Journal of General Internal Medicine

, Volume 28, Issue 12, pp 1581–1588 | Cite as

Economic Analyses of the Be Fit Be Well Program: A Weight Loss Program for Community Health Centers

  • Debra P. RitzwollerEmail author
  • Russell E. Glasgow
  • Anna Y. Sukhanova
  • Gary G. Bennett
  • Erica T. Warner
  • Mary L. Greaney
  • Sandy Askew
  • Julie Goldman
  • Karen M. Emmons
  • Graham A. Colditz
  • For the Be Fit Be Well Study Investigators
Original Research



The U.S. Preventive Services Task Force has released new guidelines on obesity, urging primary care physicians to provide obese patients with intensive, multi-component behavioral interventions. However, there are few studies of weight loss in real world nonacademic primary care, and even fewer in largely racial/ethnic minority, low-income samples.


To evaluate the recruitment, intervention and replications costs of a 2-year, moderate intensity weight loss and blood pressure control intervention.


A comprehensive cost analysis was conducted, associated with a weight loss and hypertension management program delivered in three community health centers as part of a pragmatic randomized trial.


Three hundred and sixty-five high risk, low-income, inner city, minority (71 % were Black/African American and 13 % were Hispanic) patients who were both hypertensive and obese.


Measures included total recruitment costs and intervention costs, cost per participant, and incremental costs per unit reduction in weight and blood pressure.


Recruitment and intervention costs were estimated $2,359 per participant for the 2-year program. Compared to the control intervention, the cost per additional kilogram lost was $2,204 /kg, and for blood pressure, $621 /mmHg. Sensitivity analyses suggest that if the program was offered to a larger sample and minor modifications were made, the cost per participant could be reduced to the levels of many commercially available products.


The costs associated with the Be Fit Be Well program were found to be significantly more expensive than many commercially available products, and much higher than the amount that the Centers for Medicare and Medicaid reimburse physicians for obesity counseling. However, given the serious and costly health consequences associated with obesity in high risk, multimorbid and socioeconomically disadvantaged patients, the resources needed to provide interventions like those described here may still prove to be cost-effective with respect to producing long-term behavior change.


weight loss RCT pragmatic trial cost cost-effectiveness health disparities 



We would like to thank Barbara L. McCray for her editorial support.


This work was supported in part by grant funding from the National Heart Lung Blood Institute (UO1-HL087071). G. Bennett was supported by K22CA126992.

K. Emmons was supported by K05CA124415-04. G. Colditz was supported in part by P30CA091842 and the Foundation for Barnes-Jewish Hospital. E. Warner was supported by grant 5T32CA009001-36 from the National Cancer Institute.


The opinions and statements in this manuscript do not represent the official opinion of NHLBI/ NCI/NIH.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


