LM in Workplace Guidebook

GUIDEBOOK

Bringing Lifestyle Medicine into Workplaces A STRATEGIC BLUEPRINT FOR HIGH-PERFORMANCE ORGANIZATIONS From the American College of Lifestyle Medicine (ACLM) and American College of Occupational and Environmental Medicine (ACOEM)

Authors ACOEM

Manijeh Berenji, MD, MPH, FACOEM, FACPM

Muhammad Asif, MBBS, MPH, FACOEM, DoccMed

Health Sciences Associate Clinical Professor, University of California Irvine School of Medicine and the Joe C Wen School of Population and Public Health; A Society for Total Worker Health® Founding Member

Saudi Aramco ExxonMobil Refinery, Ltd Marina Mathew, MD, MPH, FACOEM, DipABLM Occidental Petroleum Corporation

Robert McLellan, MD, MPH, FAAFP, FACOEM

Beth Garver, MS

Professor, Emeritus, Medicine, Community and Family Medicine, and The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth; A Society for Total Worker Health® Founding Member

Lifestyle Medicine and Community Health Center Consultant

Connie Chuang, MD, MPA, MPH, MSc, DipABLM, NBC-HWC

Nathan M. Jones, MD, MPH, DipABLM

Divya Hedgren, MD, DipABLM Adult & Geriatric Psychiatrist

Occupational Medicine Physician (International SOS, Beacon Occupational Health, and United States Air Force)

Health Life Work Medical Care, LLC Marielle Borom, DO

Martha Shepherd, DO, MPH, FAAFP, DipABLM, FACLM

Annemieke De Wilde, MD, MPH, FACOEM, DipABLM

Vanderbilt University Medical Center

Samuel Ko, MD, MPH

Valeria S. Tivnan, MPH, Med

Health and Human Performance Section,

Vice-President of Population Health Strategy & Well-being, IMA Financial Corp.

Acknowledgement: The authors wish to thank Nathan Jones, MD, MPH the ACOEM - ACLM Board Liaison, for guidance and consultation, George Friedman-Jimenez, MD, DrPH for review and edits, and Alyssa Schultz, PhD for editing and document preparation.

© 2026 American College of Lifestyle Medicine. All rights reserved.

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Table of Contents Introduction

page 5

RATIONALE FOR ADVANCING WORKPLACE HEALTH, SAFETY, AND WELL-BEING THROUGH AN OCCUPATIONAL & ENVIRONMENTAL MEDICINE (OEM) MODEL INFORMED BY

5

LIFESTYLE MEDICINE (LM) PRINCIPLES THE INTEGRATION OF LM AND OEM

5

CORE FRAMEWORKS AND METHODOLOGY

8

CREATING A CULTURE OF HEALTH

8

PUTTING THE GUIDE INTO ACTION

9

Strategic Blueprint for Workforce Health and WellBeing: Integrating Lifestyle Medicine and Total Worker Health® Principles

page 11

DEFINING ELEMENT #1: DEMONSTRATE LEADERSHIP COMMITMENT TO WORKER SAFETY AND HEALTH AT ALL LEVELS OF THE ORGANIZATION

13

DEFINING ELEMENT #2: DESIGN WORK TO ELIMINATE OR REDUCE SAFETY AND HEALTH HAZARDS AND PROMOTE

14

WORKER WELL-BEING DEFINING ELEMENT #3: PROMOTE AND SUPPORT WORKER ENGAGEMENT THROUGHOUT PROGRAM DESIGN AND

16

IMPLEMENTATION DEFINING ELEMENT #4: ENSURE CONFIDENTIALITY AND PRIVACY OF WORKERS

17

DEFINING ELEMENT #5: INTEGRATE RELEVANT SYSTEMS TO ADVANCE WORKER WELL-BEING

17

Steps to a Healthier, Safer, Happier Workforce

page 19

ORGANIZATIONAL ASSESSMENT

19

ORGANIZATIONAL SYSTEMS EVALUATION

28

ORGANIZATIONAL READINESS

29

ASSEMBLE YOUR WORKPLACE WELLNESS TEAM

29

WORKPLACE HEALTH, SAFETY, AND WELL-BEING

30

ASSESSMENT CONCEPTUALIZED FRAMEWORKS FOR ORGNAIZATIONAL

31

STRESS AND WORK STRUCTURE COMPARISON OF MAJOR WORKPLACE WELL-BEING AND

32

PSYCHOSOCIAL ASSESSMENT TOOLS INTEGRATED ASSESSMENT STRATEGY FOR COMPREHENSIVE

34

WORKPLACE HEALTH PRACTICAL CONSIDERATIONS FOR ORGANIZATIONAL

35

IMPLEMENTATION DEVELOP IMPLEMENTATION STRATEGY

37

BEHAVIORAL NUDGES

39

CHOOSE OPTIMAL PARTNERS

39

EXECUTE STRATEGY

42

EVALUATE EFFECTIVENESS

45

CONCLUSION

55

Appendix RATIONALE FOR ADVANCING WORKPLACE HEALTH, SAFETY,

page 57 57

AND WELL-BEING CULTURE OF HEALTH

64

ASSESSMENT TOOLS

65

RESOURCES

67

References

page 83

INTRODUCTION “People are an organization’s most valuable asset and the key to its success.”

— Dave Bookbinder, The NEW ROI: Return on Individuals

Rationale for Advancing Workplace Health, Safety, and Well-Being Through an Occupational & Environmental Medicine (OEM) Model Informed by Lifestyle Medicine (LM) Principles

strategically managed investment approach.

A healthy workforce is essential for a

This Guide is the result of a burgeoning

prosperous business, as healthy workers (used

collaboration between the American College

interchangeably with employees) are more

of Occupational and Environmental Medicine

productive, engaged, and aligned with an

(ACOEM) and the American College of Lifestyle

organization’s mission and goals.1 However, the

Medicine (ACLM). This collaboration represents

existing health landscape in the United States

the structural integration of two complementary

presents substantial challenges that directly

but very distinct disciplines. ACOEM has spent

affect workforce performance and organizational

decades contributing to health promotion, injury

cohesion. Currently, the U.S. faces a significant

and disease prevention, worker engagement

chronic disease burden, with 50% of adults

strategies within workplace systems, control of

having at least one chronic condition, including

occupational hazards, and the advancement of

one in five with diabetes, one in 20 with heart

regulatory and organizational policy frameworks,

disease, and one in three with obesity.2 These

elevating the science of return-to-work and

conditions, compounded by mental health

disability management. Its focus has traditionally

conditions affecting nearly one in five adults,

centered on how work environments, policies,

are the leading drivers of healthcare costs and

and operational structures influence safety,

productivity loss through absenteeism and

function, and recovery while ACLM has brought

presenteeism.3 For instance, diabetes alone

domain expertise grounded in evidence-based,

costs $413 billion annually in medical expenses

whole-person prescriptive lifestyle change to

and lost productivity.3 Because the majority of

treat, reversal, and prevent chronic disease

chronic illnesses are directly linked to unhealthy

through the application of the six pillars of

lifestyle habits, lifestyle medicine offers a

lifestyle medicine—a whole-food and plant-

strategic investment to target the root causes of

predominant eating pattern, physical activity,

poor health. For the lifestyle medicine and OEM

restorative sleep, stress management, avoidance

practitioner, this Guide provides the framework

of risky substances, and connectedness. While

to reposition an organization’s relationship

OEM has traditionally focused on protecting

with healthcare from a rising cost burden to a

workers from hazards and on improving health-

The time-tested OEM model guided by lifestyle medicine principles is what allows prevention, clinical care, workplace adaptations, and financial stewardship to move in the same direction.4, 5, 6, 7

The Integration of LM and OEM

5

related productivity, it is now systematically

determinant of health, with individuals spending

integrating lifestyle medicine principles to

nearly one-third of their lives in the workplace.

address the interaction between occupational

Workers are therefore biological, psychological,

risk factors and personal health behaviors and

and social beings whose job demands, workplace

to enhance worker health and performance.8

culture, physical environment, and personal lives

This alignment supports a Total Worker Health®

all influence their health, safety, and ability to

(TWH) approach, viewing the worker as a whole

function at work. Rather than focusing solely

being—biological, psychological, and social—

on injuries or exposures, OEM emphasizes how

whose health is shaped by the interplay of work,

lifestyle factors like workload, stress, sleep,

life, and environment. The OEM field focuses

social support, and personal health behaviors

on protecting and promoting the health and

affect overall well-being and performance. The

safety of the workforce – addressing the root

ultimate goal is to help people remain healthy,

causes of chronic illness through evidence-based

productive, and fulfilled at work by preventing

lifestyle interventions – this resource establishes

illness and injury, accommodating individual

a framework in which the workplace becomes

needs, and promoting environments that support

an environment that supports physical, mental,

physical, mental, and social health. In this way,

and social health across the entire spectrum of

OEM and lifestyle medicine align with a holistic,

prevention and treatment. By embedding lifestyle

person-centered approach, recognizing that a

medicine concepts into workplace practice

healthy work environment is focused on caring for the whole person, not just managing isolated

While some may consider healthy workers and

health risks. The overlap between lifestyle

workforce health to be interchangeable, they

medicine and OEM provides the foundation for

are not fully synonymous. To begin, consider

building a cohesive system that promotes the

the difference in approach between population

health, safety, and well-being of workers in the

health management and clinical medicine. The

workplace (see Figure 1).

former necessitates attention to regulatory frameworks, interventions on populationlevel social determinants, environmental considerations, and engagement strategies designed to provide access and the motivation to promote the participation of a large percentage of the population. On the other hand, the clinician, while sensitive to the impact of these same factors, directs their attention to the individual in their consultation room. Further, viewing individuals as whole beings whose health is shaped by the interaction between work, life, and environment, rather than as a collection of symptoms or risk factors is critical. From this perspective, work is recognized as a social

6

FIGURE 1 Interaction between Lifestyle Medicine and Occupational and Environmental Medicine

WORKPLACE SAFETY ERGONOMICS PHYSICAL ACTIVITY OPTIMAL NUTRITION RESTORATIVE SLEEP CONNECTEDNESS STRESS MANAGEMENT AVOIDANCE OF RISKY SUBSTANCES

EXPOSURE CONTROL

PREVENTION WELLNESS

INJURY PREVENTION

SAFETY

RETURN-TO-WORK

HEALTH

CHRONIC DISEASE MANAGEMENT

PRODUCTIVITY PSYCHOLOGICAL WELL-BEING

MENTAL HEALTH POPULATION HEALTH MANAGEMENT

ILLNESS/INJURY TREATMENT

LIFESTYLE MEDICINE

OCCUPATIONAL AND ENVIRONMENTAL MEDICINE

9 Use Pillars of LM

7

Core Frameworks and Methodology

Creating a Culture of Health

The Guide utilizes evidence-based interventions

While smart organizations are good at the classic

to address the root determinants of health,

fundamentals of business, such as strategy,

safety, and well-being across three levels of

marketing, finance, and technology they largely

prevention:

neglect the other half – workforce wellbeing .

Signs that an organization has a strong culture

9 Primary: Preventing disease before it starts

of health include having clear and intentional

through habits like nutritious eating and

goals and objectives around well-being, high

stress management.

morale and productivity, and very low turnover among tenured workers. Creating a culture of

9 Secondary: Identifying and reversing

psychological safety is often a key element.

early-stage disease through screening and

The ultimate goal is to achieve a healthy

intensive lifestyle modifications.

organizational culture AND a sustainable Culture of Health. A true culture of health uses

9 Tertiary: Reducing complications and improving the quality of life for those with

the workplace environment and peer cues to

established diagnoses.

“nudge” workers toward healthy choices. Unlike fragmented “health camps” or peripheral wellness

ACLM describes lifestyle medicine through six

programs, this Guide offers a systematic year-

lifestyle intervention pillars: whole food, plant-

long programmatic approach focused on the

predominant dietary pattern; physical activity;

core lifestyle medicine pillars, translated into

restorative sleep; stress management; avoidance

specific KPIs and performance measurements

of risky substances; and connectedness. In this

and aligned with the principles of TWH. To

Guide, to incorporate lifestyle medicine and OEM

achieve this, the Guide provides systematic

principles, the PERFORM acronym is used to

methods and resources to:

describe foundational healthy behaviors: Physical

• Evaluate organizational health status through survey-based data.

activity, Eat well, Restorative sleep, Form positive social connections, Optimize your attitude and

• Implement industry-specific KPIs and performance metrics.

mindset, Reduce or avoid risky substances, and Manage stress.

• Connect with evidence-based resources and programs.

These guiding principles are the foundation of ACLM, which also advocates for broader changes

By creating work conditions that empower

at the organizational and societal level, raising

workers, lifestyle medicine in the workplace

awareness in workplaces and communities about

can integrate OEM principles and strategies to

policies and environmental changes that can

promote safety, health, and well-being, creating a

support individuals on their journey towards

thriving organization where people are motivated

better health and wellness. This has a ripple

to perform at their highest level.

effect, benefiting businesses and the community

This culture change not only improves health

by improving health and reducing costs.

in the long run but also creates real-time

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improvement in an organization’s ability to deliver

access and use its collective intelligence. Most

on tasks and commitments. It sets itself apart

organizations exploit only a fraction of the

from benefits programs, which bring wellness

knowledge, experience, and intellectual capital

and chronic disease management programs

that is available to them. But the healthy ones tap

to the workforce (and their dependents) with

into almost all of it.

messages for healthy lifestyle behaviors typically

This Guide will equip you and your team with

focused on behaviors performed outside working

information and materials to evaluate your

hours. Changing culture in the workplace is

organization’s well-being and health status.

a powerful way to also change behaviors in

Once assessed, it will guide you in developing

the home environment.9 For all of the above-

a plan, collaborating with available resources,

mentioned reasons, workplaces are an ideal place

and fostering a supportive work environment

to start changing our social perspective on health

to maintain positive organizational health.

from “my doctor will fix me” to “I am the owner of

Systematically implementing the pillars of

my health.”

lifestyle medicine, translating them into industry-

Putting the Guide Into Action

specific KPIs and performance metrics, and formulating organization-wide health promotion

Every leader recognizes that their company

campaigns to optimize the impact of lifestyle

would be transformed if they could achieve the

medicine, OEM, and TWH are the purposes of

characteristics of a healthy organization. They

the Guide. This curated approach distinguishes

immediately recognize the practical connection

it from arbitrarily selected health promotions

between poor physical and psycho-social work

by providing an organized program with a

conditions, poor health and overall performance.

consistent emphasis on core lifestyle medicine

Yet even with this awareness, even well-

factors, moving away from fragmented “health

intentioned leaders return to work and gravitate

camps.” Improving company culture is crucial for

back to what they are accustomed to doing.

employers and can impact the following metrics:

People who work for organizations that do not

9 Worker Satisfaction and Retention: A

prioritize health will eventually come to approach

positive work culture can lead to higher job

work with depletion instead of vitality. This leads

satisfaction among workers, which in turn

to a diminished sense of hope and lower self-

improves retention rates. Workers are more

esteem, which leaks beyond the walls of the

likely to stay with a company where they

companies where they work, into their families

feel valued and supported.

and the entire community. If leaders focus on creating a healthy organization, and nudge the

9 Productivity and Performance: A healthy

workforce towards better health, productivity

work culture can foster a supportive

will increase and organizational performance will

environment where workers feel motivated

transform.

to perform at their best. This can lead to

A good way to view organizational health is to

increased productivity and better overall

see it as an intelligence multiplier. The healthier

performance. Sickness absence reviews

an organization is, the more effectively it can

are a high-impact area for identifying

9

frequent illness patterns and addressing

Conclusion

specific wellness needs. To enhance this, we recommend integrating analytics to monitor

In this time of rising chronic disease, escalating

both individual and overall organizational

costs, and growing workforce strain, physicians,

health trends.

especially those formally trained in lifestyle medicine and/or OEM, are uniquely positioned

9 Attracting Talent: A strong company culture

to help organizations shift from reactive care

can be a key factor in attracting top talent.

to proactive health creation. The purpose of

Job seekers often look for organizations

this Guide is to provide a simple and evidence-

with a positive reputation and a culture that

based roadmap for comprehensive workplace

aligns with their values.

health approach that integrates OEM, TWH, and lifestyle medicine principles uniformly. This

9 Worker Health and Well-being: A positive

Guide is not simply a collection of programs; it

work culture improves worker well-being,

is a structured roadmap for aligning prevention,

resulting in fewer instances of burnout,

clinical excellence, organizational and financial

stress-related illnesses, and earlier return to

stewardship. By integrating OEM expertise with

work post medical absence.

lifestyle medicine principles, physicians can help transform the workplace into a living system that supports human flourishing and organizational

Any program will need to evolve. New challenges

resilience. When implemented with intention

and areas to refine will need consideration,

and measured through meaningful KPIs, the

and revisiting certain aspects of the toolbox

result is more than reduced risks or lower costs;

will become necessary. As such, refer to those

it is a sustainable Culture of Health improving

sections. A critical next step in this strategy is

workers to operate at their best, leaders manage

gathering survey-based data to answer ‘How

with clarity, and organizations fully harness their

Healthy is the Organization?’ in the context of

collective intelligence. The work begins here,

specific risk factors. By utilizing a checklist-

with assessment, alignment, and decisive action.

based questionnaire aligned with ACLM guiding principles and TWH approaches, employers can identify key organizational, occupational, and workforce health factors to inform strategy development and establish industry-focused KPIs with success attributes tailored to their specific work environments and operational risks.

