ABSTRACT
BACKGROUND
The U.S. Preventive Services Task Force has released new guidelines on obesity, urging primary care physicians to provide obese patients with intensive, multi-component behavioral interventions. However, there are few studies of weight loss in real world nonacademic primary care, and even fewer in largely racial/ethnic minority, low-income samples.
OBJECTIVE
To evaluate the recruitment, intervention and replications costs of a 2-year, moderate intensity weight loss and blood pressure control intervention.
DESIGN
A comprehensive cost analysis was conducted, associated with a weight loss and hypertension management program delivered in three community health centers as part of a pragmatic randomized trial.
PARTICIPANTS
Three hundred and sixty-five high risk, low-income, inner city, minority (71 % were Black/African American and 13 % were Hispanic) patients who were both hypertensive and obese.
MAIN MEASURES
Measures included total recruitment costs and intervention costs, cost per participant, and incremental costs per unit reduction in weight and blood pressure.
KEY RESULTS
Recruitment and intervention costs were estimated $2,359 per participant for the 2-year program. Compared to the control intervention, the cost per additional kilogram lost was $2,204 /kg, and for blood pressure, $621 /mmHg. Sensitivity analyses suggest that if the program was offered to a larger sample and minor modifications were made, the cost per participant could be reduced to the levels of many commercially available products.
CONCLUSIONS
The costs associated with the Be Fit Be Well program were found to be significantly more expensive than many commercially available products, and much higher than the amount that the Centers for Medicare and Medicaid reimburse physicians for obesity counseling. However, given the serious and costly health consequences associated with obesity in high risk, multimorbid and socioeconomically disadvantaged patients, the resources needed to provide interventions like those described here may still prove to be cost-effective with respect to producing long-term behavior change.
Similar content being viewed by others
REFERENCES
Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:373–8.
Stafford RS, Farhat JH, Misra B, et al. National patterns of physician activities related to obesity management. Arch Fam Med. 2000;9:631–8.
Ma J, Xiao L, Stafford RS. Underdiagnosis of obesity in adults in US outpatient settings. Arch Intern Med. 2009;169:313–4.
Galuska DA, Will JC, Serdula MK, et al. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282:1576–8.
Bleich SN, Pickett-Blakely O, Cooper LA. Physician practice patterns of obesity diagnosis and weight-related counseling. Patient Educ Couns. 2011;82:123–9.
Glasgow RE. What types of evidence are most needed to advance behavioral medicine? Ann Behav Med. 2008;35:19–25.
Svetkey LP, Pollak KI, Yancy WS Jr, et al. Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients. Hypertension. 2009;54:1226–33.
Bosworth HB, Olsen MK, Neary A, et al. Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Educ Couns. 2008;70:338–47.
Ogden CL, Lamb MM, Carroll MD, et al. Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS Data Brief 2010;1–8.
Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–41.
Karlamangla AS, Merkin SS, Crimmins EM, et al. Socioeconomic and ethnic disparities in cardiovascular risk in the United States, 2001-2006. Ann Epidemiol. 2010;20:617–28.
Winkleby MA, Kraemer HC, Ahn DK, et al. Ethnic and socioeconomic differences in cardiovascular disease risk factors: findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA. 1998;280:356–62.
McGruder HF, Malarcher AM, Antoine TL, et al. Racial and ethnic disparities in cardiovascular risk factors among stroke survivors: United States 1999 to 2001. Stroke. 2004;35:1557–61.
Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–209.
Redmond N, Baer HJ, Hicks LS. Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey. Hypertension. 2011;57:383–9.
Osei-Assibey G, Kyrou I, Adi Y, et al. Dietary and lifestyle interventions for weight management in adults from minority ethnic/non-White groups: a systematic review. Obes Rev. 2010;11:769–76.
Yancey AK, Kumanyika SK, Ponce NA, et al. Population-based interventions engaging communities of color in healthy eating and active living: a review. Prev Chron Dis. 2004;1:A09.
Kumanyika SK, Gary TL, Lancaster KJ, et al. Achieving healthy weight in African-American communities: research perspectives and priorities. Obes Res. 2005;13:2037–47.
Kumanyika SK, Obarzanek E, Stevens VJ, et al. Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991;53:1631S–8.
Tunis SR, Stryer DB, Clancey CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624–32. PMID 14506122.
Zwarenstein M, Treweek S, Gagnier JJ, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;337:a2390. doi:10.1136/bmj.
Greaney ML, Quintiliani LM, Warner ET, et al. Weight management among patients at community health centers: the Be Fit Be Well Study. Obes Weight Manag. 2009;5(5):222–8.