  1. 1.
    Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:373–8.PubMedGoogle Scholar
  2. 2.
    Stafford RS, Farhat JH, Misra B, et al. National patterns of physician activities related to obesity management. Arch Fam Med. 2000;9:631–8.PubMedCrossRefGoogle Scholar
  3. 3.
    Ma J, Xiao L, Stafford RS. Underdiagnosis of obesity in adults in US outpatient settings. Arch Intern Med. 2009;169:313–4.PubMedGoogle Scholar
  4. 4.
    Galuska DA, Will JC, Serdula MK, et al. Are health care professionals advising obese patients to lose weight? JAMA. 1999;282:1576–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Bleich SN, Pickett-Blakely O, Cooper LA. Physician practice patterns of obesity diagnosis and weight-related counseling. Patient Educ Couns. 2011;82:123–9.PubMedCrossRefGoogle Scholar
  6. 6.
    Glasgow RE. What types of evidence are most needed to advance behavioral medicine? Ann Behav Med. 2008;35:19–25.PubMedCrossRefGoogle Scholar
  7. 7.
    Svetkey LP, Pollak KI, Yancy WS Jr, et al. Hypertension improvement project: randomized trial of quality improvement for physicians and lifestyle modification for patients. Hypertension. 2009;54:1226–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Bosworth HB, Olsen MK, Neary A, et al. Take Control of Your Blood Pressure (TCYB) study: a multifactorial tailored behavioral and educational intervention for achieving blood pressure control. Patient Educ Couns. 2008;70:338–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Ogden CL, Lamb MM, Carroll MD, et al. Obesity and socioeconomic status in adults: United States, 2005-2008. NCHS Data Brief 2010;1–8.Google Scholar
  10. 10.
    Flegal KM, Carroll MD, Ogden CL, et al. Prevalence and trends in obesity among US adults, 1999-2008. JAMA. 2010;303:235–41.PubMedCrossRefGoogle Scholar
  11. 11.
    Karlamangla AS, Merkin SS, Crimmins EM, et al. Socioeconomic and ethnic disparities in cardiovascular risk in the United States, 2001-2006. Ann Epidemiol. 2010;20:617–28.PubMedCrossRefGoogle Scholar
  12. 12.
    Winkleby MA, Kraemer HC, Ahn DK, et al. Ethnic and socioeconomic differences in cardiovascular disease risk factors: findings for women from the Third National Health and Nutrition Examination Survey, 1988-1994. JAMA. 1998;280:356–62.PubMedCrossRefGoogle Scholar
  13. 13.
    McGruder HF, Malarcher AM, Antoine TL, et al. Racial and ethnic disparities in cardiovascular risk factors among stroke survivors: United States 1999 to 2001. Stroke. 2004;35:1557–61.PubMedCrossRefGoogle Scholar
  14. 14.
    Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics–2011 update: a report from the American Heart Association. Circulation. 2011;123:e18–209.PubMedCrossRefGoogle Scholar
  15. 15.
    Redmond N, Baer HJ, Hicks LS. Health behaviors and racial disparity in blood pressure control in the national health and nutrition examination survey. Hypertension. 2011;57:383–9.PubMedCrossRefGoogle Scholar
  16. 16.
    Osei-Assibey G, Kyrou I, Adi Y, et al. Dietary and lifestyle interventions for weight management in adults from minority ethnic/non-White groups: a systematic review. Obes Rev. 2010;11:769–76.PubMedCrossRefGoogle Scholar
  17. 17.
    Yancey AK, Kumanyika SK, Ponce NA, et al. Population-based interventions engaging communities of color in healthy eating and active living: a review. Prev Chron Dis. 2004;1:A09.Google Scholar
  18. 18.
    Kumanyika SK, Gary TL, Lancaster KJ, et al. Achieving healthy weight in African-American communities: research perspectives and priorities. Obes Res. 2005;13:2037–47.PubMedCrossRefGoogle Scholar
  19. 19.
    Kumanyika SK, Obarzanek E, Stevens VJ, et al. Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. Am J Clin Nutr. 1991;53:1631S–8.PubMedGoogle Scholar
  20. 20.
    Tunis SR, Stryer DB, Clancey CM. Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624–32. PMID 14506122.PubMedCrossRefGoogle Scholar
  21. 21.
    Zwarenstein M, Treweek S, Gagnier JJ, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. BMJ. 2008;337:a2390. doi: 10.1136/bmj.PubMedCrossRefGoogle Scholar
  22. 22.
    Greaney ML, Quintiliani LM, Warner ET, et al. Weight management among patients at community health centers: the Be Fit Be Well Study. Obes Weight Manag. 2009;5(5):222–8.CrossRefGoogle Scholar
  23. 23.
    Bennett GG, Warner ET, Glasgow RE, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172:565–74.PubMedCrossRefGoogle Scholar
  24. 24.
    Glasgow RE. Enhancing the scientific foundation of internet intervention research. Ann Behav Med. 2009;38:46–7.PubMedCrossRefGoogle Scholar
  25. 25.
    Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.PubMedCrossRefGoogle Scholar
  26. 26.
    Ritzwoller DP, Sukhanova A, Gaglio B, et al. Costing behavioral interventions: a practical guide to enhance translation. Ann Behav Med. 2009;37:218–27.PubMedCrossRefGoogle Scholar
  27. 27.
    Ritzwoller DP, Sukhanova AS, Glasgow RE, et al. Intervention costs and cost-effectiveness for a multiple-risk-factor diabetes self-management trial for Latinas: economic analysis of ¡Viva Bien! Transl Behav Med. 2011;1:427–35.PubMedCrossRefGoogle Scholar
  28. 28.
    Bennett GG, Herring SJ, Puleo E, et al. Web-based weight loss in primary care: a randomized controlled trial. Obesity (Silver Spring). 2010;18:308–13.CrossRefGoogle Scholar
  29. 29.
    Glasgow RE, Gaglio B, Bennett G, et al. Applying the PRECIS criteria to describe three effectiveness trials of weight loss in obese patients with comorbid conditions. Health Serv Res. 2012;47(3 Pt 1):1051-67.PubMedCrossRefGoogle Scholar
  30. 30.
    National Heart Lung and Blood Institute. Aim for a health weight. Available at: 2012. Accessed February 9, 2012.
  31. 31.
    Rosner B, Langford HG. Judging the effectiveness of antihypertensive therapy in an individual patient. J Clin Epidemiol. 1991;44:831–8.PubMedCrossRefGoogle Scholar
  32. 32.
    Frick KD. Microcosting quantity data collection methods. Med Care. 2009;47:S76–81.PubMedCrossRefGoogle Scholar
  33. 33.
    Sukhanova A, Ritzwoller DP, Alexander G, et al. Cost analyses of a web-based behavioral intervention to enhance fruit and vegetable consumption. Int J Behav Nutr Phys Act. 2009;6:92.PubMedCrossRefGoogle Scholar
  34. 34.
    Bureau of Labor Statistics. Occupational employment and wages--May 2009. Available at: 2010. Accessed April 23, 2013.
  35. 35.
    CNN Money. Slim your body, not your wallet. Available at: 2011. June 3. Accessed April 23, 2013.
  36. 36.
    Tsai AG, Wadden TA. Systematic review: an evaluation of major commercial weight loss programs in the United States. Ann Intern Med. 2005;142:56–66.PubMedCrossRefGoogle Scholar
  37. 37.
    Rasu RS, Hunter CM, Peterson AL, et al. Economic evaluation of an Internet-based weight management program. Am J Manag Care. 2010;16:e98–104.PubMedGoogle Scholar
  38. 38.
    Gustafson A, Khavjou O, Stearns SC, et al. Cost-effectiveness of a behavioral weight loss intervention for low-income women: the Weight-Wise Program. Prev Med. 2009;49:390–5.PubMedCrossRefGoogle Scholar
  39. 39.
    Krukowski RA, Tilford JM, Harvey-Berino J, et al. Comparing behavioral weight loss modalities: incremental cost-effectiveness of an internet-based versus an in-person condition. Obesity (Silver Spring). 2011;19:1629–35.CrossRefGoogle Scholar
  40. 40.
    Tate DF, Finkelstein EA, Khavjou O, et al. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med. 2009;38:40–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Herman WH, Brandle M, Zhang P, et al. Costs associated with the primary prevention of type 2 diabetes mellitus in the Diabetes Prevention Program. Diabetes Care. 2003;26:36–47.CrossRefGoogle Scholar
  42. 42.
    Department of Health and Human Services, Centers for Medicare & Medicaid Services, MLN Matters. Intensive Behavioral Therapy (IBT) for obesity. Available at: 2011. Accessed April 23, 2013.
  43. 43.
    Gearhardt AN, Bragg MA, Pearl RL, et al. Obesity and public policy. Annu Rev Clin Psychol. 2012;8:405-30.PubMedCrossRefGoogle Scholar
  44. 44.
    Gold MR, Siegel JE, Russell LB, Weinstein MC. Cost-Effectiveness in Health and Medicine. Oxford, England: Oxford University Press; 1996.Google Scholar
  45. 45.
    Glasgow RE, Steiner JF. In: Brownson RC, Colditz G, Proctor E, eds. Comparative Effectiveness Research to Accelerate Translation: Recommendations for “CERT-T”. 1st ed. New York: Oxford University Press; 2012:72–93.Google Scholar