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Strategic Blueprint for Workforce Health and Well-Being: Integrating Lifestyle Medicine and Total Worker Health® Principles In an environment marked by rising healthcare

effect sizes, and inconsistent long-term impact.

costs, workforce shortages, and increasing

While there were positive effects identified on

productivity pressures, the economic case for

mental health and musculoskeletal disorders, the

employer investment in workforce health has

overall evidence base remains heterogeneous

never been stronger. Research conducted by

and difficult to interpret definitively. This

the McKinsey Health Institute in collaboration

raises an important question for employers,

with the World Economic Forum estimates

policymakers, and occupational health leaders

that improving worker health and well-being

on how to interpret and act upon such mixed

could unlock as much as $11.7 trillion in global

findings.13 A seminal work by Goetzel and

economic value.10 Employers have many

colleagues analyzed the effectiveness of

opportunities and responsibilities to optimize

workplace health promotion programs and

their workers’ health, safety, and well-being.11

found that organizational culture was a critical

Robust evidence shows that employers are

component, as well as the importance of

uniquely positioned to play an active role in

measuring broader success metrics including

optimizing worker health, safety, and well-being.

health outcomes, job satisfaction, attrition,

A meta review evaluating the effectiveness

company performance, and more.14

of workplace health promotion interventions

Given the substantial influence that workplace

between 2011 and 2024 found that the strongest

environments exert on physical and psychosocial

evidence supported interventions focused on

health outcomes, employers must adopt

stress reduction and mental health promotion,

comprehensive, evidence-based frameworks

with positive effects seen for those interventions

that integrate the principles of TWH and lifestyle

aimed at reducing sedentary behavior and, to

medicine to guide health promotion efforts by

a lesser extent, promoting physical activity,

aligning organizational policies, hazard controls,

healthier diets, improved glucose control, and,

and workplace design with strategies that

among healthcare workers, increased vaccination

address psychosocial risk factors and the root

uptake.12 The literature on workplace health

causes of chronic disease through nutrition,

promotion continues to present a mixed and

physical activity, restorative sleep, stress

often inconclusive picture, a reality reinforced

management, avoidance of risky substances, and

by a recent systematic review evaluating the

connectedness. Lifestyle behavior practices can

effectiveness of workplace health promotion

be powerful tools for optimizing personal health

programs for industrial workers.13 This review

and performance.15, 16 However, health promotion

overall found variability in outcomes, modest

11

programs, in the absence of a comprehensive

often excluded from these programs. At this

strategy that fully utilizes the organizational

sub-threshold level, unfortunately, the workers’

levers within an employer’s control, are unlikely

health and performance are already affected.

to create a program that sustainably optimizes

Therefore, systematically identifying upstream

the health of the entire workforce. If a lifestyle

risk factors through robust data collection and

medicine initiative is perceived as an isolated

analysis is essential to detect sub-threshold

effort disconnected from real working conditions

health risks early, ensure inclusion of at-risk

in a workplace that does not prioritize worker

workers, and intervene before declines in health

well-being, it will ultimately fail. When leadership

and performance become clinically significant.

visibly champions and commits to worker health,

To ensure this approach becomes integrated into

intentionally embeds it into short- and long-

the organization’s culture, TWH’s key defining

term strategic planning, develops the structural

elements must be considered.17

and organizational infrastructure, devotes the

TWH is an approach developed and promoted by

necessary resources, ties it to performance

the Centers for Disease Control and Prevention’s

metrics, and role models healthy behaviors, they

(CDC) National Institute for Occupational

create the cultural and operational conditions for

Safety and Health (NIOSH). The five elements

success.

are: demonstrating leadership commitment,

Once worker health is embedded as a core

designing work to eliminate hazards, promoting

organizational value rather than a peripheral

worker engagement, ensuring confidentiality, and

concept, it creates a stable foundation upon

integrating relevant systems for comprehensive,

which clinical expertise and evidence-based

holistic health. It emphasizes fully integrated

health behavior strategies can meaningfully

workplace programs, policies, and practices

contribute. OEM and lifestyle medicine-trained

that synergistically promote worker health and

health professionals can be leveraged to develop

well-being across all levels of an organization.

comprehensive, effective workforce health

The program’s website includes manuals and

programs.

workbooks that can guide the application of this approach.18

When a workplace adopts a TWH-aligned lifestyle medicine approach, it should be

The Harvard T.H. Chan School of Public Health,

evidence-based and implemented with sufficient

Center for Work, Health, and Well-being also

rigor to achieve meaningful therapeutic benefit.

emphasizes an Integrated Approach, outlining

This means these programs must have a

the six key characteristics to an effective

robust methodology with clear timelines and

integrated approach to worker safety, health,

benchmarks with organizational support to

and well-being: leadership commitment;

produce measurable, sustained changes in

participation; policies, programs, and practices

health behaviors outcomes. Employers often

focused on positive work conditions;

accomplish this by deploying chronic disease

comprehensive and collaborative strategies;

management programs that target individuals

adherence; and data-driven change.19

with established disease. However, those with

This section demonstrates how the TWH’s 5

risk factors that can lead to chronic disease are

12

Key Defining Elements17, in conjunction with

Examples of how to communicate clear

the Integrated Approach philosophy, can be

leadership commitment to an organizational

used to introduce lifestyle medicine initiatives

health and well-being strategy through

into the workplace to improve “healthcare

accessible omnichannels include:

spending reduction, productive enhancement,

9 Consistently communicating the message

individual worker health and recovery, leadership

that leadership is committed to the clear

engagement, workplace culture, strategic

priorities of worker safety, health, and

planning, and human performance.”15

well-being for all workers in the entire

Defining Element #1: Demonstrate leadership commitment to worker safety and health at all levels of the organization

organization. Leaders drive accountability and provide the necessary resources and environment to create positive working conditions that support healthy lifestyle behaviors.19

Strong, visible leadership commitment to advancing the health, safety, and well-being

9 Making easy access to the necessary

of its workforce is foundational to successful

resources to create working conditions that

interventions. Although individual divisions/

lead to frictionless adaptation to lifestyle

departments within a large organization can

changes.

create favorable conditions for a culture of health, senior leadership has the platform

9 Showing commitment to cultivating an

to set the tone and ultimately improve

environment, both at the workplace and at

workforce health. In addition, leaders who fall

home, conducive to initiating and sustaining

between the highest executive tier and mid-

healthy lifestyle behavioral changes. In

level management need to be involved to

conjunction with providing resource access,

demonstrate organizational-wide commitment.

employers should create positive working

Successfully integrating lifestyle medicine with a

conditions that demonstrate that health and

TWH approach and securing leadership’s buy-in

well-being are embedded in the company’s

and sustained support requires aligning with the

strategy.

company’s business vision, mission, and goals.20 This would require a risk-based approach that

9 Adhering to “federal and state regulations,

prioritizes cross-domain coordination, such

as well as ethical norms, such as a respectful

as among Human Resources (HR) benefits

workplace that advances worker safety,

and wellness, Health, Safety, Environment

health, and well-being.”19 Allowing workers

(HSE), and occupational and environmental

to feel confident that regulations reduce

health professionals (e.g., MDs and industrial

exposure to hazards can create the physical

hygienists), to ensure the strategic integration of

and psychological safety and security that

evidence-based lifestyle medicine in ways that

the U.S. Surgeon General has deemed

meaningfully support occupational outcomes.15

necessary to protect workers from harm.21

13

Organizations can follow the Hierarchy of

Defining Element #2: Design work to eliminate or reduce safety and health hazards and promote worker wellbeing.

Controls framework to identify unhealthy conditions that could be removed such as poor food availability, excessive overtime, toxic team dynamics, high-stress workflows, or substance

The TWH approach promotes a hazard-free

exposures. Next, consider things that could be

work environment that is consistent with the

swapped for better options such as healthy

“traditional occupational safety and health

cafeteria options, sleep-supporting schedules,

prevention principles of the Hierarchy of

flexible shifts, organizational culture initiatives

Controls”17 (see Figure 2). Designing controls

(aimed at reducing psycho-social risk factors),

and strategies that protect your workers’ safety,

and workload redesign. Third in the hierarchy

health, and well-being is presented in order of

is the use of engineering controls to alter the

expected effectiveness, with a strong emphasis

physical workspace to make healthier choices

on organizational-level interventions to eliminate

easier, such as walking paths, fitness facilities,

and reduce recognized work hazards. Applying

standing desks, and noise reduction. The

the Hierarchy of Controls to TWH also allows

following level is administrative controls to create

you to measure, evaluate, and redesign lifestyle

policies and programs that can reinforce health

medicine programs, keeping them current and

such as manager training, wellness education,

responsive rather than reactive to support

burnout monitoring, and schedule redesign. The

continuous improvement, maintain participant

final step in the hierarchy of controls is tools to

trust, and ensure limited resources are not

support workers in managing their own health

wasted. Combining health and safety with health

and safety. Examples of these include personal

promotion, rather than treating them as separate

protective equipment, counseling, health

silos, helps to address work-related and personal

coaching apps, nutrition programs, and lifestyle

lifestyle risks simultaneously.

medicine interventions offered in the workplace.

14

FIGURE 2 | Hierarchy of Controls Integrating TWH and Lifestyle Medicine Principles in the Workplace. (Adapted from Lee et al. for NIOSH, 2016)

ELIMINATION Remove the hazard entirely

SUBSTITUTION Replace with a healthier option

HIERARCHY OF CONTROLS ENGINEERING CONTROLS Redesign the workplace

ADMIN CONTROLS Change policies and practices

BEHAVIOR CHANGE Healthy and safe choices

PERFORM FRAMEWORK

P

Physical Activity

O

Example: Make stairwells visible, accessible, attractive, and safe.

E

Example: Replace performance reviews to focus on growth and celebrate process goal achievement.

Eat Well Example: Healthy meals subsidized by employer at 20% below less healthy options.

R F

Optimize Your Attitude and Mindset

R

Reduce/Avoid Risky Substances

M

Manage Stress

Restorative Sleep Example: Eliminate rotating shift work in favor of permanent shifts.

Form Positive Social Connections Example: Voluntary peer mentoring program pairing early-career staff with experienced employees.

15

Example: Offer Employee Assistance Program (EAP) with rapid access to counseling and treatment referrals.

Example: Implement Mindfulness-Based Stress Reduction program and continually reinforce strategies.

memberships, mindfulness sessions, or

Defining Element #3: Promote and support worker engagement throughout program design and implementation

counseling services.

3. Foster a Supportive Environment: Create a culture of support and open communication where workers feel comfortable discussing

Leaders can launch initiatives and drive change

their challenges and seeking help when

strategically, but creating the sustainable culture

needed. Encourage managers to check

necessary to advance workforce health requires

in regularly with their team members and

a hybrid approach that combines bottom-

provide support and guidance.

up engagement in intervention design with

4. Recognize and Reward Workers:

top-down support.22 Worker disengagement

Acknowledge workers’ hard work and

is a common reason why health promotion

achievements through verbal praise,

interventions fail. The key to success is designing

recognition programs, or rewards. Feeling

interventions in collaboration with your workers,

appreciated boosts morale and contributes

including members of worker groups vulnerable

to a positive work environment.

to safety and health risks. The Center for

5. Invest in Professional Development: Provide

the Promotion of Health in the New England

opportunities for workers to learn and grow

Workplace, a TWH Center of Excellence (CPH-

in their careers. Offer training programs,

New) has created a toolkit that can guide this

workshops, and mentorship opportunities to

approach.23

help workers develop new skills and advance

To enhance workers’ health and well-being,

in their roles.

employers can involve them in designing,

6. Ensure Fairness and Transparency: Be

implementing, evaluating, and refining internal

transparent about company policies,

initiatives in the following specific ways.

decision-making processes, and

1. Promote Work-Life Balance: Encourage

opportunities for advancement. Ensure that

workers to take breaks, use their vacation

policies are fair and equitable for all workers.

time, and avoid overworking. Implement

7. Promote a Diverse and Inclusive Culture:

policies that support flexible work

Foster a culture that celebrates and values

arrangements, such as remote work options

diversity and inclusion. Encourage diversity

or flexible hours.

in hiring practices, provide diversity training,

2. Provide TWH-aligned Lifestyle Medicine

and create inclusive policies and practices.

Programs: provide lifestyle medicine

Collaborative employer-employee engagement

programs as a clinical intervention focused on

can foster a positive work culture that supports

the six pillars of lifestyle medicine. Employers

worker health and well-being, leading to

can establish an on-site lifestyle medicine

improved, sustained satisfaction, retention, and

clinic, contract with a lifestyle medicine

performance.24 The Johns Hopkins Office of

certified education or treatment program,

Well-being offers many resources for managers

or include lifestyle medicine providers in

and leaders to develop the skills needed to

their health plan provider network. These

effectively promote a healthy culture, including

strategies can be supported by gym

key elements of creating such a culture.25

16

Care should be taken to ensure members

Defining Element #4: Ensure confidentiality and privacy of workers

of worker groups vulnerable to safety and health risks are involved while avoiding any discrimination or disciplinary action.

The use and management of worker health

and self-reported surveys that collect and track

Defining Element #5: Integrate relevant systems to advance worker well-being

protected health and personal information can

An essential component of lifestyle medicine is

assessments, electronic health records, management systems, program evaluations,

inadvertently lead to stigma, discrimination,

recognizing all factors that affect worker health.

or other adverse employment consequences.

Employer attempts to improve workplace health

The handling of this type of information is

with lifestyle interventions may fail without

subject to laws such as the Health Insurance

addressing key social determinants of health,

Portability and Accountability Act (HIPAA), the

such as fair pay, human resource policies,

Americans with Disabilities Act (ADA), and the

benefits, supervisor behavior, and occupational

Genetic Information Nondiscrimination Act

safety. “Working conditions, home and

(GINA). Practices such as data aggregation, data

community life, and personal health behaviors

de-identification, and encryption are vital to

and conditions all contribute to the risk of injury

designing safe and respectful workplace health

and disease.”4 Figure 3, created by CPH-NEW,

interventions. In the absence of a methodology

shows an integrative approach to addressing

that guarantees personal privacy, an employer

health. By using all levers, an organization can

risks legal liability and fails to build the trust

generate synergistic benefits while efficiently

necessary for employee engagement.

using limited resources, including time, money,

Building trust and securing active workforce

and human resources.

participation are essential to successful integration. Doing so requires a set of foundational strategies, including: 9 Adhering to legally recognized medical confidentiality standards, supported by safeguards and processes that comply with all applicable regulatory and countryspecific requirements.

9 Clear assurance that workers’ health information is used exclusively to support well‑being, regardless of individual differences in job position, and never for punitive or disciplinary purposes.

17

integrated interventions19:

FIGURE 3

1. Coordination of goals and activities between the occupational safety and the health promotion functions across domains;

The CPH-NEW Total Worker Health® model of integration.

2. Assessment of both work and non-work hazards that impact worker safety, health, and well-being; 3. Emphasis on interventions that prioritize mitigation of workplace contributors to poor worker health, safety, and well-being; and 4. Participatory engagement empowering workers to collaborate “in pivotal ways during intervention prioritization and planning to develop self-efficacy in addressing root causes, skill transfer, building program ownership, empowerment, and continuous improvement.”

Conclusion Reproduced from Punnett L, Cavallari JM, Henning RA, et al. Defining “Integration” for Total Worker Health®: A New Proposal. Ann Work Expo Health. 2020;64(3):223–235. doi:10.1093/ annweh/wxaa003. © 2020 The Authors. Used under CC BY-NC 4.

Integrating lifestyle medicine within a TWH framework offers employers a strategic, evidence-based pathway to create healthier, safer, and more resilient organizations. When leadership commitment, hazard elimination, worker engagement, confidentiality, and

As understanding grows that many diseases

systems integration are aligned, workplace

have multiple contributing causes, prevention

health initiatives move beyond isolated

strategies that target several interacting risk

programs to become embedded components

factors at once can have a much greater impact

of organizational culture. This comprehensive

than focusing on just one. For example, noise

approach recognizes that worker well-being

and solvent exposure together increase the risk

is shaped not only by individual behaviors but

of hearing loss , so prevention efforts both in

also by working conditions, organizational

and outside of the workplace could significantly

policies, and the broader social context in which

reduce cases by addressing multiple sources of

workers live and work. By prioritizing prevention,

exposure simultaneously, a strategy that could

fostering trust, and engaging workers as partners

also apply to other conditions like transmissible

in design and implementation, employers can

diseases.

build sustainable programs that enhance health

8

outcomes, strengthen performance, reduce

To predict or evaluate the success of a workplace

avoidable costs, and cultivate a culture in which

health and wellness programs, CPH-NEW

people and business thrive together.

proposes a set of four TWH-specific metrics for

18

Steps to a Healthier, Safer, Happier Workforce behaviors are realistically feasible within current

Organizational Assessment

workflows, whether supervisors role model and

The first step in bringing lifestyle medicine into

reinforce them, and whether organizational

the workplace is to conduct a comprehensive

incentives align with worker health goals.

organizational assessment. This assessment

This diagnostic phase establishes a baseline,

moves beyond individual health risk appraisals

surfaces structural barriers, and prioritizes high-

and examines the broader systems that

impact opportunities. Ultimately, organizational

shape worker health—leadership priorities,

assessment ensures that lifestyle medicine

job design, workload, scheduling practices,

interventions are not generic or performative

physical environment, benefits structure,

but instead are strategically focused, culturally

food environment, psychosocial climate, and

aligned, and operationally embedded within the

existing safety infrastructure. By evaluating

enterprise.

both quantitative data (e.g., health claims,

The CDC has developed a Workplace Health

absenteeism, turnover, workers’ compensation

Model (see Figure 4) that brings “a coordinated

trends, productivity metrics) and qualitative input

approach to workplace health promotion results

(e.g., worker surveys, focus groups, frontline

in a planned, organized, and comprehensive

feedback), organizations can methodically

set of programs, policies, benefits, and

identify upstream drivers of chronic disease risk.

environmental supports designed to meet the

An effective assessment also distinguishes

health and safety needs of all workers.”1 The CDC

between the theoretical and the lived experience

Workplace Health Model provides an effective

of workers. It evaluates whether healthy

framework that can lead to success.

19

FIGURE 4 Systematic Framework for Implementation: CDC Workplace Health Model1

Reproduced from the Centers for Disease Control and Prevention (CDC). CDC Workplace Health Model.

Published July 15, 2024. https://www.cdc.gov/workplace-health-promotion/php/model/index.htm

20

In the CDC’s Workplace Health Model,

availability and feasibility of the health initiative27,

conducting a pre-intervention assessment is

fragmented communication systems, competing

foundational to building effective, evidence-

operational demands, and organizational cultures

informed workplace health and well-being

that do not support participatory engagement or

programs. According to CDC guidance, the

open feedback.

first key step in the systematic development of a workplace health promotion initiative is an

INDIVIDUAL & INDUSTRY BARRIERS

organizational workplace health assessment,

It is important to understand the workforce’s

which helps employers understand existing

demographic composition as age distribution,

conditions, worker health needs, and the

gender mix, socioeconomic status, race and

organizational capacity to support change.

ethnicity, educational attainment, and health

This assessment typically examines a broad

literacy levels all shape health risks, engagement

range of factors, including individual health

patterns, and intervention effectiveness.

risks and behaviors, the physical and social

Different demographic groups experience

work environment, and organizational policies,

varying prevalence of cardiometabolic disease,

practices, and culture that influence worker

musculoskeletal conditions, sleep disruption,

health outcomes. Tools such as the CDC

caregiving demands, and stress exposure.

Worksite Health ScoreCard26 can be used to

Socioeconomic factors influence access to

capture this information, identify gaps, and

healthy food, transportation, stable housing,

prioritize improvements based on evidence-

and healthcare, while cultural background and

based strategies. By conducting a readiness

lived experience may affect trust in employer-

assessment early in the process, employers can

sponsored initiatives and responsiveness to

tailor interventions to meet the specific needs

behavior change strategies.

of their workforce and ensure that planning and

After understanding workforce demographics,

implementation efforts are well grounded in

organizations must then examine industry-

data and organizational context, improving the

specific characteristics, including sector, job

likelihood of sustained success over time.

demands, scheduling patterns, regulatory

It is necessary to identify and overcome

environment, physical and psychosocial

potential barriers to successful implementation

exposures, and employment structure

before beginning the initiative. These barriers

(e.g., hourly vs. salaried, unionized vs. non-

might include:

unionized, remote vs. on-site). Industry context determines feasibility: shift work, production

ORGANIZATIONAL BARRIERS

quotas, emotional labor, sedentary roles, and

Organizations seeking to conduct a workplace

decentralized work sites each require different

assessment in preparation for a TWH-aligned

structural supports. Aligning interventions

lifestyle medicine initiative often face several

with both demographic realities and industry

structural and cultural barriers. Common

conditions ensures that lifestyle medicine

obstacles include limited executive prioritization,

strategies are practical, equitable, and embedded

insufficient staffing or analytic capacity,

within the operational realities of work.

