Assessing Effectiveness and Cost-Benefit of the Trinity Hospital Twin City Fit For Life Program for Weight Loss and Diabetes Prevention in a Rural Midwestern Town

Abstract

IntroductionObesity is a top public health priority in the United States. This article reports on the Fit For Life (FFL) health education program designed to address the determinants of obesity in rural settings and help participants lose weight.Purpose and ObjectivesWe evaluated the implementation of the original FFL program, a replication program, and a diabetes-focused program.Intervention ApproachThe original FFL program (2006 to 2012) was a 12-week session of classes meeting once weekly. Lecture topics included stress management, nutrition, healthy eating, reading food labels, fitness, disease prevention, and healthy aging. The replication program, conducted in 4 locations from 2012 to 2015, helped determine if the FFL program could be implemented on a larger scale, with outcomes similar to the original program. The longer, more-intensive FFL diabetes prevention program, conducted in 2016 and 2017, sought to reduce the number of rural adults at risk for diabetes.Evaluation MethodsWe evaluated FFL participation and outcome data from 2009 through first quarter 2017. We calculated rates of course participation and completion and measured changes in several health indicators. We constructed a linear regression model to examine the impact of health behaviors on weight loss and calculated program cost-effectiveness.ResultsFrom 2009 to 2017, FFL was delivered to over 1,200 people; 82% of participants completed the program. Completing participants lost an average of 2.7 kg or 3% of their total weight. Overall, 68% of participants said they exercised more per week at the end of the program than at the beginning. Estimated cost per kilogram lost for replication sites was between $73 and $101 for original FFL, in line with other programs. The more resource-intensive diabetes prevention program cost per kilogram lost was $151 to $171.Implications for Public Health PracticeWeight loss and lifestyle management are major ways to counteract obesity. Improving program options, especially in rural locales, should be a key policy priority. These programs should be considered for population-based expansion, perhaps by health departments or public–private health care consortiums.

A Systematic Review of the Evidence for Non-surgical Weight Management for Adults with Severe Obesity: What is Cost Effective and What are the Implications for the Design of Health Services?

“…Participants also offered 5 individual sessions Usual care defined as referral to dietitian Lifestyle WMP: In person v referral to dietitian Remote intervention v referral to dietitian In-person v referral to dietitian RCT (1 b ; N/A) Third party payer 2018 (US$) N/A Cost per kg lost Cost per person achieving 2%/5% weight loss N/A N/A Hollenbeak et al [ 33 ] USA Primary care practices People with obesity and metabolic syndrome, without diabetes 39 kg/ m 2 WMP based on Diabetes Prevention Programme with group conference phone calls WMP based on Diabetes Prevention Programme with individual phone calls Group v individual RCT (1; N/A) Society 2013 (US$) N/A Cost per QALY N/A N/A Little et al [ 14 ] UK Primary care practices People with BMI ≥ 30 kg/m 2 (or ≥ 28 kg/m 2 with risk factors) 37 kg/ m 2 E-learning (with and without face-to face support). Physical activity advice with low carbohydrate (< 50 g/day) or deficit of 600 kcal/day Brief verbal and online healthy eating advice Lifestyle WMP: Remote v control In-person v control RCT (1; N/A) NHS and PSS 2013–2014 (GBP) N/A Cost per QALY N/A N/A McKnight et al [ 15 ] USA Hospital based Diabetes prevention programme: risk of type 2 diabetes, as defined by HbA1c ≥ 5.7% or a BMI ≥ 25 kg/m 2 36 kg/m 2 Original Fit for LIfe (FFL) diabetes prevention programme on nutrition and exercise: 12 weekly sessions of 90 min Fit for L...…”

“…Lifestyle WMPs (11 within trial, 11 decision models and 3 neither within trial nor decision models) included diet and physical activity advice [ 6 ••, 12 , 13 , 15 – 22 , 24 •, 25 , 30 , 31 , 40 ], low carbohydrate diets [ 14 , 21 ], commercial WMPs (Weight Watchers and Vtrim, Slimming World) [ 10 , 11 , 28 , 32 ], the Counterweight programme [ 19 ] and Look AHEAD [ 6 ••, 23 ••]. The comparators were either no active treatment (most often occurring in decision models) or usual care, with heterogeneous definition of usual care across the studies.…”

Reach and Weight Loss Among Comparison Group Participants Who Enrolled in the Active Intervention After a Diabetes Prevention Trial

“…Future studies should examine the costs associated with this strategy. At a rate of $742 per person for participation in the digital DPP ( 13 ) and an average weight loss at 12 months of 6.8 pounds, the average cost per pound of weight loss was $109 (or $241/kg), which is comparable to resource-intensive lifestyle modification programs ranging from $34 to $1,005, regardless of program duration ( 14 , 15 ). Additionally, the cost for this study was approximately $130,592 (176 × $742/person-year in 2020 US dollars), which may be conceptualized as part of the overall retention costs.…”

Promoting the Science and Practice of Implementation Evaluation in Public Health

“…Economic evaluations are critical to public health professionals, health care organizations, and funders interested in deciding how to maximize use of limited fiscal and human resources (11). McKnight and associates assessed the effectiveness and cost benefit of replicating a 12-week wellness program targeting adults in 4 rural locations (12). Researchers reported information on participation, completion, and changes in several health outcomes and discussed how a combination of factors influenced researchers’ ability to achieve results similar to those derived in the original wellness program.…”