BACKGROUND: Current recommendations support bariatric surgery among the morbidly obese as an option to mitigate future risk of cardiovascular disease, diabetes and hypertension. To date, there is little evidence on the effect of extensive lifestyle interventions among those high-risk individuals in reducing the need for such procedures. METHODS: The purpose of the present study is to examine the efficacy of an intensive lifestyle workplace intervention on significant body weight and cardiovascular disease risk factors across the spectrum of obesity. Changes in BMI are being measured from baseline to 6 months follow up, along with corresponding improvements in cardio-metabolic risk. In addition, the decrease in participants meeting criteria for bariatric surgery over the study period is examined. Bariatric surgery criteria were defined as BMI≥40 or BMI between 35 and 40 and at least one of the following co-morbidities: diabetes, hypertension, or high cholesterol. Short term results (at 9-12 weeks follow-up) of this study are being presented at AHA 2014 in March. RESULTS: The study population consisted of 152 individuals (49±10 years, 78% female) with BMI≥27 at baseline and complete data at 6 month follow-up. A total of 71 (47%) participants lost at least 10 % of their body weight. Additionally, 37% dropped an entire BMI category. Of note, 39%(16 of 41) who were classified as BMI>40 were in BMI 35-39 at follow-up, respectively 44%(14 of 32) of individuals in the BMI category 35-39 successfully moved to the BMI category 30-34 at 6 months follow-up. Forty-five participants (35% of total) initially met criteria for bariatric surgery. At 6 months of follow-up 40% (18 of 45, p<0.001) of these candidates no longer needed bariatric surgery. CONCLUSIONS: Worksites can be effective for achieving clinically important reductions in body weight and diminish the potential need for procedures among a small proportion of morbidly obese individuals. Many lifestyle interventions succeed in achieving short term reductions but are unable to sustain them over longer periods. Our program shows promising results at 6 months and continued follow up will allow us to determine whether workplace wellness interventions similar to ours are a viable and lasting alternative to bariatric surgery.

Background: With about 59% of the entire US population currently in the work force, American Heart Association has emphasized worksite-based interventions to improve cardiovascular health among the working population. The primary aim of this study was to assess the short-term (12 weeks) efficacy of an ongoing multi-component, behavioral intervention improvement program (My Unlimited Potential (myUP), among employees of Baptist Health South Florida (BHSF), a large not-for-profit health care system. Methods: BHSF employees with two or more Cardio-metabolic risk factors, such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were considered for the study. Behavioral interventions were focused on diet and physical activity modifications. Results: Overall 202 (48±10 years, 78% females) employees enrolled in myUP wellness program. The retention of subjects was high with 89% (n=181) of subjects following up at 12 weeks. The figure below demonstrates the baseline, follow-up and estimated mean change in anthropometric, exercise capacity on treadmill test and CM participants. BMI reduction >5% was noted in 38% of the participants. Significantly higher, clinically meaningful, endpoints, especially in attaining blood pressure goals and exercise capacity (>10 METS), during the short-term follow-up in this behavioral intervention program (figure), were achieved. Conclusion: These findings suggest that an intensive behavioral modification intervention program, delivered to employees in a health care setting, results in significant short term benefit in weight reduction, increase fitness level and concomitantly improve cardio-metabolic risk profile. Further follow-up is in progress to ascertain whether these benefits are sustainable over a longer duration.

