Real Appeal is a digital weight loss program designed to help individuals achieve lasting lifestyle changes through small, practical steps. It combines online coaching, on-demand fitness resources, and a science-backed approach. The program aims to make healthy living accessible and sustainable without requiring drastic life overhauls.
Core Components of Real Appeal
Real Appeal offers several key components to support participants in their weight loss journey:
Online Coaching: Participants work with a dedicated health coach to maintain accountability and set achievable wellness goals. Weekly meetings provide guidance, and coaches offer additional support as needed.
Fitness on Demand: The program eliminates the need for expensive gym memberships or specialized equipment, providing access to on-demand fitness resources that can be used with any online device.
Success Kit: Each member receives a Success Kit, which includes a body weight scale, an electronic food scale, and a balanced portion plate to support portion control and mindful eating. The kit also grants access to Fitness on Demand through the program dashboard and is delivered after attending the first live session with a coach, typically within 7-10 business days.
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Program Structure and Curriculum
Real Appeal is structured as a 52-week program accessible online from any location. Its curriculum is based on the Centers for Disease Control and Prevention (CDC) Diabetes Prevention Program (DPP) curriculum. The curriculum emphasizes the importance of physical activity, healthy eating, stress management, and motivation. It is divided into two phases:
Core Phase: The first 16 weeks focus on establishing healthy habits.
Maintenance Phase: Weeks 17 through 52 focus on maintaining progress and reinforcing positive behaviors.
Throughout both phases, participants attend weekly, 30-minute online group classes led by a health coach. These classes, averaging 30 participants, cover topics such as overcoming barriers to physical activity, meal planning, mindful food shopping, managing emotional eating, and improving sleep habits. The program also incorporates an entertaining video series that reinforces healthy lifestyle concepts.
Participants are also instructed to set daily calorie goals and use the Real Appeal application to track food intake, water consumption, exercise, weight, blood pressure, moods, and emotions. The exercise tracker can be synchronized with Fitbit or Jawbone activity trackers.
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Enrollment and Accessibility
Real Appeal is marketed to human resource departments as an employee health benefit covered through health insurance. Employees can register for the program online and schedule an online welcome session with a health coach. During this session, they provide their height, weight, and medical history, receive an overview of the program, and select a convenient time for their weekly group sessions. The program is designed to remove common barriers to participating in work-site health promotion programs by providing access, convenience, and cost coverage.
Reported Outcomes and Benefits
Several studies have examined the effectiveness and financial impact of the Real Appeal program:
Weight Loss: A study of participants who enrolled between July 2015 and June 2016 showed that those who attended at least one session lost an average of 2.8% of their body weight, with 23% achieving 5% or more weight loss. Participants who attended nine or more sessions lost an average of 4.3% of their body weight, with 36% achieving 5% or more weight loss.
Medical Cost Savings: A study published in the April 2021 issue of the peer-reviewed journal Obesity found that medical cost savings for employers and payers participating in Real Appeal were at least two times more than any program fees. Specifically, participants' medical costs were 12% less than a control group ($771 per person), representing 2.3 times the medical cost savings when compared to program costs.
Engagement and Retention: The program has demonstrated high engagement, retention, and participation rates. In the first year of the program, 16% of the eligible population enrolled, with over 70% attending at least four sessions and over 50% attending at least nine sessions.
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Real Appeal aims to address the obesity epidemic by providing a scalable and accessible weight loss solution. The program's focus on lifestyle intervention, combined with online coaching and on-demand fitness resources, offers a comprehensive approach to weight management.
Testimonials
The Real Appeal program has garnered positive feedback from participants who have experienced significant health improvements:
Crystal: As a pre-diabetic individual, Crystal found it difficult to even get out of bed. Through Real Appeal, she was motivated to finish multiple half marathons and lost 200 pounds.
Demond: Unhealthy eating habits and a lack of exercise made Demond's work life challenging. Real Appeal helped him develop healthy habits, resulting in a 52-pound weight loss.
Brian and Julie: High blood pressure and uncontrolled portions led Brian and Julie to seek change through Real Appeal, enabling them to succeed together.
