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Igel L.I.,New York Medical College | Sinha A.,New York Presbyterian Weill Cornell Medical Center | Saunders K.H.,New York Medical College | Apovian C.M.,Boston University | And 2 more authors.
Current Atherosclerosis Reports | Year: 2016

Metformin is not currently used for weight loss or diabetes prevention because it lacks an FDA indication for obesity and/or pre-diabetes treatment. Based on the evidence, metformin has been shown to decrease the incidence of type 2 diabetes, and compares favorably to other weight-loss medications in terms of efficacy as well as safety. Thus, metformin should be considered for a treatment indication in patients with these conditions. © 2016, Springer Science+Business Media New York. Source

Ellis P.,UnitedHealth Center for Health Reform and Modernization | Sandy L.G.,UnitedHealth Group Inc. | Larson A.J.,UnitedHealthcare | Stevens S.L.,Global Health Division
Health Affairs | Year: 2012

Reforming payment methods to move away from fee-for-service reimbursement is widely seen as a crucial step toward controlling health care costs. Although there is a good deal of evidence about variability in costs under Medicare, little has been published about the variability of costs for care that is financed by private insurance. We examined both quality and actual medical costs for episodes of care provided by nearly 250,000 US physicians serving commercially insured patients nationwide. Overall, episode costs for a set of major medical procedures varied about 2.5-fold, and for a selected set of common chronic conditions, episode costs varied about 15-fold. Among doctors meeting quality and efficiency benchmarks, however, costs for episodes of care were on average 14 percent lower than among other doctors. Some markets exhibited much higher variation in episode costs, but there was essentially no correlation between average episode costs and measured quality across markets. The overall analysis suggests that changing incentives through payment reforms could help to improve performance, but providers are at different stages of readiness for such reforms and thus will often need support in order to succeed. © 2012 Project HOPE-The People-to-People Health Foundation, Inc. Source

Foster G.D.,Temple University | Sundal D.,UnitedHealth Center for Health Reform and Modernization | McDermott C.,YMCA of Greater Providence | Jelalian E.,Brown University | And 2 more authors.
Pediatrics | Year: 2012

OBJECTIVE: Clinic-based treatments of childhood obesity are effective but typically have limited reach and are costly. In this study, we evaluated the effects of a scalable weight management program for children and teenagers. METHODS: Participants were 155 children and their parent/guardian. Children had a mean ± SD age of 11.3 ± 2.8 years, BMI z score of 2.23 ± 0.41, and a percentage overweight of 72.5 ± 34.0. Most (92%) were obese, and nearly half (46.5%) were >99th percentile for BMI. The primary outcome was change in percentage overweight from baseline to 6 months. RESULTS: At 6 months, children experienced a 3.4 percentage point reduction in percentage overweight (P = .001). Children <13 years had a 4.3 percentage point reduction in percentage overweight, whereas those ≥13 years had a 1.0 percentage point reduction. Those who attended a greater number of face-to-face group sessions experienced greater changes in percentage overweight. There were significant improvements in child health-related quality of life as reported by both children and their parents. CONCLUSIONS: These data suggest that a scalable, community-based pediatric obesity intervention can result in clinically significant reductions in percentage overweight, as well as improvements in health-related quality of life. Copyright © 2012 by the American Academy of Pediatrics. Source

Trost S.G.,University of Queensland | Sundal D.,UnitedHealth Center for Health Reform and Modernization | Foster G.D.,Temple University | Lent M.R.,Temple University | Vojta D.,UnitedHealth Center for Health Reform and Modernization
JAMA Pediatrics | Year: 2014