Bennett GG, Warner ET, Glasgow RE, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172:565–74.
Glasgow RE. Enhancing the scientific foundation of internet intervention research. Ann Behav Med. 2009;38:46–7.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.
Ritzwoller DP, Sukhanova A, Gaglio B, et al. Costing behavioral interventions: a practical guide to enhance translation. Ann Behav Med. 2009;37:218–27.
Ritzwoller DP, Sukhanova AS, Glasgow RE, et al. Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien! Transl Behav Med. 2011;1:427–35.
Bennett GG, Herring SJ, Puleo E, et al. Web-based weight loss in primary care: a randomized controlled trial. Obesity (Silver Spring). 2010;18:308–13.
Glasgow RE, Gaglio B, Bennett G, et al. Applying the PRECIS criteria to describe three effectiveness trials of weight loss in obese patients with comorbid conditions. Health Serv Res. 2012;47(3 Pt 1):1051-67.
National Heart Lung and Blood Institute. Aim for a health weight. Available at: http://www.nhlbi.nih.gov/resources/obesity/education/aim.htm. 2012. Accessed February 9, 2012.
Rosner B, Langford HG. Judging the effectiveness of antihypertensive therapy in an individual patient. J Clin Epidemiol. 1991;44:831–8.
Frick KD. Microcosting quantity data collection methods. Med Care. 2009;47:S76–81.
Sukhanova A, Ritzwoller DP, Alexander G, et al. Cost analyses of a web-based behavioral intervention to enhance fruit and vegetable consumption. Int J Behav Nutr Phys Act. 2009;6:92.
Bureau of Labor Statistics. Occupational employment and wages--May 2009. Available at: http://www.bls.gov/oes/2009/may/oes_nat.htm. 2010. Accessed April 23, 2013.
CNN Money. Slim your body, not your wallet. Available at: http://money.cnn.com/2011/06/03/pf/weight_loss_programs.moneymag/index.htm. 2011. June 3. Accessed April 23, 2013.
Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med. 2005;142:56–66.
Rasu RS, Hunter CM, Peterson AL, et al. Economic evaluation of an Internet-based weight management program. Am J Manag Care. 2010;16:e98–104.
Gustafson A, Khavjou O, Stearns SC, et al. Cost-effectiveness of a behavioral weight loss intervention for low-income women: the Weight-Wise Program. Prev Med. 2009;49:390–5.
Krukowski RA, Tilford JM, Harvey-Berino J, et al. Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition. Obesity (Silver Spring). 2011;19:1629–35.
Tate DF, Finkelstein EA, Khavjou O, et al. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med. 2009;38:40–5.
Herman WH, Brandle M, Zhang P, et al. Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention Program. Diabetes Care. 2003;26:36–47.
Department of Health and Human Services, Centers for Medicare & Medicaid Services, MLN Matters. Intensive Behavioral Therapy (IBT) for obesity. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM7641.pdf. 2011. Accessed April 23, 2013.
Gearhardt AN, Bragg MA, Pearl RL, et al. Obesity and public policy. Annu Rev Clin Psychol. 2012;8:405-30.
Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. Oxford, England: Oxford University Press; 1996.
Glasgow RE, Steiner JF. In: Brownson RC, Colditz G, Proctor E, eds. Comparative Effectiveness Research to Accelerate Translation: Recommendations for “CERT-T”. 1st ed. New York: Oxford University Press; 2012:72–93.
Acknowledgements
We would like to thank Barbara L. McCray for her editorial support.
Funding/Support
This work was supported in part by grant funding from the National Heart Lung Blood Institute (UO1-HL087071). G. Bennett was supported by K22CA126992.
K. Emmons was supported by K05CA124415-04. G. Colditz was supported in part by P30CA091842 and the Foundation for Barnes-Jewish Hospital. E. Warner was supported by grant 5T32CA009001-36 from the National Cancer Institute.
Disclaimer
The opinions and statements in this manuscript do not represent the official opinion of NHLBI/ NCI/NIH.
Conflict of Interest
The authors declare that they do not have a conflict of interest.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Trial Registration: clinical trials.gov Identifier: NCT00661817
Rights and permissions
About this article
Cite this article
Ritzwoller, D.P., Glasgow, R.E., Sukhanova, A.Y. et al. Economic Analyses of the Be Fit Be Well Program: A Weight Loss Program for Community Health Centers. J GEN INTERN MED 28, 1581–1588 (2013). https://doi.org/10.1007/s11606-013-2492-3
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11606-013-2492-3