Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI

Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI

Summary More than one third (34.9%) of Americans are obese. 1 Obesityrelated diseases, such as cardiovascular disease, type 2 diabetes, cancer, and osteoarthritis cost $147 billion in 2008 alone. 2 An obese individual will spend significantly more on medical expenses than a normal weight counterpart. Such health risks greatly impact employers health-care costs and employee productivity. Retrofit is a targeted weight-loss solution with proven outcomes that can help decrease these health-related costs. PROGRAM METHODS Retrofit participants received support from weight-loss experts who coached them through the behavior change process with a focus on long-term lifestyle changes and increased happiness. The highly-personalized program included the use of a proprietary Lifestyle Patterns Inventory, a comprehensive Intake Form regarding medical history, behaviors and preferences and regularly scheduled videoconference coaching sessions. Support from the experts extended to a participant s private online dashboard where expert coaches provided feedback on participant food logs and activity as well as proactive messaging to encourage behavior and accountability. Self-awareness and monitoring was enabled by a wifi enabled scale, wireless activity tracker and mobile app. A subset of participants that graduated from the program were further analyzed at one year from their start date. PROGRAM RESULTS Participants who graduated from the Retrofit program had an average weight loss of 14.79 pounds or 6.41% of their initial body weight. 55.5% of graduates lost 5% or more of their initial weight. They also had an average decrease in BMI of 2.24 BMI units. The number of average weigh-ins per week and average number of activity tracker days per week were statistically significant for successful weight loss. Successful participants also had a higher number of average food log entries per week, along with a higher average daily step count when dividing by gender; however these differences were not statistically significant. POUNDS LOST 0-3 -6-9 -12 BASELINE GRADUATION AVERAGE WEIGHT LOSS OF 14.79 POUNDS OR 6.41% OF INITIAL WEIGHT 55.5% OF GRADUATES LOST 5% OR MORE OF THEIR INITIAL WEIGHT 2.24 BMI UNITS GRADUATES HAD AN AVERAGE DECREASE IN BMI OF 2.24 BMI UNITS DISCUSSION Retrofit helps a majority of program graduates reach a significant weight loss at one year. This is accomplished through regular weight-loss expert coaching sessions, proactive and individualized asynchronous support from coaches, along with self-monitoring via wi-fi enabled scale and wireless activity tracker. The Retrofit program can provide a weight-loss solution for the workplace to increase employee happiness and performance while decreasing healthcare costs. 1 (Ogden, Carroll, Kit, & Flegal, 2014) 12 (Finkelstein, Trogdon, Cohen, & Dietz, 2009) Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI Retrofit Page 1

Introduction More than two-thirds of American adults are overweight or obese. As weight increases so does the risk for developing coronary heart disease, type 2 diabetes, cancer, hypertension, osteoarthritis, and many other diseases and medical conditions. 3 These health problems can have significant economic consequences. Studies have shown that overweight and obese people spend $1,429 to more than $4,000 more on annual medical expenses than their healthyweight counterparts. 4 In addition to direct medical expenses, obese and overweight individuals drive indirect costs due to absenteeism and presenteeism in the workplace, 5 and increased costs of insurance premiums. Retrofit is a personalized, holistic weightmanagement solution based on scientific principles regarding nutrition, activity and mindset. Retrofit provides expert coaching and interactive support that engages participants to make the behavior changes required for successful weight loss. The model uses a unique high-tech, high-touch, highly personalized approach that fits participants lifestyles and advocates small changes that lead to effective weight loss, sustainable changes and increased happiness. Program components include the following: 1:1 one-to-one video coaching with a master-level or higher Wellness Expert in behavioral science, nutrition or exercise physiology MORE THAN TWO-THIRDS OF AMERICAN ADULTS ARE OVERWEIGHT OR OBESE This white paper highlights critical components of a weight-loss program that has a majority of graduates losing a significant amount of initial weight at one year. Some of those critical program components include: Regularly scheduled, live video coaching sessions with dedicated weight-loss experts Proactive individualized asynchronous feedback provided by the weight-loss experts Routine self-monitoring of weight and physical activity 52-week online class curriculum to educate and engage participants about health and weight management, including behavioral principles and activity and nutritional instruction community dashboards that allow participants to connect with other program participants for support and encouragement 3 (Dixon, 2010) 4 (Finkelstein, Trogdon, Cohen, & Dietz, 2009; Cawley & Meyerhoefer, 2012) 5 (Robroek, van den Berg, Plat, & Burdorf, 2011; Colditz, 1999; Lehnert, Sonntag, Konnopka, 2013; Trogdon, Finkelstein, Hylands, Dellea, Kamal-Bahl, 2008) Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI Retrofit Page 2

