Stepped-care is effective, cheaper for weight loss

Helping heavy people lose weight is typically an expensive endeavor, but new research suggests starting them on a basic weight-loss program - and only adding more intensive help if they need it - could be cheaper and still effective.

So-called stepped-care is used all the time in medicine, said Robert Klesges, a preventive medicine researcher from the University of Tennessee Health Science Center in Memphis, who has studied the approach.

For example, if you come into the doctor's office with high blood pressure, you could be told to make some diet and lifestyle changes and return in a few months - and only then, if your numbers are still high, the doctor might prescribe you a drug, he said.

Researchers have wondered if that same approach could be applied to helping overweight and obese people shed extra pounds.

"The challenge with it is, the standard way of doing weight management (as a behavioral intervention) is very time-expensive as well as cost-expensive," said John Jakicic, the lead author of the new study from the University of Pittsburgh.

That includes frequent group or individual meetings with a counselor, for example.

"We're trying to find ways to deliver virtually the same effectiveness, if not better effectiveness, at a lower cost."

Jakicic and his colleagues designed a stepped-care program that started with a monthly group session and mailings and escalated to individual counseling appointments and meal replacements only for people who didn't lose weight initially.

Then, they randomly assigned 363 overweight and obese adults, mostly women, to go through the stepped-care program or a traditional weight-loss intervention. The standard program included weekly to monthly group sessions that didn't change based on how many pounds people lost.

All participants were encouraged to decrease their daily calories to 1200 to 1800 per day, depending on their initial weight, and exercise up to five hours each week by six months into the program.

Eighteen months later, people in both groups had lost weight. Those in the standard program dropped from an average of 205 pounds to 188 pounds - equal to an eight per cent weight loss. In the stepped-care group, weight fell from 204 pounds to 190 pounds, on average, for a slightly smaller seven per cent weight loss.

Participants saw similar fitness improvements as well as decreases in blood pressure and resting heart rate, according to findings published Tuesday in the Journal of the American Medical Association.

However, the stepped-care approach proved to be cheaper to implement: it cost $785 per participant, including the expense for both the researchers to run sessions and the participants themselves, versus $1,357 in the standard treatment group.

"For a much lower cost, we were able to deliver virtually identical weight loss," Jakicic told Reuters Health. "It's a very promising finding."

The stepped-care approach, he said, "may be very appealing to folks who don't have the time to do weekly intervention meetings."

It's possible that by tinkering with the type of treatments offered in the stepped-care program, those people could lose more weight, researchers said.

For example, Klesges said starting out "too un-intensive" might mean some people get frustrated and drop out before they can actually lose any weight.

Jakicic said it's possible some people who really aren't losing weight after a month or two could be moved up to more intensive steps sooner in future studies. In addition, researchers could develop programs using technology to help lower costs even further, he added.

"What we now have to do is develop steps for the stepped-care intervention that people will find perhaps a little more intensive," Klesges, who wasn't involved in the new study, told Reuters Health.

"We have to balance efficacy and cost-effectiveness."

Still, he called stepped-care "highly promising" and agreed this approach could be used not just in controlled studies, but in the real world for people seeking to lose weight.

SOURCE: Journal of the American Medical Association, online June 26, 2012

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