Programs deliver success for overweight, diabetic patients
■ Participants in a VA program lost weight and kept it off. Patients with diabetes were even more likely to take part.
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Large health system programs can help obese and overweight patients — especially those diagnosed with type 2 diabetes — make lifestyle changes that lead to a healthier existence, a study shows.
Researchers combed through data from more than 400,000 people who have participated in the VA Health Care System's MOVE! program since 2005. MOVE! — short for Managing Overweight and/or Obesity for Veterans Everywhere — is a national program available to veterans, helping them to lose weight and keep it off through wise eating choices and physical activity.
The data showed that the 145,686 participants who were still checking in with the program after three years lost 1.3% of their weight. Their mean body mass index levels decreased to 35.8, down from 36.3, according to the findings, presented at the American Diabetes Assn. meeting in Chicago in June.
Results were even better for the 8.7% of veterans who were more active in the program. Those who attended at least eight sessions during a six-month period and had at least 129 days between their first and last session lost 2.7% of their weight. Researchers found that veterans with diabetes were more likely to actively participate than veterans without diabetes (9.6% versus 7.8%).
“It is very encouraging to see a program on a large scale have a real impact. We hope other people take notice,” said Sandra L. Jackson, MPH, a study author and a PhD candidate in nutrition and health sciences at Emory University in Atlanta.
Millions of Americans involved in one health care setting or another could take advantage of similar programs, said Lawrence S. Phillips, MD, professor of medicine at Emory University School of Medicine's Division of Endocrinology and director of the Clinical Studies Center at the Atlanta VA Medical Center.
About 26 million U.S. adults have diabetes. Another nearly 80 million have prediabetes, but only about one in 10 is aware of it, according to a Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report published March 22.
“Diabetes is a problem of epidemic proportions. We are older, heavier and more sedentary as a society, and these are cardinal factors in the diabetes epidemic,” Dr. Phillips said. “The key way to reverse this is lifestyle change. The good news is this research shows that participation does not have to be entirely voluntary to work, and the health care system can and should be part of the solution.”
In previous studies, researchers looked at programs where participants volunteered to be part of the group research, suggesting there was a higher level of motivation to lose weight, Jackson said. Here, veterans were more likely to be recommended to the program by a physician or other health care professional.
“We are not saying physicians can wave a magic wand, but if they do reach out to people, some will go,” Jackson said. “Physicians should continue to mention these programs to their patients and encourage them to be more active.”
Jackson said researchers plan to further study how to best encourage active participation and to look at what the impact is on veterans' health and the VA health system.
YMCA and AMA partnership
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80 million Americans have prediabetes, but only about 10% of them are aware of it.
Meanwhile, the American Medical Association is working with the YMCA of the USA to increase physician referrals to the YMCA's Diabetes Prevention Program. The initiative uses an evidence-based approach to help patients diagnosed with prediabetes increase physical activity and lose weight. The YMCA's program is available in nearly 80 locations in 30 states and the District of Columbia. It has been shown to cut the number of new cases of type 2 diabetes among participants by 58%.
The partnership makes it easier for physicians to refer patients, track their involvement and share information about the patients' progress, with their permission.
“These new studies add to our understanding of how lifestyle interventions can influence cardiometabolic health,” said AMA President Ardis Dee Hoven, MD, an internal medicine and infectious disease specialist in Lexington, Ky. “In selecting our approach to preventing type 2 diabetes, the AMA conducted a thorough review of the literature and found that the weight of the evidence supports promoting wider participation in the YMCA's Diabetes Prevention Program.”
Another study presented at the American Diabetes Assn. meeting found that people with type 2 diabetes who were involved in a long-term lifestyle intervention program that focused on losing weight through decreased calories and increased physical activity did not reduce their risk for heart attacks or strokes compared with a control group that was given only diabetes support and education. There also was not a significant drop in the lifestyle intervention group's LDL cholesterol compared with the control group, according to the study posted online June 24 in The New England Journal of Medicine.
However, the research showed that there were positive changes for the group that lost weight through fewer calories and more physical activity: improved physical quality of life; reduced microvascular complications; lowered risk for depression; and diminished medical costs because of fewer hospitalizations, outpatient care needs and medications.
The study, funded by the National Institute of Diabetes and Digestive and Kidney Diseases, looked nationally at more than 5,000 overweight obese adults ages 45 to 76 who had been diagnosed with type 2 diabetes. Griffin P. Rodgers, MD, the institute's director, said the study “reinforces the recommendation that overweight and obese people with type 2 diabetes should increase their physical activity levels and lose weight to improve their health.”