Evaluation of Medicare's Intensive Behavioral Therapy for Obesity: the BieneStar Experience.

INTRODUCTION: In 2011, the Centers for Medicare and Medicaid Services began to reimburse primary care providers for intensive behavior therapy for obesity. This study evaluated a Centers for Medicare and Medicaid Services intensive behavior therapy for obesity program as implemented in primary care clinics. METHODS: Data for this retrospective cohort study were obtained between May 2012 and February 2015 and statistical analysis was performed in 2017. The sample included 643 participants who attended at least one BieneStar intensive behavior therapy for obesity program session. The primary outcome was weight, and covariates were number of sessions, age, race/ethnicity, diagnosis of hypertension and diabetes, and type of health insurance. RESULTS: Of 643 participants that initiated the BieneStar program, 641 had complete data. The median reduction in weight of participants was as follows: those who attended fewer than four sessions, 0 kg (95% CI=0, 0.11 kg); between four and eight sessions, 1.1 kg (95% CI=0.86, 1.59 kg); and more than eight sessions 3.7 kg (95% CI=3.36, 4.55 kg). Medians of weight were significantly different between each classification of session numbers (p<0.01). Participants lost on average 0.102 kg of weight per session attended. CONCLUSIONS: The BieneStar program showed that the weight of participants decreased as they attended more sessions. Further studies are needed to determine if these results can be reproduced in other office-based primary care clinics and the program's impact on chronic disease.

Reducing Cardiovascular Disparities Through Community-Engaged Implementation Research: A National Heart, Lung, and Blood Institute Workshop Report.

Cardiovascular disparities remain pervasive in the United States. Unequal disease burden is evident among population groups based on sex, race, ethnicity, socioeconomic status, educational attainment, nativity, or geography. Despite the significant declines in cardiovascular disease mortality rates in all demographic groups during the last 50 years, large disparities remain by sex, race, ethnicity, and geography. Recent data from modeling studies, linked micromap plots, and small-area analyses also demonstrate prominent variation in cardiovascular disease mortality rates across states and counties, with an especially high disease burden in the southeastern United States and Appalachia. Despite these continued disparities, few large-scale intervention studies have been conducted in these high-burden populations to examine the feasibility of reducing or eliminating cardiovascular disparities. To address this challenge, on June 22 and 23, 2017, the National Heart, Lung, and Blood Institute convened experts from a broad range of biomedical, behavioral, environmental, implementation, and social science backgrounds to summarize the current state of knowledge of cardiovascular disease disparities and propose intervention strategies aligned with the National Heart, Lung, and Blood Institute mission. This report presents the themes, challenges, opportunities, available resources, and recommended actions discussed at the workshop.

Embedding clinical interventions into observational studies.

Novel approaches to observational studies and clinical trials could improve the cost-effectiveness and speed of translation of research. Hybrid designs that combine elements of clinical trials with observational registries or cohort studies should be considered as part of a long-term strategy to transform clinical trials and epidemiology, adapting to the opportunities of big data and the challenges of constrained budgets. Important considerations include study aims, timing, breadth and depth of the existing infrastructure that can be leveraged, participant burden, likely participation rate and available sample size in the cohort, required sample size for the trial, and investigator expertise. Community engagement and stakeholder (including study participants) support are essential for these efforts to succeed.

HEALTHY study school food service revenue and expense report.

BACKGROUND: Food service directors have a concern that federal reimbursement is not meeting the demands of increasing costs of healthier meals. The purpose of this article is to report the food option changes and the annual revenues and expenses of the school food service environment. METHODS: The HEALTHY study was a 3-year (2006 to 2009) randomized, cluster-designed trial conducted in 42 middle schools at 7 field centers. The schools selected had at least 50% of students who were eligible for free or reduced-price lunch or who belonged to a minority group. A randomly assigned half of the HEALTHY schools received a school health intervention program consisting of 4 integrated components: nutrition, physical activity, behavioral knowledge and skills, and social marketing. The nutrition component consisted of changing the meal plans to meet 5 nutrition goals. Revenue and expense data were collected from income statements, federal meal records, à la carte sale sheets, school store sale sheets, donated money/food records, and vending machines. RESULTS: Although more intervention schools reached the nutritional goals than control schools, revenues and expenses were not significantly different between groups. CONCLUSION: The HEALTHY study showed no adverse effect of school food policies on food service finances.

Identifying barriers that hinder onsite parental involvement in a school-based health promotion program.

We investigated whether barriers to onsite parental involvement in the Bienestar Health Program Parent Component could be identified and whether participation rates could be increased by addressing these barriers. All nonparticipating parents of fourth-grade students of San Antonio Independent School District from 4 schools, which were selected randomly from 20 intervention schools in Bienestar, were invited to take part in this study. A total of 47 of 223 (21%) parents engaged in one of four focus groups offered. Parents identified barriers to their involvement in Bienestar that fit into five descriptive categories: (a) low value, (b) high cost, (c) competing family demands, (d) concerns about the program design, and (e) social role norms. The Bienestar Parent Component was then modified according to the focus group findings, which resulted in a marked increase in parental involvement from 17% to 37% overall. These findings suggest that even when parents are involved in the initial design of parent-friendly and culturally sensitive programs, as was the case for Bienestar, maximizing parental involvement may require additional assessment, identification, and remediation of barriers.