HMR Weight Management Services Corp., Boston, Massachusetts, United States of America.
Center for Outcomes Research and Real-World Evidence, Healthcare Services and Solutions, Merck & Co., Inc, Kenilworth, New Jersey, United States of America.
PLoS One. 2018 Apr 18;13(4):e0195794. doi: 10.1371/journal.pone.0195794. eCollection 2018.
Obesity increases the risk for diabetes and cardiovascular events, with a corresponding growth in medical costs. High intensity lifestyle intervention (HILI) is the cornerstone for weight management. We assessed the effectiveness of clinic-based HILI on weight loss and associated clinical outcomes by duration of program participation and comorbid conditions.
This was a retrospective cohort study of patients who enrolled in HILI weight management programs at Health Management Resources (HMR) clinics located across the U.S. Patients completed health risk assessments (HRA) and were enrolled for up to 24 months at the time of follow-up HRA. HMR programs provide weekly group coaching to achieve reduced calorie intake, increased fruit/vegetable intake, and physical activity ≥2,000 kcal/wk. A Markov model predicted avoidance of diabetes and cardiovascular events and projected cost savings due to weight loss.
Of the 500 patients included in the analysis, 67% were female and mean age was 54.1 years (s.d. 11.6). The baseline weight and BMI were 243.5 lbs (range 144.0-545.0) and 38.8 kg/m2 (range 25.4-85.0), respectively. Overall, patients lost an average of 47.4 lbs (18.9% of initial body weight [IBW]); the amount of weight loss was consistent among those with diabetes/pre-diabetes (50%), high/moderate risk for dyslipidemia (60%), hypertension/pre-hypertension (86%), and severe obesity (37%). The mean IBW lost was 16.4%, 19.3%, 20.7% for ≤6 months (n = 165), 7-12 months (n = 140), 13-24 months (n = 195) of program participation, respectively. The simulation model estimated 22 diabetes and 30 cardiovascular events and $1,992,370 medical costs avoided over 5 years in the 500 patients evaluated.
Patients in the HMR clinic-based HILI program achieved substantial weight loss regardless of duration of program participation, risk profile and comorbid status. The HMR program could be an effective strategy to prevent costly diabetes and cardiovascular events, particularly in high risk patients.
肥胖会增加糖尿病和心血管事件的风险，同时也会导致医疗费用的相应增长。高强度生活方式干预（HILI）是体重管理的基石。我们评估了基于诊所的 HILI 对体重减轻和相关临床结果的影响，具体取决于参与项目的时间长短和合并症情况。
这是一项回顾性队列研究，纳入了在美国各地 HMR 诊所参加 HILI 体重管理项目的患者。患者完成健康风险评估（HRA），并在随访 HRA 时最多参加 24 个月的项目。HMR 项目提供每周小组指导，以实现减少卡路里摄入、增加水果/蔬菜摄入以及每周活动量达到 2000 卡路里以上。Markov 模型预测了避免糖尿病和心血管事件的发生，并预测了因体重减轻而节省的成本。
在纳入分析的 500 名患者中，67%为女性，平均年龄为 54.1 岁（标准差 11.6）。基线体重和 BMI 分别为 243.5 磅（范围 144.0-545.0）和 38.8 kg/m2（范围 25.4-85.0）。总体而言，患者平均减轻了 47.4 磅（初始体重的 18.9%）；在患有糖尿病/前期糖尿病（50%）、高/中度血脂异常风险（60%）、高血压/前期高血压（86%）和严重肥胖（37%）的患者中，体重减轻的幅度一致。在 ≤6 个月（n = 165）、7-12 个月（n = 140）、13-24 个月（n = 195）的项目参与期间，平均初始体重减轻分别为 16.4%、19.3%和 20.7%。模拟模型估计，在 500 名接受评估的患者中，5 年内可避免 22 例糖尿病和 30 例心血管事件，以及 199.237 万美元的医疗费用。
无论参与项目的时间长短、风险状况和合并症情况如何，参加 HMR 诊所基于诊所的 HILI 项目的患者都实现了显著的体重减轻。HMR 项目可能是预防昂贵的糖尿病和心血管事件的有效策略，特别是在高风险患者中。
