of vegetables, fruits, and fibre, as observed in some studies [11,13,17], is a desirable target in lifestyle change programmes, given its potential to reduce obesity risk [22,23]. One exception was observed in the study by LaCaille et al. [14], in which a reduction in fruit and vegetable intake among health system employees was attributed to demanding work routines, reinforcing the influence of occupational context on adherence to nutritional recommendations.

In addition to dietary change, improvements in waist circumference were reported in a subset of studies, indicating benefits beyond body weight. These findings reinforce the role of waist circumference as a sensitive marker of cardiometabolic improvement in workplace interventions [18,24].

Individualised nutritional planning was the most frequently cited dietary intervention in the studies included in this review [11,12,13,14,15,16,17,18]. The presence of nutrition professionals within workplace programmes appears crucial for effective counselling and adherence, enabling workers to translate recommendations into daily practice [25].

Three studies reported direct employer involvement in promoting healthy eating at the workplace, such as subsidising healthier foods and changing portion sizes [12,14,17]. Employer engagement emerged as a facilitating factor, not only for individual adherence but also for creating an enabling food environment and addressing the economic burden of obesity-related absenteeism [9].

Physical activity promotion was another recurrent strategy, although with heterogeneous outcomes. While few studies reported increased physical activity levels, improvements in fitness indicators and reductions in sedentary time during work hours were consistently observed [13,14,16,17,18]. Creating a work environment that encourages workers to remain active is essential for health promotion, considering that adults spend most of their waking hours at work. Recent evidence also supports a broader “24-h time-use approach,” integrating physical activity, sedentary behaviour, and sleep into a continuous behavioural framework [26], which could expand the scope of occupational interventions beyond isolated workplace activities.

Workplace environment has been increasingly associated with worker health and should be incorporated into obesity prevention and treatment strategies [27,28,29,30,31]. Several studies evaluated the use of pedometers to stimulate workers to increase their daily step count [11,14,15,16,17]. However, LaCaille et al. (2016) [14], whose experimental and control groups differed only in pedometer use, did not observe statistically significant differences between them. These results suggest that comprehensive workplace interventions may yield greater behavioural change than isolated device-based strategies. Low-intensity physical activities—such as walking breaks or stair climbing—appear more feasible for long-term adherence than rigid or high-intensity programmes [14].

Additional strategies, such as individualised exercise prescriptions, installation of bicycle racks, informational campaigns, counselling to achieve at least 150 min of activity per week, and partnerships with gyms, were also reported [12,13,14,15,16,17,18]. These measures align with the evidence that modifying the built environment and organizational culture can positively influence physical activity patterns and obesity prevention in the workplace [27].

Behavioural interventions described in the analysed protocols included health education lectures, informative materials, cognitive behavioural therapy sessions, knowledge assessments, and individual counselling [11,12,13,14,15,16,17,18]. Among these, cognitive-behavioural approaches and educational reinforcement appear particularly effective in promoting self-monitoring, motivation, and sustained behaviour change [12,17,18].

Motivational incentives were commonly reported. Financial rewards for adherence and goal achievement were the most frequent strategy [11,13,14,15,18]. Previous research has shown that even modest financial rewards can effectively motivate overweight workers to participate in weight-loss actions [28]. However, the sustainability of these results remains uncertain once incentives are removed, indicating that intrinsic motivation and organizational support may be equally important for long-term maintenance.

Family and social support mechanisms also play an essential role in sustaining behavioural change. Family involvement strategies, implemented in the study by Wilson et al. (2014) [12], appear promising, as family members help create a supportive environment that reinforces healthy behaviours [29].

Digital tools and technological innovations emerged as promising adjuncts to traditional workplace programmes. Two studies used digital platforms for guidance and support [11,13], both reporting positive experiences and scalability. Complementary findings from recent trials suggest that immersive three-dimensional virtual platforms may enhance engagement, provide cost-effective scalability, and overcome participation barriers [30]. Integrating such technologies could extend the reach of workplace interventions, especially in low- and middle-income settings with limited access to in-person programmes.

Finally, it is noteworthy that all studies included in this review were conducted in high-income countries. This concentration reflects the greater institutional emphasis placed on worker health in such contexts but also underscores the knowledge gap in low- and middle-income settings. Future research should integrate innovative strategies such as immersive digital platforms and 24-h time-use frameworks to optimise long-term outcomes and tailor interventions to diverse socioeconomic and occupational settings [26,30].

Limitations

This review presents certain limitations that should be acknowledged. The literature search was limited to a single database (PubMed), which may have restricted the scope of retrieved studies despite comprehensive use of MeSH terms and keywords. The heterogeneity of study designs precluded quantitative synthesis or meta-analysis. In addition, the methodological quality of included studies varied, and reporting was often incomplete. Nonetheless, these limitations are inherent to integrative reviews and were mitigated by transparent procedures, independent review, and adherence to PRISMA 2020 guidelines.

5. Conclusions

This integrative review demonstrated that workplace-based obesity treatment models combining dietary interventions, physical activity, and behavioural change produce modest effects on body weight but meaningful improvements in lifestyle habits and cardiometabolic health. Despite methodological heterogeneity and limited long-term follow-up, the evidence supports the relevance of multi-component programmes that address not only individual behaviour but also organisational and environmental determinants of obesity. Future studies should be conducted in more diverse socioeconomic and occupational settings, using robust experimental designs and exploring innovative strategies such as digital tools, immersive platforms, family engagement and structural modifications in the workplace to enhance adherence and sustainability of results. In summary, workplace interventions targeting lifestyle modification represent a feasible and promising avenue for promoting workers’ health, provided they are sustained, context-sensitive and supported by institutional commitment.