Managing Overweight and Obesity: Behavior-based Interventions

Behavior-based interventions are the foundation of all treatments for overweight and obesity and are designed to help participants achieve or maintain a 5% or greater weight loss.

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January 09, 2020

For employers seeking to align their weight management strategy with the latest evidence, this resource offers recommendations on creating a comprehensive benefits package to treat obesity, including behavior-based interventions and pharmacological and surgical treatment.

What Are They?

Behavior-based interventions are the foundation of all treatments for overweight and obesity and are designed to help participants achieve or maintain a 5% or greater weight loss. They are conducted either in-person or electronically (or a mix of both) and are led by trained interventionists (i.e. health professionals or trained health educators) who use behavioral strategies to help participants make dietary changes and increase physical activity.31,32 

Who Can Benefit From These Programs?

Employees with a body mass index (BMI) ≥30 or those with a BMI >25 with one or more cardiovascular risk factors may benefit from participation in behavior-based interventions.32

Why Should Employers Offer Them?

Evidence shows that behavior-based weight loss interventions lead to clinically significant improvement in weight status (5% weight loss) and the reduced incidence of Type 2 Diabetes in people with obesity.32

Experts recommend that providers screen patients for obesity using BMI and/or waist circumference. Screening should occur at annual visits or more frequently for adults with overweight or obesity.31,32 Screening enables providers to refer people with obesity to behavior-based interventions. A diagnosis of obesity can be a driver of weight loss success.30

Efficacy

People who participate in behavior-based weight loss interventions generally lose more weight and have greater reductions in waist circumference than those in control conditions at up to 24 months of follow-up.32 Due to the wide variety of behavior-based interventions offered and the different populations they serve, it’s difficult to identify the most effective intervention characteristics.32 However, research indicates that the benefits of behavioral interventions may depend on the following factors:

  • Intensity: A 2018 research review indicated that a higher number of sessions was associated with more weight loss.32 A separate research review supports this, showing that high-intensity interventions (12-26 sessions per year) average 6% weight loss, whereas those in low- to moderate-intensity programs (<12 sessions per year)average only 2.8% weight loss.33
  • Delivery: In-person programs have been shown to decrease weight by 5-10%. Telephone-based and electronically-delivered programs that include personalized feedback have also been shown to be effective. While the weight loss achieved in these programs may be slightly less than in-person programs, it is still clinically significant.33
  • Peer Support: Evidence shows that the inclusion of group sessions – either as the main mode of delivery or as an additional component – is related to greater weight loss.32
  • Personalization: Findings from the 2018 research review indicate that the benefits of behavior-based interventions may depend on the ability to tailor it to the social, environmental and individual factors of the employee.32

Evidence indicates that employers should offer high-intensity programs delivered either in-person or electronically (or in combination), with peer support and personalization.

Consistent with behavioral treatments for other chronic conditions, maintenance and/or relapse prevention strategies are important aspects of behavior-based interventions.

Interventions Offered in the Health Care Setting

Although policies and practice guidelines have laid the groundwork for physicians to play a greater role in delivering behavior-based interventions in the health care setting weight-related counseling by primary care providers remains low. Only 35-60% of providers give specific guidance on diet, physical activity or weight control to their patients with obesity.34-38 And nearly two-thirds of surveyed physicians felt they lack effective strategies to help patients with overweight or obesity.39

Per the Affordable Care Act, health plans have the option to refer patients to commercial or community-based behavior-based interventions.40 Health plans have responded by offering high-intensity telephonic coaching or promoting and reimbursing providers who offer the Diabetes Prevention Program.

Policies and Practice Guidelines Promoting Behavior-based Interventions in the Health Care Setting

  • In 2012 the U.S. Preventive Services Task Force (USPSTF) recommended that primary care providers screen all adults for obesity and offer or refer those individuals with a BMI >30 to intensive, multicomponent behavioral interventions.33
  • Beginning in June 2013, per the Affordable Care Act, all non-grandfathered health plans are required to provide coverage for the USPSTF recommendation above.40
  • In June 2013 the American Medical Association recognized obesity as a disease requiring a range of medical interventions.41
  • In November 2013 an expert panel convened by the American College of Cardiology, the American Heart Association and The Obesity Society released new practice guidelines for the treatment of overweight and obesity in adults.31

Interventions Offered by Employers

Employers provide a variety of weight management programs, including telephonic disease management or coaching, group-based weight management (either on-site or in the community) and digital weight management programs.42 Many employers have multiple offerings in place to meet the diverse needs and preferences of employees. Although not all digital solutions are high-intensity programs (>12 sessions per year), some include the elements that evidence indicate are necessary to achieve at least 5% weight loss.

weight management programs 
Figure 1: Types of Weight Management Programs Offered by Employers in 2018

In recent years, digital weight management programs have gained traction among large employers as a way to offer scalable high-intensity behavior-based interventions.


Among employers with weight management programs, 50% offered incentives to employees and 46% offered incentives to spouses/domestic partners in 2018.43 Average employee participation in these programs was 10% in 2016.44

Behavior-based intervention Checklist:

  • Find out how your health plans are offering obesity counseling services. Assess your health plan’s adherence to NCQA’s HEDIS measure related to adult obesity screening. As a part of this, request information detailing how the plan is working with physicians to improve compliance. Additionally, verify and communicate to employees what the health plan is covering related to obesity counseling. Finally, ensure that the services covered include an adequate number of sessions to support behavior change.
  • Make sure weight management programs are evidence-based. For either internally-staffed or vendor-run weight management programs, ensure they are high-intensity, delivered in-person, electronically, or in combination, and include peer support and personalization. They should also include maintenance and/or relapse prevention strategies.
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TABLE OF CONTENTS

  1. What Are They?
  2. Who Can Benefit From These Programs?
  3. Why Should Employers Offer Them?
  4. Efficacy
  5. Interventions Offered in the Health Care Setting
  6. Interventions Offered by Employers
  7. Behavior-based intervention Checklist