21

design rather than uniform implementation.

With these demographic and industry considerations in mind, the current evidence

Table 1 contains a list of industries, demographic

base indicates that lifestyle behavioral health

groups, and professions that have been studied

change interventions show variable effectiveness

to assess the most effective lifestyle health

across workplace settings and populations,

behavior change interventions in their respective

underscoring the need for context-specific

workplace settings.

TABLE 1.

Studies of Workplace Wellness Programs focused on Physical Activity among Various Industries, Professions, and Demographic Groups of Workers Industry/Profession/

Published Citation

Summary

Ernawati et al., 202228

Systematic review of workplace

Demographic Group Female Workers

wellness programs for working mothers found reductions in stress, depression, and burnout, with improvements in mental health, healthy behaviors, and work–life balance across included studies.

Reed et al., 201729

Systematic review and metaanalysis showed workplace physical activity interventions modestly improved cardiometabolic markers (BMI, LDL, glucose), with inconsistent effects on moderate-to-vigorous physical activity levels.

22

Healthcare

Bischoff et al., 201930

Evaluation of workplace health promotion programs found small improvements in health behaviors, though effects on productivity, absenteeism, and clinical outcomes were inconsistent.

Di Mario et al., 202331

Umbrella review found yoga and mindfulness interventions reduced stress, anxiety, and burnout among healthcare workers, though study quality varied and stronger trials were recommended.

Upadhyaya et al., 202032

Review of workplace wellness interventions found improvements in employee well-being and stress outcomes, with mixed evidence for sustained clinical or economic impact.

Worley et al., 202233

Systematic review of hospitalbased dietary and physical activity interventions found most programs improved staff health behaviors, particularly multicomponent and incentivebased approaches.

Higher Education

Plotnikoff et al., 201534

Review of workplace physical activity interventions found small but positive effects on fitness and activity levels, with greater benefits in structured, supported programs.

Hybrid Remote Workers

Crane et al., 202235

Scoping review identified limited but emerging evidence that work-from-home interventions can improve physical activity and reduce sedentary behavior, highlighting gaps in intervention design.

23

Industrial Workers

Javanmardi et al., 202513

Systematic review of workplace health promotion for industrial workers found generally positive but heterogeneous health effects, limited by high risk of bias across studies.

Male Workers

Bezzina et al., 2022

36

Review of workplace mental health initiatives found modest improvements in stress and well-being, emphasizing the role of organizational context in effectiveness.

Maritime Workers

Baygi et al., 202037

Systematic review of maritime workplace lifestyle interventions found limited and inconsistent health benefits, with overall modest study quality.

24

Nurses

Chan & Perry, 201238

Systematic review of lifestyle interventions for nurses found few high-quality studies, but reported improvements in smoking reduction, fitness, and body composition in limited trials.

Chappel et al., 2017

39

Review of workplace wellness initiatives found improvements in employee engagement and selected health behaviors, with mixed evidence for clinical outcomes.

Chong & Shorey, 202240

Review of workplace mental health interventions showed reductions in stress and burnout, particularly when programs were sustained and multicomponent.

Kelly & Wills et al., 201841

Systematic review found workplace health promotion programs produced small improvements in health behaviors, with limited evidence of long-term impact.

Power et al., 202142

Review of workplace wellness programs found modest improvements in diet and physical activity, particularly in multicomponent interventions.

Stanulewicz et al., 201943

Review of physical activity interventions in occupational settings found small but positive effects on activity levels and fitness outcomes

25

Public Safety Workers

MacMillan et al., 201744

Review of workplace interventions targeting physical activity reported modest improvements, with greater effectiveness when interventions were structured and supported by leadership.

MacMillan et al., 202045

Updated review found continued evidence of small improvements in workplace physical activity, emphasizing the importance of sustained program delivery.

School Staff

Hill et al., 2022

Review of workplace well-being

46

interventions found reductions in stress and improvements in employee well-being, though effects varied by intervention type.

Nathan et al., 202047

Randomized workplace wellness trial found increased selfreported healthy behaviors, but no significant changes in clinical outcomes or healthcare utilization.

Shift Workers

Flahr et al., 201848

Review of workplace lifestyle programs found modest improvements in physical activity and health behaviors, with limited long-term evidence.

Monnaatsie et al., 2021

49

Review of workplace health promotion in low-resource settings found improvements in health knowledge and behaviors, with variability in program sustainability.

Lassen et al., 2018

50

Review of workplace nutrition interventions found improvements in dietary behaviors and small reductions in cardiometabolic risk factors.

26

Truck Drivers

Lalla-Edward et al., 201651

Evaluation of workplace health programs in healthcare settings showed improvements in health behaviors, with limited evidence for broader system-level outcomes.

Virraga, et al., 202452

Recent review found workplace wellness interventions improved employee well-being and selected health behaviors, though heterogeneity limited conclusions about long-term effectiveness.

27

effective integrated approach to worker safety,

Organizational Systems Evaluation

health, and well-being17:

The organization begins by first determining

• Leadership commitment. Leadership makes worker safety, health, and well-being a clear priority for the entire organization.

Leaders drive accountability and provide the necessary resources and environment to create positive working conditions.

whether it is ready for such organizational change. It then has to ascertain whether it has the internal expertise to conduct a robust needs assessment, plan and implement an evidence-based lifestyle medicine intervention, and accurately measure and evaluate results. If

• Participation. Stakeholders at every level of an organization, including workers and organized labor, help plan and carry out efforts to protect and promote worker safety and health.

it does not, the organization should retain the services of a trustworthy external consultant or consulting firm. (See Appendix for suggestions.)

Ideally, this third-party organization will bring both experience and expertise, as well as an

• Policies, programs, and practices focused on positive working conditions. The organization enhances worker safety, health, and well-being with policies and practices that improve working conditions.

uncompromising commitment to data-driven initiatives. Additional essential components of a successful intervention include an internal multidisciplinary steering committee with

• Comprehensive and collaborative strategies.

Workers from across the organization collaborate to develop comprehensive health and safety initiatives.

representatives from various stakeholders at every level of the organization, as well as seasoned subject-matter experts well-versed in TWH and/or the targeted pillars of lifestyle

• Adherence. The organization adheres to federal and state regulations, as well as ethical norms— such as a respectful workplace—that advance worker safety, health, and well-being.

medicine. Stakeholder participation is not only a means of gathering diverse perspectives but also fosters a sense of ownership, increases commitment to change, and improves the fit between intervention activities and actual work

• Data-driven change. Regular evaluation guides an organization’s priority setting, decision-making, and continuous improvement of worker safety, health, and well-being initiatives.

conditions. Moreover, by engaging internal stakeholders early and often, organizations can clarify goals and objectives, surface relevant practices that support those goals, anticipate potential barriers, and adapt intervention

Effective workplace health promotion programs

components in real time to maintain relevance

tended to be more effective when there were

and effectiveness.53 This internally grounded,

at least weekly contacts between participants

participatory approach increases the likelihood

and program staff or activities, suggesting

that the program will be integrated into existing

that frequent, repeated engagement with

processes, sustain engagement, and ultimately

the program (e.g., regular check-ins, follow-

produce meaningful improvements in worker

up prompts, or structured interactions)

health and organizational well-being.

helps reinforce behavior change and sustain

There are six relevant key characteristics to an

participation in physical activity initiatives in workplace settings.54

28

principles into practice, despite wanting to do

Organizational Readiness

so, if it does not first address these foundational Organizational readiness refers to an institution’s

elements.57 Conversely, high readiness (as

preparedness to adopt, implement, and

reflected in shared commitment, adequate

sustain a new intervention or program before

resources, clear communication, and active team

it begins. In the context of health-related

member involvement) increases the likelihood of

interventions, readiness is not simply about

successful adoption, smoother implementation,

resources on paper but encompasses a shared

and ongoing integration into organizational

psychological and structural state: workers and

routines.55

leaders must not only value the change and

Assemble Your Workplace Wellness Team

understand its necessity but also believe in their collective capability to achieve it and have the organizational structures in place to support

A successful workplace wellness initiative

meaningful action.

55

begins with assembling a multidisciplinary team

The researchers at the Center for the Promotion

that reflects the diversity of the workforce

of Health in the New England Workplace (CPH-

and the complexity of organizational systems.

NEW) highlight an Organizational Readiness

Rather than positioning wellness as a human

Tool (ORT) grounded in a conceptual model to

resources add-on, organizations should adopt

operationalize this readiness for participatory

a participatory strategy in which workers,

health and well-being programs. Although

supervisors, frontline staff, leadership, and

originally tailored to TWH initiatives, the

subject-matter experts collaboratively shape

dimensions identified—such as existing health

the program from the outset. The participatory

and well-being programs, organizational

approach, as outlined in the CPH-NEW Healthy

approaches to health, resource availability,

Workplace Toolkit56, emphasizes joint problem-

teamwork, worker participation capacity, and

solving, shared decision-making, and continuous

communication about priorities—are directly

feedback loops. This structure ensures that

related to lifestyle medicine interventions.55

interventions are grounded in TWH principles,

Supportive policies and structures are essential

aligned with operational realities, and responsive

for lifestyle medicine programs which include

to both health and production goals. By involving

coordinated efforts across clinical care

those directly affected by workplace conditions,

focused on nutrition, physical activity, stress

organizations move beyond top-down

management, sleep, and social support.

programming toward sustained systems change.

Finally, assessing readiness before

A well-constructed wellness team typically

implementation allows an organization to identify

includes representatives from senior leadership,

strengths and gaps that could facilitate or

middle management, frontline workers,

hinder success and sustainability. For example,

occupational health and safety personnel, human

an organization that lacks management

resources, and when appropriate, union or

commitment or cross-departmental coordination

workforce representatives. Including individuals

may struggle to embed lifestyle medicine

with expertise in lifestyle medicine, surfaces

29

barriers early, and increases the likelihood that

and Leadership, “data is useful information that

chosen interventions will be feasible, culturally

you collect to support organizational decision-

appropriate, and supported across occupational

making and strategy.”59 A comprehensive

and environmental health, data analytics, and

workplace health, safety, and well-being

organizational development strengthens the

assessment begins with structured measurement

team’s ability to translate evidence into practical

using validated tools rather than relying solely

interventions.

on anecdotal impressions or isolated metrics.

55, 58

The participatory model

encourages the team to begin with structured

Organizations should integrate multiple

listening sessions and data review to identify

quantitative and qualitative data sources,

upstream risk factors, work organization issues,

including OSHA injury and illness logs, workers’

and environmental contributors to health

compensation claims, disability duration data,

outcomes. This collaborative diagnostic phase

absenteeism and presenteeism metrics, and

fosters trust,

worker engagement surveys. Quantitative and qualitative data can help leaders recognize areas

Importantly, a participatory approach fosters

of strength (both past and present), define

shared ownership and accountability. When

strategy based upon pre-selected/prioritized

workers help identify challenges, prioritize

metrics, and identify specific opportunities for

solutions, and assess progress, they are more

improvement.

likely to perceive the initiative as meaningful and credible rather than merely symbolic.

There is growing interest in developing a

Leadership’s visible engagement through

standardized set of measures to systematically

resource allocation, policy alignment, and role

assess the effectiveness of workplace health

modeling signals that health is embedded in the

promotion efforts. One recent scoping review

organization’s strategic priorities. Over time,

identified 102 such measures that can be

this team-based, participatory infrastructure

used to assess TWH outcomes and factors

becomes a standing governance mechanism for

associated with those outcomes.60 Currently,

continuous improvement, ensuring that wellness

key assessment instruments include the Healthy

efforts evolve with workforce needs, industry

Work Survey (HWS)61, the NIOSH Worker

demands, and emerging health risks rather than

Well-Being Questionnaire (WellBQ)62, the

remaining static, one-time programs.

HERO Scorecard63, the CDC Worksite Health ScoreCard26, the Mayo Clinic Well-being Index64,

Workplace Health, Safety, and Wellbeing Assessment

and the American Heart Association (AHA) WellBeing Works Better™ Scorecard65. These tools represent widely used frameworks for evaluating

“What gets measured gets managed.”

organizational health promotion programs,

-Robert S. Kaplan & David P. Norton

psychosocial exposures, and worker population well-being. Many instruments evaluate

Assessing your current approach to optimizing

overlapping domains, including organizational

workforce health is the very first step in building

support, psychosocial stressors, population

a culture of health and well-being in the

lifestyle behaviors, and chronic disease risk.

workplace. According to the Council on Quality

Some also allow benchmarking against national

30

or industry standards. Table 2 provides a detailed

These models provide the theoretical foundation

comparison of leading tools, including domains,

for contemporary psychosocial workplace

number of items, format, scoring, and reporting

assessment tools and guide the selection of

capabilities.

survey instruments for organizational evaluation.

Conceptual Frameworks for Organizational Stress and Work Structure

Assessment of these domains aligns closely

Occupational psychosocial stressors are work

do not comprehensively assess other core

environment conditions that provoke harmful

lifestyle medicine domains such as nutrition,

emotional and physical responses and, when

physical activity, sleep, or avoidance of risky

chronic, contribute to adverse mental and

substances. ACLM’s Lifestyle Medicine Whole

physical health outcomes. These stressors are

Person Health Index (LMWPHI) assesses the

embedded within work organizations through

six pillars of lifestyle medicine and is intended

policies, procedures, and environmental

to inform individualized treatment, remission,

arrangements. Occupational psychosocial

and prevention goals within clinical care. The

stressors are commonly conceptualized through

LMWPHI may be incorporated as an evidence-

integrated occupational stress models, including

informed composite measure, integrating

the Job Demand-Control (JDC), Effort-Reward

validated and guideline-informed domain specific

Imbalance (ERI), and Job Demands-Resources

screeners across the six lifestyle medicine

(JDR) models.66

pillars into a structured, scalable assessment

with the psychosocial pillars of lifestyle medicine, particularly stress management and connectedness. However, these domains

framework. While the individual components are

The JDC model assumes that worker stress

evidence-based, the composite instrument itself

arises from an imbalance between job demands

remains under active refinement and validation

and decision control. High job demands, such

and should not yet be considered fully validated

as workload, tight deadlines, and fast working

or fully evidence-based as a standalone measure.

pace, combined with low job control, such as limited decision-making authority or lack of skill

The most recent iteration, as of March 25, 2026,

development or use, lead to increased stress.

reflects ongoing refinement of item selection, scoring standardization, and alignment with

The ERI model posits that work stress results

real‑world clinical workflows. This version

from an imbalance between effort expended

integrates brief, pragmatic screeners—including

and rewards received, including esteem, income,

the ACLM Diet Screener‑9, Exercise Vital Sign

status control, job security, and opportunities for

with strength assessment, PHQ‑2–based

promotion.

stress screening, and guideline‑informed sleep

The JDR model integrates concepts from JDC

measures—into a unified scoring framework. It

and ERI, expanding the reward domain to include

also enhances interpretability through scaled

job resources such as feedback, supervisor

domain scores and a composite lifestyle score,

support, coworker support, and participation

incorporates constructs of readiness and

in decision-making in addition to the rewards

motivation to support behavior change, and

described in the ERI model.

is designed for efficient use in routine clinical

31

encounters.

• High job demands and workload

The LMWPHI is intended for use in individualized

• Low job control and decision-making authority

clinical care settings to support shared decisionmaking and lifestyle-based care planning. It is not

• Limited skill use

yet validated for population health management,

• Low supervisor and coworker support

workforce health assessments, or benchmarking

• High work–family conflict

purposes.

• Low reward and promotion opportunities

Other tools for assessing psychosocial risk

• Poor safety climate

factors in the workplace include the United

• Health conditions, including general, physical, and mental health outcomes

Kingdom’s Health and Safety Executive’s Stress Indicator Tool (SIT).68 Many European countries

These comprehensive measurements

and others around the globe require regular

provide a detailed characterization of the

stress assessments in the workplace. Because SIT

psychosocial work environment. The HWS

is specific to stress, it is used in many English-

includes multiple items per construct, enabling

speaking countries. Other stress assessment

robust measurement of work-organization

tools may be available through a country’s

hazards. Results can be aggregated to produce

regulatory agency. A validated tool for assessing

organizational-level reports and compared to

psychological safety climate is the PSC-12 and,

national reference data to identify psychosocial

because of its brief 12-question length, it can be

risk profiles and intervention priorities. The

utilized when a comprehensive well-being and

Healthy Work Campaign (HWC) is an initiative

psychosocial assessment is not feasible.

from the Center for Social Epidemiology (CSE), a

Comparison of Major Workplace Well-being and Psychosocial Assessment Tools

non-profit organization. The mission of the CSE and the HWC is to raise awareness of the health impacts of work stress and to equip individuals and companies with tools to promote healthy

HEALTHY WORK SURVEY (HWS)

work, healthy organizations, and healthy people.

The Healthy Work Survey (HWS) is a validated

In pursuit of their mission, the CSE developed a

instrument designed to assess workplace

free, validated, confidential, and voluntary web-

psychosocial hazards and work organization

based survey, integrated with measures from

factors in the United States.61 The HWS

the NIOSH Quality of Worklife questionnaire,

operationalizes and integrates key constructs

to identify work-related psychosocial hazards

from the JDC, ERI, and JDR models, providing a

associated with mental and physical health

comprehensive assessment of psychosocial work

problems. The survey takes approximately

exposures.

20 minutes to complete, and automatically generated results provide a detailed report of an

The HWS includes 55 questions. Core domains

organization’s work stress profile.

include:

NIOSH WORKER WELL-BEING QUESTIONNAIRE (WELLBQ)

32

The NIOSH Worker Well-Being Questionnaire

The HERO Scorecard63 originated from the

(NIOSH WellBQ)62 allows organizations to

WellBQ framework and was developed in

gather input from their workforce, providing

consultation with leading authorities on

an integrated assessment of worker well-being

population health and well-being. The HERO

across multiple spheres, including quality of

Scorecard includes 67 questions across six

working life, circumstances outside of work, and

domains:

physical and mental health status. The WellBQ

• Strategic planning

was released in 2021 as a manually scored paper-

• Organizational and cultural support

and-pencil instrument and includes 126 core

• Program integration

questions across five domains:

• Program offerings

• Work evaluation and experience

• Participation strategies

• Workplace policies and culture

• Measurement and evaluation

• Workplace physical environment and safety climate

The HERO Scorecard is administered online and

• Health status

provides automated scoring and benchmarking against other organizations. Organizations may

• Home, community, and society

engage HERO Preferred Provider organizations

Optional modules include five questions on work

to interpret results and develop strategic plans

arrangements and ten demographic questions.

for improving workforce health initiatives.

The WellBQ is nearly twice as long as the HWS, which may limit feasibility and participation in

CDC WORKSITE HEALTH SCORECARD

large organizational deployments.

The CDC Worksite Health ScoreCard26 is a

While the HWS and WellBQ include overlapping

comprehensive organizational self-assessment

measures of health outcomes, the WellBQ

tool designed to evaluate workplace health

omits several key sources of workplace stress

promotion programs, policies, environmental

explicitly assessed in the HWS, including work

supports, and health plan benefits. The

hours, mandatory overtime, supervisory status,

ScoreCard includes 154 questions organized

pay structure, low wages, wage theft, shift work,

across 18 modules:

use of job skills, emotional demands, electronic

• Organizational supports

monitoring, understaffing, physical job demands,

• Occupational health and safety

procedural justice, and union representation.

