Clinically Significant Weight Loss

HMR offers proven solutions for healthcare payers and providers looking to address the problem of obesity. Obesity and its comorbidities are estimated to be responsible for 75% of healthcare spending.¹ HMR can help your population lose weight, and learn how to incorporate the lifestyle changes needed to reduce risk factors and maintain weight loss long term.

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

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Proven Effective

Decision Free® plan

43-66 lbs.

At 12-26 Weeks¹

Healthy Solutions® plan

28-37 lbs.

At 12-26 Weeks²

¹J Am Diet Assoc 2009; 109:1417-1421; Int J Obes 2007; 31:488-493; J Am Coll Nutr 2005; 24:347-353.
²J Am Diet Assoc 2009;109:1417-1421; Postgrad Med 2011;123:205-213; Int J Obes 2007;31:1270-1276; Obes 2013;21:1951-1959.
These studies were supported and/or sponsored by HMR, including financial support in some cases. Some of the investigators in some of the studies were employees of HMR and/or members of the HMR Medical Advisory Board.

Intensive Lifestyle-Change Intervention

"Meaningful weight loss" is more than just pounds lost. Helping your overweight population lose weight, become more active, and live a healthier lifestyle can be an effective, sustainable way to reduce medical risk factors and associated costs. Learning and practicing healthy lifestyle skills is critical for long-term weight and health management. It can also help reduce the risk factors associated with the development of heart disease, stroke, diabetes, cancer, and other expensive, chronic diseases. Healthy lifestyle changes - average American versus HMR participant:

The Average American

12.6

Cups

Fruits & Vegetables per person per week¹

83

Million

No Physical Activity during the last year

HMR PARTICIPANT*

44.6

Full Cups

Fruits & Vegetables Weekly average over 12 weeks

2,134

Kcals

Physical Activity Weekly average over 12 weeks

¹ State of the Plate: 2010 Study of America's Consumption of Fruits and Vegetables-The Produce for Better Health Foundation. Reported as 1.8 cups of fruits and vegetables per day. ²PA Council-4/22/15. ³Donnelly JE, et al. Int J Obes 2007. Data self-reported.
^*Enrolled in Healthy Solutions at Home with phone support.

Health Outcomes

Weight loss 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. The following are changes associated with weight loss for HMR clinic 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).

Poster T-2083 presented at Obesity Week 2014; Boston, MA

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Case Study

Palo Alto Medical Foundation

Data from 76 patients who enrolled in HMR's 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.

¹ Stifler LTP (HMR Founder), Treating Obesity and Preventing Costly Chronic Conditions. Group Practice Journal, April 15, 2011, 26-30
² Data on file.

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Case Study

University of Kentucky Medical School

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 from baseline to six months decreased $197.28 for HMR clinic patients, vs. an increase of $131.91 for control patients. Insulin costs were estimated based upon scheduled insulin used and cost information from Drugs.com

Case Study

Aurora Health Care

Data from employees who enrolled in HMR's Healthy Solutions at Home Program (n=76), and completed at least 10 weeks (February 2013 - September 2013). Average time in the program was 16 weeks, and included participants in Phase 1 (weight loss) and Phase 2 (maintenance).

PARTICIPANT SATISFACTION† 92% very satisfied or satisfied with rate of weight loss

-24.1

LBS

Mean Weight Loss at 12 Weeks

-3.9

BMI

Average BMI Change at 12 Weeks

39

Full Cups

Fruits & Vegetables *average per week

1,896

Kcals

Physical Activity *average per week

¹Confare AS, May SH, Facing the Obesity Epidemic. Group Practice Journal, April 2014;63:42-48
^†Satisfaction data from 40 participants
^*Self-reported data.

U.S. Preventive Services Task Force recommends the following behavioral interventions for weight loss, 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

Moyer VA. Screening for and Management of Obesity in Adults: U.S. Preventive
Services Task Force recommendation statement. Ann Intern Med, 2012; 157; 373-378

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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.

These studies were supported and/or sponsored by HMR, including financial support in some cases. Some of the investigators in some of the studies were employees of HMR and/or members of the HMR Medical Advisory Board.

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 associatedwith 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 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 yetoverlooked weight-loss outcome.