Abstract P185: Paradoxical Outcomes Among Group Lifestyle Balance Participants In Real-world Clinical Practice

Abstract

Introduction: The CDC established the National Diabetes Prevention Program (NDPP) initiative in 2010, leading to implementation of numerous group-based lifestyle interventions, such as the 12-month Group Lifestyle Balance (GLB) program, in community and clinical settings. Heterogeneity in weight outcomes is common. While evidence suggests that session attendance is associated with greater weight loss, some participants do not achieve weight loss even with high session attendance. Conversely, some may achieve clinically significant weight loss (≥5%) with lower attendance. In this study, we sought to identify and characterize such paradoxical interventional outcomes. (i.e., high session attendance and <5% weight loss compared with low attendance and ≥5% weight loss). Hypothesis: No a priori hypotheses. Methods: We conducted a longitudinal descriptive analysis of overweight/obese GLB participants using electronic health record data from an integrated healthcare delivery system in Northern California (2010-2017). We focused on the 12-week intensive core phase of the curriculum because prior studies show that weight loss outcomes achieved during this period are highly correlated with long-term weight loss. We categorized patients into 4 mutually exclusive groups by session attendance (<9/≥9 session) and weight change from baseline to 12-weeks follow-up (<5%/≥5% weight loss). The threshold of 9 sessions corresponds to 75% adherence, a quality metric used by Medicare. Results: Among 1,818 evaluable participants, we identified 870 (47.9%) with paradoxical outcomes. Of these, 104 (12.0%) achieved ≥5% weight loss with <9 sessions attended (paradoxical responders) and 766 (88.0%) achieved <5% weight loss despite attending ≥9 sessions (paradoxical non-responders). The remaining 948 participants (52.1%) achieved weight loss consistent with a dose response, based on number of sessions attended. Conclusions: Nearly half of all GLB participants in this integrated health system had paradoxical outcomes, with more than 40% classified as paradoxical non-responders. These results suggest that session attendance may not be as sensitive a predictor of weight outcomes as previously thought, and other approaches are needed to understand the complex factors influencing goal attainment in behavioral lifestyle programs.