Negative impact of CVD as the leading cause of death in the US is worsened by the significant burden of obesity and associated morbidity and concerns about the growing population inactivity. The American Heart Association has emphasized worksite-based interventions to improve CV health. We evaluated the benefits of improved physical activity(PA) and weight loss(WL) among employees of the Baptist Health South Florida enrolled in a wellness intervention program. Methods: Employees with two or more Cardio-metabolic risk factors , such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were enrolled in an intervention program themed “My unlimited potential”. Interventions were focused on diet and PA modifications. We defined improved physical activity as the difference in the metabolic equivalents (METs) at 12 weeks follow-up and at baseline. WL (lbs) was the difference in weight at follow-up. The relationship between WL and changes in METs was explored in an ordered logistic regression. Results: Overall 203 (48±10 years, 78% females) employees were enrolled with a retention rate of 89% (n=181) at 12 weeks follow-up. At baseline the median weights was 211 lbs., and mean METs- 8.6, while at follow-up the median weight was 200 lbs, and the mean METs 11. At 12 weeks follow up 38% had significant WL (lost >5% of baseline weight). The median WL was 8.4 (IQR 4.8-13.0) lbs and the mean change in METs was 2.4±1.8. Median WL increased with increasing tertiles of METs change; tertile1- 6.5(4-11) lbs., tertile2- 9(6-13)lbs. tertile3- 11(7-15)lbs. Increased PA was related to increased WL across BMI categories adjusting for age, gender and baseline weight. Conclusion: This study points strongly toward the benefit of increasing PA among other lifestyle modification interventions in controlling weight. Although further follow-up of this population to evaluate sustainability of change is needed, our results clearly relate improved PA and health.

Introduction: Workplace wellness programs are part of the American Heart Association’s (AHA) strategy at improving cardiovascular health. Data suggest that most cost and risk borne by employers is with metabolic syndrome (MS). The current study aimed to ascertain the primary to short-term (12 weeks) efficacy of a lifestyle intervention improvement program (My Unlimited Potential (myUP), among employees of a health care system in improving metabolic status as well as associated degree of vascular inflammation as measured by high sensitivity C-reactive protein (hs-CRP). Methods: The MyUP enrolled high risk individuals with at least 2 of the following cardio-metabolic risk factors, total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30. Improvement in cardio-metabolic risk was assessed by the change in number of metabolic risk components and C-reactive protein (CRP) from baseline to 12 week follow-up. Results: Overall 203 (48±10 years, 78% females) employees were enrolled. The retention of subjects was high with 89% (n=181) of subjects following up at 12 weeks. There were significant changes in the distribution of the number of components of the metabolic syndrome from baseline to 12 weeks follow up, see figure 1. Overall only 25% met criteria for MS at 12 week as compared to 48% at baseline. There were changes in the overall median hsCRP at 12 weeks follow-up compared to baseline, 3.6(1.8-7.9) vs. 4.4(2.0-8.4). We also noticed improvement in median hs-CRP levels across the categories of improving metabolic risk factors. Among individuals who had improvement in 1-2 MS risk factors, the median hsCRP at follow-up compared to baseline was 4.6(2.2-8.8) vs. 5.2(2.7-8.9) p=0.6090 and those with improvements in >2 MS components it was 3.3(2.5-5.3) vs. 5.0(3.5-7.14) p=0.1614. Conclusion: Measurable cardio-metabolic risk reduction was achieved, benefiting participant of a targeted Life style modification intervention program.

Background: In this study we aim to assess the short term effects of clinically significant Blood Pressure (BP) reduction after a behavioral intervention on systemic inflammation, measured by elevated high sensitivity c-reactive protein (HSCRP), in a high cardiovascular disease (CVD) risk cohort. Methods: The study was conducted among 180 employees of Baptist Health South Florida who had 2 or more CVD risk factors such as obesity, diabetes, hypertension or elevated total cholesterol and was involved in a three-month workplace lifestyle intervention. The intervention focused on nutritional and physical activity modifications. At baseline and at 3 months follow-up, anthropometric, clinical, and laboratory measures were obtained. Significant BP reduction was defined as systolic blood pressure (SBP) reduction ≥ 10mmHg or diastolic blood pressure (DBP) reduction ≥ 5mmHg at 3 months of follow-up. A HSCRP >3mg/L was considered elevated. Results: Over the 3-month study period the median SBP decline was 16mmHg (IQR 4 -23mmHg) while the median reduction in DBP was 10mmHg (IQR 6 -16mmHg). 87% (156 participants) experienced significant BP reduction. Among those without significant BP reduction, the prevalence of elevated HSCRP at baseline was 58% and at follow-up it was 75% (p = 0.125). However, among those who had significant BP reduction, there was significant reduction in the prevalence of elevated HSCRP from 66.7% to 57.1% (p<0.001). In unadjusted conditional logistic regression analyses significant BP reduction was associated with 94% reduction in the risk of elevated HSCRP at follow-up. In a fully adjusted model, this association persisted. Conclusion: Clinically significant reduction in blood pressure over a short period in a high cardiovascular disease risk working population is independently associated with markedly diminished risk of elevate hs-CRP. Longer follow-up intervention studies are required to further understand if these effects are sustained.

