Background: Estimates of the economic value of investing in real-life diabetes prevention lifestyle interventions are scarce. We assessed the cost of implementation and cost-effectiveness of a church-based lifestyle intervention (Fit Body and Soul [FBAS]), in which African American participants received 18 lifestyle education sessions.

Methods: An incremental cost-effectiveness ratio (ICER) was calculated using data from a cluster randomized controlled trial comparing FBAS with a health education (HE) control group among 604 overweight participants in 20 churches. We calculated the ICER as the difference in costs to deliver FBAS vs. HE over the difference in weight change at one-year follow-up. Costs included those incurred for participant identification (screening at baseline) and program implementation (payment for health advisors to lead sessions, materials, equipment, and incentives to churches and participants). To estimate adjusted difference in weight (kg) change between FBAS and HE, we fit mixed linear models, accounting for clustering of participants within churches and for age, sex, and educational attainment. We repeated this analysis for waist circumference (cm).

Results: The per-person intervention cost of FBAS was $50.39 more than HE (per-person FBAS cost: $442.22; per-person HE cost: $391.83). The adjusted difference in weight change between the FBAS group and the HE group was 1.9 kg (95% CI 1.0, 2.8), and the adjusted difference in waist circumference change was 2.4 cm (95% CI, 1.3 to 3.4). Compared to HE, implementation of FBAS cost an additional $26.52 per kg weight lost and $21.00 per cm reduction in waist circumference.

Conclusion: For a modest increase in cost, FBAS led to greater weight loss and reduction in waist circumference among African Americans compared to standard HE at a church setting.


E.C. Rhodes: None. E. Chandrasekar: None. S. Patel: None. K. Narayan: None. T.V. Joshua: None. L. Marion: None. L.B. Williams: None. M.K. Ali: None.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at