A Gym-Based Wellness Challenge for People With Type 2 Diabetes: Effect on Weight Loss, Body Composition, and Glycemic Control

Context. Modification of diet and exercise is known to be effective in treating diabetes and obesity, but options for practical, effective interventions are few. Objective. To assess the effectiveness of a gym-based fitness competition with financial incentives in weight loss and diabetes control in adults with type 2 diabetes. Design. Retrospective analysis of outcomes of a quality improvement initiative in diabetes care. Analysis was made from comparisons of measurements made of participants before enrollment to those of the subset of enrolling participants who finished the challenge. Setting. Outpatient multispecialty group practice clinic and private gym in rural eastern Washington State. Participants. Sixty-nine adults with type 2 diabetes who were followed by the participating clinic. Participants were recruited from diabetes disease management registries and from newspaper and posted advertisements. Interventions. Participants competed in a 5.5-month, gym-based structured exercise and diet program with close clinical monitoring. Substantial financial awards were made at the end of the program based on a point system that included credits for diet tracking, gym attendance, body composition improvement, participation in patient education sessions, and adherence to the diabetes care regimen. Main outcome measures. The primary outcomes were weight loss and body composition improvement. Secondary outcomes included quality of life assessment and improvements in hemoglobin A 1c (A1C) and lipid levels. Results. Thirty participants (45%) finished the program and could be evaluated. Significant ( P < 0.05) improvements were seen for A1C results; weight loss; decrease in body fat; inches lost from abdomen, thigh, and hips; and physical component score from a quality-of-life scale (the Short-Form 8 [SF-8] health survey). Weight loss was seen in 28 of the 30 patients who completed the program (mean loss = 15.9 lb; median = 14.5 lb; range = 4.5–49.7 lb). A1C reductions were seen in 86% of these participants (mean = –1.52%; median = –1.6%; range = +0.8 to –5.0%). Physician-directed reduction of one or more diabetes, lipid-lowering, or anti-hypertensive medications occurred in 28%, and discontinuation of one more medications occurred in 28%. Conclusion. Structured financial incentives are highly effective in achieving weight loss and improved clinical outcomes in some adults with type 2 diabetes.