IMPORTANCE Active video gamesmay offer an effective strategy to increase physical activity in overweight and obese children. However, the specific effects of active gaming when delivered within the context of a pediatric weight management program are unknown. OBJECTIVE To evaluate the effects of active video gaming on physical activity and weight loss in children participating in an evidence-based weight management program delivered in the community. DESIGN, SETTING, AND PARTICIPANTS Group-randomized clinical trial conducted during a 16-week period in YMCAs and schools located in Massachusetts, Rhode Island, and Texas. Seventy-five overweight or obese children (41 girls [55%], 34 whites [45%], 20 Hispanics [27%], and 17 blacks [23%]) enrolled in a community-based pediatric weight management program. Mean (SD) age of the participants was 10.0 (1.7) years; body mass index (BMI) z score, 2.15 (0.40); and percentage overweight from the median BMI for age and sex, 64.3% (19.9%). INTERVENTIONS All participants received a comprehensive family-based pediatric weight management program (JOIN for ME). Participants in the program and active gaming group received hardware consisting of a game console and motion capture device and 1 active game at their second treatment session and a second game in week 9 of the program. Participants in the program-only group were given the hardware and 2 games at the completion of the 16-week program. MAIN OUTCOMES AND MEASURES Objectively measured daily moderate-to-vigorous and vigorous physical activity, percentage overweight, and BMI z score. RESULTS Participants in the program and active gaming group exhibited significant increases in moderate-to-vigorous (mean [SD], 7.4 [2.7] min/d) and vigorous (2.8 [0.9] min/d) physical activity at week 16 (P < .05). In the program-only group, a decline or no change was observed in the moderate-to-vigorous (mean [SD] net difference, 8.0 [3.8] min/d; P = .04) and vigorous (3.1 [1.3] min/d; P = .02) physical activity. Participants in both groups exhibited significant reductions in percentage overweight and BMI z scores at week 16. However, the program and active gaming group exhibited significantly greater reductions in percentage overweight (mean [SD], -10.9%[1.6%] vs -5.5%[1.5%]; P = .02) and BMI z score (-0.25 [0.03] vs -0.11 [0.03]; P < .001). CONCLUSIONS AND RELEVANCE Incorporating active video gaming into an evidence-based pediatric weight management program has positive effects on physical activity and relative weight. Source

Vojta D.,UnitedHealth Center for Health Reform and Modernization | Vojta D.,UnitedHealth Group Inc. | Koehler T.B.,Diabetes Prevention and Control Alliance | Koehler T.B.,UnitedHealth Group Inc. | And 4 more authors.
American Journal of Preventive Medicine | Year: 2013

Background: Twenty-six million U.S. adults have diabetes, and 79 million have prediabetes. A 2002 Diabetes Prevention Program research study proved the effectiveness of a lifestyle intervention that yielded a 58% reduction in conversion to type 2 diabetes. However, cost per participant was high, complicating efforts to scale up the program. Purpose: UnitedHealth Group (UHG) and the YMCA of the USA, in collaboration with the CDC, sought to develop the infrastructure and business case to scale the congressionally authorized National Diabetes Prevention Program nationwide. Emphasis was placed on developing a model that maintained fidelity to the original 2002 Diabetes Prevention Program research study and could be deployed for a lower cost per participant while yielding similar outcomes. Design: The UHG created the business case and technical and operational infrastructure necessary for nationwide dissemination of the YMCA's Diabetes Prevention Program (YMCA's DPP), as part of the National Diabetes Prevention Program. The YMCA's DPP is a group-based model of 16 core sessions with monthly follow-up delivered by trained lifestyle coaches. Setting/participants: A variety of mechanisms were used to identify, screen, and encourage enrollment for people with prediabetes into the YMCA's DPP. Intervention: Substantial investments were made in relationship building, business planning, technology, development, and operational design to deliver an effective and affordable 12-month program. The program intervention was conducted July 2010-December 2011. Data were collected on the participants over a 15-month period between September 2010 and December 2011. Data were analyzed in February 2012. Main outcome measures: The main outcome measures were infrastructure (communities involved and personnel trained); engagement (screening and enrollment of people with prediabetes); program outcomes (attendance and weight loss); and service delivery cost of the intervention. Results: In less than 2 years, the YMCA's DPP was effectively scaled to 46 communities in 23 states. More than 500 YMCA Lifestyle Coaches were trained. The program enrolled 2369 participants, and 1723 participants completed the core program at an average service-delivery cost of about $400 each. For those individuals completing the program, average weight loss was about 5%. UHG anticipates that within 3 years, savings from reduced medical spending will outweigh initial costs. Conclusions: Large-scale prevention efforts can be scalable and sustainable with collaboration, health information technology, community-based delivery of evidence-based interventions, and novel payment structures that incentivize efficiency and outcomes linked to better health and lower future costs. © 2013 American Journal of Preventive Medicine. Source

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