betterMD.net,
Inc.
NAASO The Obesity Society 2005 Annual
Scientific Meeting
October 15 - 19, 2005 Vancouver, British Columbia, Canada
Four
Year Comparison of Surgical and Non-Surgical Interventions in an Insurance Company Weight Management Program
DAVID C. MURDY, MD. Janesville, Wisconsin,
United States.
Background: The WEA Trust — betterMD.net Obesity Management Study is a
five-year study of Internet-directed weight management care.
Objectives: Measure and compare weight loss over time for both surgical and non-surgical interventions.
Subjects: WEA-insured members throughout Wisconsin with a BMI over 30 were eligible and 84 subjects (19 male/65 female) were enrolled in the study over a 34 month period. [Average age = 50 (31 - 67) / Mean BMI = 45]. Time elapsed since enrollment ranges from 21 to 57 months (mean = 44). Three (3) subjects were removed from the analysis due to pregnancy, two (2) were removed due to psychological issues and two (2) were removed due to non-related medical complications.
Methods: Applicants selected 1 of 3 treatment options, received an exam and PCP approval, met study protocols and paid an up-front fee (50% refunded upon completion). All treatment options included diet exercise and lifestyle education with regular PCP follow-up and Internet support.
Results: The surgical arm achieved better than a 25% weight loss average at year 1 (p<0.05) and additional 13.5% over years 2 (NA) and 3 (p<0.05), with an average regain of 7.5% over the 4th year (NS). The non-surgical arms achieved over an 18% weight loss average at year 1 (p<0.05) and regained an average of 2.7% over years 2 through 4 (NS).
Discussion: These results demonstrate the success of an insurance company program for weight loss treatment through an interactive disease management website. They also show the comparability of non-surgical interventions to bariatric surgery.
Four Year Comparison of Surgical and Non-Surgical
Interventions in an Insurance Company Weight Management Program
OBJECTIVES
§WEA Trust, a group
insurance provider for 78% of Wisconsin school districts and 155,000 members currently doesn’t cover
obesity care.
§WEA sought a
Comprehensive Weight Management solution for their members statewide.
SUBJECTS
§The WEA Trust –
betterMD.net Obesity Management Study was open to WEA insured clients with a BMI of 30 or more.
§84 of a possible 220
patients enrolled in the study; average patient age 50 (range 31 - 68); 65 females (77%) and 19
males (23%)
§Surgical arm: average
baseline BMI 51.3 (range 38.9 - 70.1); average baseline weight 316 lbs. (range
205 - 420 lbs.)
§Non-Surgical arm:
average baseline BMI 43.7 (range 30.8 - 72.5); average baseline weight 269
lbs. (range 178 - 447 lbs.)
§7 patients have been
withdrawn – 3 patients due to pregnancy, 2 patients for behavioral services referrals, and 2
patients for non-related medical complications
§Each participant
completed a Study agreement with WEA and paid an “up-front” fee based, in
part, on the expected costs of treatment. Informed consent was also
obtained.
§The “up-front” fee for
the Low-Calorie Diet plus medication (LCD+meds) arm was $1,500, the Very Low-Calorie Diet (VLCD)
followed by meds arm was $2,000 and $5,000 for the bariatric surgery arm.
§50% of the “up-front”
fee will be reimbursed at the end of the five year study period based on compliance (number of
visits, lab tests, and follow-up surveys.)
METHODS
§Enrollment at web site:
www.betterMD.net
§On-line Treatment
Planner generates plans based on a stepped-care model
§Plans reviewed and
selected by patient and their primary care provider
§Treatment option
approved & returned to betterMD.net
§Medications and
nutritional supplements distributed by betterMD.net based on treatment
protocol
§Referral to surgery and
other providers per Study protocol
§Web-based Plan
Preferences and Goal Setting support
§Exercise and Food
Diaries online
§Weekly Checklist
Reports submitted online (reviewed and commented on by betterMD.net
staff)
§Secure web messaging
platform (vScribe) accessed through secure web portal
§Weekly eNewsletter
(Health-e-Thoughts) and weekly Medical Director’s chat session online
§Order, Visit, and
Compliance Monitoring
§Individual follow-up,
and extended support via phone, fax and e-mail
TREATMENT
OPTIONS
•Non-Surgical (Low Calorie Diet PLUS weight loss
medications or Very Low Calorie Diet FOLLOWED by weight loss
medications.)
•Surgical (RNY Surgery referral for patients who have failed
other physician-supervised effort.)
•All options include diet, exercise and lifestyle
education with regular follow-up and Internet support over the five year
study period.
CONTACT
INFORMATION
David C. Murdy, M.D.
Chief Medical Officer office: 608-754-7339
betterMD.net, Inc. toll free: 877-578-1067
Janesville, WI 53546 e-Mail: david.murdy@betterMD.net
David C. Murdy, M.D.
-19.7%
(6.5) 3
-25.7%
(10.9) 3
-24.5%
(14.8) 4
-13.3%
(16.2) 5
LCD+Meds
key: WL% (StDev) n; * = p<0.05 for within vs.
baseline; + = p<0.05 for between Surgical and Non-Surgical;
# = p<0.05 for Year 1 vs. Year 3
-15.5%
(9.4) 11 *
-15.8%
(12.4) 27 *
-16.0%
(12.2) 36 *
-18.2%
(11.6) 50 *
Non-Surgical
-14.0%
(10.1) 8
-14.5%
(12.2) 24
-15.0%
(11.7) 32
-18.8%
(11.1) 45
VLCD
-31.1%
(3.8) 3*+
-38.6%
(9.6) 8 *+#
-31.8%
(9.4) 13 *+
-25.1%
(10.7) 17 *+
Surgical
Year 4
Year 3
Year 2
Year 1
Mean Weight Change (lbs.) as % Body Mass
OUTCOMES
Of the 84 enrolled patients, 7 (8%) were
withdrawn for pregnancy, medical complications and psych referral; 4 (5%)
changed insurance, 5 (6%) dropped for medical reasons, and 33 (39%) were lost
to follow-up. Additionally, 21 (25%) have not yet completed their fourth year.
The lost to follow-up by treatment arm
comparison: 11 patients (61% of 18) were lost to follow-up in the surgical
arm, while 22 (33% of 66) were lost to follow-up in the non-surgical arm.
There were 3 crossovers in year two and 1 crossover in year four, however this
analysis was calculated on an intention to treat basis.
These significant
improvements in blood pressure and comorbidities do not take into account
medication changes over the course of the study. In some cases, improvements
in lab values precipitated the discontinuation of diabetes, blood pressure
and/or lipid lowering drugs.
CONCLUSIONS
/ DISCUSSION
These results demonstrate the success of
an insurance company program for weight loss treatment through an
interactive disease management website.
The majority of patients achieved, and
maintained more than a 15% weight loss over the first four years of the study,
with few dropping out or crossing over from the medical to the surgical arm of
the study.
Results also show the comparability of
non-surgical options to gastric by-pass surgery at substantially lower
costs. Non-surgical options were less than one fourth as expensive as gastric bypass surgery ($6,613
vs. $30,388) over the first four years of the study. The ratio of dollars
spent to weight loss percentage in the non-surgical group was less
than half of the surgical group (see graph below).
This research supports incorporating
obesity care using an interactive Internet disease management website into
traditional insurance benefits and medical practice.
$427
$977