Weight loss intervention for patients with type 2 diabetes linked to higher employment

Key takeaways:

• Employment levels increased by 2.9 percentage points in patients with type 2 diabetes who were assigned to a lifestyle intervention vs. control.
• There was no significant change in disability benefit receipt.

A 10-year intensive lifestyle intervention designed for weight loss in those with type 2 diabetes and overweight/obesity was tied to significantly higher employment levels compared with diabetes education alone, according to researchers.

“Assessing whether any intervention for type 2 diabetes is worth the cost requires considering the effects on labor productivity,” Peter J. Huckfeldt, PhD, a professor of health care administration leadership at the University of Minnesota School of Public Health, and colleagues wrote in JAMA Internal Medicine. “By improving physical function and mental health, lifestyle interventions could have positive effects on labor market participation, productivity at work and earnings.”

But these associations have not been previously studied. So, the researchers conducted a cohort study to examine the connections between an intensive lifestyle intervention for weight loss in those who have type 2 diabetes with earnings, employment and disability benefit receipt compared with a control condition of diabetes education and support.

The analysis included 3,091 trial participants who had type 2 diabetes and overweight or obesity, 59.4% of whom were women. Among them, 1,559 were randomly assigned to the intensive lifestyle intervention Look AHEAD (Action for Health in Diabetes), which was designed to help patients achieve and maintain 7% weight loss. It consisted of weekly sessions with behavioral therapists, dieticians, exercise specialists and lifestyle counselors for 6 months, which then decreased to a monthly basis by year 4. The rest of the participants were enrolled in a control group consisting of group-based diabetes education sessions three times annually over the first 4 years, then one session each year thereafter. All participants were assigned to a group from Aug. 22, 2001, to April 30, 2004. The end of the intervention period was Sept. 14, 2012.

The researchers linked the trial data with Social Security Administration data records to assess whether the intervention improved labor market outcomes. They used difference-in-differences models to estimate relative changes in earnings, disability benefit receipt and employment both before and after the intervention.

Huckfeldt and colleagues found that the intensive lifestyle intervention was linked to higher employment levels, a finding that they wrote indicates “labor market productivity should be considered when evaluating interventions to control chronic diseases.”

In the intervention group, employment increased by 2.9 percentage points (95% CI, 0.3-5.5) relative to the control group. However, there was no significant change in disability benefit receipt: 0.9 percentage points (95% CI, 2.1 to 0.3).

“A previous cost-effectiveness analysis of Look AHEAD (focused on health utility and health care spending) found mixed evidence for whether the benefits of the intervention justified the costs,” the researchers wrote. “Our findings imply that the intervention had benefits in terms of employment and disability benefit receipt that are not captured by typical cost-effectiveness frameworks, although overall effects on earnings and disability payments were statistically insignificant.”

A subgroup analysis that focused on participants with less education than a college degree revealed larger associations between the intervention and employment, along with statistically significant reductions in disability benefit receipt and payments. However, “the disability estimates could reflect random chance due to multiplicity.”

“The magnitudes of the estimates were sizable, representing a 4% increase in employment overall and a 7% increase in employment for the group with lower educational attainment,” they wrote.

Huckfeldt and colleagues concluded that their findings “speak to the long-standing scientific inquiry into how health affects socioeconomic status.”

“Prior work has established the importance of in utero and childhood health on the formation of cognitive and noncognitive abilities and economic outcomes during adulthood,” they wrote. “Our study provides evidence that improving health later in life (in this case, by improving type 2 diabetes management) may also have positive economic benefits by extending the ability to work and reducing participation in the Social Security Administration’s disability programs.”