Assessing effectiveness and cost-benefit of the Trinity Hospital Twin City fit for life program for weight loss and diabetes prevention in a rural Midwestern town

Timothy McKnight, Jennifer R. Demuth, Natalie Wilson, Jonathon P. Leider, Alana Knudson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Introduction Obesity is a top public health priority in the United States. This article reports on the Fit For Life (FFL) health education program designed to address the determinants of obesity in rural settings and help participants lose weight. Purpose and Objectives We evaluated the implementation of the original FFL program, a replication program, and a diabetes-focused program. Intervention Approach The original FFL program (2006 to 2012) was a 12-week session of classes meeting once weekly. Lecture topics included stress management, nutrition, healthy eating, reading food labels, fitness, disease prevention, and healthy aging. The replication program, conducted in 4 locations from 2012 to 2015, helped determine if the FFL program could be implemented on a larger scale, with outcomes similar to the original program. The longer, more-intensive FFL diabetes prevention program, conducted in 2016 and 2017, sought to reduce the number of rural adults at risk for diabetes. Evaluation Methods We evaluated FFL participation and outcome data from 2009 through first quarter 2017. We calculated rates of course participation and completion and measured changes in several health indicators. We constructed a linear regression model to examine the impact of health behaviors on weight loss and calculated program cost-effectiveness. Results From 2009 to 2017, FFL was delivered to over 1,200 people; 82% of participants completed the program. Completing participants lost an average of 2.7 kg or 3% of their total weight. Overall, 68% of participants said they exercised more per week at the end of the program than at the beginning. Estimated cost per kilogram lost for replication sites was between $73 and $101 for original FFL, in line with other programs. The more resource-intensive diabetes prevention program cost per kilogram lost was $151 to $171. Implications for Public Health Practice Weight loss and lifestyle management are major ways to counteract obesity. Improving program options, especially in rural locales, should be a key policy priority. These programs should be considered for population-based expansion, perhaps by health departments or public-private health care consortiums.

Original languageEnglish (US)
Article number170479
JournalPreventing Chronic Disease
Issue number8
StatePublished - Aug 1 2018

Bibliographical note

Funding Information:
This project was supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) (grants D04RH23617and G20RH26409). The information or content and conclusions are those of the authors and should not be construed as the official position or policy of-nor should any endorsements be inferred by-HRSA, HHS, or the US government. Images and tables are original work. Parties interested in using Fit For Life materials (including evaluation surveys and so forth) should contact Dr. McKnight and Ms. Demuth.

Publisher Copyright:
© 2018, Centers for Disease Control and Prevention (CDC).


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