BACKGROUND: Bariatric surgery among the morbidly obese is recommended as an option to mitigate future risk of cardiovascular disease, diabetes and hypertension. To date there is little evidence on the effect of extensive lifestyle interventions among these high-risk groups in reducing the need for such procedures in extended periods. METHODS: The purpose of the present study is assess efficacy of an intensive lifestyle workplace intervention on significant body weight across the spectrum of obesity in a worksite wellness program, called “My Unlimited Potential (MyUP)” conducted at Baptist Health South Florida. Changes in BMI are being measured from baseline to 12 months follow up, along with corresponding improvements in cardio-metabolic risk. In addition, the decrease in participants meeting criteria for bariatric surgery over the study period is examined at 6 and 12 months. Bariatric surgery criteria were defined as BMI≥40 or BMI between 35 and 40 and at least one of the following co-morbidities: diabetes, hypertension, or high cholesterol. RESULTS: The study population consisted of 272 individuals (48±9 years, 78% female) with BMI≥27 at baseline. Complete data at 12-month follow up was available for 141 individuals (52%). A total of 21(14%) and 14 (10%) participants had lost at least 10 % of their body weight by 6 months and 12 months respectively. Forty-six participants (32%) initially met criteria for bariatric surgery. At six month follow-up 43% (20 of 46, p<0.001) of these candidates no longer needed bariatric surgery. Of these, 80% (16 out of 20) retained their weight loss at 12 months. CONCLUSIONS: This worksite wellness program effectively obviated the need for bariatric surgery in approximately half of those who were initially eligible at 1 year of follow up. Replication of this program with a larger cohort with stricter attention to attrition is needed to asses the utility of our program and its implications as a larger corporate wellness strategy.

Background: Current recommendations support bariatric surgery among the morbidly obese as an option to mitigate future risk of cardiovascular disease, diabetes and hypertension. To date, there is little evidence on the effect of extensive lifestyle interventions among those high-risk individuals in reducing the need for such procedures. Methods: The purpose of the present study was to examine the efficacy of an intensive lifestyle workplace intervention on significant body weight and cardiovascular disease risk factors across the spectrum of obesity. Changes in BMI were measured from baseline to 12 week follow up, along with corresponding improvements in cardio-metabolic risk. In addition, the decrease in participants meeting criteria for bariatric surgery over the study period was examined. Bariatric surgery criteria were defined as BMI≥40 or BMI between 35 and 40 and at least one of the following co-morbidities: diabetes, hypertension, or high cholesterol. Results: The study population consisted of 169 individuals (49±10 years, 77% female) with BMI≥27 at baseline and complete data at follow-up. A total of 65 (39%) participants lost at least 5% of both their initial BMI and body weight. Additionally, 32% dropped an entire BMI category. Of note, 38%(18 of 48) who were classified as BMI>40 were in BMI 35-39 at follow-up, respectively 37%(13 of 55) of individuals in the BMI category 35-39 successfully moved to the BMI category 30-34 at 3 months follow-up. Sixty-three participants (37% of total) initially met criteria for bariatric surgery. At 12 weeks follow-up 35% (22 of 63) of these candidates no longer qualified. Conclusions: Worksites can be effective for achieving clinically important reductions in body weight and diminish the potential need for procedures among a small proportion of morbidly obese individuals. Further follow-up is needed to ascertain whether weight loss can be sustained long-term, and if the short term gains will translate to significant improvements in cardio-metabolic risk profile.

