Economic evaluation of a weight control program with e-mail and telephone counseling among overweight employees: a randomized controlled trial.

BACKGROUND: Distance lifestyle counseling for weight control is a promising public health intervention in the work setting. Information about the cost-effectiveness of such interventions is lacking, but necessary to make informed implementation decisions. The purpose of this study was to perform an economic evaluation of a six-month program with lifestyle counseling aimed at weight reduction in an overweight working population with a two-year time horizon from a societal perspective. METHODS: A randomized controlled trial comparing a program with two modes of intervention delivery against self-help. 1386 Employees from seven companies participated (67% male, mean age 43 (SD 8.6) years, mean BMI 29.6 (SD 3.5) kg/m2). All groups received self-directed lifestyle brochures. The two intervention groups additionally received a workbook-based program with phone counseling (phone; n=462) or a web-based program with e-mail counseling (internet; n=464). Body weight was measured at baseline and 24 months after baseline. Quality of life (EuroQol-5D) was assessed at baseline, 6, 12, 18 and 24 months after baseline. Resource use was measured with six-monthly diaries and valued with Dutch standard costs. Missing data were multiply imputed. Uncertainty around differences in costs and incremental cost-effectiveness ratios was estimated by applying non-parametric bootstrapping techniques and graphically plotting the results in cost-effectiveness planes and cost-effectiveness acceptability curves. RESULTS: At two years the incremental cost-effectiveness ratio was €1009/kg weight loss in the phone group and €16/kg weight loss in the internet group. The cost-utility analysis resulted in €245,243/quality adjusted life year (QALY) and €1337/QALY, respectively. The results from a complete-case analysis were slightly more favorable. However, there was considerable uncertainty around all outcomes. CONCLUSIONS: Neither intervention mode was proven to be cost-effective compared to self-help.

Effectiveness of phone and e-mail lifestyle counseling for long term weight control among overweight employees.

OBJECTIVES: To determine the effectiveness of a weight-management program with personal counseling by phone or e-mail. METHODS: A randomized controlled trial of a 6-month program comparing two modes of intervention delivery (phone, n = 462; Internet, n = 464) with self-directed materials (control, n = 460), among overweight employees. Change in body weight after 2 years was the main outcome. RESULTS: Among complete cases, weight loss in the Internet group was 1.2 kg (95% confidence interval [CI], -1.9 to -0.4) and in the phone group 0.8 kg (95% CI, -1.5 to 0.03), compared with the control group. Multiple imputation of missing body weight resulted in comparative weight losses of -0.9 kg (95% CI, -2.0 to 0.3) and -0.4 kg (95% CI, -1.4 to 0.7). CONCLUSIONS: Among complete cases, the Internet intervention showed modest long-term weight loss, but among all participants neither program version was more effective than self-help.

Phone and e-mail counselling are effective for weight management in an overweight working population: a randomized controlled trial.

BACKGROUND: The work setting provides an opportunity to introduce overweight (i.e., Body Mass Index >or= 25 kg/m2) adults to a weight management programme, but new approaches are needed in this setting. The main purpose of this study was to investigate the effectiveness of lifestyle counselling by phone or e-mail on body weight, in an overweight working population. Secondary purposes were to establish effects on waist circumference and lifestyle behaviours, and to assess which communication method is the most effective. METHODS: A randomized controlled trial with three treatments: intervention materials with phone counselling (phone group); a web-based intervention with e-mail counselling (internet group); and usual care, i.e. lifestyle brochures (control group). The interventions used lifestyle modification and lasted a maximum of six months. Subjects were 1386 employees, recruited from seven companies (67% male; mean age 43 (SD 8.6) y; mean BMI 29.6 (SD 3.5) kg/m2). Body weight was measured by research personnel and by questionnaire. Secondary outcomes fat, fruit and vegetable intake, physical activity and waist circumference were assessed by questionnaire. Measurements were done at baseline and after six months. Missing body weight was multiply imputed. RESULTS: Body weight reduced 1.5 kg (95% CI -2.2;-0.8, p < 0.001) in the phone group and 0.6 kg (95% CI -1.3; -0.01, p = 0.045) in the internet group, compared with controls. In completers analyses, weight and waist circumference in the phone group were reduced with 1.6 kg (95% CI -2.2;-1.0, p < 0.001) and 1.9 cm (95% CI -2.7;-1.0, p < 0.001) respectively, fat intake decreased with 1 fatpoint (1 to 4 grams)/day (95% CI -1.7;-0.2, p = 0.01) and physical activity increased with 866 METminutes/week (95% CI 203;1530, p = 0.01), compared with controls. The internet intervention resulted in a weight loss of 1.1 kg (95% CI -1.7;-0.5, p < 0.001) and a reduction in waist circumference of 1.2 cm (95% CI -2.1;-0.4, p = 0.01), in comparison with usual care. The phone group appeared to have more and larger changes than the internet group, but comparisons revealed no significant differences. CONCLUSION: Lifestyle counselling by phone and e-mail is effective for weight management in overweight employees and shows potential for use in the work setting. TRIAL REGISTRATION: ISCRTN04265725.

Development of general and central obesity from childhood into early adulthood in African American and European American males and females with a family history of cardiovascular disease.

