clinically significant weight loss through lifestyle intervention

HMR offers proven solutions for healthcare providers, health systems, employer groups, and insurance providers looking to address the problem of obesity. Obesity and its comorbidities, such as diabetes, heart disease, and hypertension, are estimated to be responsible for approximately 75% of healthcare spending.1 HMR can help your population lose weight, while learning how to incorporate the lifestyle changes necessary to reduce medical risk factors and to maintain weight loss long term.

the problem

Americans are in the midst of a “lifestyle disease” epidemic2

The rising rates of obesity and physical inactivity are leading to more diabetes and cardiovascular disease. The Centers for Disease Control and Prevention (CDC) has identified four behaviors, two of which are inactivity and poor nutrition, as primary causes of chronic disease in the United States.3

  • Average person consumes 1.8 cups of fruits and vegetables per day4
  • 83 million Americans reported they did not engage in any physical activities in the last year5

the solution

More than just a “diet”, HMR’s high intensity lifestyle-intervention program can help your population lose weight, become more active, and live a healthy lifestyle.

Published results6 for the Healthy Solutions® plan with phone support.

WEIGHT LOSS
median weight loss at 12 weeks
23 LBS
FRUITS & VEGETABLES
weekly average over 12 weeks
44.6 FULL CUPS*
PHYSICAL ACTIVITY
weekly average over 12 weeks
2,134 KCALS*

1Finkelstein EA et al. Am J Prev Med. 2012;42(6):563—570

2Kuzawa C.W., “Review of T.M. Pollard, Western Diseases: An Evolutionary Perspective.” Integrative and Comparative Biology, 2009. 49(1):pp. 81–82.

3Centers for Disease Control and Prevention, Chronic Disease Overview. 2010. As of July 15, 2012: http://www.cdc.gov/chronicdisease/overviewindex.htm

4State of the Plate: 2010 Study of America’s Consumption of Fruits and Vegetables–the Produce for Better Health Foundation

5Physical Activity Council 2015 Participant Report

6Donnelly JE, et al. Int J Obes, 2007;31(8):1270—1276

*Data self-reported

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health outcomes

It is well reported that weight reduction is associated with favorable changes in medical risk factors such as blood pressure, lipids, and blood glucose and the medications commonly used to treat these risk factors. Changes associated with weight loss are detailed below.

43 U.S.–based HMR clinics health risk reductions and medication changes (n=721)

The following reflects mean weight loss and associated changes in health risk factors and changes in medication from patients who: enrolled in HMR’s clinic-based Decision-Free® or Healthy Solutions® programs at one of 43 U.S.-based HMR clinics, completed a baseline health risk assessment (HRA), and a follow-up HRA during the weight-maintenance phase of the program (July/August 2013). Patients were excluded if they did not have continuous enrollment in the HMR program between the time of initiation and completion of the HRA or if they did not have complete biometric values.

MEAN WEIGHT LOSS
weight loss of 21.4% of total body weight exceeds the 5—10% that’s considered clinically significant
-48.4 LBS
TOTAL CHOLESTEROL/HDL RATIO
-10.3 %
FASTING GLUCOSE
-9.4 %
TRIGLYCERIDES
-26.7 %
SYSTOLIC BLOOD PRESSURE
-7 mmHg
DIASTOLIC BLOOD PRESSURE
-4 mmHg

percent of medications eliminated at follow-up

Poster T-2083 presented at Obesity Week, 04Nov2014, Boston, MA

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case studies

The following case studies are from prominent hospitals and medical centers that offer the HMR Program.

Palo Alto Medical Foundation health risk reductions and medication changes

Data from 76 patients who enrolled in clinic-based Decision-Free® or Healthy Solutions® programs. Patients completed a baseline Health Risk Assessment (HRA) and a follow-up HRA during the weight-maintenance phase of the program at an average of 2.5 years follow-up. Patients were excluded if they did not have complete biometric values.