Introduction: Several heart rate (HR) during exercise, such as heart rate recovery (HRR) and Chronotropic index (CI), have been associated with increased risk of cardiovascular disease (CVD) and CVD mortality. However, only a handful of studies have examined the effects of improving physical fitness on changes in HR profile. We assessed the effects of improving physical fitness on HR profile in a high risk population free from known CVD who were undergoing an intensive lifestyle intervention program. Methods: The study population included 204 participants of a lifestyle intervention program who had at least 2 metabolic risk factors at baseline. The program focused on improving nutrition, physical fitness and promotion of healthy lifestyle using a multi-disciplinary approach including one-on-one counseling and fitness training throughout the 12 week program with close supervision. Participants underwent exercise stress testing at baseline and at 12 weeks. Results: Over the 12 week period there was a significant increase in metabolic equivalents (([[Unable to Display Character: ∆]]METS) mean difference = 2.1 95%CI: 1.9, 2.4 p Conclusion: Improvement in HR profiles can be achieved in a high risk population through programs that focus on physical fitness even if there is no improvement in weight, and regardless of baseline cardiometabolic risk. Improvement in HR profiles, not just weight loss, should be included in criteria for measuring success of similar interventions.

Background: With about 59% of the entire US population currently in the work force, the American Heart Association has emphasized worksite-based interventions to improve cardiovascular health among the working population. The primary aim of this study was to assess effectiveness of an ongoing multi-component, lifestyle improvement program (My Unlimited Potential [MyUP]) extending into 6 months, among employees of Baptist Health South Florida (BHSF), a large not-for-profit health care system. Methods: BHSF employees with 2 or more Cardiometabolic risk factors, such as total cholesterol ≥ 200 mg/dl, systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg, hemoglobin A1C ≥ 6.5%, and body mass index (BMI) ≥ 30 were considered for the study. Behavioral interventions were focused on dietary and physical activity modifications. Results: Overall 202 (48±10 years, 78% females) employees who enrolled in the MyUP wellness program. The retention of subjects was high with 89% (n=181) at 12 weeks and 80% (n=162) at 6 months. The table and figure below demonstrate the baseline, 12 week and 6 months averages in anthropometric and laboratory profile in participants. Comparing follow-up from 3 months to that at 6 months, clinically meaningful improvement in endpoints were especially noted for BMI, BP, HDL targets, and reducing burden of systemic inflammation (figure). Conclusion: These findings suggest that an intensive behavioral modification intervention program, delivered to employees in a health care setting, results in both significant short and intermediate term benefit in weight reduction, improved blood pressure control and hbA1c, and concomitantly improves cardio-metabolic risk profile. Further follow-up is in progress to ascertain whether these benefits are sustainable over longer periods.

Background: Studies have demonstrated that improving physical fitness is associated with weight loss and improvement in cardio-metabolic risk profile. However, the effect of improvement in aerobic fitness on metabolic risk in the absence of significant weight loss in a high risk working population is poorly understood. We examined efficacy of both weight reduction and increased aerobic fitness on metabolic syndrome in an ongoing multicomponent lifestyle intervention improvement program (My Unlimited Potential (myUP)), among employees of Baptist Health South Florida (BHSF). Methods: The study population included 158 participants who had at least 2 metabolic risk factors at baseline. An advanced nurse practitioner, registered dietician, exercise physiologist, certified diabetic educator, and registered nurse met with participants to provide one-on-one counseling and fitness training. During the first 12 weeks the multidisciplinary team rigorously supervised participants. Results: Over the 12 week period, there was a significant increase in METS (median difference 2.7; IQR 1.4 to 3.4 p<0.001). Over the same period the prevalence of metabolic syndrome reduced from 48% to 25% (p <0.001). The increase in METS was greater among those with significant weight loss defined as weight loss at least 5% of baseline body weight (median difference = 1.30, P<0.001). In a fully adjusted logistic regression model, there was markedly significant reduction in the risk of metabolic syndrome at 3 months among those who had shown improvements in fitness alone (OR 0.15, p=0.025) and among those who had both improvements in fitness and significant weight loss (OR 0.14, p=0.030). Conclusion: Improvements in respiratory fitness as can be seen with exercise, even in the absence of significant weight loss, is associated with significant reduction in cardiometabolic risk. In an intensive lifestyle modification interventional program aimed at CVD risk reduction, emphasis should be placed at increasing physical fitness, not only on weight loss.