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Debra P. Ritzwoller
    • 1
    Email author
  • Russell E. Glasgow
    • 2
  • Anna Y. Sukhanova
    • 1
  • Gary G. Bennett
    • 3
    • 4
  • Erica T. Warner
    • 5
    • 6
  • Mary L. Greaney
    • 6
  • Sandy Askew
    • 4
  • Julie Goldman
    • 6
  • Karen M. Emmons
    • 6
    • 7
  • Graham A. Colditz
    • 5
    • 8
  • For the Be Fit Be Well Study Investigators
  1. 1.Institute for Health Research, Kaiser Permanente ColoradoDenverUSA
  2. 2.Division of Cancer Control and Population Sciences, National Cancer InstituteBethesdaUSA
  3. 3.Department of Psychology and NeuroscienceDuke UniversityDurhamUSA
  4. 4.Duke Global Health InstituteDuke UniversityDurhamUSA
  5. 5.Department of EpidemiologyHarvard School of Public HealthBostonUSA
  6. 6.Center for Community Based Research, Division of Population Sciences, Dana Farber Cancer InstituteBostonUSA
  7. 7.Department of Society, Human Development and HealthHarvard School of Public HealthBostonUSA
  8. 8.Division of Public Health Sciences, Department of Surgery, Alvin J. Siteman Cancer CenterWashington University School of MedicineSt LouisUSA

Personalised recommendations