New JAMA study shows stepped-care intervention results in weight loss at lower cost, UNC's Deborah Tate co-author
“Most weight loss programs are intense during the initial weeks of treatment, become less intense over time and maintain a fixed contact schedule for participants, regardless of treatment success or failure,” said Deborah Tate, PhD, co-author of the study funded by the National Heart, Lung and Blood Institute of the National Institutes of Health. Tate also is associate professor of nutrition and health behavior at the Gillings School of Global Public Health and a member of the Lineberger Comprehensive Cancer Center at the University of North Carolina at Chapel Hill.
“An alternative is stepped-care,” Tate added. “It begins with a low-intensity intervention that is increased or adjusted if weight loss milestones are not achieved as planned.”
Tate, along with principal investigator John Jakicic, PhD, and other colleagues, examined whether a stepped-care weight loss intervention (STEP) would result in greater weight loss compared with a standard behavioral weight loss intervention (SBWI). Jakicic also is chair and professor of the Department of Health and Physical Activity and director of the Physical Activity and Weight Management Research Center at the University of Pittsburgh.
“We found that stepped-care resulted in a comparable loss of weight for participants, but cost less to implement than standard care,” Tate said.
More than 350 participants, half recruited and treated at UNC and half at the University of Pittsburgh, were assigned randomly to one of the two weight loss interventions between May 2008 and February 2010. All participants were placed on a low-calorie diet, prescribed increases in physical activity and scheduled to attend group counseling sessions during the 18-month period.
Participants in the stepped-care group, however, received individual modifications in their counseling frequency and weight loss strategies every three months, based on how their observed weight loss compared to their weight loss goals. The type of counseling received also varied and could include group, individual or telephone sessions.
After 18 months, the average weight loss was 16.8 lbs. in the SBWI group and 13.7 lbs. in the STEP group. Both groups had significant and comparable improvements in resting heart rate, blood-pressure level and fitness.
Estimated costs, however, differed significantly. The STEP group cost payers, such as insurance companies and the individuals receiving the service, 28 percent less than standard care in the SBWI group. Additionally, the participant costs of travel and personal time were cut in half. The significantly lower costs for STEP were attributed to fewer face-to-face meetings as participants progressed through the steps.
“A stepped-care approach could prove to be a cost-effective means for obesity treatment,” Tate said.
Other members of the UNC research team were Karen Erickson, MPH, RD, project manager and counselor, and Kristen Polzien, PhD, exercise physiologist and counselor, both from the Lineberger Comprehensive Cancer Center.
Joining Jakicic at the University of Pittsburgh were Kelli Davis, PhD, research assistant professor, Physical Activity and Weight Management Research Center, and Amy Rickman, PhD, RD, assistant professor of health and physical activity and assistant director of the Physical Activity and Weight Management Research Center.
Researchers at Wake Forest University and the Duke-National University of Singapore Graduate Medical School managed the data analysis for the study.
The complete study can be found on the JAMA website.