Weight Management Demonstration Project: HEALTH
Condition: Weight Loss
MeSH terms: Body Weight; Weight Loss
Study type: Interventional

Summary: 
      The study investigated the effectiveness and cost-effectiveness of a cognitive and behavioral
      weight management program, complemented by an interactive Web site and brief telephone
      coaching, implemented among TRICARE non-active-duty beneficiaries.

      A total of 1,755 participants from four Midwestern states were randomized to one of three
      randomized controlled trial groups with increasing intervention intensity: mailed material
      and basic Web access (RCT1), plus an interactive Web site (RCT2), plus brief phone- and
      Web-based coaching support from health lifestyle coaches (RCT3). The study assessed changes
      in participants' weight, blood pressure, diet, and physical activity from baseline to 6, 12,
      and 15 to 18 months. Analyses estimated overall cost savings and calculated the
      cost-effectiveness ratio of each randomized controlled trial compared with a "do-nothing"
      alternative as the cost per quality-adjusted life year.
    

Detailed description: 
      Lifestyle modification interventions that promote healthful eating habits and physical
      activity can be effective in producing weight losses of 4% to 9% of initial bodyweight. If
      maintained, this level of weight loss can reduce hypertension, high blood glucose, and
      elevated lipids. However, weight losses often plateau after 6 months, and weight regain
      begins after 12 months. Accordingly, there is interest in interventions, such as Web-based
      reinforcement and brief counseling to maintain weight loss over time and in the relative
      cost-effectiveness of program delivery modes.

      Most obesity treatment programs focus on outcomes for individuals without assessing
      population-based cost savings. This study suggests that a broader perspective can help to
      identify the benefit of weight management in adult populations. Accordingly, this study
      assessed the cost-effectiveness of a weight management program in a population of adults
      served by a large health care system-the TRICARE Management Activity (TMA), the agency that
      manages the TRICARE health care benefits for active-duty service members, retired service
      members, their families, National Guard/Reserve members, and their families. The annual
      direct medical costs of overweight/obesity for beneficiaries enrolled in TRICARE Prime are
      estimated to exceed $1.1 billion. This study investigated the effectiveness and
      cost-effectiveness of methods to deliver a cognitive-behavioral weight loss intervention.
    

Intervention name(s): RCT1; RCT2; RCT3
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): the bookHEALTH manual and eHEALTH tools, the basic Internet component of the intervention; bookHEALTH and an interactive version of eHEALTH that provided tailored computerized feedback whenever participants submitted weekly assessments; bookHEALTH, the interactive version of eHEALTH, and telephonic coaching support provided by trained health lifestyle coaches every 2 weeks alternating between a telephone call (typically 15 to 20 minutes) and a personalized e-mail. The coaches used motivational interviewing, helped participants solve problems, and reinforced their successes.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Behavioral Weight Management Intervention; weight loss; cost-effective analysis; high blood pressure; randomized clinical trial; behavioral interventions; physical activity; dietary change; obesity