Lose Weight and Avoid Diabetes the Smart Way

Several people have asked me how I lost about 40 pounds last year. The secret was a not-really-secret program called Omada, that Intermountain Healthcare sponsored. My wife's doctor had recommended the program to her to prevent diabetes, but this is primarily a weight-loss program, and she didn't qualify because she isn't overweight. When she told me that, I said, "Hey, I know someone who may qualify: Me." So I applied via IHC online and was accepted. Within a few days I had cellular-network bathroom scales, a health coach, and a team of other weight-losers, all connected online.

The reason this program worked for me was because it helped me make lifetime lifestyle changes in the way I eat and exercise. I don't believe most diet programs would work for me, especially the ones that require purchasing specially prepared foods or prescribe all-liquid or other weird diets. These are not things I could sustain after the weight-loss period. The Omada program included eating smarter (primarily sensible portions with less carbs) and exercising regularly. These are things I can commit to long term. Even though I'm no longer in the core part of the Omada program, I still weigh myself daily on the scales, track my progress on my phone, and follow the bloglike interactions of others on the program.

Last June The Wall Street Journal ran an article called "How Apps Can Help Manage Chronic Diseases." It featured a section that explains the Omada program very well and includes a short interview the WSJ did with me. Here's the Omada section of the article:

Diabetes: Keeping the Condition at Bay

Prediabetes—higher-than-normal blood sugar—increases the risk of stroke and heart attack. According to the Centers for Disease Control and Prevention, prediabetes affects 86 million adults, or more than one in three, and as many as 30% of them will develop diabetes within five years unless they lose weight through a healthy diet and exercise.

While many health plans and insurers offer diabetes-prevention plans, the lifestyle changes to ward off diabetes can require daily hand-holding, so more are looking for ways to deliver such programs digitally. In collaboration with the American Medical Association, Salt Lake City-based Intermountain Healthcare, with 22 hospitals and 185 clinics, is pilot-testing an online program provided by San Francisco-based Omada Health for patients at risk for diabetes. The yearlong program starts with a core 16-week online course on better lifestyle habits, and assigns patients to a personal health coach and private online support forum with moderated discussions.

Participants receive a pedometer and a cellular scale that transmits their weight readings to their Omada profile, and are visible to the coach. They log their daily activity and food either online or with a mobile app; if they have a connected device such as an Apple Watch, they can link it with the program to transmit activity automatically. Their results are displayed on a personal dashboard. After the initial sessions, Omada provides a 36-week sustaining curriculum focusing on weight maintenance. “You can’t just send someone a scale and a step tracker and pray for results,” says Omada Chief Executive Sean Duffy. “You have to combine these instruments with high-touch intervention” that includes social support and personalization.

Coaches usually reach out once or twice a week to check on whether participants have completed their lesson, answer questions and congratulate the patient on tracking activity or meals. Patients can also communicate as often as they like with coaches, who are required to respond within a day of any outreach. Omada sends Intermountain aggregate patient reports to show how an overall population is doing, but can also send individual patient reports for follow-up. Coaches can also encourage patients struggling in the program to reach out to their Intermountain doctors.

Research has shown that Omada participants are able to maintain weight loss and lower average blood-sugar levels two years after starting. In one study of 501 Humana Medicare Advantage beneficiaries, published in the Journal of Aging and Health, participants lost 7.5% of their initial weight after 12 months, improved blood-sugar levels, and lowered cholesterol. In addition to reducing their risk of diabetes, participants also reported improvements in self-care, diet and exercise, and lower feelings of depression and isolation.

“The new reality is that patients want to seek care in their own environment and on their own schedule online, as opposed to going to the office and waiting for a provider,” says Mark Greenwood, an Intermountain physician and one of the initiative’s program leads. “The future of primary care is to be both physician and navigator, hooking up patients with technology to help them manage their conditions.”

Omada estimates health plans and insurers it contracts with recoup their investment in the program within two years, with a predicted net savings of more than $2,000 per participant over five years. Dr. Greenwood says payment for the program will be based on outcomes. But he also says savings will come from preventing progression to full-blown diabetes, which can cost $8,000 a year to manage per patient.

One Intermountain participant, Michael Astle, 64, enrolled after he learned his blood sugar was in the high range. “I knew that my health was at risk, and I wanted to lose weight,” he says, but he kept putting off doing anything about it. He liked using the cellular scale to track his weight and the app on his phone to record activity and diet, and though he never met the other online participants, he says the forum helped “form a bond if someone was struggling or feeling bad and needed encouragement.”

Within 16 weeks he was down to 190 pounds from 227, and continues to lose weight toward his goal of 180. Mr. Astle says it is motivating to know that every time he steps off the scale, it sends his weight to his coach, “and I can’t let it go back up.”