incentaHEALTH Research

Cost effectiveness and return on investment of a scalable community weight loss intervention

Michaud, Tzeyu L.; You, Wen; Wilson, Kathryn E.; Su, Dejun; McGuire, Todd J.; Almeida, Fabio A.; Bayer, Amy L.; Estabrooks, Paul A. In: Preventive Medicine, Vol. 105, 01.12.2017, p. 295-303.


This study assessed the lifetime health and economic consequences of an efficacious scalable community weight loss program for overweight and obese adults. We applied a state-transition Markov model to project lifetime economic outcome (US dollar) and the degree of disease averted as a result of a weight loss intervention, compared with no intervention, from a payer perspective. Effect sizes of the intervention on weight loss, by sex, race and ethnicity, and body mass index (BMI) of participants, were derived from a 12-month community program. Relative risk of diseases across BMI levels and other parameters were informed by the literature. A return on investment (ROI) analysis was conducted to present the overall cost-benefit of the program. Simulation results showed that among 33,656 participants and at a cost of $2.88 million, the program was predicted to avert (with a corresponding estimated medical costs saved of) 78 cases of coronary heart disease ($28 million), 9 cases of strokes ($971,832), 92 cases of type 2 diabetes ($24 million), 1 case of colorectal cancer ($357,022), and 3 cases of breast cancer ($483,259) over the participant lifetime. The estimated medical costs saved per participant was $1403 ($1077 of African American men and $1532 of Hispanic men), and the ROI was $16.7 ($12.8 for African American men and $18.3 for Hispanic men) for every $1 invested. We concluded that a scalable efficacious community weight loss program provides a cost-effective approach with significant ROI, which will assist informed decisions for future adoption and dissemination.

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Estabrooks, P.A., Wilson, K.E., McGuire, T.J. et al. J GEN INTERN MED (2017). doi:10.1007/s11606-016-3971-0

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AUTHORS Paul A. Estabrooks, Ph.D. Department of Health Promotion, Social and Behavioral Health / University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365 USA Kathryn E. Wilson, Ph.D. Department of Health Promotion, Social and Behavioral Health / University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365 USA Todd J. McGuire, BS IncentaHealth LLC, Denver, CO, USA Samantha M. Harden, Ph.D. Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA NithyaPriya Ramalingam, BSc Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA Lia Schoepke, MBA.-HA IncentaHealth LLC, Denver, CO, USA Fabio A. Almeida, Ph.D. Department of Health Promotion, Social and Behavioral Health / University of Nebraska Medical Center, 984365 Nebraska Medical Center, Omaha, NE, 68198-4365 USA Amy L. Bayer, MPH Kaiser Permanente Colorado, Prevention and Chronic Care Solutions, Denver, CO, USA

A Quasi-Experiment to Assess the Impact of a Scalable, Community-Based Weight Loss Program: Combining Reach, Effectiveness, and Cost


Primary care addresses obesity through physician oversight of intensive lifestyle interventions or referral to external programs with demonstrated efficacy. However, limited information exists on community program reach, effectiveness, and costs across different groups of participants.


To evaluate a scalable, community weight loss program using reach, effectiveness, and cost metrics.


Longitudinal pre–post quasi-experiment without control.


Enrolled participants in Weigh and Win (WAW), a community-based weight loss program.


A 12-month program with daily social cognitive theory-based email and/or text support, online access to health coaches, objective weight assessment through 83 community-based kiosks, and modest financial incentives to increase program reach.

Main Measures

Number of participants, representativeness, weight loss achievement (3%, 5% of initial weight lost), and cost of implementation.

Key Results

A total of 40,308 adults (79% women; 73% white; BMI = 32.3 ± 7.44, age = 43.9 ± 13.1 years) enrolled in WAW. Women were more likely than men to enroll in the program and continue engagement beyond an initial weigh-in (57% vs. 53%). Based on census data, African Americans were over-represented in the sample. Among participants who engaged in the program beyond an initial weigh-in (n = 19,029), 47% and 34% of participants lost 3% and 5% of their initial body weight, respectively. The average duration for those who achieved 5% weight loss was 1.7 ± 1.3 years. African American participants were more likely to achieve 5% weight loss and remain enrolled in the program longer compared to non-African American participants (2.0 ± 1.3 vs. 1.6 ± 1.2 years). Implementation costs were $2,822,698. Cost per clinically meaningful weight loss for African Americans ($257.97/3% loss; $335.96/5% loss) was lower than that for Hispanics ($318.62; $431.10) and Caucasians ($313.65; $441.87), due to the higher success rate of that subgroup of participants.


Weigh and Win is a scalable technology-supported and community-based weight loss program that reaches a large number of participants and may contribute to reducing health disparities.

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