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.