• Maternal health and lactation support

Additionally, the WellBQ includes only one item each on job autonomy and workload demands,

• Nutrition

whereas the HWS includes multiple items for

• Physical activity

these core psychosocial variables, allowing for

• Sleep and fatigue

more robust measurement of work organization

• Tobacco use

hazards.

• Cancer prevention

HERO SCORECARD

• Cardiovascular disease risk factors • Musculoskeletal disorders

33

• Prediabetes and diabetes

The American Heart Association (AHA) Well-

• Vaccine-preventable diseases

Being Works Better™ Scorecard65 helps management self-identify current practices that

• Weight management

promote employee flourishing. The tool provides

• Alcohol and substance use

benchmarking and customized guidance to

• Depression

improve key domains related to workforce well-

• Stress management

being and organizational health practices. This

The ScoreCard can be completed manually or

scorecard assesses organizational practices and

online and uses structured scoring to identify

culture that support well-being. It includes best-

program gaps and track improvements over time.

practice questions in areas such as: leadership

Compared with the HWS and WellBQ, the CDC

and strategy, workplace culture and environment,

ScoreCard emphasizes health promotion and

health equity and inclusion, program

chronic disease prevention rather than detailed

implementation and evaluation, compensation

psychosocial work-organization hazards.

and benefits, and well-being strategies such as mental health support, burnout prevention,

MAYO CLINIC WELL-BEING INDEX

safety, and engagement.

The Mayo Clinic Well-being Index64 is utilized

Integrated Assessment Strategy for Comprehensive Workplace Health

in healthcare settings and general industry to measure workforce well-being and risk of distress. The instrument is administered

Although the HWS provides a comprehensive

through customizable, purchasable packages,

assessment of psychosocial work organization

and aggregate reports provide measures of

hazards, this toolkit aims to promote a healthy

well-being across multiple domains, predict

work environment that extends beyond

risk of distress in more than six dimensions,

psychosocial factors to include physical and

track individual and organizational progress

nutritional health. Pairing one of the psychosocial

over time, and offer actionable insights to

measurement instruments with a tool such as

organizational leadership. The most common

the CDC Worksite Health ScoreCard allows

version of this assessment has nine questions

organizations to evaluate both psychosocial

and can be completed in less than one minute.

stressors and health promotion programs related

Domains include burnout, fatigue, quality of life,

to nutrition, physical activity, chronic disease

meaningfulness of work, and work-life balance.

prevention, and occupational safety. Combining psychosocial hazard assessment tools with

AHA WELL-BEING WORKS BETTER™

programmatic health promotion assessments

SCORECARD

provides a more comprehensive framework for identifying intervention priorities and developing multilevel workplace health strategies.

Practical Considerations for Organizational Implementation

34

and more likely to achieve higher completion

Practical Considerations for Organizational Implementation

rates. Benchmarking and aggregate reporting capabilities facilitate real-time feedback,

Survey selection should consider organizational

strategic planning, and longitudinal evaluation of

size, workforce characteristics, and scoring

organizational health and well-being initiatives.

capacity. Longer instruments, such as the WellBQ

After completing the most appropriate

provide comprehensive assessments but may

assessment, an organization can identify areas

reduce participation rates and require manual

of strength and opportunities for improvement.

scoring. Shorter instruments with structured

This Assessment is the first step to identifying

or automated scoring, such as the HWS, HERO

organizational priorities and developing a

Scorecard, and CDC Worksite Health ScoreCard,

successful strategy.

may be more feasible for large organizations

35

TABLE 2: Comparison of Workplace Health, Safety, and Well-being Assessment Tools Tool

Primary Focus

# of

Format

Scoring

Online

Automated

Benchmark

Notes

Items American Heart

Organizational

Association (AHA)

Well-being

assessment rather

Practices

than for individuals;

Well-Being Works Better™ Scorecard

96

Yes

Organizational

Recognition-based

65

tiering (BronzePlatinum) CDC Worksite Health Health Promotion Scorecard

26

154

Programs

Online/

Structured

Internal

Manual

Comprehensive coverage of chronic disease

Healthy Work Survey

Psychosocial

(HWS)61

Hazards; Health,

55

Online

Automated

Yes

Free; Employer guide available

Safety, Jobrelated metrics HERO Scorecard63

Organizational

67

Online

Wellness Programs

Automated;

Yes

Can repeat annually and

Maximum

track longitudinally; can

Score = 200

work with vendor to develop strategic plan based on results

Mayo Clinic Well-

Distress / Well-

Being Index64

being

9

Online

Automated

Vendor

Very brief. Dual use: individual respondents receive immediate feedback and organizations can collect deidentified data in aggregate

NIOSH Worker Well-

Total Worker Well-

being Questionnaire

being

126+

Online

Manual/ Automated

(WellBQ)62

Limited

Free; Measures multiple domains with validated scales. HERO Clearinghouse

36

Develop Implementation Strategy

requires selecting and sequencing interventions based on documented risk burden, workforce

There is no one-size-fits-all strategy to

demographics, and organizational readiness.

implement a TWH-aligned lifestyle medicine-

Programs should not be deployed as isolated rote

grounded culture of health in the workplace.

activities; rather, they should reflect a structured

The most effective strategy for any organization

response to identified needs and maturity level.

will vary by a number of factors such as goals/

Effective workplace interventions operate at

priorities, investment commitment, workforce

organizational, team, and individual levels rather

demographics, industry, physical location,

than treating wellness as a siloed program.

company leadership/culture, etc. Essential A. ORGANIZATIONAL LEVEL

components for a successful intervention include: an internal multi-disciplinary steering

At the organizational level, workplace

committee with representatives from various

interventions are designed to modify upstream

stakeholders at every level of the organization,

determinants of health.72 Such upstream changes

as well as seasoned subject matter experts

implicitly acknowledge work as a determinant of

in lifestyle medicine and/or board certified

health, a perspective underscored in integrated

occupational and environmental medicine

OEM frameworks that emphasize the symmetry

physicians trained in population and public

between workplace exposures and chronic

health.

disease risk.15 Structural interventions targeting

STEP 1. DEFINE MULTI-LEVEL INTERVENTION ARCHITECTURE

upstream determinants of health embedded in work design and organizational operations recognize that worker health behaviors and

Workplace health, safety, and well-being

outcomes are shaped substantially by systemic

programs have evolved beyond isolated

and environmental conditions rather than by

wellness offerings into integrated organizational

individual choices alone.

systems that shape individual worker behavior and influence enterprise-wide outcomes.

Contemporary organizational research

Contemporary workplace intervention science

emphasizes that modifying structural and

emphasizes that effective implementation

cultural aspects of work can produce measurable

requires more than checklists; it demands a

improvements in well-being and performance.73,

tailored, data-informed strategy aligned with the

74

organization’s mission, workforce demographics,

optimizing shift scheduling to mitigate circadian

culture, and the maturity of its health and safety

disruption and fatigue and aligning workloads

infrastructure.70 Drawing on the integrated OEM

with recovery principles directly addresses

and lifestyle medicine model advanced by Hymel

sleep and fatigue-related risk factors.75 Manager

and colleagues15, an implementation strategy can

training in supportive management practices

be designed that aligns multi-level interventions

strengthens psychological safety, enhances

with employee engagement principles.

role clarity, and reduces job strain, which are

As an example, redesigning policies by

well-established contributors to occupational

Consistent with systems-based workplace

stress–related morbidity.76, 77 In parallel, value-

intervention science71, effective implementation

37

based benefit redesign that lowers financial

framing in shaping day-to-day workplace

barriers to preventive services, chronic disease

behaviors.

management, and evidence-based lifestyle interventions reinforces health-promoting

C. INDIVIDUAL LEVEL

behaviors at the systems level.78 Collectively,

Individual-level supports should be risk-stratified

these structural approaches shift the focus of

and integrated into broader organizational

interventions from downstream remediation

strategy. At the individual level, risk-stratified

to primary prevention by embedding health

supports should be offered as part of a

protection and promotion into the organization’s

continuum of services, including targeted

operational architecture, thereby facilitating

lifestyle medicine programming, digital coaching,

sustained improvements in workforce well-being

chronic disease management pathways, and

and enterprise performance.

personalized behavioral planning.15 Although individual interventions have historically

B. TEAM LEVEL

achieved small effect sizes in isolation, when

At the team level, intervention design should

embedded within supportive organizational and

leverage behavioral economics principles to

environmental structures, they contribute to

shape daily decision environments. Behavioral

synergistic improvements in health outcomes.

interventions in team-based work settings show that modifying the immediate work environment

STEP 2. DETERMINE FINANCIAL INCENTIVES AND BEHAVIORAL DESIGN

and norms can meaningfully influence collective health behaviors, even without explicit individual mandates. In a quasi-experimental field study conducted across multiple departmental teams

Financial Incentives

in a governmental organization, default changes to height-adjustable workstations (HAWS) led

Financial incentives remain a central mechanism

to significant increases in standing behavior

for enhancing employee engagement in

compared with control conditions, with the

workplace health initiatives. Contemporary

highest effects observed when transparent

evidence emphasizes that incentive structure,

default message were combined with low-

framing, and equitable design are more

threshold group coaching (e.g., movement

important than incentive magnitude alone. Early

planning and ergonomic prompts).79 The

randomized trials demonstrated that financial

default “choice architecture”—raising HAWS

rewards can increase participation in weight

to standing height—leveraged automatic

loss and preventive health behaviors.80 Recent

behavioral tendencies toward preset options, and

systematic reviews and meta-analyses confirm

when paired with clear, team-wide contextual

that incentives are most effective when tied to

information and peer awareness, produced

specific, proximal behaviors, such as program

sustained, elevated stand-up work ratios even

enrollment, coaching attendance, medication

after the intervention period. These findings

adherence, or completion of preventive

underscore the importance of team-level

screenings, rather than distal biometric outcomes

environmental cues and shared contextual

that may be influenced by social determinants

38

beyond individual control. Incentives should

workstation defaults, reduce the cognitive

prioritize engagement, be reasonably achievable,

effort required for healthy behaviors and can

and avoid tying rewards to biometric targets that

produce measurable changes in physical activity

may be influenced by factors outside individual

and dietary patterns.85 A recent workplace

control.81 Modern design principles prioritize

survey, combined with a quasi-experimental

behavioral alignment and fairness. Graduated

study design, shows that transparent defaults,

or escalating incentive models where rewards

combined with minimal educational framing, yield

increase with sustained engagement, capitalize

sustained behavioral change without diminishing

on the goal-gradient effect and reinforce habit

perceived autonomy.86

formation over time.81 Furthermore, hybrid

However, nudges are not universally transferable;

models that combine individual-level incentives

their effectiveness depends on contextual

with team-based rewards leverage social

adaptation, workforce demographics, leadership

accountability and peer influence to sustain

modeling, and cultural fit.87 Contemporary

workforce participation.82 Participation should

implementation research further suggests that

be voluntary, with reasonable alternatives or

combining nudges with structural interventions

accommodations provided to ensure equitable

(e.g., scheduling redesign, workload adjustments)

access. In addition, incentive implementation

amplifies impact by aligning environmental

must comply with the rules set forth by the

signals with feasible opportunities for behavior

EEOC. More information can be found here:

change.88 In integrated workplace health

https://www.eeoc.gov/regulations/questions-

systems, nudges function not as isolated

and-answers-about-eeocs-notice-proposed-

tactics but as reinforcing components within

rulemaking-employer-wellness-programs

a comprehensive architecture of protection,

Behavioral Nudges

promotion, and performance optimization.

Behavioral economics supports the use of

Choose Optimal Partners

“nudges,” which are low-friction, choice-

Identifying the optimal partners to implement

preserving environmental cues designed to

a TWH-aligned lifestyle medicine-grounded

influence health-related decision-making.83

health workplace intervention is a strategic

Since the original publications on nudge theory

decision that can determine whether an initiative

came out in the late 2000s, a recent scoping

integrates smoothly into operations or remains

review of nudging interventions in organizational

fragmented and short-lived. Partner selection

settings demonstrates that workplace nudges

should be guided not only by technical expertise,

are most effective when paired with tangible

but by alignment with organizational structure,

incentives, require minimal effort, and are

culture, data capacity, and long-term strategic

socially supported by leadership or peers.

goals. Selecting between internal experts,

Moreover, interventions targeting high-cost

external consultants, or third-party vendors

behaviors or lacking enabling infrastructure were

to implement a lifestyle medicine program is

less successful.84 Environmental placement

fundamentally a question of capacity, control,

strategies, such as stair prompts, the strategic

complexity, and long-term institutional goals.

placement of healthy foods, and ergonomic

39

Each model serves a distinct function. The

• Lower vendor dependency

decision should be based on implementation

• More seamless data integration within existing systems

needs.

Key Decision Questions:

Limitations: • Limited specialized expertise (behavioral science, AI and newer digital tools, analytics sophistication)

To determine the optimal mix, the leadership team/decision-making body should consider these five questions:

• Bandwidth constraints

1. Do we have internal expertise in implementation science and workplace/ organizational systems?

• Risk of internal bias or blind spots • Slower innovation adoption When to Choose Internal Partners:

2. Do we need to focus on designing the strategy and framework, or on executing and delivering the solution in practice?

• Mature health and safety governance exists • Data systems are well-integrated

3. Should this initiative begin as a small-scale pilot to test and refine the approach, or are we ready to deploy it across the entire organization?

• Leadership commitment is stable • Implementation is incremental rather than transformative

4. What level of complexity is involved in integrating this data across into our systems and workflows?

Internal leadership is particularly effective in phased models where institutional embedding is the primary goal.

5. Is long-term organizational integration a priority?

External Consultants

Internal Experts

Best for: Strategic planning, readiness assessment, governance design, and short-

Best for: Organizations with existing

term expertise infusion. Consultants typically

infrastructure, strong governance, and technical

provide advisory services rather than delivering

capability. Internal teams (e.g., occupational

operational programs. They help design the

health, HR, safety, benefits, data analytics,

architecture.

leaders with subject matter expertise) are often

Advantages:

best positioned to lead implementation when sufficient expertise and bandwidth exist.

• Objective external perspective

Advantages:

• Expertise in implementation frameworks • Governance and policy design support

• Deep knowledge of organizational culture and operations

• Ability to facilitate cross-functional alignment • Strategic roadmap development

• Established trust relationships • Easier alignment with existing governance structures

Limitations: • Usually not responsible for long-term delivery

• Greater long-term sustainability

40

• Limited operational integration after engagement ends

Limitations: • Variable customization

• May require internal team or vendor for execution

• Risk of poor cultural fit • Data integration challenges

• Can be expensive for ongoing support

• Potential misalignment with governance

When to Choose a Consultant:

• Cost

• Conducting organizational readiness assessments

When to Choose a Vendor:

• Designing phased implementation strategies

• Internal capability gaps exist

• Building governance structures

• Technology platforms are required

• Restructuring benefits or procurement systems

• Enterprise-scale delivery is planned • Specialized coaching or clinical services are needed

• Evaluating existing programs

• Time-to-implementation is constrained

Consultants are most effective in early phases (exploration and preparation) or during structural

Vendors are often most appropriate during pilot

redesign.

and expansion phases when structured delivery

Vendors

systems are required. ACLM provides a list of

Best for: Operational delivery, digital platforms,

of engaging with a vendor. These programs

structured programs, and scalable infrastructure.

are grounded in strong evidence, demonstrate

Vendors typically provide products or services

safety and are aligned with the pillars of lifestyle

(e.g., digital health platforms, coaching services,

medicine. You can find them here: https://

biometric screening, nutrition programs).

lifestylemedicine.org/potential-partner/aclm-

certified programs that can support the decision

certified-programs/

Advantages:

The decision matrix outlined in Table 3 can

• Specialized expertise

help organizations make their respective

• Established program content

determinations.

• Technology platforms • Operational infrastructure • Scalability • Defined service-level agreements

41

TABLE 3: Strategic Decision Matrix Factor

Internal Experts

Consultant

Vendor

Governance Design

Moderate

Strong

Limited

Strategic Planning

Moderate

Strong

Limited

Operational Delivery

Variable

Limited

Strong

Cultural Alignment

Strong

Moderate

Variable

Data Integration

Strong

Advisory

Variable

Scalability

Moderate

Limited

Strong

Long-term

Strong

Advisory

Variable

Sustainability

and escalation procedures. Executive

Execute Strategy

sponsorship should be formalized, and crossThe disciplined execution of a TWH/LM

functional oversight should be operational.

workplace intervention depends less on the

Governance determines how resources are

ambition of its vision and more on adherence to

allocated, how conflicts are resolved, and how

core implementation principles that govern how

priorities are reinforced. Without it, expansion

change is introduced and scaled.58 The success

leads to variability, inconsistency, and a dilution

of any intervention depends on (1) a systematic

of intent. Breadth without governance creates

and gradual approach, (2). a proper diagnosis or

fragmentation; governance before breadth

risk analysis that identifies risk factors and risk

creates stability. Clear authority and structured

groups, (3) a series of theory-driven measures

oversight provide the scaffolding that allows

that logically deal with those problems previously

subsequent scaling to remain coherent and

identified in the risk analysis, (4) a participatory

aligned with enterprise strategy.

approach that engages both workers and middle STEP 2. START SMALL

management, and (5) a sustained commitment from senior management. Across all phases,

Organizational change is most stable when

from pilot through institutional embedding,

introduced in contained environments before

these five foundational principles anchor a stable

being generalized. Beginning with a defined

rollout and protect against premature adoption.

pilot structure allows leaders to observe realworld operational dynamics, test assumptions

STEP 1. BUILD INFRASTRUCTURE

about workflow integration, and identify

No initiative can outpace its governance

contextual barriers that may not be visible

architecture. Before expanding, organizations

in planning sessions. Starting small reduces

must clearly define decision-making authority,

reputational risk, minimizes disruption, and

accountability structures, reporting schedules,

creates a controlled setting for learning. Pilot

42

development at the organizational level should

reporting without harmonized data systems

be intentional and grounded in implementation

risks misinterpretation, loss of credibility,

science. The purpose of the initial pilot is to

and erosion of trust. Data alignment includes

test feasibility under controlled conditions,

integrating cross-functional metrics, ensuring

not to demonstrate transformation in the

interoperability across platforms, and clarifying

most complex environment. Communication

analytic responsibility. When data systems are

pathways, supervisory expectations, workflow

stable and definitions consistent, leadership

integration, policy alignment, scheduling logistics,

visibility reinforces accountability rather than

and third-party interfaces must be stress-tested

generating confusion. Measurement should

during the pilot phase. Testing reveals friction

follow infrastructure development, not precede

points such as unclear ownership, conflicting

it.

