PREVENTIVE MEDICINE 18, 460-474 (1989) Weight Loss Competitions at the Worksite: How They Work and How Well’ ‘Aunerr J. STUNKARD, M.D.," Rita Yorr COHEN, P#.D.."? AND MicHAEL R. J. FELIXt* 133 S, 36th Sieet, Philadelphia, Pennsylvania 19104, and University of Pennsytvai ih Locoming College, Williamsport, Pennsylvania 17701 siute of Community -Thnee sudies were conducted to evaluate the effectiveness of competition as a method of seaiht iss at the worksite. Study | found team competitions more effective then ether wee ooh or individual competion for men and more effective than individual comps (oo or Seady 2 replcsed the eflectivenes of team competitions a 10 worksites re ee af Your vanables (gender, age. type of employment (buecolar vs white: ae aac rth of asigment to tars) upon four outcomes (eerie. tron, ca aug und cowveffectveness), was assessed. Tis study showed that he resus of aan oe were robust and widely generalizable, Recruitment was bigh, attrition ve fo see oes large, and coselTctveness favorable, Study 3, however, found only United ee eee of weisht loss folowing competitions. © 19 Arles Pee. INTRODUCTION “This report isthe third in a series that describes the use of weightloss compe, tition at the worksite (1, 2). These competitions represent a major advance over vecamal types of worksite Weight loss programs. No fewer than nine reports Hace documented the disappointing record {low rates of participation, high attri ran 0.809%), and limited weight losses (3-11) of traditional programs, By con: hast two innovations, designed to take advantage of special worksite characier- rests ‘have improved upon the results of traditional programs. One innovation; sees et financial incentives implemented through payroll deductions, reduced Une ction to 6% in one study (12) and to 21% in another (13). The second innova- qian. the use of weight loss competitions, has had even more far-reaching rests, ‘Our frst study revealed the potential of these competitions —extremely effec: tive recruitment (almost all overweight persons at the worksites), very low ati: ties (0.3%), and weight losses that averaged 5.5 ky during a 12-week program (1). ‘Our second report found that team competitions were significantly more effective than individual competitions (2) It raised the question whether it was competition heel, the cooperation involved in team competitions, that was the effective ‘element in weight loss competitions, «Supported in part by grants from the W. K. Kellogg and John & Catherine Macarius Fours ona era gy as Research Scientist Award from the National Institute of Mental Health 19 Pr. Suunkard, Ta whom reprint requests should be addressed. eee nee sre: Department of Psychology, University of Delaware, Newark, DE 19711 * Gument addres: Henry J. Kaiser Family Foundation, Menlo Park, CA 025 4 0917435789 $3.00 (Cony © 19 by Ace PT. ‘Aap rpocon a fo oreWORKSITE WEIGHT LOSS COMPETITIONS. 461 The present report describes three related studies. Study I addressed the ques- tion as to the effective element in weight loss competitions. Study 2 determined how widely the results of competitions can be generalized, and study 3 assessed the maintenance of the weight losses achieved in competitions. These studies were part of a community-based health promotion program. The County Health Improvement Program (CHIP) was a multiple risk factor reduction program designed to reduce cardiovascular disease risk in Lycoming County, a largely rural region of 118,000 persons in North Central Pennsylvania (14). The five risk factors targeted by CHIP were hypertension, smoking, elevated serum cholesterol, obesity, and physical inactivity. CHIP operated through five chan- nnels—the mass media, the health sector, voluntary and community organizations, and the schools, as well as the worksites which are the focus of the present study. STUDY 1 Study I assessed the effective element in weight loss competitions by compar- ing three conditions: individual competition, pure cooperation, and their combi- nation in team competitions. Subjects and Methods All employees at six worksites were invited to participate in weight loss pro- grams. The worksites were then assigned to one of the three conditions described below. Characteristics of the worksites are shown in Table 1. There were no significant differences among participants at the six worksites in percentage over- weight nor any difference between men and women in initial percentage over- weight or mean age (39 for both). Employees were invited to an introductory meeting at which the 12-week pro- sram Was described. Height and weight were measured, and individual weight loss TABLE | Cuazactenisrics oF Worxsires iv Stuy Companina Teas Comrerttion, INpiviouat Comperition, wo Cooeenarion Team Tnividual competitions competitions Cooperation ‘Type of company Manufscwring Manufacturing Bank Number of employees 2s 2s 0 Participation (%) 24% 139% 19% Participation () 3 a ‘Type of company Manufacturing - Manufacturing [Number of employees 220, ‘Bs Participation (6) 108% 18% Participation (n) 2 a Type of company = = Bank Number of employees 2 Participation (2) 5% Participation () 6462 STUNKARD, COHEN, AND FELIX goals were set, on the basis of the midpoint of the desirable body weight of the 1959 Metropolitan Life Insurance Company tables (15). In order to discourage crash dieting the maximum goal for each participant was 20 Ibs. Although partic- pants could lose more than 20 Ibs, they received no credit for losses that ex. ceeded their goal. Each participant contributed $5.00 to enter the program and $5.00 was contributed by management. Thus the pool of money that served as incentive was equated across conditions. The program consisted of weekly weigh-ins conducted by a member of the research team, at which time participants received a page of weight loss sugges- tions based on behavioral principles (16). No professionally trained staff took part in these weigh-ins. Weigh-ins and weight loss suggestions were thus the same in all three conditions; only the structure of the program was systematically varied ‘among them. Treatment | (team competition). Subjects were randomly assigned to teams within each worksite—33 participants in three teams at the first worksite and 22 participants in two teams at the second worksite. Competitions were conducted according to the format used in our earlier studies (1, 2, 16). The team goal consisted of the collective weight loss goals of each of its members. To increase the salience of the competition and to enhance public commitment, participants ‘were weighed during the lunch period in a prominent site in the company cafete- ria. Employees were thus able to see and interact with both their teammates and their competitors at the weigh-in each week. In addition, a large poster of a weight loss barometer, similar to posters used in United Way campaigns, was placed at the worksite. Each team’s progress was recorded on a weekly basis to provide feedback and incentive. Only the team percentages were displayed. The team that achieved the greatest percentage of its weight loss goal was the winner and re- ceived the entire pool of money. Treatment 2 (individual competition). This competition involved individuals, Participants who reached their weight loss goals received a percentage of the total pool, while those who achieved from 75 to 997 of their goal received half of this amount. Thus, there was no incentive for cooperation: the fewer the participants who lost weight, the more each participant would win. Posters in this competition displayed the weight losses of participants without identifying them, to permit ‘them to gauge their progress vis a vis that of their competitors. Treatment 3 (pure cooperation). In the cooperation condition the prize was based on the percentage of the goal achieved by the entire worksite. Ifthe group lost at least 50% of its goal, participants received their original contribution plus ‘an amount from management depending upon the percentage of goal attained: $10.00 for 100%, $5.00 for 80-9996, $2.50 for 65-797, They received nothing from management for losses of less than 65% and forfeited their contribution for losses of less than 509%. As in the team competition, posters displayed only the group's Progress, ‘Two changes were made in the initial plans for assignment of companies to treatment conditions. In the individual competition condition, the first trial made it clear that this treatment was not effective and not particularly valued by par- icipants. Accordingly, since the sample size was adequate for statistical analysis,WORKSITE WEIGHT LOSS COMPETITIONS 463 second worksite was not assigned to this condition. On the other hand, in the cooperation condition an unexpectedly large number of participants (25%) was found to be less than 10% overweight and thus not acceptable for statistical analysis. Accordingly, two other worksites were added to this condition to reach an adequate sample size. All applicants who were at least 5 Ibs overweight were accepted into the pro- gram. Data analyses presented in this report, however, are confined to persons who were at least 10% overweight. Furthermore, heights, necessary for calculat~ ing percentage overweight, were not available for a few participants. As a result of these two factors, the