For more than 20 years, a bilingual school health program known as Bienestar, the brainchild of Dr. Roberto Trevino, has been teaching elementary and middle school students throughout San Antonio and South Texas the skills to stay healthy and avoid the twin epidemics of obesity and diabetes. University Health System provided some early funding and support for the work.
On Valentine’s Day, Dr. Trevino — director of the Social & Health Research Center in San Antonio — held a news conference at University Health System’s Texas Diabetes Institute to discuss a newly published study that took elements of his Bienestar program and adapted it to obese adults.
It wasn’t easy, Dr. Trevino said, humorously explaining the difference between working with children and adults: “Children listen.”
Still, in a paper published in the American Journal of Preventive Medicine, the effort appears to be a success. More than 640 adults attended at least one session of intensive behavioral therapy based on the Bienestar model at the South Alamo Medical Group, a primary care practice with six locations throughout San Antonio. They were taught by an experienced health educator.
The Bienestar program’s lessons cover nutrition, physical activity, mental health, oral health, and prevention of obesity and its associated chronic conditions such as diabetes and cardiovascular disease.
While participation varied and no-shows and cancellations were frequent, the study found those who attended between four and eight sessions saw a median weight loss of 2.4 pounds. Those who took part in more than eight sessions lost just over eight pounds. In general, patients lost a quarter pound for every session they attended.
Participants — many of them who suffered from diabetes and hypertension — saw decreases in their weight and median BMI, or body mass index, regardless of their age, sex, race/ethnicity, health insurance coverage or a diagnosis of diabetes, high blood pressure or both.
Dr. Trevino said his curriculum can be used in other physician practices, although his findings found participants did better when working with non-physicians such as dietitians and health educators.
In 2011, the federal government began offering modest Medicare reimbursement of $24.21 per session for intensive behavior therapy for obesity in adults, making this kind of program feasible. However, little research has since been done on the effectiveness of that therapy — and no other studies to date have looked at Medicare-funded therapy taking place in primary care provider offices.
Partial funding for the study came from the Medtronic Foundation.