BACKGROUND: Obesity is associated with multiple health problems, often originating in childhood. OBJECTIVE: The objective was to investigate differences in the development of adiposity from childhood to adulthood as related to race, sex, and socioeconomic status (SES). DESIGN: Individual growth curve modeling for waist circumference, body mass index, and sum of skinfold thicknesses (triceps, subscapular, and suprailiac) was performed in an 11-y cohort study of 622 African Americans and European Americans aged 4.2-27.5 y. We examined the development of adiposity in 2 ways: 1) differences related to race, sex, and parents' education (SES), and 2) differences between obese, overweight, and normal-weight persons at the end of their childhood (> 17 y of age). RESULTS: The sum of skinfold thicknesses was greater in females than in males, with a larger increase with age. Race, sex, and SES showed a complex relation with body mass index and the sum of skinfold thicknesses. The low-SES group showed the fastest increase in waist circumference with age. The obese group showed the most rapid increase in the 3 measures of adiposity. Growth curves for the obese group were distinguishable from those for the normal-weight persons at an earlier age for African Americans than for European Americans. CONCLUSIONS: The development rate of adiposity from childhood into early adulthood is influenced by sex and SES but not by race. However, race, sex, and SES had joint effects on adiposity levels. The development of obesity can begin to be distinguished in midchildhood, but the age at which this distinction becomes apparent depends on race.

Differential influence of family history of hypertension and premature myocardial infarction on systolic blood pressure and left ventricular mass trajectories in youth.

OBJECTIVE: To examine the influence of genetic susceptibility to essential hypertension (EH) and the genetic susceptibility to premature myocardial infarction (MI) on longitudinal development of systolic blood pressure (SBP) and left ventricular mass (LVM) in youth. METHODS: Individual SBP and LVM growth curves across age were created for a sample of 745 subjects (age range: 4.9-27.5 years) and a sample of 687 subjects (age range: 8.2-27.5 years), respectively. Each sample had an approximately equal proportion of African American and European American males and females, with annual assessments over a 10-year period. Family history (FH) of EH and FH of premature MI were used as measures of genetic susceptibility to EH and to premature MI, respectively. Positive FH (FH(+)) of EH and of premature MI were defined, respectively, as verified EH in 1 or both biological parents, and verified MI in any biological parent or grandparent before 55 years of age. RESULTS: Subjects with an FH(+) of EH had higher SBP levels and stronger increases in SBP over time than subjects with a negative FH (FH(-)) of EH. Subjects with an FH(+) of EH also showed higher LVM levels than subjects with an FH(-) of EH. In addition, the effect of an FH(+) of EH on LVM was stronger in females than males. The effects of FH of EH on SBP and LVM could not be explained by differences in socioeconomic status, but the effect on LVM was no longer significant after adjustment for BMI. FH of MI had no significant effects on SBP or LVM. CONCLUSIONS: Effects of genetic susceptibility to EH on SBP and LVM trajectories were observed in childhood, whereas no such effects were found for FH of MI. Genetic markers of EH may improve the understanding of individual differences in susceptibility to develop hypertension and LV hypertrophy.

Moderators of blood pressure development from childhood to adulthood: a 10-year longitudinal study.

OBJECTIVE: To examine the effect of ethnicity on the development of blood pressure (BP) from childhood into early adulthood within the context of height, sex, adiposity, and socioeconomic status (SES). STUDY DESIGN: Individual growth curves of systolic BP (SBP) and diastolic BP (DBP) were created for 745 black and white male and female youths, with annual assessments over a 10-year period (age range, 4.9-27.5 years). RESULTS: Blacks had higher SBP levels (P <0.01) than whites, respectively. Moreover, black female subjects showed a greater SBP increase over time (P <.05) than white female subjects. Black male and female subjects also showed higher DBP levels (P <.001) than white male and female subjects, respectively, but the rate of change of DBP did not differ. Ethnic differences in BP trajectories persisted after adjusting for SES and/or changes in height and/or adiposity in both male and female subjects. CONCLUSIONS: Ethnic differences in SBP become manifest in childhood in girls, in early adolescence in boys, and tend to increase with age. Ethnic differences in DBP become manifest in childhood in both boys and girls and remain stable over time. The ethnic differences cannot be entirely explained by individual differences in SES, growth, or adiposity. Identification of mechanisms responsible for increase of BP in childhood will improve prevention of hypertension in adulthood.

Reproducibility of ambulatory blood pressure measures in African-American adolescents.

OBJECTIVE: The primary purpose of this study was to evaluate the reproducibility of ambulatory blood pressure (BP) measures in African-American (AA) adolescents. METHODS: Forty-one AA adolescents (age 16.6 +/- 1.3 yrs, 16F) with high-normal BP were measured on 3 occasions at 2-month intervals. Systolic BP (SBP), diastolic BP (DBP), and heart rate (HR) measures were recorded using the Spacelabs ambulatory BP monitor 90207 (Redmond, Wash) in the natural environment over 24-hour periods. Mixed model repeated measures ANOVAs were used to analyze the underlying error variance-covariance (V-C structures as well as mean differences for the 3 visits. RESULTS: Daytime measures: there were no significant mean differences across visits for daytime SBP, DSP, and HR (all Ps > .57). The error V-C matrix was heterogeneous Toeplitz for daytime SBP. Correlations between visits 1 and 2, 1 and 3, and 2 and 3 for daytime SBP were rs = 0.71, 0.47, and 0.71, respectively. Compound symmetry (CS) was the preferred model for daytime DBP (r = 0.68) and HR (r = 0.75). Nighttime measures: there were no significant mean differences across visits for nighttime SBP, DBP, and HR (all Ps > .29). The error V-C matrix was unstructured for nighttime SBP. Correlations between visits 1 and 2, 1 and 3, and 2 and 3 for SBP were rs = 0.74, 0.33, and 0.33, respectively. CS was preferred for night-time DBP (r = 0.58) and HR (r = 0.74). CONCLUSION: Collectively, these findings demonstrate that 3 measurements of ambulatory-derived DBP and HR measures are stable across 4 months, but SBP was only stable across 2 months in African-American adolescents.