Association for Public Policy Analysis & Management

Approximately 29.1 million Americans have diabetes, and an additional 86 million are pre-diabetic. Given the significant economic costs of type 2 diabetes, employers have begun adopting targeted, health promotion programs designed to delay or prevent diabetes onset in their populations. In April 2015, a large, public employer in the Midwestern United States launched Omada, a weight loss program for individuals identified to be at high risk of developing diabetes. The digital program is group-based, health-coach led, and utilizes digital pedometers and cellular weight scales to promote objective and timely measurement of health behaviors and outcomes. The program includes a 16 week core phase consisting of educational content, food and activity tracking, online discussion posts, and private messaging with the coach, as well as a 36 week sustain phase.

This study has two objectives: 1) to assess the demographic, health status, and attitudinal factors associated with individuals’ engagement with the program, and 2) to evaluate the impact of individuals’ engagement on changes in health and economic outcomes over time. Primary data sources include health plan eligibility and medical claims for years 2012-2016 and health risk assessment (HRA) responses for 2013-2016. Claims data provide individuals’ demographics characteristics (age, sex), clinical diagnoses, program engagement, and medical care spending, whereas the HRA responses provide information on health behaviors, health status, and worker productivity.

Of 6,647 eligible participants at the time the program was launched, 31% enrolled in the program; 73% of those who enrolled completed the core phase; and 46% of core phase completers achieved a weight loss goal of 5% or 10% of baseline body weight. Using sequential logit estimation, we find that older workers were less likely to enroll, but more likely to complete the core phase and achieve weight loss. Females were 26 percentage points more likely than males to enroll and 6 percentage points more likely to complete the core phase, but 10 percentage points less likely to achieve their weight loss goal, conditional on completing the core phase. Individuals who reported during the pre-period an intention to lose weight within the next one to six months were more likely to enroll in the program, but not more likely to complete the core phase or lose weight relative to those with no plans to change.

We used difference-in-differences model estimation to evaluate the impact of program engagement on health behaviors (exercise frequency per week, food consumption), self-reported health status, and economic outcomes. Omada participants, defined as core phase completers and weight loss achievers, significantly increased their moderate and vigorous exercise frequency by 0.4 to 0.5 additional days per week on average, relative to non-participants. Significant effects were also reported for food consumption, including increased servings of fruits and vegetables. Participants also exhibited small but significant increases in self-reported health status relative to eligible, non-participants. Preliminary analyses of economic outcomes do not indicate reductions in medical care spending or absenteeism. Results from this study expand the evidence base regarding the adoption of targeted efforts to address diabetes prevention through the workplace.