Coaching better health

Type 2 diabetes is a common and serious health concern for many people in the United States that carries substantial health care expenses. Health complications associated with poorly managed diabetes can include shorter lifespans, lower quality of life and more extensive use of health care services. Weight loss and behavior modification programs may be effective at reducing the incidence and consequences of type 2 diabetes; however, such programs are less available in rural areas than in cities. Previous research investigated the effectiveness of programs offered through Cooperative Extension Service (CES) offices in rural counties for achieving weight loss, but relatively little focus has been placed on the cost-effectiveness of these programs in preventing or delaying type 2 diabetes.

Tiffany A. Radcliff, PhD, and Murray J. Côté, PhD, of the Texas A&M School of Public Health, along with colleagues from the University of Florida and the University of Colorado recently published a study in the Journal of the Academy of Nutrition and Dietetics. The study used data from a randomized trial to assess the cost-effectiveness of three levels of a lifestyle modification intervention based on nutrition education and behavioral coaching to a nutrition education-only approach.

For the trial, researchers randomly assigned obese adults to receive a standardized weight loss program. Participants then received either eight sessions of nutrition education or eight, 16, or 24 sessions of a nutrition education program with behavioral coaching with physical activity goal setting and problem solving over two years to help maintain their healthy habits. Sessions were delivered through CES offices using a mix of in-person and telephone-based interactions. Researchers measured participants’ weight and diabetes status at the beginning and end of the trial.

Quantitative modeling methods following the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) were used to predict changes in diabetes status and related measures of quality adjusted life years and health care costs over a five-year follow-up period.

The study results indicated that all of the intervention levels led to lower costs and greater quality adjusted life years than the education only program. Per-person costs of each program ranged from $90 for the education only intervention to $191 for 24 sessions of the intervention with behavioral coaching.

“Among the three levels of intervention with coaching, the moderate level had the greatest relative improvement in quality adjusted life years and the low-dose level had the lowest costs,” Côté said. “Because the low-dose level has fewer sessions, it would require less staffing and may be more feasible to implement in rural counties.”

According to Radcliff and her colleagues, the findings point to CES-based programs being of significant benefit to rural areas that are often lacking in more typical weight loss and diabetes management programs. “This research indicates that CES offices are well-positioned to bring evidence-based programs to rural areas. Our results also suggest that a mix of education and coaching are cost-effective in helping rural residents improve their health,” Radcliff said.