number of subjects whose weight losses are reported in Table 2, especially in the cooperation condition, is somewhat lower than the number of subjects who are listed as participants in Table 1 Data Analysis Most analyses were conducted on percentage change in initial weight which was subjected to analysis of variance and analysis of covariance with initial weight as the covariate. To facilitate the comparison of changes between men and women, change in percentage overweight as well as in weight was analyzed. Results for the analyses of variance and covariance did not differ, so only the results of the former are reported. Similarly, the statistical significance of the differences in percentage weight change shown in Table 1 is almost identical to that of the differences in weight change shown in Figs. I and 2. While participants did not receive credit in the competitions for weight losses of greater than 20 Ibs, some lost more than 20 Ibs and their actual weight losses were used in the analysis, Frequencies were analyzed by the x? test. Results Arition, defined as attendance at fewer than 8 ofthe 12 weekly weigh-ins, was far lower for the team competition (0%) and the cooperation condition (19%) than for the individual competition (17%) (x? = 22.01, P< 0.001). ‘There were differences in the pattern of weight losses between men and women. Among men, team competition was clearly more effective than the other two ‘modalities. Figure 1 shows that men lost more weight in the team condition than in the other two conditions (P < 0.01), which did not differ significantly from each other. Among women there was no significant difference between the team and co- operation conditions, both of which outperformed the individual competition ig. 2). The results of weight loss in kilograms shown in Figs. 1 and 2 are the same as. those of percentage weight loss shown in Table 2, with one exception. Men lost more weight than did women, as is usual for the heavier people, but there was no difference between men and women in percentage weight loss. Questionnaires administered to participants in the team competition and coop- eration conditions revealed a very favorable response to the program. All partic. ipants in each program, for example, recommended that the program be con464 STUNKARD, COHEN, AND FELIX Is MEN KILOGRAMS LOST +4. Fio. 1. Diseibution of weight losses among men in the three conditions. Note that these weight losses are in kilograms and notin percentage overweight, as was utilized inthe analyses reported in ‘the body of the text. The statistical sigaiicance ofthe results. however. isthe same for bath measures: ‘men in the team condition lost more weight than those inthe other two conditions. ducted again. The team competition, however, was more effective than the co- ‘operation condition on two measures—fostering high morale (77% vs 56%), x? = 69, P < 0.001) and improving relations with co-workers (59% vs 28%), x° 13.00; P < 0.001). There was no significant difference between men and women on any of the questionnaire results. STUDY 2 The generalizability of team competitions was tested in 10 competitions con- ducted at 15 worksites with different types of employees and different methods of assignments to teams. Subjects and Methods A total of 1,177 employees took part in the competitions, 20% of the work force, land an even higher percentage of persons who were at least 10% over ideal body ‘weight—466 men and 488 women. In addition, 222 persons who were less than 10% overweight participated; their results are discussed below in the section on “mildly overweight persons." There were no statistically significant differences in the mean age of male and female participants who were more than 10% over- weight (m = 39) nor between their age and that of the entire work force (m = 38) Likewise there was no difference between men and women in their mean initial percentage overweight (32.6 and 32.5%, respectively). Competitions were con- ducted at worksites representing a wide variety of activities—four banks, several light manufacturing firms, and a community college (Table 3). Competitions were ‘conducted both between and within worksites. When conducted within worksites,WORKSITE WEIGHT LOSS COMPETITIONS 465 WOMEN : OGRAMS LosT +4 Fic, 2, Distribution of weight losses among women inthe three conditions. Asia the case of men, weight losses are in kilograms rather than in percentage overweight, as was utilized in the analyses reported inthe body of the text. The statistical significance ofthe results, however, isthe same for both measures: there was no difference in weight losses ofthe women inthe team and