Research and Scientific Basis
Real Appeal's approach is rooted in decades of clinical research, emphasizing that consistent, small steps can lead to sustainable weight loss. The program incorporates intensive lifestyle intervention methodology, based on the Centers for Disease Control and Prevention’s diabetes prevention program curriculum, to promote healthy lifestyle habits, including physical activity and healthy eating.
A study examining real-world program data over a three-year period analyzed medical cost trends for participants in the Real Appeal program. The findings indicated that medical cost savings to employers and payers were more than double the program fees when compared to a control group with similar characteristics. Cecelia Horstman, the lead researcher and former director of health outcomes at Rally Health, noted that while the health benefits of digital weight loss programs have been demonstrated in other studies, few have assessed the financial impact on employers and payers.
In this study, Real Appeal participants’ medical costs were compared to a control group matched by age, gender, geographic region, health risk, baseline medical costs, and chronic conditions. Participants who attended at least one session over a 52-week period experienced an average weight loss of 3%. Medical expenditures for this group were 12% less than the control group, translating to $771 per person and representing 2.3 times the medical cost savings compared to program costs. For participants who attended more than nine sessions over a year, the average weight loss was 4.4%.
The study’s co-authors included obesity medicine specialists Louis J. Aronne, Caroline Apovian, Donna H. Ryan, John Foreyt, Hannah Tuttle, and Donald Williamson.
Rally Health's Role
Rally Health is a consumer-centric digital health company that collaborates with health plans, health care providers, and employers to engage consumers in managing their health. The company’s flagship offering, Rally®, is a digital health platform providing web and mobile solutions to help people manage their employee benefits, health and well-being, and health care needs. Nearly 60 million consumers have access to the Rally platform through more than 200,000 employers and health plans, including UnitedHealthcare and BlueCross BlueShield of South Carolina. Rally Health has been working since 2010 to transform the consumer health experience. Rally Health is part of the Optum business of UnitedHealth Group.
Addressing the Obesity Epidemic
Given the significant disease burden and economic costs associated with obesity in the United States, scalable approaches to weight loss and weight management are essential. Real Appeal seeks to address this need by providing an online intensive lifestyle intervention weight-loss program.
Data collected from participants who enrolled in the program from July 2015 through June 2016 revealed that among 437,215 eligible adult beneficiaries, 69,598 adults enrolled, with 87% meeting at-risk criteria for prediabetes, diabetes, or cardiovascular disease. The intent-to-treat cohort (n = 52,461), who attended at least one session, experienced an average of 2.8% body weight loss, with 23% achieving 5% or more weight loss. Active participants (n = 38,836) lost an average of 3.5% body weight, with 29% achieving 5% weight loss.
These results highlight the need for effective and scalable weight loss and weight-loss maintenance interventions that can be implemented across a wide geographic area.
The Importance of Behavioral Interventions
Intensive multicomponent behavioral interventions have been shown to produce average weight losses of 4 to 7 kg and lead to improvements in glucose tolerance and other cardiovascular risk factors. Guidelines recommend comprehensive lifestyle interventions, including diet, physical activity, and behavior therapy, with at least 14 sessions over 6 months and follow-up for 1 year. The US Preventive Services Task Force recommends that clinicians screen for obesity and offer or refer patients with a BMI > 30 for intensive behavioral therapy.
However, a major barrier to implementing intensive behavioral counseling is the lack of trained individuals to effectively treat the large number of individuals who need these services. Real Appeal addresses this unmet need by providing online delivery of intensive lifestyle intervention targeting employees, removing common barriers associated with participating in work-site health promotion programs, including access, convenience, and cost.
Program Design and Marketing
The Real Appeal program was designed to utilize evidence-based principles of intensive behavioral therapy and deliver the intervention in ways that would appeal to a large audience and promote engagement. Several approaches were used to maximize participation. Unlike traditional diabetes prevention programs (DPPs) that limit enrollment to people with prediabetes, Real Appeal includes participants with prediabetes and others who would receive demonstrable medical benefits and those primarily focused on weight loss. By creating a broad base of participation, it was hoped that colleagues could enroll in the program together, regardless of comorbid disease conditions, maximizing the potential for coworker support.
