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The Diabetes Educator
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PROFESSIONAL DEVELOPMENT

Weight Loss Through Living Well

Translating an Effective Lifestyle Intervention Into Clinical Practice

Kathleen M. McTigue, MD, MS, MPH, Molly B. Conroy, MD, MPH, Lori Bigi, MD, MS, Cynthia Murphy, BSN, Med and Melissa McNeil, MD, MPH

From the University of Pittsburgh, Department of Medicine, Pittsburgh, Pennsylvania.

Correspondence to Kathleen M. McTigue, MD, MS, MPH, Center for Research on Health Care, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 (mctiguekm{at}upmc.edu).

Purpose

To translate the Diabetes Prevention Program (DPP) lifestyle intervention into a clinical setting and evaluate its effectiveness.

Methods

The authors implemented a group-based version of the DPP lifestyle curriculum in a large academic medicine practice. It is delivered by a nurse educator over 12 weekly sessions with optional reenrollment, available on a self-pay basis, and implemented using existing clinical resources (eg, electronic medical record referrals, scheduling, conference rooms, communication technology). The program was evaluated using a controlled before-after design, including all patients referred between April 1, 2005, and February 1, 2007. Patients with a body mass index (BMI) ≥25 kg/m2 were eligible if their primary care providers felt the program was medically appropriate and safe. Change in weight (kg) and frequency of achieving ≥7% weight loss were examined.

Results

Referred patients were primarily female (84%), with an average age of 49.91 years (SE, 1.46) and average BMI of 39.65 kg/m2 (SE, 0.73). Among eligible patients, 93% of enrollees and 80% of nonenrollees had follow-up weights recorded within the evaluation window. Over 1 year, mean weight change was –5.19 kg (95% confidence interval [CI], –7.71 to –2.68) among enrollees and +0.21 kg (CI, –1.0 to 1.93) among nonenrollees (P < .001). A ≥7% loss was found for 27% of enrollees and 6% of nonenrollees (P = .001).

Conclusions

An evidence-based lifestyle intervention can be effectively translated into the clinical setting. Use of existing resources may facilitate patient flow and minimize cost. This provider-integrated preventive care approach may provide a model for incorporating knowledge from behavioral science into clinical care.

The Diabetes Educator, Vol. 35, No. 2, 199-208 (2009)
DOI: 10.1177/0145721709332815
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