The 65 million Americans who are trying to lose weight spend an estimated $44 billion on their weight-reduction efforts each year. Little is known about the costs of providing weight-loss programs of varying intensity as integral components of healthcare. The levels of weight-loss program intensity described in the National Academy of Science include: self-help, non-clinical, and clinical. Survey data suggests that self-help is the most common weight control approach used in the United States, but clinical trial data suggests that intervention intensity predicts weight loss. The traditional nonclinical approach used by most commercial weight-reduction programs involves an open-group format in which support is provided by the leader and those attending the session. The goal of the current study was to evaluate weight-loss outcomes and the effect on CVD risk factors, and the resources required (from the perspective of a managed care organization) of the self-help, nonclinical, and clinical approaches to weight control. The research evaluated the metabolic effect and costs of a do-it-yourself approach, using a workbook as the minimal intervention control, an expert computer system together with the workbook to optimize use of resources, and the addition of staff consultation to the computer system and workbook as the most intensive intervention.

The randomized, controlled clinical trial evaluated the metabolic effects and costs of three levels of intervention intensity for providing cognitive behavioral weight control intervention in a managed care environment. The study was conducted in a freestanding Health Maintenance Organization (HMO) with an enrollment of 25,000 patients.

Participants were recruited from the HMO’s patient population, and from the surrounding community. The study included 588 individuals (BMI >25 kg/sq m), and achieved an 81 percent completion rate.

The mean energy intake and percent of energy from fat decreased from baseline in all three-intervention groups; there was not a statistically significant difference in the mean nutrient intake change by intervention group. All of the intervention groups reported a mean increase in walking time, as well as in the number of blocks walked each day. All of the groups achieved a statistically significant weight loss. The most intensive intervention group (workbook with computer and staff added) lost significantly more weight than the least intensive (workbook-alone) group. The mean weight loss in the intermediate group (workbook and computer) was not significantly greater than the weight loss in the workbook-alone control group.

The most intensive intervention group had a significant increase in the mean HDL cholesterol levels and a decrease in the mean diastolic blood pressure level. The mean amount of clerical time utilized per participant in each of the randomization groups was 1.35 minutes for the least intensive group. 2.28 minutes for the intermediate intensive group. and 2.47 minutes for the most intensive group. The mean amount of professional staff time utilized in conducting the most intensive intervention was 227.1 minutes per participant. The cost of staff time per participant for each intervention group over the 12-month study period, was $0.35 for the least intensive group. $0.59 for the intermediate intervention group, and $92.33 for the intensive intervention group.

The findings suggest that the computer tailoring of weight-control programs may facilitate implementation of weight-control programs in HMOs. In the current randomized trial, the most intensive intervention resulted in a significantly greater mean weight loss compared with the do-it-yourself control arm. The computer tailoring system promoted diary keeping, which in turn was associated with greater weight loss. Although the cost per pound lost was the lowest in the least intensive intervention group, the satisfaction with the program increased as the intervention intensity increased.

Dietitians and other healthcare professionals should consider using computer-based communications to maintain frequent contact, promote self-monitoring, and tailor behavioral goals. Managed care organizations could potentially incorporate all three options as preventive health services. Patients could opt for an approach based on availability and personal preference for learning method and time.