Effectiveness of a Group-Based Lifestyle Change Program Versus Usual Care: An Electronic Health Record, Propensity Score–Matched Cohort Study


      Translational lifestyle change programs for community and clinical settings have been available for a decade, yet there are limited data on their comparative effectiveness. This study examines the effectiveness of a Centers for Disease Control and Prevention–aligned lifestyle change program relative to usual care in clinical practice.


      This was an electronic health record–based retrospective cohort study conducted in a community-based healthcare system. Investigators identified adult program participants and usual-care patients in the electronic health record between 2010 and 2018 and defined their index date (baseline) as the first lifestyle change program encounter or a random encounter date, respectively. Participants were matched 1:2 to usual-care patients on baseline demographics and clinical characteristics using propensity-score methods. Changes in body weight and blood pressure were examined from baseline through 24 months.


      The authors identified 2,833 program participants and 438,432 usual-care patients meeting study eligibility criteria. A total of 2,833 program participants were matched to 4,776 usual-care patients; the average age was 54 years, and 80% of the participants were female. Program participation was associated with a 1.9- and 1.6-fold higher prevalence of clinically meaningful (≥5%) weight loss at 12- and 24-month follow-up than usual care and a higher prevalence of blood pressure control at 12 months but not at 24 months. Patients without type 2 diabetes at baseline had more pronounced outcomes than those with type 2 diabetes.


      This study demonstrates the effectiveness of an evidence-based, Centers for Disease Control and Prevention–aligned lifestyle change program in reducing cardiometabolic risk factors compared with usual care in clinical practice, with long-term reductions in weight and transient reductions in blood pressure.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Knowler WC
        • Barrett-Connor E
        • Fowler SE
        • et al.
        Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
        N Engl J Med. 2002; 346: 393-403
        • Hamman RF
        • Wing RR
        • Edelstein SL
        • et al.
        Effect of weight loss with lifestyle intervention on risk of diabetes.
        Diabetes Care. 2006; 29: 2102-2107
        • Ratner R
        • Goldberg R
        • Haffner S
        • et al.
        Impact of intensive lifestyle and metformin therapy on cardiovascular disease risk factors in the Diabetes Prevention Program.
        Diabetes Care. 2005; 28: 888-894
        • Ackermann RT
        • Finch EA
        • Brizendine E
        • Zhou H
        • Marrero DG
        Translating the Diabetes Prevention Program into the community: the DEPLOY Pilot Study.
        Am J Prev Med. 2008; 35: 357-363
        • Parikh P
        • Simon EP
        • Fei K
        • Looker H
        • Goytia C
        • Horowitz CR
        Results of a pilot diabetes prevention intervention in East Harlem, New York City: project HEED.
        Am J Public Health. 2010; 100: S232-S239
        • Katula JA
        • Vitolins MZ
        • Rosenberger EL
        • et al.
        One-year results of a community-based translation of the Diabetes Prevention Program: Healthy-Living Partnerships to Prevent Diabetes (HELP PD) project [published correction appears in Diabetes Care. 2012;35(2):455].
        Diabetes Care. 2011; 34: 1451-1457
        • Kanaya AM
        • Santoyo-Olsson J
        • Gregorich S
        • Grossman M
        • Moore T
        • Stewart AL
        The Live Well, Be Well study: a community-based, translational lifestyle program to lower diabetes risk factors in ethnic minority and lower-socioeconomic status adults.
        Am J Public Health. 2012; 102: 1551-1558
        • Ockene IS
        • Tellez TL
        • Rosal MC
        • et al.
        Outcomes of a Latino community-based intervention for the prevention of diabetes: the Lawrence Latino Diabetes Prevention Project.
        Am J Public Health. 2012; 102: 336-342
        • Ma J
        • Yank V
        • Xiao L
        • et al.
        Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial.
        JAMA Intern Med. 2013; 173: 113-121
        • Ali MK
        • Echouffo-Tcheugui J
        • Williamson DF
        How effective were lifestyle interventions in real-world settings that were modeled on the Diabetes Prevention Program?.
        Health Aff (Millwood). 2012; 31: 67-75
      1. About the national DPP. Centers for Disease Control and Prevention National Diabetes Prevention Program. Updated November 15, 2018. Accessed May 26, 2019.