cooperation conditions, both of which were greater than thor inthe individual competition subjects were assigned by the company, either randomly, by sex, or by division of the company. Results Four outcome measures indicated that the 10 competitions of Study 2 were as effective as those in Study 1. Furthermore, they compared most favorably with traditional methods of weight loss at the worksite in terms of recruitment, attri- tion, weight losses, and costleffectiveness. Study 2 showed that team competi- tions can operate in a wide variety of settings, with different kinds of persons, and with differing methods of assignment to teams. Recruitment. A very large percentage of all employees (21%) joined the com- petitions. Some were not frankly obese and we do not know the percentage of ‘overweight persons at these worksites. It is unlikely to have exceeded the national average of 25 to 30% of adults. Despite this favorable result, there were differences in the type of employee entering the competitions. Two traditionally underrepresented groups, men and blue-collar workers, were also underrepresented in the competitions, although probably not to the same degree. Although the overall work force was 672 male and 33% female, participants were 43% male and 57% female (x? = 308.98, P < 0.004). Blue-collar workers were less likely to join competitions than were white-collar workers. Dividing the worksites somewhat arbitrarily into blue-collar and white- collar, 58% of the work force was blue-collar, 42% white-collar. Participants, on the other hand, were 38% blue-collar and 62% white-collar (x? = 222.65, P < 0.001).466 STUNKARD, COHEN, AND FELIX TABLE? niriar Weicn AND WeicitT Loss oF Parriciratrs 1 Srupy Comranino TEAM COMPETITION, INDIVIDUAL COMPETITION. AND COOPERATION “Team competition Individual competion _Cooperation Men Women _-Men_—Women__—Men__ Women * Fry a 20 6 us Tria weigh ke) ola 1 912 7 aT T5A Standard deviation 36 9 Ba fe Final weight ke) a0 670 BL 71 887 1 Standard deviation Be itd 180 ofa 1313). Weightloss tke) or aa 29 os 3942 Inia percent overweight 32-432. 308 so S86 Percent weight change 9016 50 10 ss 68 “Analysis of weigh change across groups was assessed using & 5.x 2.52 (Groups x Sex X Tras) repeated-measures analysis of variance ‘on percentage overweight. Sourse g F Pe Groups 2 098 rs Sex 1 om as. ‘Teal 1 16 o.oo1 Groups * Tal 2 BS 00 “Attrition, Table 3 shows that attrition was even lower in this study than that in clinical programs (17). Attrition was greater than 4% at only one worksite, and that was a special case. The 13% attrition at the college was due to a summer vacation. Weight loss. Weight losses were large and compared favorably with those of clinical programs. Among persons who were initially more than 109% overweight, ‘Weight losses in the 12-week program were 6.3 kg for men and 4.4 kg for women. ‘The difference between the sexes was due to the greater weight of the men; when thelr difference in weight was controlled by use of percentage of initial weight lost, tho difference between men (—9.1%) and women (~8.0%) was not statistically significant. ‘Factors associated with success in weight loss were assessed by means of a regression analysis. These factors were age, sex, type of competition (between warksites, between divisions within worksites, and between randomly assigned Teams), type of worksite (blue-collar vs white-collar) size of company, and per- Centage ofthe work force which participated. The analysis assessed percentage ‘overweight after treatment, entering initial percentage overweight first in all equa tions. Two regressions were conducted, one in which each main effect was en- tered second and one in which each main effect was entered last (afterall the other main effect predictors). None of the main effects was significant in either regres- ‘Sion, suggesting that competitions were equally effective in achieving weight loss under these conditions.WORKSITE WEIGHT LOSS COMPETITIONS 467 TABLE 3 (Cuaractenisrics oF Worxsires ConDUcTING TEAM COMPETITIONS Number of Type of Number or Patticnamts ps seage competion company _ employees Gm) (2) attrition 1 Sbanks «S76 ~SSCTSSC 0 2 Manufacturing 225, rr) 3 Manufacturing 1072 pss tse + College 08 aos 8 5 Manufacturing 239, Mop Gg 6 4 banks 930 3st 7 Manufacturing 653 s Bo 2 3 Manufacturing — 220 ize te ae 0) 9 School district $30 2364s 1 [0 Manufacturing 909 mm 2 4 ne 5762 47 Mean: $76 1a -26 ‘Nore. The worksites in competitions 1, 4, 6, and 9 were somewhat arbitrarily classified as white. collar and the other six as blue-collar on the bass ofthe satus ofthe majority of employees. Most worksites had a mixcure of blue-collar