MEAN WEIGHT LOSS
weight loss of 21.4% of total body weight exceeds the 5—10% that’s considered clinically significant
-53 LBS
TOTAL CHOLESTEROL/HDL RATIO
-12.8 %
FASTING GLUCOSE
-8.9 %
TRIGLYCERIDES
-36.7 %
SYSTOLIC BLOOD PRESSURE
-11 mmHg
DIASTOLIC BLOOD PRESSURE
-8 mmHg

percent of medications eliminated at follow-up

Stifler LTP, Treating Obesity and Preventing Costly Chronic Conditions.

Group Practice Journal, April 15, 2011, 26–30

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University of Kentucky Medical School insulin cost reduction

This was a retrospective comparison study (chart review) between patients with diabetes who went through the HMR clinic program (n=29) or a usual care group in an endocrine specialty clinic (n=26) who completed lifestyle education classes by a certified diabetes educator. Average 30-day estimated cost of insulin from baseline to six months for HMR clinic patients decreased $197.28 vs. $131.91 increase for control patients.

  • p<0.05: comparing the difference from baseline to six months among the Control group and HMR Program participants.
  • Insulin costs were estimated based upon scheduled insulin used and cost information from Drugs.com

Poster T-2585 presented at Obesity Week 05 Nov 2014, Boston, MA

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Aurora Health Care weight loss and lifestyle changes

Employees succeeded in losing weight with Healthy Solutions® at Home. Data from employees who completed at least 10 weeks (February 2013—September 2013), (n=76), average of 16 weeks including participants in both Phase 1 (weight loss) and Phase 2 (maintenance)1. Employees were provided incentives for participating in the HMR Program.

MEAN WEIGHT LOSS
median weight loss at 12 weeks -11.1% of initial body weight and an average BMI change of -3.9
24.1 LBS
WEEKLY WEIGHT LOSS
average per week in first 10 weeks
1.9 LBS
FRUITS & VEGETABLES*
average per week
39 FULL CUPS
PHYSICAL ACTIVITY*
average per week
1,896 KCALS
PARTICIPANT SATISFACTION†
very satisfied or satisfied with rate of weight loss
92 %

1Confare AS, May SH, Facing the Obesity Epidemic. Group Practice Journal, April 2014;63:42–48

†Satisfaction data from 40 participants

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U.S. Preventive Services Task Force recommends the following behavioral interventions1, 100% supported by the HMR Program

  • Individual or group sessions
  • Setting weight-loss goals
  • Improving diet and nutrition
  • Physical activity
  • Addressing barriers to change
  • Self-monitoring
  • Strategies to maintain lifestyle changes

1Moyer VA. Screening for and Management of Obesity in Adults: U.S. Preventive

Services Task Force recommendation statement. Ann Intern Med, 2012; 157; 373–378


a selection of clinical study highlights

publications

Obesity Epidemic: Driving Down Weight, Medications and Cost. AMGA Group Practice Journal, April 2015 pgs 18—19

Highlight: A retrospective study of 984 patients with obesity (mean BMI of 44 kg/m2) at one HMR clinic demonstrated a 19% reduction in body weight after 52 weeks in the program. Weight loss was associated with decreased use of medications to treat diabetes, hypertension, and dyslipidemia, which was estimated to achieve a 54% reduction in annual medication costs relative to baseline. Weight loss most significantly impacted the use of diabetes medications, which was associated with an estimated 82% reduction in annual costs.

Facing the Obesity Epidemic: Optimizing Employee Weight Management. AMGA Group Practice Journal, April 2014 pgs 42—48

Highlight: Both HMR clinic and remote programs were effective at providing clinically significant weight loss of 45.2 and 24.1 pounds, respectively.

obesity week poster presentations

High Intensity Lifestyle Intervention and Use of Meal Replacements is Associated with Clinically Meaningful Weight Loss. Poster T-2083-P, 04Nov2014, Boston, MA

Highlight: A retrospective study of 721 obese patients participating in an HMR clinic program showed a mean decrease in initial body weight of nearly 19 percent. The mean duration of program participation was approximately two years, and more than 80 percent of patients in the study had at least a 10 percent reduction of their initial body weight at follow-up. Weight loss in this study was associated with decreases in total cholesterol, triglycerides, fasting plasma glucose, systolic and diastolic blood pressure, and decreased use of medications used to treat diabetes, high blood pressure, and lipid disorders in some patients.

