Can healthcare providers motivate patients to change their lifestyles and improve their health? Researchers from Emory University in Atlanta, Georgia, in a presentation at the American Diabetes Association’s 73rd Scientific Sessions, Chicago, Illinois, believe it is possible.

The researchers explained that previous studies that have shown that lifestyle changes, including becoming more physically active and eating well-balanced meals, do help people lose weight, and reduce their risk of developing diabetes type 2, cardiovascular diseases and other complications. However, those studies included highly-motivated volunteer-participants.

The Diabetes Prevention Program (DPP), implemented by the National Institutes of Health, has demonstrated that intensive lifestyle intervention done on a one-on-one basis helped individuals lose weight and reduce their risk of developing type 2 diabetes significantly.

The DPP became a template for other less costly group programs aimed at helping people lose weight and improve their overall long-term health. By using this model, many smaller community-based studies have been successful. However, these too have used highly-motivated volunteers.

In this latest study, the researchers looked at participants from VA Medical Centers from various parts of the country. They wanted to determine how effective healthcare providers are on a national level at getting their patients to make lifestyle changes.

Sandra L. Jackson, MPH, a PhD candidate in Nutrition and Health Sciences at Emory University in Atlanta, whose dissertation research focuses on this theme, said:

“We wanted to see how effective a lifestyle change program would be for patients in a national health care system. In order to achieve wide-scale results in reducing the prevalence of diabetes in this country, we need to get to patients who are at risk. One way of doing this is through their health care providers, and such a strategy – if found to be effective – could be replicated across many healthcare systems.”

Jackson and team gathered and analyzed data from the records of 400,000 patients in the MOVE! ((Managing Obesity and Overweight in Veterans Everywhere) VA program. Patients were referred to MOVE! by their doctors during routine medical consultations.

The MOVE! Program is available at 130 VA clinics and hospitals across the USA. Participants come together once a week for group lifestyle intervention sessions that concentrate on such issues as physical activity and diet. Although the programs are very similar, they differ slightly from facility to facility and may be run by exercise physiologists, nutritionists, diabetes educators, or other experts.

The study found that among the MOVE! Participants:

  • A loss of body weight of 1.3% was maintained for over 36 months (average)
  • 2.7% loss of body weight was maintained for over 36 months among those who enrolled in at least eight sessions over a six-month period

The team also found that veterans with type 2 diabetes were more likely to join MOVE! compared to their counterparts who had no diabetes when the program began.

Participants who lost more pounds after six months had a lower risk of developing diabetes over a 3-year-period. For every extra pound lost, type 2 diabetes risk went down by 1%, after taking into account baseline, gender and age.

Lawrence S. Phillips, MD, Professor of Medicine at Emory University School of Medicine, Division of Endocrinology, and Director of the Clinical Studies Center at the Atlanta VA Medical Center, said:

“Around the country, there are hundreds of millions of Americans who are involved in one health care setting or another. 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. 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.”

The Healthy Living Partnerships to Prevent Diabetes (HELP PD) study – which was modeled after one used in the NIH Diabetes Prevention Program, was found to help participants in a group setting lose weight and have better glucose control comparable to those achieved with one-on-one counseling from health professionals, according to dietitians at the Wake Forest Diabetes Care Center in Winston-Salem, North Carolina. They presented their findings at the American Diabetes Association’s 70th Scientific Sessions (2010).

Participants were divided into two groups:

  • The lifestyle weight loss group – they received six months of weekly behavioral weight loss sessions in a group, and then meetings once a month, during which they were encouraged to change their eating habits and be physically active for up 180 minutes each week
  • The usual care group – a dietician visited the person twice, and they were sent a quarterly newsletter with advice on lifestyle changes.

Those in the lifestyle weight loss group achieved and maintained weight loss of 7.3% of body weight after 12 months compared to 1.3% in the other group.

Researchers reporting on the “Look AHEAD” trial, explained at the same ADA Scientific Sessions in Chicago that a 10-year intensive lifestyle intervention program for type 2 diabetes patients that concentrated on exercise and weight loss did not reduce stroke or heart attack risk, but provided some other health benefits.

Written by Christian Nordqvist