and white-collar employees. One of these findings is so important that it deserves special attention: weight loss was as great among blue-collar workers as among white-collar workers, Blue-collar vs white-collar workers. There has been little experience with health Promotion programs for blue-collar workers in comparison with the vast experi- ence with white-collar workers. As noted above, blue-collar workers were less likely to enter competitions than white-collar workers, even though they seemed more likely to enter competitions than other types of health promotion programs (18). We therefore were particularly interested in the evidence that, if they entered programs, they lost weight as readily as did white-collar workers. To investigate this finding more intensively we focused on competition No. 10 within a manu. facturing firm in which, despite its classification as a blue-collar worksite, equiv. alent numbers of blue-collar and white-collar workers participated, Eleven teams of varying composition competed—S largely blue-collar, 5 largely white-collar, and I mixed. A measure of the relative success of the two types of employees is the percentage of persons within each team who reached their weight loss goal. Overall, 50% of blue-collar workers reached this goal compared to 449% of white-collar workers. Table 4 demonstrates in an even more striking ‘manner this similarity between the results achieved by the two types of workers, Costleffectiveness. Costs were estimated according to standard methods. The ‘major item was the time of the 6-10 members of the industry Heart Health Com- mittee who planned, coordinated, and administered the program with minimal assistance from the staff of the County Health Improvement Program (CHIP), These Committees, described elsewhere (14), were important elements in CHIP and played a key role in the initiation of its health promotion programs at the worksite. They were thus favorably situated to implement the competitions andBlue-collar employees White-collar employees Team number _n ching goal on team a veahing goal woo way 7 T 7 7 9 z 5 » 0 1 3 s . " " 4 18 18 ° 0 5 3 u 1 4 ‘ 3 2 3 6 7 1 ir 0 5 1 8 9 0 5 10 1 4 4 3 4 Tout 50 the real op Sibht loss program withthe next best record (Ip, Figure 3 shows the results of several programs, {idly overweight persons. Large numbers of persons who were less than 109% eight Siac oar i the competitions “to help the team" ae well ga lose soa gains it Was often easy for them to reach their very meters weight loss cowie {hey were valuable members of the teams and the Participation was a Tor boost to morale. Forty-one men and 181 women ine category took part women atstically significant difference in the mean ages of nc, (m = 34) and women (m = 33) nor in ther initial percentage ‘overweight (7.9 and 5.0, and shangh Milly overweight men lost 3.4 ke (3-890) and weve, 2.9 kg 3.1%) 1nd shared in the improved morale and personal reins of their heavier col- ues.WORKSITE WEIGHT LOSS COMPETITIONS 469 a Cost por 1% Reduction 1 eee pee” one cree gue To SEE” HS tle aS cycacs par en Fo, 3. The cost per 1% reduction in pereniage oversight for diferent weigh los pros. Estimates Update for inflaton forthe Unser lc andthe Conese Fragen wert eed from Yates (9) and forthe Worst propa with Professional apd Lay Leaden om Drswel ab (i, Estimates fr Cine Very-Low-Caorie Dit an Behavior Therapy a fos Stnked i) STUDY 3 Maintenance of weight loss is the final, critical element in programs of weight control. It was the one element of weight loss competitions that proved to be a failure. Follow-up studies using measured weights were conducted following three of the competitions (Nos. 1, 6, and 10 in Table 3). As shown in Table 3, competitions | and 6 were conducted in banks while competition 9 was conducted in the school district, with teachers and administrators. These three sites differed from the other seven by having higher proportions of white collar workers and higher rates of participation in the competitions—from 27 to 45%. Both factors might be ex- pected to bias the maintenance of weight loss in a favorable direction. ‘The percentage of persons who were followed-up decreased with the duration of time from the end of treatment, from 87% at 6 months in competition 3 to 58% at I year in competition 9 (Table 5). This attrition adds a bias favoring the inclu- sion of persons who had succeeded in maintaining their weight loss to that con- tributed by the selection of worksites noted above, Despite these favorable bi ases, in the first (6 mos) follow-up only 54% of the weight loss had been main tained. In the 8 mos follow-up of the second