Patients Who are Eligible for Bariatric Surgery Achieve Clinically Significant Weight Loss Maintenance and Biometric Changes Through Lifestyle Intervention Using Meal Replacements. Poster T-2569-P, 04Nov2014, Boston, MA

Highlight: A retrospective analysis of 441 obese adults with a BMI ≥ 40 kg/m2 participating in an HMR clinic program achieved clinically significant weight loss. The mean duration of program participation was approximately two years, and nearly 85 percent of patients had a weight loss of greater than 10 percent of their initial body weight at follow-up. Weight loss in some patients in this study was associated with favorable biometric changes and a reduction in use of medications for treatment of diabetes, high blood pressure, or lipid disorders.

Clinical Outcomes in Patients with Diabetes Mellitus using a Medically Supervised Commercial Weight Reduction Program Compared to Standard Care in Endocrine Specialty Clinic. Poster T-2585-P, 04Nov2014, Boston, MA

Highlight: HMR patients saw a reduction of total medication usage of 28 percent, with at least one medication discontinued in 80 percent of patients, and reduction in A1C levels (7.5%±2;bsl 8.3±1.9). Preliminary data shows that when compared to CDE-led diabetic education emphasizing lifestyle change, patients in an intensive lifestyle program like HMR utilizing weekly coaching, meal replacements and exercise, had a 6.9 point reduction in BMI and achieved a similar A1C with greater reduction in medication use.

Behaviors that Predict Weight Loss Maintenance at One Year. Poster T-495-P, 04Nov2013, Atlanta, GA

Highlight: A retrospective analysis of 934 adults participating in an HMR clinic program found that the participants who lost more than 10 percent of their initial body weight were five times as likely to keep the weight off at the one-year mark. This supports previous research that greater initial weight loss increases the likelihood of keeping the weight off long-term.

A 12-Week Low-Calorie Diet Plus Behavioral Modification Acutely Improves Glycemic Parameters in Type 2 Diabetes Mellitus. Poster T-552-P, 04Nov2013, Atlanta, GA

Highlight: A review of 129 people with type 2 diabetes shows a favorable impact on fasting plasma glucose levels, glycated hemoglobin levels, medication use, and overall glycemic profile when combining a low-calorie diet with a behavior modification program.

Weight Management Program Participants Achieve Substantial Risk Factor and Medication Changes with Weight Loss. Poster T-430-P, 04Nov2013, Atlanta, GA

Highlight: A study of an HMR program demonstrated an average weight loss of 43 pounds over 3.6 years and an average BMI decrease of 10.5 points amongst 1,256 HMR participants. Overall, 93 percent of patients had reductions in risk factors for chronic disease. All patients had an initial health risk appraisal (HRA) on program entry and a follow-up HRA in 2012.

Weight Loss in a Health Care System: A Population Health Approach. Poster T-883-P, 04Nov2013, Atlanta, GA

Highlight: Aurora Health Care, a Wisconsin-based integrated system, offered healthcare premium incentives if employees participated in one of five weight loss options. This study evaluated two programs offered by HMR: an in-clinic and remote phone program. Both programs showed high average weekly weight loss, high compliance, increased consumption of fruits and vegetables, and increases in physical activity. Aurora projects the implementation of these weight management programs, combined with their other wellness programs, will combined save more than an estimated $97 million over six years, enabling the system to curb costs and meet employee health objectives.

Survey of Weight Program Participants Indicates Improvement in Quality of Life. Poster T-772-P, 04Nov2013, Atlanta, GA

Highlight: Nearly 71 percent of 706 HMR program participants reported that their overall health is greater or somewhat better than before participating in HMR programs. Top areas where improvement was noted include self-esteem, level of energy and ability to perform daily tasks such as climbing stairs and walking. The study demonstrates the positive impact of weight loss on quality of life – an important yet overlooked weight-loss outcome.


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