Funded by the U. S. Department of Defense TRICARE Management Agency (TMA), the Healthy Eating and Active Living in TRICARE Households (HEALTH) trial was conducted between 2005 and 2008 to identify a cost effective potential benefits program that would produce weight loss in overweight/obese patients. The TMA wanted to determine the level of intensity/resource utilization required to produce meaningful weight loss, for both participants and the overall population.

 

The goals of HEALTH were:

• to evaluate the effectiveness of behavioral lifestyle interventions on weight loss (i.e., did participants achieve 10% weight loss from baseline to 6 months?), and
• to help eligible TRICARE beneficiaries in Illinois, Indiana, Michigan, and Ohio develop and maintain healthy dietary and physical activity habits to manage their body weight (i.e., did participants not gain weight over time?)

The randomized controlled trial (RCT) consisted of three groups into which 1,755 participants were assigned at a study center enrollment session. All three groups in the RCT:

• received a pre-enrollment  introductory packet that includes information about the RCT and the HEALTH program in general, information about orlistat, an appointment card for an enrollment session, and details about the enrollment session itself, an envelope for bringing  their existing medications and dietary supplements to the enrollment.
• had baseline assessments (weight, blood pressure, physical activity) and returned to the study center at 6-month intervals for in-person follow-up assessments.
• received bookHEALTH (a cognitive-behavioral skill building workbook) and had access to some level of eHEALTH (interactive website) and teleHEALTH hotline to report weekly weight, calorie intake, and physical activity after training at the enrollment session.
• were expected to record/report their weight, physical activity, calorie intake, stress and initiation and use of any medications etc. on a weekly basis via eHEALTH or teleHEALTH.

 

In addition, the three RCT Groups were distinguished as follows:
RCT 1: This group received no calls and did not have access to HEALTH coaches. The internet screens to which they had access were static and educational in nature, with information and games. The participants in this group were self-directed and received no interactive/personalized attention. They each received a pedometer and a scale at enrollment.

 

RCT 2: This group had access to highly interactive eHEALTH internet screens that provided graphs of their successes when they entered their data each week and supportive messages. In addition, there were computer-generated email messages to the participants that were personalized with their identity and data but not written by a HEALTH coach. The participants in this group received a pedometer and a scale at enrollment.

 

RCT 3: This group had access to the same highly interactive eHEALTH internet screens and had personalized interactions with HEALTH coaches every two weeks. These interactions alternated between scheduled telephone calls and scheduled emails. The participants in this group received a pedometer and a scale at enrollment.

 

The study assessed changes in weight, blood pressure, and physical activity from baseline to 6, 12, and 15-18 months. Study retention was 31% at 12 months. Participants experienced significant weight loss (-4.0%, -4.0%, and -5.3%, respectively, in each RCT group after 12 months and -3.5%, -3.8%, and -5.1%, respectively, after 15 to 18 months), increased physical activity, and decreased blood pressure. Cost-effectiveness ratios were $900 to $1,100/quality-adjusted life year (QALY) for RCT1 and RCT2 and $1,900/QALY for RCT3. The cost recovery period to the government was 3 years for RCTs 1 and 2 and 6 years for RCT3. Thus, a relatively inexpensive cognitive-behavioral weight management intervention improved patient outcomes. Extrapolation of savings for the entire TRICARE population would significantly reduce direct medical costs.

 

PUBLICATION
Hersey JC, Khavjou O, Strange LB, Atkinson RL, et al. The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the HEALTH weight management demonstration. Preventive Medicine. 2012 Jan 1;54(1):42-9. Epub 2011 Oct 6.

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