Purpose: To examine the impact of body mass index (BMI) on the effectiveness of a disease management-health promotion intervention among community-dwelling Medicare beneficiaries with disabilities.
Design: Secondary data analyses of a randomized controlled trial.
Settings: Nineteen counties in upstate New York and on the West Virginia-Ohio border.
Subjects: Four hundred fifty-two Medicare beneficiaries who participated in the Medicare Primary and Consumer-Directed Care Demonstration between August 1998 and June 2002 and completed the 22-month follow-up.
Intervention: Multicomponent disease management-health promotion intervention involving patient education, individualized health promotion coaching, medication management, and physician care management.
Measures: Body mass index and dependence in Activities of Daily Living (ADLs).
Analysis: Multivariate linear regression.
Results: The intervention resulted in significantly less worsening in ADLs dependence among normal-weight participants (coefficient, -.42; p = .04). However, the intervention did not have a significant effect for underweight participants (F test p = .33 vs. underweight participants in the control group) or overweight or obese participants (F test p = .78 vs. overweight or obese participants in the control group).
Conclusions: A positive effect of the intervention on disability was found among normal-weight participants but not among underweight or overweight or obese participants. Future health promotion interventions should take into consideration the influence of BMI categories on treatment effects.