PSUN337 Evaluation of Intensive Behavioral Therapy as a Tool to Combat Obesity in a Rural Outpatient Endocrinology Clinic

Abstract

Abstract Introduction The prevalence of obesity in the United States has risen from 30.5% in 2000 to 42.4% in 2018. Given this steep increase and the association of obesity with multiple comorbidities, the focus has now turned to behavioral modifications. In 2011, Medicare began to reimburse providers for intensive behavior therapy (IBT) for obesity. Background Medicare beneficiaries with a BMI ≥ 30 kg/ m2 are eligible for IBT. The program at Hamilton Diabetes and Endocrinology Center (HDEC), followed a structure similar to that of the nationwide IBT program. It begins with a nutritional assessment and a personalized lifestyle intervention plan. The program includes 20 visits over a 12-month period. At the six-month point mark, we aim to achieve a target weight loss of 6.6 lbs. A thorough literature review revealed limited data on the outcomes of the program. The purpose of our study is to present data which has shown effectiveness of this program in the rural setting. Methods A retrospective cohort study was conducted with data obtained between September 2020 to October 2021. The sample being studied included 96 participants after exclusion of those that were unable to complete the program. The participants were matched based on their baseline demographic characteristics. The outcomes studied were weight in pounds, BMI and HbA1C. Using paired t-tests we compared the change in weight before and after implementation of the program, with BMI and HbA1C as secondary outcomes. Results The participants began the IBT program with an initial mean weight of 249.4 lbs. and ended the program with a final mean weight of 244.7 lbs. Comparison of the data using paired t-tests revealed that the change in weight was about 4.7 lbs. (95% confidence interval of 2.9 - 6.6, P <0.001). The change in BMI was 0.8 kg/m2 (95% CI: 0.5–1.1, P <0.001). About 31.25% of our study participants were able to lose more than 6.6 lbs. However, it is pertinent to note that our study was conducted during the time of the pandemic, leading to missed appointments and effects on lifestyle. Despite our limitations, the data revealed a statistically significant difference in weight and BMI at the final visit compared to the initial visit. The HbA1C values were reduced by 0.25%, however this change was not statistically significant (P = 0.185). Conclusion Analysis of the IBT program at the HDEC has shown a favorable response. In an ideal world, free of limitations by the pandemic, this program is likely to, achieve an even greater degree of weight loss. This brings about a need for raising awareness within the community. Implementation of IBT programs and promoting lifestyle interventions result in reduction of obesity and therefore lead to an improved quality of life. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.