competition, this value had fallen to 51% and in the 1 yr follow-up of the third competition, it was only 279%. DISCUSSION The great potential of the worksite for health promotion raises the question of hhow best to realize this potential. Until recently weight loss programs have failed to capitalize on the unique characteristics of the worksite. Weight loss compet tions have radically changed this picture and have introduced a new dimension to470 STUNKARD, COHEN, AND FELIX TABLES 1 OF WeIcHT Lossts IN Tunez Conrerimons Competition aumber ‘ 10 G banks) (4banks) (manufacturing company) Number of participants completing competition 76 22 19s Duration of follow. (months) 6 8 2 Percentage followed-up a 6 8 Weightloss during program (ks) 59 49 62 Weight loss a follow-up (kg) 32 25 u Percentage weight loss maintained se 2 a weight reduction at the worksite. It is vitally important to understand how weight loss competitions exert their effect. The first major finding of the present report contributes to this understanding. Although subject to the limitations of a quasi-experimental design (20), our first study showed that competitions between teams were more effective than either cooperation of individual competition for men and more effective than individual competition for women. It appears that the combination of cooperating with one's peers in competing against an out-group is an important element in team compe- titions. Furthermore, a finer-grained analysis suggests that men and women may be motivated somewhat differently in these endeavors. For women, cooperation appears to be more important, and individual competition less important, than is the case for men. It is of interest that competition/cooperation was a major topic in older social psychological literature, with results similar to those of the present report (21-23). Laboratory studies of the earlier era, for example, had indicated that competition, both group and individual, was more effective than cooperation, even though Participants tended to rate cooperation more highly. Although occasional studies still address these issues (24), for reasons that are not clear, this field of research has largely died out. Perhaps the demonstration of the great potential of compe- titions in promoting healthy behaviors will lead to a revival of the field. The second major finding of this report is the high rate of worksite health promotion program recruitment. Earlier experience with storeworkers in New York City is instructive (4). Three years of intensive effort under the sponsorship of a highly popular, health-oriented union succeeded in enrolling a total of 171 of the 15,000 union members in a traditional weight reduction program at the work- site. Other traditional programs have achieved higher rates of recruitment, but one compares with the 21% of the entire work force at the 10 sites described in Study 2. Furthermore, as noted above, it seems likely that only 25 to 30% of the work force was overweight. If so, it appears as if a majority of overweight persons were recruited into the program. Not only the number but also the character of recruits into the program is Worthy of comment. Weight loss competitions attract two large groups that tra-WORKSITE WEIGHT LOSS COMPETITIONS a ditionally have not participated in health promotion programs—blue-collar work= ers and men. This finding is of considerable significance since these groups could probably benefit more from health promotion efforts than the traditional partici- Pants, white-collar workers and females. This benefit of weight loss competitions, when combined with the favorable costleffectiveness, commends them even more highly. A measure of the success of this approach is provided by a worksite smoking cessation program which demonstrated that competitions increased re~ cruitment into the program (25). The third major finding of this report is that the weight losses achieved in competitions were poorly maintained. These results probably underestimate the extent of the problem, since persons who did not participate in the follow-up ‘measurements are more likely to have regained weight than those who did. These findings are important because the only previous report on maintenance of weight loss following competitions had indicated that weight losses were well maintained (1), That report had been based upon the results of competition 3 of the present series. The difference in outcome of the two reports is due to differences in the composition of the samples. Although a disappointment, the poor maintenance of weight loss is not surpris- ing. The weight losses achieved in clinical programs have also been