High intensity lifestyle intervention and long-term impact on weight and clinical outcomes

Background
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.
Methods
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.
Results
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.
Conclusion
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.

背景
肥胖会提升糖尿病及心血管事件的发病风险，同时伴随医疗成本的相应攀升。高强度生活方式干预（High Intensity Lifestyle Intervention, HILI）是体重管理的核心手段。本研究依据项目参与时长与合并症状况，评估了基于诊所开展的HILI在减重及相关临床结局方面的有效性。

方法
本研究为回顾性队列研究，纳入了在美国各地健康管理资源（Health Management Resources, HMR）诊所参与HILI体重管理项目的患者。所有患者均完成健康风险评估（Health Risk Assessment, HRA），并在随访健康风险评估时完成最长达24个月的项目登记。HMR项目通过每周团体辅导，帮助患者实现热量摄入减少、果蔬摄入增加，以及每周至少2000千卡的体力活动量。本研究采用马尔可夫（Markov）模型预测糖尿病与心血管事件的规避情况，并估算由减重带来的医疗成本节约。

结果
本研究纳入的500例分析患者中，67%为女性，平均年龄为54.1岁（标准差11.6）。患者的基线体重与体质指数（Body Mass Index, BMI）分别为243.5磅（范围144.0~545.0磅）与38.8 kg/m²（范围25.4~85.0 kg/m²）。整体而言，患者平均减重47.4磅（占初始体重[Initial Body Weight, IBW]的18.9%）；在合并糖尿病/前驱糖尿病（50%）、血脂异常高/中度风险（60%）、高血压/高血压前期（86%）以及重度肥胖（37%）的患者中，减重幅度保持一致。按项目参与时长划分，≤6个月（n=165）、7~12个月（n=140）及13~24个月（n=195）的患者平均初始体重减重率分别为16.4%、19.3%与20.7%。模拟模型估算显示，在本次评估的500例患者中，5年内可规避22例糖尿病事件、30例心血管事件，且节省医疗成本共计1,992,370美元。

结论
参与HMR诊所开展的HILI项目的患者，无论项目参与时长、风险特征与合并症状态如何，均实现了显著的体重减轻。HMR项目可作为预防高额医疗成本相关的糖尿病与心血管事件的有效策略，尤其适用于高风险患者群体。