The current state of lifestyle intervention implementation research: where do we go next?

Practice: Lifestyle interventions can be successfully implemented in a variety of settings, with clinical settings reporting the best outcomes and rates of adoption. However, community setting implementations reach more diverse populations. Training resources are now widely available. Policy: Cost is a significant barrier to both the implementation and adoption of interventions. Third party reimbursement for lifestyle interventions would catalyze adoption and sustainability. Research: Cost, staff turnover, institutional commitment, staff commitment and self-efficacy, and lack of a plan to transition from research funded resources to institutional funded resources are barriers that should all be taken into account in future implementation studies. In the USA, the prevalence of obesity is 33.8% [1] and type 2 diabetes is 27% [2]. The landmark Diabetes Prevention Program (DPP) showed that a lifestyle intervention facilitating a 7% weight loss had a significantly greater impact on diabetes risk than placebo or metformin with a risk reduction of 58% over 3 years [3]. Similar findings were reported in diabetes prevention studies in Finland and China [4, 5]. The impact of lifestyle interventions appears to be long term [3, 4]. In the 10-year follow-up of the DPP, the incidence of diabetes in the placebo and metformin groups (who had been offered the lifestyle intervention following the initial intervention period) fell to equal that of the lifestyle group; however, the cumulative incidence of diabetes remained lowest in the lifestyle group [6]. The China Da Qing Study revealed reduced incidence of diabetes from a lifestyle intervention at 20-year follow-up [5]. Widespread availability of lifestyle interventions could have a tremendous impact on public health.