90

58

policies, bottlenecks in reporting, or gaps in

STEP 5. INSTITUTIONALIZE THROUGH

digital infrastructure. Addressing these issues

STRUCTURAL EMBEDDING

at a small scale prevents magnification during expansion. Process validation ensures that the

Cultural messaging alone does not create

implementation mechanics are reliable before

sustainability. Institutionalization occurs

additional units are brought into scope. Scaling an

when practices are embedded within formal

untested process multiplies inefficiencies; refining

organizational structures such as budget

processes first multiplies stability.

cycles, procurement standards, performance evaluations, capital planning, and policy

STEP 3. SCALE DELIBERATELY

frameworks. When expectations are written

Operational processes—not program content—

into managerial review processes and funding

determine whether an initiative integrates into

is recurring rather than discretionary, initiatives

daily practice. Informed by pilot findings, the

move beyond reliance on individual champions.

organization can assess, analyze, and develop

Structural embedding transforms a program

a scaling strategy in clearly demarcated phases

into an operational norm. Cultural alignment

rather than aspirational timelines. This staged

may follow, but it is sustained by structural

expansion preserves adaptability while preventing

reinforcement. Without embedding into systems

the operational strain that often accompanies

and incentives, even well-intentioned initiatives

enterprise-wide launches. Deliberate scaling

remain vulnerable to leadership turnover,

reflects an understanding that capacity must

competing priorities, or fiscal pressure.

grow in parallel with scope.

STEP 4. ALIGN DATA SYSTEMS Data infrastructure must mature before executive dashboards amplify visibility. Metrics require standardized definitions, reliable data sources, clear ownership, and consistent reporting intervals. Premature enterprise-level

43

and time, decreased productivity, increased

General Principles of Success for Implementing Workplace LM Interventions

employee turnover, and customer attrition.

The money an organization loses as a result of these problems, and the money it has to spend

“People don’t care about how much you know, until they know how much you care.”

to recover from them, is staggering. Offering evidence-based lifestyle medicine programs as a health benefit can be an effective way to reduce

– Theodore Roosevelt

cost and improve employee and organizational health.

It is important to keep in mind that an effective

Lifestyle medicine can be implemented in the

strategy to bring LM into the workplace includes

workplace as a worker-centered, value-based,

addressing all areas that affect worker health.

outcome-driven approach that goes far beyond

This goes beyond physical activity, healthy

the old-fashioned “wellness” programs. By

eating and stress management. Addressing the

working with each individual, trained clinicians

areas not as visible such as fair pay, diversity,

are able to prevent, treat, and even reverse

manager’s behavior, social determinants of

many chronic conditions through empowering

health, corporate politics and unwritten rules

people to make lifestyle modifications. This is a

must also be addressed as they can significantly

proven methodology that promotes effective

impact workers’ health and negatively influence a

weight loss and healthy weight maintenance,

company’s culture. Keys to success include:

decreases the risk of Type 2 diabetes, reduces

9 Develop and execute the program in-house

cardiovascular disease risk factors, including

to the extent possible, with extensive

lowering blood pressure, triglycerides and other

stakeholder input.91

biomarkers of cardiovascular disease, reduces insulin resistance and oxidative stress, and

9 Incorporate frequent contacts with program

more. People are empowered to address the

(at least weekly).54

root causes of their chronic diseases and, under clinical observation, may be able to reduce their

9 Design multi-component interventions that incorporate multiple lifestyle medicine

medication burden to manage their symptoms.

pillars.92

This approach to lifestyle medicine in the workplace delivers mutual benefit by improving

9 Include incentives.

93

worker health and well-being while enhancing organizational performance, productivity,

9 Prioritize policy/changes of the physical

and long-term value. Workers win by knowing

work environment to promote maintenance

how much they are valued by their employer

of positive lifestyle changes.54

and by becoming healthier, happier, and more

When it comes to organizational performance,

productive. Companies win by having a healthier

workforce health needs to be seen as the clear

organization with a thriving culture where people

priority. The financial cost of an unhealthy worker

are motivated and inspired to make a positive

population is undeniable: wasted resources

difference, not only for the organization, but for

44

the community and the world in which they live.

implemented as intended and why observed

Evaluate Effectiveness

effects occurred. Process evaluations provide

Effective workplace health and well-being

produces limited effects, or fails to achieve

initiatives depend fundamentally on structured

its intended outcomes. They typically involve

evaluation. Measurement is foundational to

the use of structured, validated instruments to

effective workplace evaluation because it fulfills

systematically assess perceptions of how an

several essential functions that determine

intervention was implemented.99

not only whether an initiative is implemented

Established process measures include worker

critical insight into why an intervention succeeds,

as planned, but whether it is effective in

participation, perceived legitimacy of the

producing meaningful and sustained impact.

intervention, stakeholder support, and degree

First, measurement establishes baseline risk and

of implementation fidelity. Collectively, these

exposure. Without deliberate measurement,

measures generate standardized, scalable

organizations cannot determine whether a

data on implementation dynamics that can

program is achieving its intended outcomes

be analytically linked to outcome results to

or simply consuming resources. Measurement

strengthen causal interpretation. By assessing

should occur across multiple domains, reflecting

employee participation trends, the evaluators

both upstream and downstream determinants of

can examine how the respective program

worker health. The methodology for evaluating

components are implemented and experienced

workplace interventions must extend beyond

and distinguish which elements functioned

simple pre-post outcome comparisons and

effectively and which did not, allowing

instead integrate lifecycle evaluation, process

researchers and practitioners, and by extension,

assessment, contextual analysis, and outcome

program managers and implementers, to refine

measurement into a coherent analytic framework.

and optimize intervention design.100 In addition,

Contemporary organizational intervention

process evaluations can identify barriers and

science emphasizes that intervention

facilitators that influence implementation,

effectiveness is best understood as the product

recognizing that these factors may operate

of dynamic interactions among intervention

at multiple levels—including leadership,

design, implementation processes, organizational

supervisors, teams, and individual workers.101

context, and stakeholder sensemaking.97, 98

While process outcome is typically easier,

Accordingly, a best-practice methods framework

quicker, and less costly, evaluations of well-

incorporates multi-phase evaluation, mixed-

chosen and valid outcomes are often more

methods measurement, and explicit linkage

interpretable and useful. Outcome evaluation

between process and outcome variables.

is the component of workplace intervention

This attention to both process and outcome

assessment that addresses whether it achieved

evaluation serves distinct but complementary

its intended goals and determines whether

purposes. Together, these approaches determine

meaningful change occurred as a result of

not only whether an intervention produced

the initiative. Outcomes must be explicitly

measurable change, but whether it was

defined prior to implementation and linked to

45

the identified risks or needs uncovered during

Controls directs attention first to elimination

baseline assessment. If the baseline assessment

and substitution strategies—removing or

utilized the HERO Scorecard, the CDC Worksite

redesigning harmful exposures, workload

Health ScoreCard, the WellBQ, or similar tools,

patterns, scheduling practices, or psychosocial

repeating these assessments can help track

stressors that contribute to chronic disease

progress, highlight areas of improvement, and

risk or work disability.17 Process metrics at this

identify remaining gaps, while also providing

level might include documentation of policy

guidance and evidence-based recommendations

changes, staffing ratios, workload redistribution,

for continued advancement. These objectives

ergonomic redesign implementation, or

should distinguish between short-term,

scheduling reforms. Outcome metrics

intermediate, and long-term outcomes. Short-

may include reductions in exposure levels,

term outcomes often reflect proximal changes,

improvements in safety climate, decreases in

such as increased knowledge, improved safety

injury rates, reduced overtime burden, or lower

practices, reduced exposure levels, enhanced

rates of work-related stress. These structural

supervisor behaviors, or shifts in organizational

indicators are critical because they address root

climate. Intermediate outcomes may include

causes rather than relying solely on individual

measurable improvements in health risk factors,

coping strategies. Depending on the lifestyle

reductions in reported stress, improvements in

behavioral change(s) of focus, associated work-

safety climate scores, or changes in work design.

centric metrics to consider may include financial,

Long-term outcomes typically involve more distal

customer, internal business process, learning

indicators such as injury rates, chronic disease

and growth, or others.102 By systematically

markers, absenteeism, turnover, productivity, or

measuring both worker- and work-centered

healthcare utilization trends.

process and outcome metrics, organizations can more accurately determine not only whether

It is recommended that organizations

an intervention was effective, but how and why

incorporate both worker-centered and work-

effectiveness was achieved.

centered process and outcome measures. These metrics should align with lifestyle behavior

While worker-centered and work-centered

health pillars as identified by ACLM and capture

metrics are essential to understanding

factors that influence modifiable chronic

effectiveness, organizations must ultimately

disease risk as well as work-related disability risk.

translate these multidimensional indicators

Worker-centered measures assess individual-

into a coherent performance framework that

level behaviors, health risks, psychosocial

aligns with enterprise strategy. Leadership

well-being, and functional capacity, while work-

teams often require a concise, prioritized set

centered measures evaluate organizational

of measures that integrate health, safety,

conditions such as workload design, supervisory

financial, and operational outcomes into routine

support, scheduling practices, safety climate,

business reporting. The balanced scorecard

and operational processes that shape worker

approach provides one such structure, allowing

health and performance. From a work-centered

organizations to track health promotion impact

perspective, the use of the Hierarchy of

alongside broader performance objectives.103

46

Within this context, employers typically select

Return on investment (ROI) can be part of

a limited number of high-value indicators that

the impact evaluation. The variables used to

reflect both implementation progress and

calculate an ROI are the costs of the planned

organizational return, ensuring that workplace

intervention, outcome measures, and the

health initiatives remain visible, measurable,

anticipated savings. Costs include program

and strategically integrated rather than siloed

development and design, incentives, marketing

initiatives. On average, the employers surveyed

material, vendor fees, technology, programs,

by Ozminkowski et al. tracked about seven

interventions, and outcome measurements per

metrics on their balanced scorecard. The authors

participant and total for the company. Public

found the most commonly tracked metrics were:

or private employer workers’ compensation or

wellness program participation, health care costs,

healthcare cost databases may be utilized to

absenteeism, wellness program satisfaction,

obtain baseline data to help estimate costs.14

health risks, job satisfaction, and safety. Table 4

ROI can be part of the impact evaluation and it

is an example of metrics which could be used to

can be measured in different ways. The Johns

evaluate financial performance.

Hopkins Institute for Health and Productivity Studies,107 led by Dr. Ron Goetzel, has developed an ROI calculator, and a basic, free calculator is available from WellSteps.108 In addition, an ROI calculator specific to mental health programs has been released by Meharry School of Global Health in the US, supported by Deloitte Health Equity Institute.109 A supporting report highlights many of the economic assumptions used in the ROI calculator.110 Outcome variables to be measured should include the number of participants who will achieve a pre-determined health outcome, for example, weight loss. Anticipated savings may be obtained from the literature or if available from organizational data based on reductions in both direct costs (reduced modifiable risk factors and medical claims/healthcare) and indirect costs (reduced absenteeism or fewer missed work or disability days, reduced presenteeism with increased productivity, and increased employee retention).

It is important to be realistic about the utility of ROI calculations for workplace lifestyle medicine interventions. Challenges include

47

TABLE 4: Organizational Metrics Type

Metric

Return on Investment (ROI)

• Benefits Measures: • Reduced healthcare expenditure (e.g. medical, hospitalization, medication use, worker’s compensation) • Increased service/product output (productivity metric) • Cost Measures: • $ invested into a lifestyle behavioral intervention (e.g. smoking cessation program, nutrition education targeted to diabetes/high cholesterol, functional strength training program; weight loss management targeted to obesity) • $ invested into a chronic condition intervention (e.g. Type 2 Diabetes Remission Program • ROI = (Net Benefit /Cost ) * 100% • Follow trend year over year

Social Return on Investment / Value of

• Productivity • Duration of or quantity of disability claims • Sick days • Business performance metrics • Company profitability • Presenteeism • Long-term medical restrictions for chronic diseases • Employee retention or turnover • Greenhouse gas emissions • Food or nutrition security

Investment

Medical Cost Savings

Benefit-to-Cost Ratio (BCR)

• Absolute cost reduction per participant per year • Percentage decrease in total medical expenditures • Longitudinal cost trends post-intervention • Workers’ Compensation Claims Cost Savings • Disease reversal (to be added in ICD coding) • Examples105,106 (BCR) = Total benefits of reduced healthcare expenditures or productivity gains / Unit of investment in a lifestyle behavior intervention

48

the time horizon required for health changes

An employer should not feel pressured to show

to yield financial savings, lack of standardized

value in all areas at once since the value story

metrics, making it difficult to draw comparisons

can evolve over time. Researchers104,111 have

and analogies, differentiating between the

developed guidance on metrics that will be

role of the program and larger factors in

most meaningful for performance insight and

producing outcomes, and variability between

informed decision making and tracked in a Value

individual industrial sectors and organizations.

Demonstration Dashboard.

Despite limitations, ROI goals can effectively

As program impact is assessed, keep in mind that

demonstrate the value of workplace lifestyle

a first priority is often to create behavior changes

interventions by utilizing company-specific

among those who need it the most. That group

baseline data, measurable outcome variables,

is also the one that will incur the most benefit

and practical interventions tailored to individual

in productivity, health, quality of life, and health

corporate resources.

care costs in the short term. Most importantly,

Generating an ROI is often financially and

focus on small wins first, and then move to more

resource intensive. In addition, ROI is not useful

ambitious results. Bringing lifestyle behavior

when comparing to other companies as different

change into a workplace is a marathon, not a

variables go into its calculation, thereby affecting

sprint!

ROI results. If a company chooses to invest

Table 5 provides examples of worker-centric

in measuring ROI, the value is in following the

metrics with a focus on overall performance,

trend year-over-year. As such, a better choice

psychosocial factors, and chronic conditions

is often to describe the Value of Investment

influenced by lifestyle behavioral interventions.

(VOI). Ozminkowski et al.104, offer recommended

As an example, one study found the most

metrics, a method to prioritize metrics, and how

common lifestyle health risk factors (HRFs)

to tell the VOI story. Specifically, employers can:

as predictors of Worker’s Compensation claim

9 Clearly state the reasons why they are

occurrence and cost were: poor sleep, the

offering health and wellness to their workers

use of poor lifting practices, and inadequate exercise.112 The most common psychosocial HRFs

9 Identify the metrics needed to support their

were stress related to finances, stress at work,

health and wellness rationale

and depression. Among all subjects, abnormal 9 Map out the source of each metric and how

body mass index (BMI) was the most common

it can be accessed by using:

HRF. Tracking performance measurement and

• Health plan data • Vendor data • In-house data

management which take remote work dynamics into consideration should be considered, as such a shift to remote work represents several challenges including communication difficulties,

9 Measure the impact of health and wellness

technical issues, and work-life balance.113

programs on their key metrics, 9 Aggregate findings into a meaningful dashboard based on their priorities.

49

Table 5 provides examples of worker-centric clinical and behavioral metrics across the LM pillars.

Assessment tools for each pillar can be found in the Appendix.

TABLE 5: Worker-centric Metrics: Clinical and Behavioral Indicators across LM Pillars LM Pillar

Behavior

Biological/ OM Measure

Medical Condition

Psychosocial Factor

Cardiovascular

Readiness to

Duration and Type Strength (dynamometer)

diagnoses

change

of Activity per Day Flexibility

Musculoskeletal

Sedentary

conditions (back and

Physical Activity Steps

behavior

Weight

Cholesterol Blood sugar (CGM trends, HBA1C) Blood pressure

neck pain, arthritis) Psychological/ mental health

Fitness (VO2 max, etc.)

Permanent medical restrictions due to chronic reversible diseases LM Pillar

Behavior

Biological/ OM Measure

Medical Condition

Psychosocial Factor

Eat Well

Fiber intake

Weight

Type 2 Diabetes

Psychological/

Protein intake

BMI

Obesity

mental health

Caloric intake

Waist Circumference

Hypertension

Sugar intake

Lipid Profile

Dyslipidemia

Fruit/vegetable

LDL Cholesterol

Metabolic Syndrome

(rainbow color)

Blood sugar (CGM

(e.g. MASLD)

intake

trends, HBA1C)

Cardiovascular

Ultra-processed

Blood pressure

condition

food intake Sodium intake

50

Obstructive sleep

Depression

Bedtime and wake Cortisol

apnea

Anxiety disorders

time consistency

Melatonin timing

Insomnia disorder

PTSD

Total sleep

Blood pressure

Restless legs syndrome Substance use

Fasting glucose / HbA1c

Circadian rhythm

disorders

sleep-wake disorders

Financial stress

(CRP, IL-6)

Shift work disorder

Caregiving

Absenteeism

Hypertension

burden

Presenteeism

Cardiovascular disease

Marital stress

After-hours email/work

Type 2 diabetes

Social isolation

engagement

Obesity

Burnout

Shift swapping patterns

Chronic pain

Overtime frequency

GERD

Commute duration

Female Breast Cancer

Restorative

Fatigue scales

Sleep

duration Screen use before bed Caffeine timing and quantity Alcohol use in the evening Nicotine use Late-night eating Exercise timing Napping frequency/

Resting heart rate

Inflammatory markers

On-call responsibilities

duration

51

LM Pillar

Behavior

Biological/ OM Measure

Medical Condition

Psychosocial Factor

Form Positive

Time spent with

Work-life Balance

Psychological/mental

Low social

Social

family/friends

Helping colleagues

health

support

Connections

Number

Emotional disclosure to

Increased inflammatory Relational

of positive

trusted coworkers

states

problems at work

Checking in on

Chronic Pain

Depression

interactions

Conflict resolution teammates behaviors Physical workspace Seeking help when layout (open vs. isolated) needed Number of strong vs. weak ties Network centrality (social network analysis) Diversity of connections

Anxiety disorders Burnout PTSD

Remote/hybrid structure

Substance use

Onboarding integration

disorders

processes Supervisor support behaviors Psychological safety climate Recognition programs Zero tolerance for incivility/bullying Diversity, equity, and inclusion practices

52

LM PIllar

Behavior

Biological/ OM Measure

Medical Condition

Psychosocial Factor

Optimize

Response

Cortisol (diurnal slope)

Self-assessment of

Depression

Attitude and

to feedback

Heart rate variability

overall health

Anxiety

Mindset

(defensive vs.