Participants Participants are defined as individuals enrolled in Retrofit programs with a starting BMI of 27 kg/m2 or greater and at least 18 years of age. A subgroup of participants, called graduates, were analyzed. Graduates are defined as participants who had a weight measurement within nine weeks of their one-year anniversary. Baseline graduate information is outlined in Table 1. TABLE 1 BASELINE GRADUATE INFORMATION GROUP N AVG. AGE (SD) AVG. WEIGHT, LBS. (SD) AVG. BMI (SD) % FEMALE % MALE All 1075 46.9 (11.1) 228 (49.7) 34.7 (6.6) 54.5 45.5 Program Description Retrofit is an online weight-loss coaching program, with the support of a master-level or higher Weight Loss Expert (WLE) or a group of experts in the fields of dietetics, behavioral change and exercise physiology. The program is focused on long-term, lifestyle-oriented behavior changes addressing mindset, nutrition and exercise. A participant begins the program by meeting with a Program Advisor, who collects basic information, ensures the participant is set-up with the necessary technology to participate in the program, and confirms that the participant has completed the proprietary Lifestyle Pattern Inventory and the Intake Form, the results of which are used to personalize coaching. Each participant is provided a wireless activity tracker, wireless scale and access to a private online dashboard. After set-up is complete, participants are assigned a WLE or expert team and begin coaching and accountability sessions via video conference. Scheduled videoconference coaching sessions are tailored to the participant based upon the individual s behavioral change goals, strategies, likes and dislikes. Coaching and accountability sessions are scheduled more frequently in the first six months of the program per a recommended session schedule. Frequency is subject to the Expert s professional assessment of the participant s needs. Each participant is provided between 12 and 36 coaching sessions, with the first session lasting 60 minutes and follow-up sessions lasting 30 minutes. In addition to video conference sessions, experts provide regular asynchronous feedback and support via the participant s private dashboard. This support is provided in both a proactive manner and passively, in response to participant questions and daily activities. Asynchronous support provided by the Experts includes general guidance on the participant s timeline, which functions similarly to the timeline of a social-networking platform. This support also includes specific areas of feedback provided within the Retrofit food logger and exercise logs, where participants can get individualized feedback on their logged meals, snacks and activity. The private dashboard provides participants the ability to monitor their own information, such as established plan items, step data, weight charts and logged life events. Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI Retrofit Page 3

Data, Results and Anaysis DATA COLLECTION AND STATISTICAL ANALYSES Demographic, health history and baseline behavioral information were collected via an electronic Intake Form prior to each participant beginning the program. Additional quantitative data are collected through the wireless fitness tracker, wireless/wifi-enabled scale and Retrofit private dashboard. All analyses were performed using Stata 13 software 6. Binary logistic regression models were used to estimate program effect. For the logistic modeling, participants that achieved greater than or equal to 5% weight-loss were coded as one. All other participants were coded as zero. PROGRAM RESULTS Participants who graduated from the programs had an average weight loss of 14.79 lbs (+/- 16.4) or 6.41% of their initial starting body weight. Of the 1,075 participants that were considered graduates, 55.5% (597 graduates) lost 5% or more of their initial body weight. They also had an average decrease in BMI of 2.24 BMI units (+/- 2.46). Outcomes and Behaviors are summarized in Table 2 & 3. POUNDS LOST 0-3 -6-9 -12 BASELINE GRADUATION AVERAGE WEIGHT LOSS OF 14.79 POUNDS OR 6.41% OF INITIAL WEIGHT 55.5% OF GRADUATES LOST 5% OR MORE OF THEIR INITIAL WEIGHT 2.24 GRADUATES HAD AN AVERAGE DECREASE IN BMI OF 2.24 BMI UNITS TABLE 2 OUTCOMES N AVG. WEIGHT LOSS LBS (SD) AVG. WEIGHT LOSS % (SD) AVE. BMI CHANGE (SD) 1075-14.79 (16.35) -6.41 (6.64) -2.24 (2.46) TABLE 3 BEHAVIORS N STEPS / DAY (SD) # AVG. WEIGH-INS/WK (SD) # ACTIVITY TRACKER DAYS/WK (SD) # FOOD LOG ENTRIES/WK (SD) 1075 6601 (3496) 2.91 (1.81) 4.97 (1.96) 8.33 (8.76) As previously described, one component of the Retrofit program was to cultivate a participant s ability to self regulate nutrition and exercise behaviors via self-monitoring through the use of the wireless/wifienabled scale, activity tracker and food logging via the Retrofit app or dashboard. These self-monitoring strategies have been proven to provide value within an intensive behavioral weight-loss program, resulting in healthy and sustainable weight loss 7. Participants who graduated and had successful weightloss outcomes, defined by losing 5% or more of their initial weight, weighed-in more often, had more accumulated steps per day on average, had a higher number of activity tracker days per week and a higher average of food log entries per week. Details of means of outcomes measures, including program outcomes and key behaviors, is outlined in Table 4. 6 StataCorp. 2013. Stata Statistical Software: Release 13. College Station, TX: StataCorp LP. 7 Wing, Tate, Gorin, Raynor, & Fave, 2006; Linde, Jeffrey, French, Pronk, & Boyle, 2005; Akers, Cornett, Savla, Davy, & Davy, 2012; Steinberg, Tate, Bennett, Ennett, Samuel-Hodge, & Ward, 2013; Burke, et al., 2011 Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI Retrofit Page 4

