Combined lifestyle intervention

When people are overweight, it is probably due to a combination of problems, which must also be tackled in combination. Local authorities and health insurance companies are therefore increasingly collaborating, as well as working with care and welfare service providers. This enables them to achieve more to make local residents healthier and more self-reliant. Combined lifestyle intervention (CLI) is a good example of this.

ZonMw helped establish CLI. Thanks to research, a growing number of CLIs have been officially recognised and entered in the National Institute of Public Health and the Environment’s Centre for Healthy Living database, and their services were added to the basic health insurance package in 2019. The focus of research is now on implementing interventions and fostering the development of a nationwide network.

CLI takes the form of group intervention sessions that can help people achieve a healthy weight, and maintain their new healthy habits. This is important, as a healthy weight is an important factor in good health, and reduces the chance of illness. 

The intervention aims to achieve a lasting, healthy change in behaviour. It involves a combination of a healthier diet and more exercise, and also psychological support to help people deal with factors that impact on lifestyle, such as stress and lack of sleep.

People who are overweight and have weight-related health risks are eligible for CLI. Participants with a referral from their GP can get two years of advice and guidance from lifestyle coaches, dieticians, physiotherapists and/or remedial therapists.

There are now seven officially recognised combined lifestyle interventions which are covered by basic health insurance:

• De BeweegKuur, a CLI involving exercise, diet and behaviour for people who are overweight
• SLIMMER, counselling to improve lifestyle for people who are overweight
• CooL lifestyle coaching
• Samen Sportief in Beweging, diet and exercise programme
• X-Fitt GLI, lifestyle programme with diet, exercise and psychological intervention for behavioural change
• Keer Diabetes2 Om, a programme for people with type 2 diabetes involving diet, exercise, sleep and relaxation
• Keer Diabetes2 Om-GLI-Online, an online programme involving diet, exercise, sleep and relaxation for people with prediabetes and type 2 diabetes without drug treatment or use of metformin only

See the map of providers (available in Dutch) to find out which organisations offer CLI in which municipalities (RIVM website).

It is now time to take CLI one step further. Researchers, local authorities and municipal health services are now working hard to ensure CLI is put into practice in the best possible way.

Municipal health services help local authorities to promote, monitor and evaluate combined lifestyle intervention. They opt for a manner of implementation that caters for local needs.

Ten regional consortiums (available in Dutch) are also working on the further development of a partnership, and are drawing up an implementation plan for CLI.

The ten consortia are:

• Gezond in Drenthe- GLI implementatie
• GLIMT: De Gecombineerde LeefstijlInterventie Maakt Utrechters viTaler
• SLIMMER beterschappen voor nier patiënten met overgewicht
• Vitaliek is COOL
• Doorontwikkeling en opschaling “GLI op maat” in the Haaglanden region
• Gezonde leefstijl in Salland (GLIS)
• Samenwerking leefstijl regio Arnhem
• Opstart GLI Rijncoepel 2021 en verder
• Doorontwikkeling Gecombineerde Leefstijlinterventies in Amsterdam
• Beweegkuur Veenendaal

CLI is also used for overweight patients with an arthritic knee (available in Dutch). Excess weight is a key factor in the development of this condition, and symptoms can be alleviated by weight loss. Researchers are investigating how cost-effective CLI is compare to the regular care available.