Impact of body mass index on the effectiveness of a disease management-health promotion intervention on disability status

Meng H, Wamsley BR, Friedman B, Liebel D, Dixon DA, Gao S, Oakes D, Eggert GM.
Am J Health Promot. 2010 Jan-Feb;24(3):214-22. doi: 10.4278/ajhp.081216-QUAN-306.

SOURCE:  Stony Brook University, Stony Brook, New York, USA.

PURPOSE:  To examine the impact of body mass index (BMI) on the effectiveness of a disease management-health promotion intervention among community-dwelling Medicare beneficiaries with disabilities.

DESIGN:  Secondary data analyses of a randomized controlled trial.

SETTINGS:  Nineteen counties in upstate New York and on the West Virginia-Ohio border.

SUBJECTS:  Four hundred fifty-two Medicare beneficiaries who participated in the Medicare Primary and Consumer-Directed Care Demonstration between August 1998 and June 2002 and completed the 22-month follow-up.

INTERVENTION:  Multicomponent disease management-health promotion intervention involving patient education, individualized health promotion coaching, medication management, and physician care management.

MEASURES:  Body mass index and dependence in Activities of Daily Living (ADLs).

ANALYSIS:  Multivariate linear regression.

RESULTS:  The intervention resulted in significantly less worsening in ADLs dependence among normal-weight participants (coefficient, -.42; p = .04). However, the intervention did not have a significant effect for underweight participants (F test p = .33 vs. underweight participants in the control group) or overweight or obese participants (F test p = .78 vs. overweight or obese participants in the control group).

CONCLUSIONS:  A positive effect of the intervention on disability was found among normal-weight participants but not among underweight or overweight or obese participants. Future health promotion interventions should take into consideration the influence of BMI categories on treatment effects.