title: A Quasi-Experiment to Assess the Impact of a Scalable, Community-Based Weight Loss Program: Combining Reach, Effectiveness, and Cost.
abstract: BACKGROUND
  Primary care addresses obesity through physician oversight of intensive lifestyle interventions or referral to external programs with demonstrated efficacy. However, limited information exists on community program reach, effectiveness, and costs across different groups of participants.
  
  
  OBJECTIVE
  To evaluate a scalable, community weight loss program using reach, effectiveness, and cost metrics.
  
  
  METHODS
  Longitudinal pre-post quasi-experiment without control.
  
  
  METHODS
  Enrolled participants in Weigh and Win (WAW), a community-based weight loss program.
  
  
  METHODS
  A 12-month program with daily social cognitive theory-based email and/or text support, online access to health coaches, objective weight assessment through 83 community-based kiosks, and modest financial incentives to increase program reach.
  
  
  METHODS
  Number of participants, representativeness, weight loss achievement (3%, 5% of initial weight lost), and cost of implementation.
  
  
  RESULTS
  A total of 40,308 adults (79% women; 73% white; BMI = 32.3 ± 7.44, age = 43.9 ± 13.1 years) enrolled in WAW. Women were more likely than men to enroll in the program and continue engagement beyond an initial weigh-in (57% vs. 53%). Based on census data, African Americans were over-represented in the sample. Among participants who engaged in the program beyond an initial weigh-in (n = 19,029), 47% and 34% of participants lost 3% and 5% of their initial body weight, respectively. The average duration for those who achieved 5% weight loss was 1.7 ± 1.3 years. African American participants were more likely to achieve 5% weight loss and remain enrolled in the program longer compared to non-African American participants (2.0 ± 1.3 vs. 1.6 ± 1.2 years). Implementation costs were $2,822,698. Cost per clinically meaningful weight loss for African Americans ($257.97/3% loss; $335.96/5% loss) was lower than that for Hispanics ($318.62; $431.10) and Caucasians ($313.65; $441.87), due to the higher success rate of that subgroup of participants.
  
  
  CONCLUSIONS
  Weigh and Win is a scalable technology-supported and community-based weight loss program that reaches a large number of participants and may contribute to reducing health disparities.
authors.affiliation: Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA. paul.estabrooks@unmc.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Estabrooks
authors.affiliation: Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Wilson
authors.affiliation: IncentaHealth LLC, Denver, CO, USA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: McGuire
authors.affiliation: Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.
authors.forename: Samantha M
authors.initials: SM
authors.lastname: Harden
authors.affiliation: Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA.
authors.forename: NithyaPriya
authors.initials: N
authors.lastname: Ramalingam
authors.affiliation: IncentaHealth LLC, Denver, CO, USA.
authors.forename: Lia
authors.initials: L
authors.lastname: Schoepke
authors.affiliation: Department of Health Promotion, Social and Behavioral Health, University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365, USA.
authors.forename: Fabio A
authors.initials: FA
authors.lastname: Almeida
authors.affiliation: Kaiser Permanente Colorado, Prevention and Chronic Care Solutions, Denver, CO, USA.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Bayer
mesh_terms: D000328:Adult; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods*; D003120:Colorado / Q000453:epidemiology; D003153:Community Health Services / Q000191:economics / Q000379:methods; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000191:economics / Q000208:ethnology / Q000503:physiopathology / Q000628:therapy*; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000191:economics
keywords: behavioral weight Loss; cost; impact; incentives; public health