The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration.

PURPOSE: The study investigated the efficacy and cost-effectiveness of a cognitive-behavioral weight management program, complemented by an interactive Web site and brief telephone/e-mail coaching. METHODS: In 2006-2007, 1755 overweight, non-active-duty TRICARE beneficiaries were randomized to one of three conditions with increasing intervention intensity: written materials and basic Web access (RCT1), plus an interactive Web site (RCT2), plus brief telephone/e-mail coaching support (RCT3). The study assessed changes in weight, blood pressure, and physical activity from baseline to 6, 12, and 15-18 months. (Study retention was 31% at 12 months.) Average and incremental cost-effectiveness and cost-offset analyses were conducted. RESULTS: Participants experienced significant weight loss (-4.0%, -4.0%, and -5.3%, respectively, in each RCT group after 12 months and -3.5%, -3.8%, and -5.1%, respectively, after 15 to 18 months), increased physical activity, and decreased blood pressure. Cost-effectiveness ratios were $900 to $1100/quality-adjusted life year (QALY) for RCT1 and RCT2 and $1900/QALY for RCT3. The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT3. CONCLUSION: A relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes. Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs.

Multidisciplinary Teams and Obesity: Role of the Modern Patient-Centered Medical Home.

With the growing obesity epidemic, it is difficult for individual primary care providers to devote the time and effort necessary to achieve meaningful weight loss for significant numbers of patients. A variety of health care professionals provide value and evidence-based care that is effective in treating obesity and other preventable diseases. Multidisciplinary collaboration between primary care physicians and other trained health professionals within patient-centered medical homes offers an effective approach to sustainable behavioral treatment options for individuals who are obese or overweight.