poorly main- tained (26-29). Maintenance of weight loss is now recognized as the major prob- lem facing the treatment of obesity and as such is the focus of vigorous research. in the clinical arena, where measures such as increasing the intensity of treatment and extending its duration are being explored. These efforts have been rewarded with modest improvement in the maintenance of weight loss for periods of as long as I year in duration (30). Thereafter, however, the effects are dissipated and by 3 years they have largely disappeared (31). Apparently the learning (and over- learning) of behavioral measures during long-term, intensive treatment is no match for the strong biological, social, and nutritional pressures to regain weight. We can hardly expect more from the far less intensive and much shorter behavior change programs used in weight loss competitions. The results of clinical programs, even after considerable research designed to improve them, remain poor. It therefore seems desirable to pursue alternative methods of weight control. Worksite weight loss competitions must rank high among these methods. However, if competitions are to realize their full potential, ‘they must achieve better weight loss maintenance. The addition of behavior mod. ification is one obvious means of improving maintenance. But behavior modifi- cation alone is unlikely to be sufficient. It has not solved the problem of weight loss maintenance in clinical programs, even after extensive research directed to this end, and there is no reason to believe that it will be more effective at the worksite. If, however, we do not confine our efforts to this one modality, the worksite offers great potential for the maintenance of weight losses, As just one obvious example, competitions to improve maintenance are an ‘option. We conducted one such maintenance competition, following competition 10, described above. The loss of some of the data prevented detailed analysis of the results of this competition, but the data which survived indicate that it was moderately effective. It enrolled about half of the 196 persons who completed thean STUNKARD, COHEN, AND FELIX original competition, who were divided into 7 new teams instead of the original 11 ‘Two of the teams, comprising about 30 members, met their goal, which consisted of maintaining weight loss on the part of those who had reached goal weight, and of reaching new goals on the part of those who had not. Other teams performed less well. One positive consequence of these competitions was that they accus- tomed participants to weekly weigh-ins. Three years after the end of the last competition 40 of the participants were continuing this practice (32). ‘The special opportunities of the worksite do not end with competitions. In fact, competitions may best be viewed as simply the beginning of a comprehensive worksite program and utilized for their unprecedented capacity for recruitment and their impressive initial weight losses. Maintenance of these weight losses requires something more which may well be additional modalities, combined with competitions in new and innovative ways. Group and organizational strategies that might achieve these ends have already been described and are ready to be applied (33, 34). They can take advantage of powerful environmental controls, several forms of social support, and the opportunity to monitor body weight into the indefinite future. The report of continuing use of weigh-ins following the weight maintenance competition (32) indicates modest long-term behavioral change on the part of a significant proportion of employees. Our task now is to increase the extent and duration of this change with the help of experimental and quasi-experimental research. It seems entirely possible that the special opportu- nities of the worksite may permit solution of the problem of weight loss mainte- nance here even before it is solved in the clinic. ‘One appropriate use of weight loss competitions is as the first step in introduc- ing health promotion programs to a worksite. We have previously described a highly effective process for introducing health promotion to the worksite (35), The enthusiasm engendered by weight loss competitions has led us to modify this already successful process by incorporating competitions into its initial stages. AS the first joint health promotion activity at the worksite, competitions can unite labor and management in an exciting new joint venture. As valuable as compet tions may be in weight loss programs, they may have even broader potential in improving labor/management relations. 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