        • Kramer MK
        • Miller RG
        • Siminerio LM
        Evaluation of a community Diabetes Prevention Program delivered by diabetes educators in the United States: one-year follow up.
        Diabetes Res Clin Pract. 2014; 106: e49-e52
        • Almeida FA
        • Shetterly S
        • Smith-Ray RL
        • Estabrooks PA
        Reach and effectiveness of a weight loss intervention in patients with prediabetes in Colorado.
        Prev Chronic Dis. 2010; 7 (Accessed August 11, 2020): A103
        • Vanderwood KK
        • Hall TO
        • Harwell TS
        • Butcher MK
        • Helgerson SD
        • Montana Cardiovascular Disease and Diabetes Prevention Program Workgroup
        Implementing a state-based cardiovascular disease and diabetes prevention program.
        Diabetes Care. 2010; 33: 2543-2545
        • Rehm CD
        • Marquez ME
        • Spurrell-Huss E
        • Hollingsworth N
        • Parsons AS
        Lessons from launching the Diabetes Prevention Program in a large integrated health care delivery system: a case study.
        Popul Health Manag. 2017; 20: 262-270
        • Ruggiero L
        • Oros S
        • Choi YK
        Community-based translation of the Diabetes Prevention Program's lifestyle intervention in an underserved Latino population.
        Diabetes Educ. 2011; 37: 564-572
        • Payne WR
        • Walsh KJ
        • Harvey JT
        • et al.
        Effect of a low-resource-intensive lifestyle modification program incorporating gymnasium-based and home-based resistance training on type 2 diabetes risk in Australian adults.
        Diabetes Care. 2008; 31: 2244-2250
        • Ely EK
        • Gruss SM
        • Luman ET
        • et al.
        A national effort to prevent type 2 diabetes: participant-level evaluation of CDC's National Diabetes Prevention Program.
        Diabetes Care. 2017; 40: 1331-1341
        • Romanelli RJ
        • Huang HC
        • Chopra V
        • et al.
        Longitudinal weight outcomes from a behavioral lifestyle intervention in clinical practice.
        Diabetes Educ. 2019; 45: 529-543
        • Greenwood DA
        • Kramer MK
        • Hankins AI
        • Parise CA
        • Fox A
        • Buss KA
        Adapting the Group Lifestyle BalanceTM Program for weight management within a large health care system Diabetes Education Program.
        Diabetes Educ. 2014; 40: 299-307
        • Betts AC
        • Froehlich-Grobe K
        Accessible weight loss: adapting a lifestyle intervention for adults with impaired mobility.
        Disabil Health J. 2017; 10: 139-144
        • Albright AL
        • Gregg EW.
        Preventing type 2 diabetes in communities across the U.S.: the National Diabetes Prevention Program.
        Am J Prev Med. 2013; 44: S346-S351
        • Driver S
        • Reynolds M
        • Kramer K
        Modifying an evidence-based lifestyle programme for individuals with traumatic brain injury.
        Brain Inj. 2017; 31: 1612-1616
        • Bang H
        • Edwards AM
        • Bomback AS
        • et al.
        Development and validation of a patient self-assessment score for diabetes risk.
        Ann Intern Med. 2009; 151: 775-783
        • Quan H
        • Li B
        • Couris CM
        • et al.
        Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries.
        Am J Epidemiol. 2011; 173: 676-682
        • Romanelli RJ
        • Sudat S
        • Huang Q
        • et al.
        Short-term weight trajectories and long-term weight outcomes from a lifestyle intervention in real-world clinical practice.
        Transl Behav Med. 2019; (In press. Online August 1, 2019.)
        • Whelton PK
        • Carey RM
        • Aronow WS
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines [published correction appears in Hypertension. 2018;71(6):e136–e139] [published correction appears in Hypertension. 2018;72(3):e33].
        Hypertension. 2018; 71: 1269-1324
        • Austin PC
        An introduction to propensity score methods for reducing the effects of confounding in observational studies.
        Multivariate Behav Res. 2011; 46: 399-424
        • Austin PC
        Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.
        Stat Med. 2009; 28: 3083-3107
        • Jiang L
        • Chen S
        • Beals J
        • et al.
        Evaluating community-based translational interventions using historical controls: propensity score vs. disease risk score approach.
        Prev Sci. 2019; 20: 598-608
        • Flamm M
        • Panisch S
        • Winkler H
        • Sönnichsen AC
        Impact of a randomized control group on perceived effectiveness of a disease management programme for diabetes type 2.
        Eur J Public Health. 2012; 22: 625-629
        • Baker SG
        • Lindeman KS
        Rethinking historical controls.
        Biostatistics. 2001; 2: 383-396
        • Brunisholz KD
        • Joy EA
        • Hashibe M
        • et al.
        Stepping back to move forward: evaluating the effectiveness of a diabetes prevention program within a large integrated healthcare delivery system.
        J Healthc Qual. 2017; 39: 278-293
        • Lau DC
        • Douketis JD
        • Morrison KM
        • et al.
        2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary].
        CMAJ. 2007; 176: S1-S13
        • Britton A
        • McKee M
        • Black N
        • McPherson K
        • Sanderson C
        • Bain C
        Threats to applicability of randomised trials: exclusions and selective participation.
        J Health Serv Res Policy. 1999; 4: 112-121
        • Mudaliar U
        • Zabetian A
        • Goodman M
        • et al.
        Cardiometabolic risk factor changes observed in diabetes prevention programs in U.S. settings: a systematic review and meta-analysis.
        PLoS Med. 2016; 13e1002095