CHAPEL HILL, N.C. – In the first six months of Blue Cross and Blue Shield of North Carolina's (BCBSNC's) program promoting healthy weight, nutrition and physical activity, a significant number of participants lost weight, increased exercise and lowered their blood pressure.
Among initial participants in the BCBSNC Healthy Lifestyle ChoicesSM program, 46 percent reported that they lost weight, with an average loss of 9 pounds. Such a moderate weight loss can be enough to improve the health and reduce the risk of heart disease and stroke for obese or overweight people. These results occurred even before BCBSNC became the first insurer in the nation to pay doctors to treat patients for obesity and launched other benefits to promote healthy weight.
"People want to do the right things when it comes to diet and physical activity, but they may need help getting started," said Dr. Bob Harris, BCBSNC senior vice president and chief medical officer. "These results aren't the end of the story, but they show we are on the right track in helping our members manage their weight and health issues related to weight."
The results will appear in the North Carolina Medical Journal, Vol. 67, No. 4 (July/August 2006) in an article authored by Harris. They are based upon a survey of participants in the pilot program for Healthy Lifestyle Choices, which ran from August through December of 2004. Of the 1,956 participants in the pilot, 727 responded to the survey.
"Blue Cross and Blue Shield of North Carolina has set the standard in promoting the idea that health insurers can engage their customers in making better health choices," said Helen Darling, president of the National Business Group on Health, a nonprofit group specializing in employer health and benefit issues. "These results show that it can be done and offer promise to businesses and individuals struggling to keep up with the cost of health care."
Positive changes reported by members in the Healthy Lifestyle Choices evaluation included:
  • 46 percent of participants reported that they lost waist inches, with an average reduction of 0.86 inches.
  • 46 percent of participants reported an increase in days of exercising, with an average increase of 0.64 days per week.
  • More than two-thirds of those who did not exercise at the beginning of the program said they had done some level of exercise during the survey period.
  • 76 percent of the participants who had hypertension reported that they moved to a lower hypertension severity category.
  • 32 percent of the participants said they had increased their intake of fruit and vegetables, with average number of servings increasing from 1.6 to 1.9 per day.
Dr. Lisa Hark, a nationally known nutritionist and registered dietitian, also praised the results.
"Small and practical nutritional and lifestyle changes done consistently can make a real, long-term difference in people's health. Blue Cross and Blue Shield of North Carolina has become a national leader in working with doctors and members to help them make these changes," said Hark, director of the Nutrition Education and Prevention Program at the University of Pennsylvania School of Medicine in Philadelphia.
Here's how the voluntary pilot program worked: Members received an invitation by mail and responded to a health questionnaire.
Participants got a personalized report suggesting opportunities to make healthy lifestyle changes, a food and physical activity diary, a step counter, a tape measure, a newsletter and other educational materials. The initial participants were members who had been diagnosed with a condition – such as obesity, high cholesterol or high blood pressure – that could be improved through lifestyle changes such as healthier food choices and increased physical activity. Healthy Lifestyle Choices is now open to all members whose coverage includes Member Health PartnershipsSM, BCBSNC's suite of care management programs.
In the year after the launch of the pilot, physician office visits by participants declined by 17.5 percent, while the number of prescription drugs they took increased by 17 percent, primarily drugs for diabetes, high cholesterol and high blood pressure.
A report issued last week by the Trust for America's Health ranked North Carolina as the 14th most overweight state – with 63 percent of the state's adults overweight or obese. BCBSNC members who are obese cost the company 32 percent more than normal weight members in medical claims and expenses.
BCBSNC encourages doctors in its networks to talk to patients about how weight, physical activity and food choices can affect overall health. It has provided physician toolkits for the treatment of obesity to over 200 high-volume primary care practices. The toolkits include: tools for assessing body mass index (BMI) and waist circumference; patient and parent education fact sheets; guidelines from the National Heart, Lung and Blood Institute for the assessment and treatment of obesity; pocket cards on the treatment guidelines; patient chart stickers, and posters for pediatric offices.
In 2005, BCBSNC launched a variety of benefit changes as part of its effort to promote healthy weight, nutrition and physical activity among its members. Those changes included:
  • Coverage of four physician office visits per year and related testing for the evaluation and treatment of obesity.
  • Coverage of two FDA-approved, prescription weight-loss drugs – Meridia and Xenical – when medically necessary.
  • Credentialing and contracting with licensed, registered dietitians to include their services in the treatment of overweight and obesity.
Those benefits apply to about 1.3 million members under employer-sponsored or individual coverage in BCBSNC's Blue Care®, Blue OptionsSM or Blue Advantage® plans.
About Blue Cross and Blue Shield of North Carolina:
Blue Cross and Blue Shield of North Carolina is a leader in delivering innovative health care products, services and information to more nearly 3.4 million members, including approximately 744,000 served on behalf of other Blue Plans. For 73 years, the company has served its customers by offering health insurance at a competitive price and has served the people of North Carolina through support of community organizations, programs and events that promote good health. Blue Cross and Blue Shield of North Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Access BCBSNC online at
1 Being obese increases the risk for many diseases, especially heart disease, stroke, cancer and diabetes. According to the National Heart, Lung and Blood Institute Obesity Education Initiative, losing 5 to 10 percent of body weight – 10 pounds for a person weighing 200 pounds – can improve health significantly for an obese person.
2 BCBSNC State of Preventive Health Report, 2004
SM Mark of the Blue Cross and Blue Shield Association.