(HRV)

Burnout

Resting heart rate

PTSD

Blood pressure

Learned

Psychological safety

helplessness

climate

Self-efficacy

Error tolerance vs. blame

Emotional

culture

intelligence

Recognition systems

Neuroticism

Growth and development

Perfectionism

growth-oriented) Willingness to learn new skills Persistence after setbacks Attribution style (external blame vs. internal control) Problem-solving vs. rumination Help-seeking behavior Initiative-taking Adaptability during change Conflict style Emotional regulation during stress Constructive

pathways

Fixed identity

Transparency in decisionmaking

beliefs Quality of life

Fixed vs. growth-oriented performance reviews Coaching availability Professional development funding Feedback frequency Engagement Absenteeism

vs. cynical

Presenteeism

communication

Innovation

Recognition of

Safety incidents

others

Turnover intention

Collaboration vs. withdrawal

53

LM PIllar

Behavior

Biological/ OM Measure

Medical Condition

Psychosocial Factor

Reduce or Avoid

Substance use

Depression

Driving after substance

disorders

Anxiety

Binge drinking

use Using substances to

Psychological/mental

PTSD

episodes

cope with work stress

health

Cannabis use

Presenteeism linked to

Chronic

Opioid use

substance use

musculoskeletal pain

(prescribed and

Breath alcohol testing

Neuropathic pain

non-medical)

Urine toxicology screens

Liver Disease

Stimulant use

Saliva testing

Cancer

Nicotine use

Carbohydrate-deficient

(ACEs)

(smoking, vaping,

transferrin (CDT)

Impulsivity

Gamma-glutamyl

Sensation-

Alcohol frequency Working while impaired

Risky Substances and quantity

smokeless)

Sedative/hypnotic transferase (GGT) use Phosphatidylethanol Energy drink/ (PEth) for alcohol caffeine overuse

Cotinine (nicotine Polysubstance use metabolite) EAP accessibility Insurance coverage for treatment Sick leave and mental health leave Workplace injuries Falls Motor vehicle accidents Productivity metrics Error rates Safety events Toxicant Exposures

54

Burnout ADHD Bipolar disorder Adverse childhood experiences

seeking Emotional dysregulation Social isolation Financial stress

LM Pillar

Behavior

Biological/ OM Measure

Medical Condition

Psychosocial Factor

Manage Stress

Poor coping

Grievances, disciplinary

Psychiatric diagnoses

Fear/avoidance

strategies

issues

Pain, including back

Perceived

Litigation

and neck

injustice

Workplace bullying

Depression

Friction with

High annual sickness

PTSD

colleagues

absence

Anxiety

Job satisfaction

Job strain

Autonomy

Time pressure

Energy

Long overtime hours

depletion/ exhaustion

Low job control

Negativism

Computer work High job demands Modified duty

Feelings of professional accomplishment

The next critical phase is the formation of a

Conclusion

participatory, multidisciplinary workplace health Integrating LM and TWH into a workplace begins

and wellness team that includes stakeholders

with a rigorous organizational assessment to

from every level, including senior leadership,

evaluate both systemic structures and worker

frontline staff, and subject-matter experts.

readiness. This foundational step moves

This inclusive structure fosters ownership

beyond simple health appraisals to examine

and accountability, moving the initiative away

leadership priorities, job design, and the physical

from being a siloed human resources "add-

environment, ensuring interventions are data-

on" toward a shared institutional priority.

driven rather than performative. By utilizing

Implementation should follow a multi-level

validated tools such as those mentioned above,

architecture that targets systemic determinants

organizations can identify upstream drivers

at the organizational level (e.g., shift scheduling

of chronic disease and surface structural

policies), behavioral norms at the team level

barriers that may hinder healthy behaviors.

through environmental "nudges," and risk-

Effectively addressing these organizational and

stratified supports for individual workers. By

demographic barriers, such as limited executive

integrating behavioral economics principles,

prioritization or socioeconomic factors affecting

such as default ergonomic settings or healthy

health literacy, ensures that the resulting

food placement, organizations can reduce the

strategy is practical, equitable, and culturally

cognitive effort required for workers to make

aligned with the specific needs of the workforce.

health-promoting choices throughout the workday.

55

Finally, for LM and TWH to remain sustainable, they must be institutionally embedded through a process of deliberate, staged execution.

Organizations should start with small-scale pilot programs to test feasibility and refine operational processes before attempting enterprise-wide expansion. Long-term success is secured when these initiatives are woven into the formal organizational fabric, including budget cycles, performance evaluations, and policy frameworks.

Continuous evaluation of both process and outcome metrics ranging from participation rates and worker satisfaction to VOI and clinical health improvements, is essential for demonstrating impact and guiding continuous improvement.

Ultimately, integrating these principles is a longterm initiative requiring sustained leadership commitment and a constant focus on datadriven evolution to meet the changing needs of the workforce.

56

Appendix: Rationale for Advancing Workplace Health, Safety, and Well-being and avoiding harmful substances. Secondary

LM Perspective

prevention aims to identify disease early and The ACLM is a fast-growing medical society that

slow or reverse its progression through screening

aims to revolutionize healthcare by addressing

and lifestyle changes when risk factors or early

the root causes of chronic illness with evidence-

disease are present. Tertiary prevention applies

based interventions. Central to this is the LM

after a disease has been diagnosed and seeks to

Fundamentals course, which highlights core

reduce complications, improve quality of life, and

knowledge around each of the six pillars of LM.

slow disease progression, showing that lifestyle

This course serves as a source of authentic

medicine remains important at every stage of

resources on topics that have been historically

health and illness.

underemphasized by traditional medical

OEM Perspective

professionals, ensuring the toolkit is grounded in the most current, evidence-based practice.

As a preventive medicine specialty, the field of

By tackling these underlying causes, Lifestyle

OEM encompasses both clinical and population

Medicine aims to treat, prevent and reverse

medicine. In the clinic, practitioners not only can

chronic illnesses. It encourages individuals to

prevent, identify, and treat work-related injuries

change their daily choices, related to dietary

and illnesses but also incorporate strategies

patterns physical activity, stress management

to improve their patients’ health behaviors.

techniques, substance use, sleep patterns, and

Also, OEM competencies include strategies

social connectivity, to achieve optimal health and

to protect and promote the overall health,

performance.

safety, and well-being of a workforce.114 OEM

The four levels of prevention -premoridal,

professionals manage the entire spectrum of

primary, secondary, and tertiary - can all be

prevention, from primary to tertiary. They have

strengthened through the power of healthy

particular expertise in supporting and returning

lifestyle choices. Primordial prevention focuses

workers to employment after injury or illness,

on preventing the development of risk factors

whether occupational or non-occupational.

in the first place through shaping a healthy

OEM recognizes that employers have a role and

environment – one where workers have access to

an opportunity to promote policies, programs,

healthy foods, opportunities for physical activity,

and practices that protect safety, promote

and positive connections with co-workers and

lifestyle interventions and overall well-being,

administration. Primary prevention builds on this

and thereby enhance business success.115 As

foundation by promoting habits like nutritious

lifestyle medicine becomes the new standard

eating, physical activity, stress management,

of health care, there is a clear link between corporate health and employee well-being.

57

This connection provides the rationale for the

and well-being. They also have opportunities

collaboration between ACOEM and ACLM in

to work with non-medical specialists, including

revising this guiding document and associated

industrial hygienists, safety professionals,

guide. Together, these organizations present a

ergonomists, human resources personnel,

compelling business case for employers to invest

supervisors, managers, and executive leaders.

in lifestyle medicine-grounded health initiatives

These individuals are responsible for the policies,

as a core strategy, rather than a peripheral

programs, and practices that create occupational

benefit.

determinants of health, safety, and well-being.

Figure 5 illustrates the common types of clinical OEM encounters, each of which presents an opportunity to incorporate lifestyle medicine interventions across the spectrum of primary, secondary (early identification and intervention before injury or disease), and tertiary prevention (diagnosis, treatment, rehabilitation, and returnto-work). Often, OEM clinicians collaborate with other health professionals, such as health educators and employee assistance counselors, who are dedicated to workers’ safety, health,

FIGURE 5 OEM Disease and Injury across Three Levels of Prevention

58

An employer may conduct certain “non-

At the primary prevention stage (see Figure

medical” assessments of job applicants before

7), non-medical interventions may include

offering employment. Examples of this type

measures to prepare the worker to safely

of assessment might include a drug test, a

manage job demands, such as ergonomic

functional capacity evaluation, or a typing

and safety training, physical conditioning,

test. The Americans with Disabilities Act

acclimatization to temperature extremes, and

prohibits employers from requiring a medical

the design of accommodations. Safety, IH, and

examination until after a job offer, but they

HR professionals can collaborate to create a safe

may make employment contingent upon the

and supportive work environment that protects

recommendations of a medical evaluation.

and, if possible, advances workers' health, safety,

Employers are responsible for providing a safe

and well-being. Medical biomonitoring can help

workplace for contracted and temporary workers,

identify whether the IH and safety controls are

but the contractor or temporary worker agency

effective in preventing hazardous occupational

commonly manages the medical interventions

exposures.

identified in the figures. The pre-placement

OEM physicians bring specialized expertise

exam may include a comprehensive history,

in identifying, evaluating, and preventing

examination, and testing (except for genetic

illness caused by toxic exposures across the

assessments, including family history). The goal

full spectrum of a worker’s daily life. Their

of the exam is to perform a medical assessment

training spans clinical medicine, epidemiology,

of the examinee’s medical fitness for performing

toxicology, exposure science, and ergonomics,

the offered job without imminent, significant

enabling them to determine whether a

harm to themselves, their co-workers, or the

specific risky substance, occupational or non-

public, with or without accommodations. Without

occupational, has contributed to disease or

releasing any protected health information,

injury. This includes well-established workplace

the examiner informs the employer whether, in

hazards such as asbestos, silica, lead, solvents,

their judgment, the individual can work without

pesticides, and irritant or allergenic dusts,

restrictions, should have accommodations to

as well as emerging public health concerns

enable the person to perform the job safely,

like PFAS and microplastics. By applying the

or cannot perform the proposed work even

emerging concept of the “exposome”—the

with accommodations. The examiner does not

cumulative 24-hour exposure profile across work,

make an employment decision or determine

home, transit, and community settings—OEM

whether to grant accommodations; by law, that

physicians can recommend targeted preventive

responsibility rests with the employer.

strategies to reduce the onset, progression, or

The pre-placement exam provides an opportunity

recurrence of diseases such as asthma, COPD,

to identify and inform the employee of medical

cancers, heavy metal toxicity, and solvent-

and lifestyle issues that could benefit them

induced neurotoxicity. When prevention fails and

through medical and behavioral interventions.

causation is established, they also play a key role

Employer benefits and programs may facilitate

in facilitating appropriate workers’ compensation

(though they cannot mandate) workers' pursuit

support.

of these interventions.

59

Lifestyle medicine physicians, whose

personal behaviors but also by cumulative toxic

“Reduce / Avoid Risky Substances” pillar has

exposures. Similarly, while reducing harmful

traditionally emphasized addictive drugs, can be

exposures remains the primary prevention

strengthened through collaboration with OEM by

strategy, adherence to evidence-based lifestyle

also considering occupational and environmental

behaviors may help mitigate some of the adverse

toxicants into prevention strategies. Many

health effects associated with cumulative low-

chronic diseases central to lifestyle medicine,

grade toxic exposures. Assessing and minimizing

including cardiovascular disease, diabetes,

both workplace and non-workplace sources

metabolic syndrome, respiratory illness, and

enhances the rigor of prevention efforts and

some cancers, are influenced not only by

supports comprehensive, evidence-based strategies to protect and improve worker health.

FIGURE 6 OEM Primary Prevention Strategies

Lifestyle medicine physicians, whose

some cancers, are influenced not only by

“Reduce / Avoid Risky Substances” pillar has

personal behaviors but also by cumulative

traditionally emphasized addictive drugs, can

toxic exposures. Likewise, potentially adverse

be strengthened through collaboration with

health effects from cumulative low-grade toxic

occupational and environmental medicine by

exposures, can be mediated by adhering to

also considering occupational and environmental

health lifestyle behaviors as promoted by lifestyle

toxicants into prevention strategies. Many

medicine experts. Assessing and minimizing both

chronic diseases central to lifestyle medicine,

workplace and non-workplace sources enhances

including cardiovascular disease, diabetes,

the rigor of prevention efforts and supports

metabolic syndrome, respiratory illness, and

comprehensive, evidence-based strategies to protect and improve employee health.

60

FIGURE 7 OEM Secondary Prevention Strategies

When primary and secondary prevention fail

other organizations’ guidelines to support insurer

to prevent illness or injury, the OEM clinician

decisions for approving treatment plans. Even

evaluates the worker and recommends a

when states have not adopted guidelines as the

treatment plan that may include referrals to other

standard of care, insurers may use them or their

specialists and rehabilitation professionals, as

own internal guidelines for case management.

well as lifestyle recommendations. ACOEM has

Figure 8 displays these tertiary prevention

published evidence-based guidelines to optimize

strategies used by OEM practitioners.

medical management. Some states use these or

61

FIGURE 8 OEM Tertiary Prevention Strategies

The OEM professional also has the responsibility

by the insurance adjuster, and may be called to

to assess and communicate their opinion about

testify under oath.

“causation,” i.e., whether the individual’s work

The OEM clinician is also responsible for writing

caused the injury or illness. This causation

a “return to work prescription” after every

opinion must be based on epidemiologic as

work-related visit. Robust evidence supports

well as individual clinical history that supports a

the therapeutic value of staying at work with

causal link. However, whether an insurer accepts

accommodations as needed or of an early

a claim as work-related is also shaped by state

return to work. The management of this aspect

and federal law. Individual states can establish

of a work-related condition is a key factor in

different standards for accepted causal links.

whether an individual’s injury or illness ultimately

For some occupations, such as firefighting,

resolves and whether they successfully return to

causation may be legally assumed for specific

work. When work status is correctly managed,

medical conditions. The clinician’s causation

permanent disability is usually a preventable

opinion provides the foundation for worker’s

condition, even after serious injury or illness.

compensation benefits provided by an insurer.

The critical nature of this aspect of occupational

The insurer may accept the clinician’s causation

healthcare usually demands much more frequent

decision or contest it by referring the matter to

follow-up than is typical for non-occupational

an “independent” examiner. Administrative courts

conditions.

serve to adjudicate contested claims. The OEM

As with other stages of prevention, non-medical

professional has a responsibility to document

interventions can play a prominent role in

their rationale for their causation opinion to

supporting recovery and return to work. These

facilitate an informed, fair, and prompt decision

62

interventions can include ergonomic changes,

sponsored health promotion. In addition, OEM

modifications to safety and IH controls, personal

recognizes the interaction of occupational

accommodations, or changes in job tasks. When

risk factors with personal risk factors and how

no appropriate worksite changes allow a worker

this interrelationship is associated with health

to return to work, vocational rehabilitation may

outcomes.8 In addition, lifestyle medicine and

enable work in other employment settings to

OEM practitioners can participate in addressing

avoid disability. As an additional example of

disparities in lifestyle health risk factors for

the benefit of integration of OEM and lifestyle

chronic diseases across many categories

medicine, both OEM practitioners and lifestyle

including, but not limited to, socioeconomic

medicine practitioners can play an important

status, income, race, ethnicity, sex, migration

role in nutrition support simply by helping

status, housing insecurity, stress, and

workers remain gainfully employed. Helping

occupation.

injured and ill workers recover more completely

A guide to implementing TWH has been

and more quickly can help them extend their

described by Rathke at the National Oceanic

ability to continue working and to work safely.

and Atmospheric Administration (NOAA)

This is easier said than done but certainly can

National Environmental Satellite, Data, and

be accomplished to a useful degree for many

Information Service (NESDIS). It describes

workers. Optimizing the ability to work and

how NESDIS promotes workplace health and

support themselves and their families can make

productivity through the TWH Program, which

purchasing healthy food easier and make lifestyle

integrates science-based system designs

medicine recommendations more feasible for

to strengthen mission capacity and foster a

many workers of all income levels. This could

healthier workforce. Grounded in OEM and

be done by strengthening options for lifestyle

work design research, NESDIS has translated

medicine practitioners to refer patients to OEM

evidence into practical, immediately applicable

practitioners, by providing relevant OEM training

insights that promote healthier, more sustainable

to lifestyle medicine practitioners, or both.

performance.

Total Worker Health (TWH) In alignment with the Total Worker Health® (TWH) approach, OEM recognizes social determinants of health which may influence worker health, safety, and well-being.17 These include a myriad of factors including control of hazards and exposures, organization of work, built environment supports, leadership, community supports, compensation and benefits , and internal and federal policies.

Evidence has accumulated to demonstrate how working conditions such as these influence the likelihood that workers will embrace employer-

63

The four priority areas of the Culture of Health

Culture of Health

framework are:

Much has been written about the Culture of

9 Worker Health: consideration of worker

Health and how companies with a strong culture

well-being, including a strong culture of

of health outperform the market.115 The Robert

safety

Wood Johnson Foundation considers a culture of health to be one in which: “good health and well-

9 Consumer Health: healthfulness and safety

being flourish across geographic, demographic,

of products and services

and social sectors; fostering healthy equitable communities guides public and private decision

9 Community Health: health and safety

making; and everyone has the opportunity to

efforts in the location of doing business

make choices that lead to healthy lifestyles.”122 This definition is not just applicable to the

9 Environmental Health: impact of operations

U.S., but equally to any organization intent on

on the environment

creating a culture of health. The Global Reporting Institute (GRI) has collaborated with the Robert

Improving an organization’s culture is a journey.

Wood Johnson Foundation to define a Culture

It requires knowing the current status, the

of Health for Business (COH4B) Framework, on

target, and the available resources. Progress is

“the role of business in impacting the health and

what matters. While each company starts at a

well-being of its stakeholders, linked to a curated

different baseline, with intervention and effort,

set of principles and business practices. It is a

each company can improve its culture of health.

multi-stakeholder-developed, evidence-based

Examples of successful culture change can be

public tool which companies can use to take

found in Fabius, et al.115

comprehensive action on the health and well-

A healthy culture allows its workforce to thrive

being of workers, families, and communities.”123

by addressing well-being and prevention while

The 16 business practices across 4 pillars help

enabling all workers to perform at their best. A

global corporations align their GRI reporting to the framework.

culture of health is more specific to workforce

Organizations that are not required to adhere to

at work and is often defined as “wellness.” It is a

health and promoting healthy lifestyle behaviors

GRI reporting standards, may consider reviewing

priority in organizational culture.

Professor Quelch’s Culture of Health “four-

Developing a sustainable culture of health and

pillar framework,” co-developed by Harvard

well-being “requires a systematic approach

T.H. Chan School of Public Health and Harvard

addressing transformational drivers of culture

Business School.124 It offers a way for businesses

change, as well as comprehensive efforts to

to evaluate their actions to maximize the well-

improve health and well-being to reduce costs

being of workers, consumers, the community,

and illness burdens.”115 TWH emphasizes the

and the environment, ultimately contributing to a

importance of management’s commitment to

healthier population and economy.

health and well-being. Managers can leverage

64

existing organizational elements such as

Assessment Tools

workforce development (health literacy), servant leadership (removing barriers to healthy

Organizational Assessment:

lifestyle and role-modeling healthy lifestyle

• AHA wellbeing scorecard: https://www. heart.org/en/healthy-living/companycollaboration/well-being-works-better/ workforce-well-being-scorecard

behaviors), and continuous improvement at the grassroots level. From the behavior change model called social cognitive therapy, we know that a strong environment (peers, credible role

• CDC Worksite Health Scorecard: https:// www.cdc.gov/workplace-health-promotion/ php/scorecard/index.html

models, workplace cues) and creating selfefficacy through capacity building, will nudge people to behavior change. It is about creating

• Healthy Work Survey: https://www. healthywork.org/employers/healthy-worksurvey-employers/

a culture where both the environment and peers encourage each other to adopt healthy lifestyle behaviors, not just at home but also in the

• HERO scorecard: https://hero-health.org/ hero-scorecard/

workplace.

