Computerized Weight Loss Intervention Optimizes Staff Time: The Clinical and Cost Results of a Controlled Clinical Trial Conducted in a Managed Care Setting

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Abstract

Objective To evaluate the costs and effects of incremental components of a weight-loss program.

Design A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity.

Subjects/setting The study included 588 individuals (BMI > 25 kg/m2) in a freestanding health maintenance organization and achieved an 81% completion rate.

Intervention Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a workbook alone, b) the addition of computerized tailoring using onsite computer kiosks with touch screen monitors, and c) the addition of both computers and staff consultation.

Main outcome measures Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and physical activity.

Statistical analysis performed Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysis assessed the relationship between weight loss and other variables.

Results For the increasing levels of intervention intensity, the mean 12-month weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost per participant being $12.33, $41.99, and $133.74. The decreases in mean BMIs for these respective intervention levels were 0.4, 0.9 and 1.2. All groups reported a decrease in energy and fat intake and an increase in blocks walked (P<.01). Intervention variables that correlated with weight loss included more computer logons, achieving computer-selected goals, more self-monitoring, increased walking, and decreased energy and fat intake, as well as higher attendance in staff consultation group sessions for that treatment condition. Weight loss correlated with decreases in fasting glucose and blood pressure.

Applications/conclusions In a weight-loss program, computers can facilitate selecting behavioral change goals. More frequent usage resulted in greater weight loss. Staff counseling to augment the computer intervention achieved the most weight loss. J Am Diet Assoc. 2001:101:1155-1162.

Section snippets

Study Design

The randomized, controlled clinical trial evaluated the metabolic effects and costs of 3 levels of intervention intensity for providing cognitive behavioral weight control intervention in a managed care environment. Assumptions from previous research (7) were utilized to calculate the sample sizes for each intervention arm to detect a difference in weight loss of 8 pounds between the minimum (do-it-yourself) workbook-only control group and the maximum intervention clinical approach (workbook

Applications

As the US prevalence of obesity and its comorbidities increase, more effort is needed for preventive services related to controlling the adverse effects of obesity. Dietitians and other health professionals should consider using computer-based communications to maintain frequent contact, promote self-monitoring, and tailor behavioral goals. Computer-based communication strategies can be readily combined with other approaches that are found to be predictors of weight loss. The cost per

References (37)

  • D.B Allison et al.

    The direct health costs of obesity in the United States

    Am J Public Health.

    (1999)
  • Thomas P, ed. Weighing the Options: Criteria for Evaluating Weight Management Programs. Washington DC: National Academy...
  • R.W Jeffery et al.

    Correspondence program for smoking cessation and weight controla comparison of two strategies in the Minnesota Hear Health Program

    Health Psychol.

    (1990)
  • J Wylie-Rosett et al.

    A weight-reduction intervention that optimizes use of practitioner time, lower glucose and raises HDL cholesterol levels in older adults

    J Am Diet Assoc.

    (1994)
  • J.E Soet et al.

    The telephone as a communication medium for health education

    Health Educ Behav.

    (1997)
  • W.L Hellersted et al.

    The effects of a telephone-based intervention for weight loss

    Am J Health Promot.

    (1997)
  • L.A Wheeler et al.

    Evaluation of computer-based education in persons with diabetes mellitus and of limited educational background

    Diabetes Care.

    (1985)
  • H DeVries et al.

    Computer-tailored interventions motivating people to adopt health promoting behaviorsintroduction to a new approach

    Patient Educ Couns.

    (1999)
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