Discussion
Weight losses of more than 10% were observed in patients after three months of treatment and these results exceed the weight loss findings reported by the several randomized clinical trials typically report five percent weight losses. Due to the large number of subjects who did not complete the three months of clinical treatment make this estimate of weight loss less certain.
The program was effective in improving cardiovascular health parameters such as percent body fat, blood pressure (systolic and diastolic), and lipids (total Cholesterol, HDL, LDL, and Triglycerides).
We have demonstrated that this self-pay program could be a viable and economically feasible approach to delay or prevent the development of type 2 diabetes and cardiovascular diseases in patients who are overweight or obese. Our cost-effective ambulatory care model enabled physicians to partner with dietitians, nurses, and behavior therapists by utilizing group nutrition and behavioral education in a weekly schedule coordinating with time for patients to consult with physicians and dietitians individually. There is no net cost to the health care group because this is a service entirely funded by monthly patient fees. The scale of the results presented in this paper could have significant potential for far-ranging economic and social impact, helping to alleviate the growing economic burden of treating IFG, IGT, and T2DM.
The economic burden associated with T2DM and cardiovascular diseases is substantial for patients, employers, and health care systems. Research by the American Diabetes Association has estimated the cost of diagnosed diabetes in 2017 is $327 billion, including $237 billion in direct medical costs and $90 billion in reduced economic productivity. Indirect costs include increased absenteeism ($3.3 billion) and reduced productivity while at work ($26.9 billion) for the employed population, reduced productivity for those not in the labor force ($2.3 billion), inability to work as a result of disease-related disability ($37.5 billion), and lost productive capacity due to early mortality ($19.9 billion)(11). Weight management programs can reduce the development of T2DM if such programs can be cost-effective and efficient within our existing medical care systems. Patient-orientated interventions are the most effective in effecting positive behavioral and health outcomes (12). The impact of weight loss on medication utilization cannot be understated even though the discontinuation of medications may not have the greatest impact on overall health care costs. However, elimination of medications may be associated with reduction in potential side effects and improvement in quality of life.
We acknowledge that this study has some important limitations. It is important to note that the electronic medical records may contain some errors. Change in medications used was not captured in the electronic data entry and we may have underestimated the effects of weight loss on glucose control medications as a result. Similarly, patients on statin drugs for hypercholesterolemia also discontinued their use of drugs when low-density lipoprotein-cholesterol levels declined below the optimal levels suggested by their doctors. Prediabetes was defined by impaired fasting blood glucose values instead of oral glucose tolerance tests or hemoglobin A1c, and the lack of information on changes of medications over time. In addition, the data analysis did not examine pharmacotherapy for weight management which was added as necessary to these strategies in a small subgroup of the patient population. About five percent of patients utilized phentermine at doses of 15 to 30 mg per day. However, pharmacotherapy was not encouraged or included in the formal program.