• Mayo Clinic Wellbeing Index: https://www. mywellbeingindex.org/ • NIOSH Well BQ: https://www.cdc.gov/niosh/ twh/wellbq/

LM Pillar Assessment: PHYSICAL ACTIVITY • International Physical Activity Questionnaire (IPAQ) • Global Physical Activity Questionnaire (GPAQ) • Godin-Shephard Leisure-Time Physical Activity Questionnaire (GLTEQ) • Baecke Physical Activity Questionnaire • Accelerometers (e.g., ActiGraph) • Wearables (Fitbit, Garmin, Apple Watch) • Pedometers • VO₂ max testing • Resting heart rate • Heart rate variability

65

REDUCE / AVOID RISKY SUBSTANCES

NUTRITION • Dietary Screener Questionnaire (DSQ – NHANES)

• Alcohol Use Disorders Identification Test (AUDIT)

• Rapid Eating Assessment for Participants (REAP-S)

• AUDIT-C (Short Version) • Fagerström Test for Nicotine Dependence (FTND)

• Starting the Conversation (STC)

• Global Adult Tobacco Survey (GATS) Core Items

• Block Food Frequency Questionnaire • Harvard/Willett Food Frequency Questionnaire

• Drug Abuse Screening Test (DAST-10) • ASSIST (Alcohol, Smoking and Substance Involvement Screening Test)

• Food Choice Questionnaire (FCQ) • Dutch Eating Behavior Questionnaire (DEBQ)

• Opioid Risk Tool (ORT)

• Mediterranean Diet Adherence Screener (MEDAS)

MANAGE STRESS

• Beverage Intake Questionnaire (BEVQ-15)

• Perceived Stress Scale (PSS-10)

RESTORATIVE SLEEP

• Job Content Questionnaire (JCQ)

• Pittsburgh Sleep Quality Index (PSQI)

• Effort–Reward Imbalance (ERI) Questionnaire

• Epworth Sleepiness Scale (ESS) • Insomnia Severity Index (ISI)

• Copenhagen Psychosocial Questionnaire (COPSOQ)

• Sleep Hygiene Index (SHI)

• Maslach Burnout Inventory (MBI)

• Occupational Fatigue Exhaustion Recovery (OFER) Scale

• Brief COPE Inventory • Coping Self-Efficacy Scale (CSES)

• Chalder Fatigue Questionnaire

ALSO, ATTITUDE AND MINDSET

• Actigraphy (Wearable Sleep Monitoring)

• General Health Questionnaire (GHQ-12)

• Consumer Wearables (Fitbit, Oura, Garmin)

• Patient Health Questionnaire (PHQ-9)

• STOP-BANG (sleep apnea risk)

• WHO-5 Well-Being Index

• Berlin Questionnaire (sleep apnea screening)

• Psychological Capital Questionnaire (PCQ)

SOCIAL CONNECTIVITY

• Growth Mindset Scale (Dweck)

• UCLA Loneliness Scale

• Connor-Davidson Resilience Scale (CD-RISC)

• De Jong Gierveld Loneliness Scale

• Utrecht Work Engagement Scale (UWES)

• Job Content Questionnaire (JCQ – Social Support Subscale) • Lubben Social Network Scale (LSNS-6)

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Resources

LIFESTYLE MEDICINE AND CLINICAL

*Disclaimer: Some resources shared may

American College of Lifestyle Medicine —

require purchase, subscription, or third-

Recommendations & Standards

CONTEXT

party registration. Inclusion does not imply

• Lifestyle medicine clinical positions on the role of physical activity within therapeutic lifestyle interventions. Includes guideline context for chronic disease management.

• https://lifestylemedicine.org/ recommendations-standards

endorsement.

Optional version to utilize for design: https:// docs.google.com/spreadsheets/d/1XLP4ntsM PXllNRSh0TlmMCDsl4iu9agslGOsOpcfqUM/ edit?usp=sharing

American College of Lifestyle Medicine

Physical Activity

First Clinical Practice Guideline on Lifestyle Interventions for Type 2 Diabetes

CORE GUIDELINE DOCUMENTS

• Latest lifestyle medicine clinical guideline highlighting evidence-based physical activity as a pillar in T2D prevention and remission strategies.

• https://lifestylemedicine.org/lifestylemedicine-and-the-path-to-type-2-diabetesremission/

Centers for Disease Control and Prevention – National Center for Chronic Disease Prevention and Health Promotion • Physical Activity Breaks for the Workplace Resource Guide.

• https://www.cdc.gov/workplace-healthpromotion/media/pdfs/2024/06/WorkplacePhysical-Activity-Break-Guide-508.pdf

AHA (American Heart Association) Physical Activity Recommendations Overview • Patient-friendly summary of Physical Activity Guidelines for heart health professionals and the general public.

• https://www.heart.org/en/healthy-living/ fitness/fitness-basics/aha-recs-for-physicalactivity-in-adults

Physical Activity Guidelines for Americans, 2nd Edition (PDF) • Comprehensive science-based guideline from the U.S. Department of Health and Human Services (HHS). Covers recommendations across age groups, intensity, dose, and special populations.

• https://health.gov/sites/default/ files/2019-09/Physical_Activity_ Guidelines_2nd_edition.pdf

WORKPLACE RESOURCES Centers for Disease Control and Prevention — Active People, Healthy Nation Initiative • National public health initiative aiming to increase physical activity levels across communities. Includes implementation toolkits.

• https://www.cdc.gov/physicalactivity/ activepeoplehealthynation/index.html

WHO Physical Activity Facts & Global Guidelines Overview • World Health Organization fact sheet summarizing why physical activity matters globally and linking to WHO Global Guidelines on Physical Activity and Sedentary Behaviour.

• https://www.who.int/news-room/factsheets/detail/physical-activity

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Community Preventive Services Task Force

Walking spree Activity Challenges (not affiliated)

— The Community Guide: Physical Activity

• Corporate health and wellness platform designed to help employers motivate their workers to live healthier, more active lifestyles through fun, engaging digital

Interventions • Systematic reviews of community and workplace strategies (e.g., point-of-decision prompts, built environment approaches).

• https://www.thecommunityguide.org/topic/ physical-activity

programs and challenges.

• https://walkingspree.com/ Wellable

World Health Organization — Global Action Plan

• All-in-one employee wellness, rewards, and recognition platform that helps organizations run customizable programs to engage workers in holistic health challenges.

on Physical Activity • Population-level strategy promoting activity through policy, transportation, and workplace design.

• https://www.who.int/publications/i/ item/9789241514187

• https://www.wellable.co/ Wellhub • Subscription to fitness, mindfulness, nutrition, sleep, and other well-being services to boost engagement and health outcomes.

• https://wellhub.com/

IMPLEMENTATION RESOURCES American College of Sports Medicine (ACSM) Physical Activity Guideline Resources • ACSM provides evidence-based recommendations, scientific reviews, and practice tools used widely by clinicians, researchers, and exercise professionals.

• https://acsm.org/education-resources/ trending-topics-resources/physical-activityguidelines CDC Physical Activity Guidelines & Recommended Strategies (CDC) • Centers for Disease Control and Prevention guidance on amounts/types of activity and community-level, evidence-based strategies for implementation.

• https://www.cdc.gov/physical-activity/php/ guidelines-recommendations/index.html SUPPLEMENTARY RESOURCES Strong People Strong Bodies • Community health evidence-based strength training, wellness education, and related programs for midlife and older adults.

• www.strongpeopleprogram.org

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LIFESTYLE MEDICINE & CLINICAL

Eat Healthy

CONTEXT CORE GUIDELINE DOCUMENTS

Academy of Nutrition and Dietetics — EvidenceBased Nutrition Practice Guidelines

Centers for Disease Control and Prevention — • Evidence-based dietary guidance and population health implementation strategies.

• Condition-specific clinical nutrition recommendations supported by systematic review.

• https://www.cdc.gov/nutrition/php/

• https://www.eatrightpro.org/practice/

Nutrition Guidelines & Recommendations

guidelines-and-positions/evidence-based-

guidelines-recommendations/index.html

nutrition-practice-guidelines

Community Preventive Services Task Force — The Community Guide: Nutrition & Obesity

American College of Lifestyle Medicine —

Prevention

Clinical Practice Guidelines (Type 2 Diabetes & Lifestyle Intervention)

• Systematic evidence on worksite food policies, pricing strategies, and environmental interventions.

• Evidence-based guidance incorporating therapeutic nutrition into chronic disease management.

• https://www.thecommunityguide.org/topic/

• https://lifestylemedicine.org/

nutrition

recommendations-standards/

National Academies of Sciences, Engineering,

American College of Lifestyle Medicine — Food

and Medicine — Dietary Reference Intakes (DRIs)

as Medicine Position Statement

• Scientific nutrient intake standards informing clinical and public health nutrition practice.

U.S. Department of Health and Human Services

• ACLM’s evidence-based dietary position recommending a whole-food, plantpredominant eating pattern for prevention, treatment, and potential reversal of lifestylerelated chronic disease.

& U.S. Department of Agriculture — Dietary

• https://lifestylemedicine.org/aclm-releases-

• https://ods.od.nih.gov/HealthInformation/ nutrientrecommendations.aspx

Guidelines for Americans (2020–2025)

updated-dietary-position-statement/

• Foundational, science-based national nutrition guidance for disease prevention and health promotion across the lifespan.

American College of Lifestyle Medicine — Six Pillars of Lifestyle Medicine (Nutrition Component)

• https://www.dietaryguidelines.gov/

• Defines whole, minimally processed plantpredominant nutrition as a core therapeutic

World Health Organization — Healthy Diet Fact Sheet & Global Recommendations

pillar.

• Global evidence-based dietary guidance focused on chronic disease prevention and nutrient adequacy.

Harvard T.H. Chan School of Public Health — Healthy Eating Plate • Evidence-informed dietary pattern emphasizing vegetables, fruits, whole grains, and healthy proteins.

• https://www.who.int/news-room/factsheets/detail/healthy-diet

69

• https://nutritionsource.hsph.harvard.edu/

Centers for Disease Control and Prevention —

healthy-eating-plate/

Healthy Eating for Healthy Weight

WORKPLACE RESOURCES

• Practical dietary strategies linked to weight management and metabolic health.

American Heart Association — Workplace Health

• https://www.cdc.gov/healthy-weightgrowth/healthy-eating/index.html

Solutions: Nutrition • Employer guidance on improving food environments and worker dietary behaviors.

Nutrition.gov — Healthy Eating Tools & Tips

• https://www.wellbeingworksbetter.org/-/ media/Healthy-Living-Files/Foodscape/

• Consumer-friendly tools, meal planning resources, and dietary education materials.

Healthy_Workplace_Food_and_Beverage_

• https://www.nutrition.gov/topics/basic-

Guide.pdf?sc_lang=en

nutrition/healthy-eating

Healthy Eating Research — Policy &

SUPPLEMENTARY RESOURCES

Environmental Strategies

15-Day Whole Food Plant-Based Jumpstart

• Evidence summaries supporting institutional and workplace nutrition policy change.

Program

• https://healthyeatingresearch.org/

• ACLM Certified Program. Physicianguided, evidence-based lifestyle nutrition intervention to prevent or reverse chronic disease.

World Health Organization — Healthy Diet & Food Policy Guidance • Global public health guidance on population nutrition strategies and workplace relevance.

• https://rochesterlifestylemedicine.org/aboutjumpstart/

• https://www.who.int/health-topics/healthy-

Adopt a Lifestyle

diet

• Self Guided or 3, 6, 9, 12-month Partner with a Coach Programs.

IMPLEMENTATION RESOURCES

• https://adoptalifestyle.com/programs

American College of Lifestyle Medicine — ACLM

Esselstyn Foundation (not affiliated)

Learning Center (Nutrition Courses & Tools)

• Free or low-cost experiential programs and partnerships focused on spreading wholefood, plant-based nutrition education, disease prevention, and lifestyle change.

• Clinical education modules and implementation resources for “Food as Medicine” integration into practice.

• https://learning.lifestylemedicine.org/

• https://esselstynfamilyfoundation.org/the-

American Heart Association — Healthy Eating

foundation-in-action/

Recommendations

Food For Life (Physicians Committee for

• Evidence-based heart-healthy dietary guidance aligned with chronic disease prevention.

Responsible Medicine - PCRM) • Nutrition education about plant-based eating for chronic health conditions through hands-

• https://www.heart.org/en/healthy-living/ healthy-eating

on classes and practical skills.

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Full Plate Living

LIFESTYLE MEDICINE & CLINICAL CONTEXT

• No cost ACLM Certified Program with options including online self-paced 7 sessions, 7 session facilitated groups, 8 sessions, or shared medical appointments.

American Academy of Sleep Medicine — Clinical Practice Guideline for the Treatment of Chronic Insomnia in Adults • Evidence-based recommendations for behavioral and pharmacologic management of insomnia (CBT-I as first-line therapy).

Restorative Sleep CORE GUIDELINE DOCUMENTS

• https://jcsm.aasm.org/doi/10.5664/ jcsm.6470

American Academy of Sleep Medicine — Recommended Amount of Sleep for Pediatric

American College of Physicians — Management

Populations

of Chronic Insomnia Disorder in Adults

• Consensus recommendations for infants, children, and adolescents.

• Guideline recommending cognitive behavioral therapy for insomnia (CBT-I) as initial treatment.

• https://aasm.org/resources/pdf/

• https://www.acpjournals.org/doi/10.7326/

pediatricsleepdurationconsensus.pdf

M15-2175

American Academy of Sleep Medicine & Sleep Research Society — Adult Sleep Duration

National Heart, Lung, and Blood Institute —

Consensus Statement

Sleep Health & Disorders Evidence Resources • Clinical information on sleep apnea, insomnia, and cardiometabolic risks.

• Evidence-based recommendation that adults should sleep 7 or more hours per night on a regular basis to promote optimal health.

• https://www.nhlbi.nih.gov/science/sleep-

• https://aasm.org/resources/pdf/pressroom/

science-and-sleep-disorders

adult-sleep-duration-consensus.pdf

WORKPLACE RESOURCES

Centers for Disease Control and Prevention —

National Institute for Occupational Safety and

Sleep and Sleep Disorders Guidelines

Health — Workplace Fatigue & Shift Work

• Public health guidance on recommended sleep duration and sleep health promotion.

Resources • Guidance on fatigue risk management, shift work disorder, and workplace safety.

• https://www.cdc.gov/sleep/index.html World Health Organization — WHO Guidelines

• https://www.cdc.gov/niosh/topics/

on Physical Activity and Sedentary Behavior

workschedules/

(Sleep Integration)

National Safety Council

• Includes 24-hour movement guidelines integrating sleep, sedentary behavior, and activity.

• Fatigue Cost Calculator & Employer Toolkit Tools for quantifying productivity and safety risks associated with sleep deprivation.

• https://www.who.int/publications/i/

• https://www.nsc.org/workplace/safety-

item/9789240015128

topics/fatigue/what-is-fatigue-costing-yourcompany

71

IMPLEMENTATION RESOURCES

Form Positive Social Connections

American Academy of Sleep Medicine — Sleep

CORE GUIDELINE DOCUMENTS

Education (Patient Resources) • Clinician-validated educational tools and sleep disorder screening information.

Centers for Disease Control and Prevention — Loneliness and Social Isolation Resources

• https://sleepeducation.org/

• Public health overview linking social connection to cardiometabolic and mental health outcomes.

Centers for Disease Control and Prevention — Sleep Hygiene & Tips for Better Sleep

• https://www.cdc.gov/social-connectedness/

• Practical behavioral guidance aligned with evidence-based sleep health recommendations.

National Academies of Sciences, Engineering,

• https://www.cdc.gov/sleep/about_sleep/

and Medicine — Social Isolation and

risk-factors/

sleep_hygiene.html

Loneliness in Older Adults (Consensus Report)

National Sleep Foundation — Sleep Health

• Comprehensive evidence review on health impacts and intervention strategies.

Recommendations • Evidence-informed sleep duration and quality guidance for the public and employers.

• https://nap.nationalacademies.org/ catalog/25663/social-isolation-and-

• https://www.sleepfoundation.org/

loneliness-in-older-adults SUPPLEMENTARY RESOURCES

U.S. Department of Health and Human Services

Circadian Care

— Our Epidemic of Loneliness and Isolation (Surgeon General’s Advisory)

• Integrated, coordinated care teams, athome diagnostics, remote monitoring, and treatment to help patients manage complex chronic conditions like heart, metabolic, pulmonary, endocrine, and sleep disorders more quickly and effectively.

• https://www.circadiancare.com/

• Landmark public health advisory outlining health risks of social disconnection and national strategies to strengthen social bonds.

• https://www.hhs.gov/sites/default/files/ surgeon-general-social-connection-advisory. pdf World Health Organization — Social Determinants of Health Framework • Global framework recognizing social connectedness as a determinant of physical and mental health outcomes.

• https://www.who.int/health-topics/socialdeterminants-of-health

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LIFESTYLE MEDICINE & CLINICAL

U.S. Surgeon General — Framework for

CONTEXT

Workplace Connection • Practical employer guidance to build cultures of belonging and reduce workplace isolation.

American Psychological Association — Evidence on Social Support & Health

• https://www.hhs.gov/surgeongeneral/

• Scientific summaries demonstrating reduced mortality and improved resilience with strong social ties.

World Health Organization — Mental Health at

• https://www.apa.org/monitor/2019/05/ce-

Work Policy Brief

priorities/workplace-well-being/index.html

• Evidence linking supportive workplace relationships with reduced burnout and improved productivity.

corner-relationships Harvard T.H. Chan School of Public Health — Human Flourishing Program

• https://www.who.int/publications/i/

• Research linking relationships to longevity and cardiometabolic health.

item/9789240053052

• https://hfh.fas.harvard.edu/

IMPLEMENTATION RESOURCES

National Institute on Aging — Social Isolation,

Campaign to End Loneliness — Loneliness

Loneliness & Health

Measurement Guidance

• Clinical evidence linking social disconnection to dementia, heart disease, and depression.

• Validated tools for measuring loneliness in population and organizational settings.

• https://www.nia.nih.gov/health/loneliness-

• https://www.cdc.gov/social-connectedness/

and-social-isolation

about/

WORKPLACE RESOURCES

Campaign to End Loneliness — Loneliness Measurement Guidance*

American Heart Association — Workplace Well-

• Validated tools for measuring loneliness in population and organizational settings.

• https://www.campaigntoendloneliness.org/

Being & Belonging • Guidance on fostering social support and psychological safety in organizations.

Greater Good Science Center — Evidence-

• https://www.heart.org/en/professional/

Based Practices for Building Connection*

workplace-health

• Research-informed interventions such as gratitude, compassion training, and structured peer engagement.

• https://greatergood.berkeley.edu/

National Institute for Occupational Safety and Health — Total Worker Health®: Social & Organizational Factors • Framework integrating psychosocial safety, belonging, and supportive work culture.

University of California, Los Angeles — UCLA Loneliness Scale

• https://www.cdc.gov/niosh/twh/

• Validated psychometric tool to assess perceived loneliness.

• https://sparqtools.org/mobility-measure/ ucla-loneliness-scale-version-3/

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SUPPLEMENTARY RESOURCES

Optimize your Attitude and Mindset

Harvard Medical School — Health Benefits of

CORE GUIDELINE DOCUMENTS

Strong Relationships • Evidence summaries linking connection to immune function and longevity.

