Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. Steven Browning

Committee Member

Dr. Erin Abner

Committee Member

Dr. Teresa Waters


Objective: To assess whether a counselor-initiated adaptation (CI) of the Look AHEAD Intensive Lifestyle Intervention (ILI) in a military setting was cost-effective relative to a self- paced adaptation (SP).

Methods: We performed cost-effectiveness analysis from a payer perspective alongside a 2014- 2017 randomized behavioral weight loss trial among 248 active-duty military personnel stationed at a US Air Force Base in Texas. We calculated incremental cost-effectiveness ratios (ICERs) for weight loss, reductions in waist circumference, and quality-adjusted life years (QALYs).

Results: After 12 months, the CI adaptation cost more per participant compared to the SP adaptation ($1,081 vs. $120), but achieved greater weight loss (1.86 vs. 0.06kg), reductions in waist circumference (1.85 vs. 0.48 cm), and more QALYs (0.871 vs. 0.856). The ICER for CI relative to the SP adaptation was $61,268 per additional QALY. At willingness-to-pay thresholds of $50,000 and $100,000 per QALY the CI adaptation was 45 and 49% likely to be cost- effective.

Conclusions: The CI delivery of the Look AHEAD ILI may offer a cost-effective approach to tackle excess weight in the US military.

Included in

Public Health Commons