MDNews - Greater Kansas

Clinic is responsible for integrating nearly 150 physicians and more than 65 mid-level Via Christi-employed providers into a cohesive and integrated multispecialty group practice at 19 fully/partially owned or managed clinics. We have a long-standing commitment to improving patients' health by offering safe and structured programs for losing weight. This commitment began in 1994 with the Prevention & Health Center, now Via Christi Weight Management (VCWM), which provides medically directed and surgical interventions for weight loss. Importantly, VCWM understands that successful long-term weight management requires a commitment to sustained lifestyle changes regardless of whether a patient chooses medical or surgical intervention. We facilitate this commitment through an integrated, multidisciplinary team-based approach. A key aspect of VCWM is the use of outcomes data to guide behavioral and medical decisions, with periodic data analysis guiding the patient care team. An important benefit of weight loss is reduced medication use. 4,5 This is particularly important given that medications for hypertension, diabetes and dyslipidemia are used more frequently by individuals with obesity than by individuals with normal body weight. 6,7 The Program VCWM uses the Health Management Resources (HMR)-developed behavioral program. HMR has delivered research-based and structured weight-loss and weight-maintenance programs for over 30 years. Both VCWM and HMR, a leader in medically managed weight-loss programs, have published data from studies that demonstrate effective outcomes associated with weight loss. 8,9 Ours is a comprehensive lifestyle program that enables par- ticipants to acquire skills to maintain a reduced-calorie diet and increase physical activity through behavioral strategies. Onsite, high-intensity, comprehensive weight-loss programs provided by trained interventionists are "the most effective behavioral weight loss treatment," supported by strong evidence in recent medical guidelines. 10 Our HMR program focuses on three measurable lifestyle behavior changes, with defined minimums that support weight loss and durable weight maintenance: + At least 2,000 kcals of physical activity per week + At least five 1-cup servings of vegetables and fruits per day for some weight-loss options and all weight-maintenance programs + Use of HMR meal replacements (MRs) — a selection of entrees, shakes, cereal and soup (at least five per day in weight loss and initially two suggested per day in weight maintenance). Portion-controlled MRs in reduced-calorie diets is supported as an effective treatment by medical and nutritional organizations. 11,12 Participants use a simple daily record-keeping system to self- monitor lifestyle behaviors. Streamlining the tracking system increases compliance, which, in turn, facilitates behavioral changes. Lifestyle skills and behavioral changes are reinforced at weekly group coaching sessions led by a health educator and during a midweek check-in phone call to report progress. The Data Story The case study below provides an overview of results, including weight loss, corresponding changes in medication use for treatment of Type 2 diabetes mellitus, hyperten- sion and dyslipidemia, as well as estimated changes in medication costs for patients with obesity enrolled over a five-year period in our medically supervised weight management program. Our study reflects data from overweight and obese participants who were enrolled in our program between 2009 and 2013. Medical staff collected and verified height, weight and baseline use of medi- cations for treatment of diabetes, hypertension and dyslipidemia. Body weight and medication changes were recorded weekly and as needed. Results reflect patients for whom data were available at baseline and at least one follow-up (i.e., 12 weeks and/or 52 weeks). We estimated drug costs using the National Average Retail Prices (NARP) for Medicaid Covered Outpatient Drugs, 13 which reports drug unit prices from U.S. pharmacies. Unit prices are averages of payment by cash, Medicaid and third-party customer. The NARP file was updated monthly until July 1, 2013. 14 Significant Outcomes Changes in body weight. VCWM patients (N=984) had a mean body mass index of 44.1 kg/m2 at baseline. Following 12 weeks of program participation, patients achieved a 12 percent average reduction in body weight, and by week 52, patients achieved a 19 percent average body weight reduction. These data are impressive for two reasons: First, the average weight loss at both time points surpasses the clinically significant range of 5–10 percent, which reduces risk for developing comorbid conditions such as diabetes and hypertension. Second, many studies demonstrate that, while 5–10 percent weight losses confer positive health benefits, greater weight losses, as shown by VCWM program participants, confer even more significant benefits. 15 (See Figure 1 for mean weights at weeks 0, 12 and 52). Decreased medication. Patients with obesity commonly have associated comorbid conditions, and it's not surprising that high percentages of our patients were taking medications for hyperten- sion or dyslipidemia. Weight loss most significantly impacted the use of diabetes medications by program patients. Average diabetes medication cost per patient per day at enrollment was estimated at $7.33, which was reduced to $2.36 by week 12 and $1.31 by week 52. (See Figures 2 and 3.) Similarly, estimated per-patient-per-day costs for hypertension and dyslipidemia were reduced by 21 percent and 14 percent, respectively, at week 12, and 42 percent and 28 percent, respectively, at week 52. Via Christi has a long-standing commitment to improving patients' health by offering safe and structured programs for losing weight. M D N E W S . CO M ■ MD NEWS Greater Kansas | 1 1

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