Computerized weight loss intervention optimizes staff time; the clinical and cost results of a controlled clinical trial conducted in a managed care setting

Objective To evaluate the costs and effects of incremental components of a weight-loss program. Design A 3-arm, 12-month randomized controlled clinical trial to evaluate 3 incremental levels of intervention intensity. Subjects/setting The study included 588 individuals (BMI > 25 kg/m2) in a f reestanding health maintenance organization and achieved an 81% completion rate. Intervention Using a cognitive behavioral approach for tailoring lifestyle modification goals, the incremental levels of intervention included a) a wo rkbook alone, b) the addition of computerized tailoring using onsite comput er kiosks with touch screen monitors, and c) the addition of both computers and staff consultation. Main outcome measures Endpoints included weight parameters, lipid profile, plasma glucose, blood pressure, intervention costs, dietary intake, and phy sical activity. Statistical analysis performed Study endpoints were analyzed using analysis of variance for normally distributed variables and analysis of covariance to control for any baseline differences. Regression and correlation analysi s assessed the relationship between weight loss and other variables. Results For the increasing levels of intervention intensity; the mean 12-mo nth weight losses were 2.2, 4.7, and 7.4 pounds, with the respective cost p er participant being $12.33, $41.99, and $133.74. The decreases in mean BMI s for these respective intervention levels were 0.4, 0.9 and 1.2. All group s reported a decrease in energy and fat intake and an increase in blocks wa lked (P < .01). Intervention variables that correlated Ns th weight loss in cluded more computer logons, achieving computer-selected goals, more self-m onitoring, increased walking, and decreased energy and fat intake, as well as higher attendance in staff consultation group sessions for that treatmen t condition. Weight toss correlated with decreases in fasting glucose and b lood pressure. Applications/conclusions In a weight-loss program, computers can facilitate selecting behavioral change goals. More frequent usage resulted in greater weight loss. Staff counseling to augment the computer intervention achieve d the most weight loss.