Impact of body mass index on the effectiveness of a disease management-health promotion intervention on disability status.

PURPOSE

To examine the impact of body mass index (BMI) on the effectiveness of a disease management-health promotion intervention among community-dwelling Medicare beneficiaries with disabilities.

DESIGN

Secondary data analyses of a randomized controlled trial.

SETTINGS

Nineteen counties in upstate New York and on the West Virginia-Ohio border.

SUBJECTS

Four hundred fifty-two Medicare beneficiaries who participated in the Medicare Primary and Consumer-Directed Care Demonstration between August 1998 and June 2002 and completed the 22-month follow-up.

INTERVENTION

Multicomponent disease management-health promotion intervention involving patient education, individualized health promotion coaching, medication management, and physician care management.

MEASURES

Body mass index and dependence in Activities of Daily Living (ADLs).

ANALYSIS

Multivariate linear regression.

RESULTS

The intervention resulted in significantly less worsening in ADLs dependence among normal-weight participants (coefficient, -.42; p = .04). However, the intervention did not have a significant effect for underweight participants (F test p = .33 vs. underweight participants in the control group) or overweight or obese participants (F test p = .78 vs. overweight or obese participants in the control group).

CONCLUSIONS

A positive effect of the intervention on disability was found among normal-weight participants but not among underweight or overweight or obese participants. Future health promotion interventions should take into consideration the influence of BMI categories on treatment effects.