Background

The prevalence of obesity in the U.S. is approaching 40% and on the rise and is associated with increased risk for comorbid conditions which translates into greater healthcare costs. Intensive Lifestyle Interventions (ILI) such as the Diabetes Prevention Program and look AHEAD trials have successfully demonstrated a modest 5-10% weight loss can significantly reduce this risk. We compare our 4 year weight loss outcomes between patients enrolled in our ILI and conservative programs.

Methods

This is a retrospective cohort study comparing primary outcomes of %TBWL, %EBWL, and ΔBMI at timed intervals between an ILI and conservative approach in a physician supervised, non-surgical weight management program. Patients in the ILI received a weekly or biweekly education over 12 weeks on dietary, behavioral and exercise topics delivered by dietitians in group and/or individual settings to promote a 1-3lb/week weight loss. The conservative program focused on similar health concepts, but was led primarily by the medical provider in a structure that was patient driven, to focus on a 0.5-2lb/week weight loss.

Results

At 3,6 and 12 months the ILI had greater results with regards to %TBWL (3 vs 6, p=<0.0001; 5 vs 8, p=<0.0001; 7 vs 9, p=0.002.) %EBWL was also better at these intervals (9 vs 19, p=<0.0001; 14.5 vs 25, p=<0.0001; 19 vs 29, p=<0.0001.) This trend continued through 36 months. ΔBMI was 1 vs 2, p=<0.0001; 2 vs 3, p=<0.0001 at 3 and 6 months. Furthermore at 1 year, patients enrolled in the ILI had a higher likelihood of achieving 5 and 10 %TBWL compared to a conservative approach. Due to limited numbers, only data through 36 months were analyzed.

Conclusions

An ILI appears to be more effective at primary weight loss outcomes and a higher likelihood of achieving at least 5 or 10%TBWL at 1 year compared to a conservative approach. This may translate into better health outcomes and reduced healthcare costs. While further studies are needed, insurers should consider expanding coverage for such services.