To increase access and convenience, the program was made accessible online via any mobile device at any time from any location. Employers cover the cost of the program, removing the cost barrier associated with enrolling in commercial weight-loss programs.
Detailed Analysis of Initial Program Data (2015-2016)
Between July 2015 and June 2016, Real Appeal was launched to 96 companies, providing health coverage to 633,645 adults. Approximately 70% of the adult population is overweight, meaning an estimated 437,215 of these adults would be considered candidates for the program. Of those, 100,876 (23% of those eligible) registered for the program, and of those who registered, 69,598 (69% of those registered) enrolled and attended a one‐on‐one welcome session. Thus, in the first year the program was offered, 16% of the eligible population enrolled and attended at least one introductory session. Enrollment rates varied by employer; employers implementing marketing best practices achieved higher enrollment rates compared with employers who marketed via other methods.
Of those who enrolled, 60,652 (87%) were considered at risk for prediabetes, diabetes, or cardiovascular disease (based on age, BMI, and medical history), and 52,461 (86%) of the at‐risk individuals attended at least one session. Participants not at risk for prediabetes, diabetes, or cardiovascular disease were offered access to the online materials but did not receive coaching support.
Key demographic data from the initial cohort reveals that 77% of the at-risk participants were female, with an average age of 45.2 years and a mean BMI of 35.5. Among the enrolled at-risk participants, 87% attended at least one session, 73% attended at least four sessions (active participants), and 52% attended nine or more sessions (program completers). The average number of sessions attended by participants was 13.
The intent-to-treat cohort (n = 52,461), all of whom attended at least one session, lost an average of 2.8% body weight, with 23% achieving 5% weight loss. Program completers, participants who attended at least nine sessions, had the best outcomes when compared with active participants and the intent-to-treat cohorts. Program completers (n = 27,164) lost an average of 4.3% body weight, with 36% of the cohort achieving 5% weight loss. Active participants (n = 38,836), those who attended four or more sessions, lost an average of 3.5% body weight, with 29% achieving 5% weight loss.
While higher weight loss produces greater health benefit, even a small amount of weight loss can benefit individuals at risk for obesity-related conditions. Fourteen percent (n = 7,536) of the participants lost between 3% and 4.9% of their body weight.
A key metric for measuring weight-loss success is reporting on the number of people who lost 5% or more of their starting weight. During the first year of program implementation, 11,989 participants achieved this benchmark. As expected, attendance was the best predictor of achieving 5% weight loss. Participants who attended nine or more sessions were 3.8 times more likely to achieve 5% weight loss, and active participants (attending four or more sessions) were 2.5 times more likely to achieve 5% weight loss compared with participants who attended fewer sessions.
Geographic region, starting BMI, and age also significantly impacted achieving the 5% weight-loss goal. Participants from the South were 12% less likely to achieve the 5% weight loss goal. Participants with obesity were 14% more likely to achieve the 5% weight-loss target.
Discussion and Broader Implications
The data from the first year of Real Appeal’s implementation demonstrates that a digital weight-loss program provided by trained health coaches can be successfully delivered across a wide geographic region with high engagement, retention, and participation rates.
The virtual format allowed participants to attend online coaching sessions, access educational resources, and track progress at their convenience.
When assessing the effectiveness of a DPP program, the CDC examines the average number of sessions attended by program participants, with an average of nine sessions required to achieve full CDC DPRP recognition. Real Appeal exceeded the CDC session requirement in all three cohorts. Depending on the type of cohort analyzed, 23% to 36% of the participants lost 5% or more of their body weight, which is similar to the range of 18% to 34% reported by O’Neil et al. The participants in Real Appeal also had similar results reported in a digital DPRP program.
The ability of Real Appeal to engage with 52,461 weight-loss participants during a 12-month period was notable. These participants had outcomes similar to those reported by other commercial weight-loss programs and digital DPP programs.