TABLE 4 MEANS OF OUTCOME MEASURES CHARACTERISTIC ALL CLIENTS (SD) CLIENTS WITH > 5% WEIGHT LOSS (SD) n 1075 597 Weight Loss, lbs -14.79 (16.35) -25.3 (13.8) Weight Loss, % -6.41 (6.64) -10.94 (4.97) BMI Change -2.24 (2.46) -3.83 (2.15) Steps / day 6601 (3496) 7130 (3553) Avg. Weigh-Ins / week 2.91 (1.81) 3.36 (1.83) Avg. # Act. Tracker days/week 4.97 (1.96) 5.42 (1.79) Avg. food log entries/week 8.33 (8.76) 9.8 (9.5) LOGISTIC REGRESSION ANALYSIS Controlling for gender, BMI, age and number of food log entries, Retrofit found that self-monitoring through the use of the wireless/wifi-enabled scale and using the activity tracker led to better weightloss outcomes. Average number of weigh-ins per week and average number of activity tracker days per week were statistically significant. For each additional day per week that a participant weighed in, they increased their odds of reaching 5% weight loss by 25%. Additionally, with each additional day per week that the activity tracker was worn, participants increased their odds of reaching 5% weight loss by 17%. The logistic regression analysis is reviewed in Table 5. TABLE 5 LOGISTIC REGRESSION ANALYSIS VARIABLE ODDS RATIO 95% CONFIDENCE INTERVAL Female Gender 1.12 0.87-1.44 Initial BMI 1.01 0.99-1.03 Age 1.00 0.99-1.01 # Weigh-Ins / week * 1.25 1.15-1.36 # Activity Tracker Days / Week * 1.17 1.08-1.26 # Food Log Entries / Week 1.01 0.99-1.03 *Statistically Significant Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI Retrofit Page 5

DISCUSSION Retrofit is a proven weight-loss solution for overweight and obese individuals. Based on this analysis, the program is statistically proven to help participants achieve significant weight loss, as well as support individuals through the change process related to health behaviors that lead to long-term weightloss maintenance. The program is unique in that the participant s weight-loss expert or weight-loss expert team actively coaches the participant through scheduled coaching sessions and provides regular asynchronous communication that helps participants stay engaged and inspired and that minimizes setbacks when they occur. Regular video conference coaching sessions provide the basis for building rapport between the expert and coach, along with providing an opportunity for goal setting, strategy selection, planning and accountability related to the participant s Lifestyle Pattern Profiles. The weight-loss expert continues coaching and individualized feedback through asynchronous communication related to the established strategies and the review of the participant s weight, food logs, exercise logs, and activity data. In addition to actively coaching, there are opportunities for more passive coaching methods, as the weight-loss expert responds directly to participant questions and issues. A majority of graduates reached at least a 5% weight loss from their initial weight. Studies have shown that a 5% weight loss or greater is clinically significant or meaningful. 8 This amount of weight loss translates into improved individual health outcomes. A weight loss of 5% can significantly reduce an individual s risk of developing medical conditions such as diabetes, high cholesterol, and cardiovascular disease. Improved health outcomes save hundreds of thousands of dollars in medical expenses and improve quality of life. 9 5% WEIGHT LOSS HAS BEEN SHOWN TO REDUCE ABSENTEEISM AND PRESENTEEISM The financial savings associated with weight loss benefit the individual, but they also translate to the workplace. A 5% weight loss has been shown to reduce absenteeism and presenteeism. 10 Substantial return on investment of workplace wellness programs have become commonplace in today s healthcare environment 11 Another recent study found that 10 modifiable health risk factors are linked to one-fifth of employer-employee healthcare spending. Obesity is one of these factors, and is associated with all of the others. These factors accounted for 22% of total annual spending or roughly $82,000,000 by the employers 12. $ 22% 10 HEALTH RISK FACTORS,INCLUDING OBESITY, ACCOUNTS FOR 22% OF TOTAL ANNUAL SPENDING OR $82M SPENT BY THE EMPLOYERS Implementing a targeted weight-loss solution that will deliver consistent and significant employee outcomes is essential for any employer that wants to achieve the financial benefit of a weight-loss program. Retrofit programs have shown that a solution including intensive behavioral weight-loss programming, with active coaching from weight-loss experts via live video coaching sessions and asynchronous individualized feedback, can generate significant weight loss in a majority of graduates. This analysis has also shown that participant engagement via self-monitoring of weight and daily activity increases the odds of significant weight loss by 25% and 17%, respectively. 8 Diabetes Prevention Program Research Group, 2002; Wing, et al., 2011) 9 Cawley, 2012; Colditz, 1999; Lehnert, Sonntag, Konnopka, Riedel-Heller, & Konig, 2013; Trogdon, Finkelstein, Hylands, Dellea, & Kamal-Bahl, 2008; Bilger, Finkelstein, Kruger, Tate, & Linnan, 2013 10 Bilger, Finkelstein, Kruger, Tate, & Linnan, 2013 11 Henke, Goetzel, McHugh, & Isaac, 2011; Serxner, Gold, Grossmeier, & Anderson, 2003 12 Goetzel, et al., 2012 Retrofit s Outcomes-Driven Weight-Management Program Proves Successful in Lowering BMI Retrofit Page 6

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