National Academies of Sciences, Engineering,

• https://www.health.harvard.edu/mind-

Emotional, and Behavioral Development

and Medicine — Fostering Healthy Mental,

and-mood/the-health-benefits-of-strong-

• Evidence review on protective cognitive and emotional factors across the lifespan.

relationships

• https://nap.nationalacademies.org/

National Alliance on Mental Illness — Building

catalog/25201

Social Support • Practical guides for strengthening community and peer support.

U.S. Department of Health and Human Services

• https://www.nami.org/Your-Journey/

& Well-Being

— Surgeon General’s Advisory on Mental Health

Individuals-with-Mental-Illness

• Identifies optimism, belonging, meaning, and emotional health as foundational public health priorities.

Stanford Center for Compassion and Altruism Research and Education — Compassion Training

• https://www.hhs.gov/surgeongeneral/

Programs

priorities/mental-health/index.html

• Evidence-based programs supporting empathy and pro-social behavior development.

World Health Organization — Mental Health Action Plan 2013–2030

• https://ccare.stanford.edu/

• Framework promoting mental well-being, prevention, and strengthening protective psychological factors across populations.

• https://www.who.int/publications/i/ item/9789240031029 LIFESTYLE MEDICINE & CLINICAL CONTEXT American Psychological Association — Clinical Practice Guideline for Depression (CBT & Behavioral Activation) • Evidence supports cognitive restructuring and behavioral activation for improving maladaptive thought patterns and outlook.

• https://www.apa.org/depression-guideline

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National Institute on Aging — Positive Affect &

outcomes.

Aging Research

• https://www.apa.org/monitor

• Evidence linking optimism and purpose in life to reduced mortality and improved cardiovascular outcomes.

Mayo Clinic — Positive Thinking & Health Outcomes • Evidence linking optimistic explanatory style with improved immune and cardiovascular

• https://www.nia.nih.gov/research

health.

WORKPLACE RESOURCES

• https://www.mayoclinic.org/healthy-lifestyle/

Gallup Organization — Workplace Engagement &

stress-management/in-depth/positive-

Well-Being Research

thinking/art-20043950

• Evidence linking growth mindset, recognition, and purpose to performance and retention.

National Institutes of Health — Purpose in Life & Health Research

• https://www.gallup.com/workplace

• Research summaries connecting meaning and psychological well-being to reduced chronic disease risk.

• https://www.nih.gov/news-events

U.S. Surgeon General — Framework for Workplace Mental Health & Well-Being • Promotes meaning, recognition, autonomy, and belonging to strengthen workplace mindset and engagement.

• https://www.hhs.gov/surgeongeneral/ priorities/workplace-well-being/index.html IMPLEMENTATION RESOURCES American Psychological Association — Building Resilience Roadmap • Evidence-informed steps to strengthen adaptive thinking and cognitive flexibility.

• https://www.apa.org/topics/resilience University of Pennsylvania Positive Psychology Center — PERMA Model & Evidence-Based Interventions • Framework for cultivating Positive emotion, Engagement, Relationships, Meaning, and Accomplishment.

• https://ppc.sas.upenn.edu/ SUPPLEMENTARY RESOURCES American Psychological Association — Growth Mindset Research Overview • Evidence supporting adaptive cognitive framing in performance and resilience

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brief counseling interventions in primary care.

• https://www.uspreventiveservicestaskforce. org/uspstf/recommendation/unhealthyalcohol-use-in-adolescents-and-adultsscreening-and-behavioral-counselinginterventions

Reduce/Avoid Risky Substances CORE GUIDELINE DOCUMENTS Centers for Disease Control and Prevention — Alcohol & Public Health Guidelines • National recommendations on alcohol consumption limits and prevention strategies.

World Health Organization — Global Strategy to Reduce the Harmful Use of Alcohol

• https://www.cdc.gov/alcohol/index.htm U.S. Department of Health and Human Services

• Population-level policy framework and intervention guidance.

Office of the Surgeon General – Alcohol and

• https://www.who.int/publications/i/ item/9789241599931

Cancer Risk • Scientific evidence for causal link between alcohol consumption and risk for at least seven types of cancer, including breast (in women), colorectum, esophagus, voice box, liver, mouth, and throat.

World Health Organization — WHO Framework Convention on Tobacco Control (FCTC) • International treaty guiding tobacco control policies and cessation strategies.

• https://www.who.int/news-room/fact-

• https://www.hhs.gov/surgeongeneral/

sheets/detail/tobacco

reports-and-publications/alcohol-cancer/ index.html

LIFESTYLE MEDICINE & CLINICAL

U.S. Preventive Services Task Force — Screening

CONTEXT

& Behavioral Counseling for Unhealthy Drug Use

American Society of Addiction Medicine —

• Evidence-based recommendations for screening adults and adolescents in primary care and providing brief behavioral interventions.

National Practice Guideline for the Treatment of Opioid Use Disorder • Evidence-based clinical recommendations for pharmacologic and behavioral treatments.

• https://www.uspreventiveservicestaskforce.

• https://www.asam.org/quality-care/clinical-

org/uspstf/recommendation/drug-use-illicit-

guidelines/national-practice-guideline

screening

National Institute on Drug Abuse — Principles of

U.S. Preventive Services Task Force — Tobacco

Drug Addiction Treatment

Smoking Cessation in Adults & Pregnant Persons

• Research-based guide to effective treatment approaches.

• Evidence-based guidance on behavioral and pharmacotherapy interventions.

• https://nida.nih.gov/research-topics/

• https://www.uspreventiveservicestaskforce.

treatment

org/uspstf/recommendation/tobacco-usein-adults-and-pregnant-women-counseling-

Substance Abuse and Mental Health Services

and-interventions

Administration — TIP 63: Medications for Opioid Use Disorder

U.S. Preventive Services Task Force — Unhealthy

• Comprehensive evidence-based clinical guideline for treatment of opioid use disorder

Alcohol Use: Screening & Behavioral Counseling • Grade B recommendation for screening and

76

Smokefree.gov — National Smoking Cessation

(MOUD).

Tools

• https://www.samhsa.gov/blog/substance-

• Free apps, text-based programs, and quitline resources.

use-disorders-treatment-options WORKPLACE RESOURCES

• https://smokefree.gov/

National Institute for Occupational Safety and

Substance Abuse and Mental Health Services

Health — Workplace Supported Recovery

Administration — National Helpline (1-800-662HELP)

• Guidance for employers on substance use prevention, stigma reduction, and recoveryfriendly policies.

• Confidential referral and treatment resource for substance use disorders.

• https://www.cdc.gov/niosh/topics/opioids/

• https://www.samhsa.gov/find-help/national-

workplace-supported-recovery.html

helpline

Substance Abuse and Mental Health Services

SUPPLEMENTARY RESOURCES

Administration — Drug-Free Workplace Toolkit

American Heart Association — Alcohol &

• Employer guidance for prevention programs and supportive policies.

Cardiovascular Health Guidance • Evidence summaries linking substance use to cardiometabolic outcomes.

• https://www.samhsa.gov/workplace U.S. Department of Labor — Recovery-Ready

• https://www.heart.org/en/healthy-living/

Workplace Toolkit

healthy-eating/eat-smart/nutrition-basics/

• Resources for building recovery-supportive workplace cultures.

alcohol-and-heart-health Centers for Disease Control and Prevention —

• https://www.dol.gov/agencies/eta/RRW-

Cannabis & Health Effects

hub/Toolkit

• Evidence summaries on cannabis-related health risks.

World Health Organization — Healthy Workplace Framework

• https://www.cdc.gov/cannabis/health-

• Guidance integrating substance use prevention into occupational health systems.

effects/ National Cancer Institute — Tobacco & Cancer

• https://www.who.int/publications/i/

Evidence

item/9789241599313 IMPLEMENTATION RESOURCES

• Research linking tobacco use to cancer and prevention strategies.

Centers for Disease Control and Prevention —

• https://www.cancer.gov/about-cancer/ causes-prevention/risk/tobacco

Tobacco Cessation Resources • Evidence-based cessation strategies and quitline access.

QuitAssist (not affiliated) • Free online resource to help adult tobacco users quit smoking, vaping, or dipping by connecting them with expert information, tools, stories, and links to resources like quitlines and support programs.

• www.Quitassist.com

• https://www.cdc.gov/tobacco/hcp/patientcare/quitlines-and-other-resources.html

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• https://www.acpjournals.org/doi/10.7326/

Manage Stress

M16-2367 National Center for Complementary and

CORE GUIDELINE DOCUMENTS

Integrative Health — Mindfulness & Stress

American Psychological Association — Clinical

Reduction Evidence

Practice Guideline for the Treatment of PTSD

• Research summaries on mindfulness-based stress reduction (MBSR), meditation, yoga, and relaxation therapies.

• Evidence-based recommendations supporting cognitive behavioral therapy (CBT) and related interventions for stressrelated disorders.

• https://www.apa.org/ptsd-guideline

• https://www.nccih.nih.gov/health/providers/ digest/mind-and-body-approaches-forstress

National Institute for Occupational Safety and

Substance Abuse and Mental Health Services

Health — Stress at Work Framework

Administration — Evidence-Based Behavioral

• Public health guidance outlining organizational and individual strategies to reduce workplace stressors.

Health Interventions • Repository of validated stress management and resilience programs.

• https://www.cdc.gov/niosh/stress/about/

• https://www.samhsa.gov/resource-search/

index.html

ebp

National Institute of Mental Health — Stress and Coping Resources

WORKPLACE RESOURCES

• Scientific overview of stress physiology and validated coping interventions.

U.S. Surgeon General — Framework for

• https://www.nimh.nih.gov/health/

Workplace Mental Health & Well-Being

World Health Organization — Guidelines on

• Evidence-informed guidance to reduce burnout and improve psychological safety at work.

Mental Health at Work (2022)

• https://www.hhs.gov/surgeongeneral/

publications/so-stressed-out-fact-sheet

• Evidence-based recommendations for preventing work-related stress, burnout, and promoting mental well-being in occupational settings.

priorities/workplace-well-being/index.html World Health Organization — WHO Self-Help Plus (SH+) Stress Management Program • Evidence-based scalable stress management intervention for community and workplace use.

• https://www.who.int/publications/i/ item/9789240053052 LIFESTYLE MEDICINE & CLINICAL

• https://www.who.int/publications/i/

CONTEXT

item/9789240035119

American College of Physicians —

IMPLEMENTATION RESOURCES

Nonpharmacologic Treatment of Chronic Pain

Centers for Disease Control and Prevention —

• Guideline supporting stress-reducing therapies such as mindfulness, CBT, and exercise.

Coping with Stress • Practical public health strategies for recognizing and managing stress.

78

• https://www.cdc.gov/mental-health/

Lyra Health

stress-management/basics/stress-basics/

• Digital mental health benefits platform connecting workers to evidence‑based therapy, coaching, and mental health support through an AI‑enhanced, technology‑driven care system designed to improve wellbeing and outcomes while reducing healthcare costs.

hlv-20049495

• https://www.lyrahealth.com/

Mayo Clinic — Stress Management Toolkit • Evidence-informed guidance on relaxation techniques, cognitive reframing, and behavioral strategies.

• https://www.mayoclinic.org/healthy-lifestyle/

National Alliance on Mental Illness — Managing

SUPPLEMENTARY RESOURCES

Stress & Mental Health

American Psychological Association — Stress in

• Community-based resources for coping and resilience building.

America Report • Annual survey data informing policy and workplace strategy.

• https://www.apa.org/news/press/releases/ stress

• https://www.nami.org/living-with-a-mentalhealth-condition/managing-stress/ Springheath • Digital mental health platform with assessments, coaching, therapy, medication support, and wellness tools and tailored mental health support through a connected virtual system.

Curalinc • Employee assistance and workforce mental health and well-being programs that offer clinically oriented, accessible behavioral health support, advocacy, and related services to help organizations support workers’ mental health and productivity.

• https://try.springhealth.com/ Wellcoaches

• https://curalinc.com/ Harvard Medical School — Relaxation Response

• Certification program to support sustainable behavior change and well‑being in clients.

Research

• https://www.wellcoachesschool.com/

• Evidence linking stress reduction practices to improved cardiometabolic markers.

CROSS-PILLAR / SYSTEMS-LEVEL INTERVENTIONS AND RESOURCES

• https://www.health.harvard.edu/mind-andmood/relaxation-techniques-breath-control-

American Institute for Cancer Research (AICR)

helps-quell-errant-stress-response

Healthy 10 Challenge • Free 10‑week interactive online program to build healthier eating and activity habits based on evidence‑based cancer prevention recommendations.

The LIFT Project • ACLM Certified Program. 10-week evidencebased well-being and resilience lifestyle medicine program to help workers improve mental wellbeing, reduce stress, and boost resilience while enhancing workplace culture and performance.

• https://www.theliftproject.global/

• https://healthy10challenge.org/ Building Resilient and Healthy Workplaces (not affiliated) • Executive-level framing and case examples that connect workforce health to organizational performance.

corporateedition/

79

symptoms and improve health and quality of life.

• https://www3.weforum.org/docs/ WEF_Building_Resilient_and_Healthy_

• https://selfmanagementresource.com/

Workplaces_2024.pdf

programs/small-group/workplace-chronic-

CDC NIOSH’s Fundamentals of Total Worker

disease-self-management-small-group/

Health Approaches

Paving the Path to Wellness

• Essential Elements for Advancing Worker Safety, Health, and Well-Being • https://www.cdc.gov/niosh/docs/2017-112/ default.html

• https://www.pavingwellness.org/pavingprogram Freedom from Diabetes (ACLM Certified Treatment Program)

Center for the Promotion of Health in the New

• Improved health through holistic lifestyle changes involving personalized medical support, diet, exercise, and behavioral transformation

England Workplace (CPH-NEW) • Supports employers in assessing and building organizational readiness and management support to successfully start Total Worker Health® or Healthy Workplace Participatory Program with tools, surveys, and consultative guidance to evaluate resources, leadership commitment, and preparation before implementation.

• freedomfromdiabetes.org Full Plate Living (ACLM Certified Education Program) • No cost ACLM Certified Shared Medical Appointment program. Can be run in the workplace as 8 session program w/o medical billing.

• https://www.uml.edu/research/cph-new/ worker/organizational-readiness.aspx Centers for Disease Control and Prevention’s

• https://www.fullplateliving.org/

National Diabetes Prevention Program (NDPP)

Fuel-Restore-Invigorate-Connect-Protect 90/10

• Evidence‑based initiative helping people at risk for type 2 diabetes make sustainable lifestyle changes through a year‑long lifestyle change program.

Principle of Energy Management • Renewing and managing personal energy across physical, emotional, mental, and spiritual dimensions rather than just trying to manage time.

• https://www.cdc.gov/diabetes-prevention/ The Chanwuyi Lifestyle Medicine Program (ACLM

• https://hbr.org/2007/10/manage-your-

Certified Treatment Program)

energy-not-your-time

• Diet, physical activity, stress management, and emotional well-being. ACLM Certified Program.

Harvard Online course “Improving Your Business Through a Culture of Health” • Online course for business leaders on implementing a “Culture of Health” to enhance organizational performance, reduce costs, boost revenue, and strengthen reputation.

• https://www.chanwuyilifestyle.psy.cuhk.edu. hk/ Chronic Disease Self-Management Program (CDSMP) (not affiliated)

• https://www.harvardonline.harvard.edu/

• Evidence‑based workshop designed to help adults with chronic conditions develop skills, confidence, and strategies to better manage

course/improving-your-business-throughculture-health

80

Harvard T.H. Chan Center for Work, Health, &

Measuring What Matters: Assessing Workplace

Well-Being

Mental Health and Well-being

• Implementing an Integrated Approach: Weaving Worker Health, Safety, and Wellbeing into the Fabric of Your Organization

• Focused on mental health but useful for governance, metrics, and accountability frameworks.

• https://dash.harvard.edu/entities/

• https://www3.weforum.org/docs/WEF_

publication/2ad61d5d-5753-4bc5-a6fa-

Assessing_Workplace_Mental_Health_and_

01f3d237d79a

Well_being_2024.pdf

Healthy Workforces Initiative

My Viva Inc. (ACLM Certified Education Program)

• Establishes the workplace as a primary setting for prevention and holistic workforce health, with a strong global employer lens.

• Digital tools, expert coaching, and clinical integration to prevent and manage chronic disease, improve resilience, and drive meaningful change.

• https://initiatives.weforum.org/healthy-

• https://discover.myvivaplan.com/

workforces/home The LIFT Project (ACLM Certified Education

Nudj Health (ACLM Certified Treatment

Program)

Program) • Nutrition, physical activity, stress management and sleep

• ACLM Certified Program 10 session program • https://www.theliftproject.global/

• https://www.nudjhealth.com/

corporateedition/ Massachusetts General Healthy Lifestyle

OHS Vulnerability Measure, Institute for Work &

Program

Health (IWH) • Measures the extent to which a worker may be vulnerable to occupational health and safety risks at work, associated with elevated rates of self-reported work injury and illness.

• https://www.iwh.on.ca/tools-and-guides/

• Virtual group visits, health and wellness coaching, and education to help patients adopt healthy behaviors to prevent and treat chronic diseases and improve overall health.

• https://www.massgeneral.org/medicine/

ohs-vulnerability-measure

internal-medicine/healthy-lifestyle-program

Ornish Program

McKinsey Workplace Intervention Tool (not

• Nutrition, Exercise, Stress Management, Relationships

affiliated) • Results of analysis of 115 evidence-based workplace interventions across four dimensions of health: physical, mental, social, and spiritual.

• https://www.ornish.com/ Pivio (formerly CHIP Program) (ACLM Certified Education Program)

• https://www.mckinsey.com/mhi/our-

• Evidence‑based LM program by the Lifestyle Medicine Institute helping prevent, treat, and reverse chronic disease through sustainable behavior change while also reducing

insights/from-potential-to-practical-fuelingperformance-with-proven-workplace-healthinterventions

healthcare costs.

• https://piviohealth.com/

81

Thriving Workplaces: How Employers Can

World Economic Forum: Workforce Health

Improve Productivity and Change Lives (2025)

Across the Value Chain

• Provides a clear business case (productivity, resilience, value creation) along with practical employer actions.

• Speaks to coordinated, scaled approach across many stakeholders.

• https://www.weforum.org/publications/

• https://reports.weforum.org/docs/WEF_

workforce-health-across-the-value-chain-

Thriving_Workplaces_How_Employers_

organizational-insights-to-mitigate-risk-and-

can_Improve_Productivity_and_Change_

create-sustainable-growth/

Lives_2025.pdf TrueNorth Health Center (ACLM Certified Treatment Program) • To address chronic conditions, educational programs, lifestyle counseling, and evidencebased therapies to promote sustainable health improvements.

• https://www.healthpromoting.com/ WELL-LEADER MINDSET™ Masterclass • 12-week wellness program for executives and other organization leaders.

• https://www.well-leadermindset.com World Economic Forum: Employer Strategies for Encouraging Healthy Weight and Metabolic Wellness • Particularly aligned with lifestyle medicine pillars (nutrition, physical activity, metabolic risk management) and offers concrete employer approaches.

• https://www.weforum.org/publications/ promoting-health-and-well-being-employerstrategies-for-encouraging-healthy-weightand-metabolic-wellness/

82

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