August 2007: Effects of Lifestyle Intervention on Health Care Costs: Improving Control with Activity and Nutrition (ICAN)

Over the past 25 years in the United States, the number of obese adults has doubled and the rate of overweight adolescents has tripled. As the obesity rates increase, so does the cost of health care. According to the article, between 1987 and 2001 there was an estimated 38% increase in the cost of diabetes due to a higher prevalence of obesity and the escalating medical costs for obese patients. In 2002, the direct cost of diabetes was $91.8 billion. This indicates that while treating obesity, emphasizing diabetes management would also be effective in decreasing health care costs. In this current study, researchers used lifestyle treatment (diet and physical activity) as the foundation for type 2 diabetes and obesity management.

The pilot study known as Improving Control with Activity and Nutrition (ICAN) was used to compare the health care costs of lifestyle intervention with the usual medical care offered to obese patients with type 2 diabetes. A random sample of 147 participants was used. The researchers assigned participants to one of two groups: usual care (n=74) or case management (n=73). Over the next year, a registered dietitian led the case management group in providing individual and group support, goal setting, behavior modification, education, referrals, and the educational material that the usual medical care group received. The eligibility criteria for participants were diagnosis of type 2 diabetes, the use of diabetes medication, and a BMI of 27 or greater. The outcome of the study was based on measuring the medical and pharmaceutical health care costs paid by the participant’s primary insurance company. The results of the RD-led lifestyle case management group did not show a contribution to the increase in health care costs. However, it also indicated a reasonable savings in health care costs per person per year. Despite the small sample size, this pilot study adds to the growing evidence that lifestyle interventions among high risk populations are cost effective.

The additional article explores three main objectives to aide in a better understanding the relationship between obesity and weight management in correlation with health care costs. The first objective looks at the cost of health care in overweight and obese patients compared to normal weight patients. The increase in prescription medication has proven to be a large contributor to the growing number of obese or overweight health care patients. The second objective explored the current cost of available obesity treatments: behavioral treatments, bariatric surgery, and obesity pharmacotherapy. The third objective, focused on cost effectiveness of obesity treatments. The research indicated that the cost effectiveness was the result of appropriate weight management that aides in the prevention of chronic illnesses and improves the quality of life. Health plan managers and disease management leaders need to be aware of the potential increase in health care costs for the obese population. An increase in awareness will allow for optimal intervention in weight management for the obese and overweight patients.

JADA Continuing Education Article:
Wolf, A.M., Siadaty, M., Yaeger, B., (2007). Effects of Lifestyle Intervention on Health Care Costs: Improving Control and Activity and Nutrition (ICAN). Journal of the American Dietetic Association,107(8):1365-1373.

Article and the JADA Continuing Education Questionnaire can be found at www.eatright.org.

Additional Article:

Bachman, K.H., (2007). Obesity, Weight Management, and Health Care Costs: A Primer. Disease Management, 10(3): 129-137.