Weight Loss Through Living Well Translating an Effective Lifestyle Intervention Into Clinical Practice

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/m(2) 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.