DENVER -- Even a few years of healthier eating and exercise can show up in better health outcomes two decades later, a new national study with Colorado ties found - but most people need significant support to make those changes.

In the late 1990s, about 3,000 people with prediabetes, including about 120 in Colorado, joined a study to determine the best way to prevent the condition from progressing to Type 2 diabetes, said Dr. Dana Dabalea, associate dean of research at the Colorado School of Public Health.

One group received about three years of intensive lifestyle coaching, another got a drug to lower their blood sugar and the third didn’t receive any specific treatment as part of the study.

The initial results were so successful that the Centers for Disease Control and Prevention put together a one-year condensed version, known as the Diabetes Prevention Program. In Colorado, 75 sites participate, with most located in the Denver area.

Close to a quarter century later, researchers used Medicare records for about 1,200 participants who were still alive and identifiable, including around 90 in Colorado who had stayed in touch with the study.

They didn’t necessarily expect much difference, given that the lifestyle change group had regained weight and cut back on exercise after the original study ended, but found they still came out ahead of the other two groups, Dabalea said.

After adjusting for demographics and other factors, the lifestyle group was about 27% less likely to have two chronic conditions and one-third less likely to have three or more. While the majority of people in all three groups had two or more conditions, the lifestyle group generally had fewer than the others.

The researchers don’t have enough data about people’s habits to be sure whether the lifestyle change group continued to eat more healthfully, or if they are still seeing the benefits of improving their baseline health two decades ago, Dabalea said.

She wasn’t part of the study in its first years, but periodically followed up with the participants as they progressed from middle age to older adulthood. The School of Public Health and other sites plan to continue monitoring the surviving participants to see whether the lifestyle changes influence dementia risk in the coming years, assuming they receive federal funding.

“There’s a legacy effect of that intervention,” she said. “Chronic diseases don’t develop overnight.”

Other studies have found that intensive lifestyle programs can improve the odds that people with multiple risk factors for cardiovascular disease, such as high blood pressure or blood sugar, can eliminate one or more risks. Typically, however, the follow-up time is relatively short, making it difficult to tell whether the changes will influence long-term health.

Weight-loss studies find a “check-mark” pattern of relatively quick loss and gradual regain after the study ends, said Stephanie Fitzpatrick, professor of behavioral health science at Feinstein Institutes for Medical Research at Northwell Health in New York.

Seeing benefits so long after participants regained weight is surprising, and suggests health insurance should pay providers to offer similar programs, she said.

“These findings are huge,” she said.

Being in a program with others struggling with the same thing and extensive support helps people feel that change is possible, so they can stick with it when they hit bumps in the road, Fitzpatrick said. Then, of course, the challenge is to integrate those new habits into daily life so they aren’t hard to maintain, she said.

Behavioral change is in vogue at the federal level, with the U.S. Department of Health and Human Services launching websites with fitness challenges, promising up to $100 million for lifestyle medicine pilot projects, pushing medical schools to spend more time teaching nutrition and threatening to withhold federal funding from hospitals that serve sugary drinks - a step the department likely doesn’t have the authority to take.

Strategies that focus on educating and encouraging people to make healthy choices aren’t wrong, but they may not address all the reasons people struggle to manage their health, such as being unable to buy fresh vegetables or living in a neighborhood where they don’t feel safe walking, said Dr. Georges Benjamin, executive director of the American Public Health Association.

“It’s not one or the other, it’s both,” he said.

The latest study shows how powerful lifestyle change can be, but most people need more than just information and their own motivation, said Don Edmondson, director of the Center for Behavioral Cardiovascular Health at Columbia University Medical Center.

Something about being in a study seems to help people stay on track, perhaps because they’re receiving personalized attention or feel they’re contributing to the greater good, he said.

“Behavior change works best when people have structure, accountability, feedback, support,” he said.

The lifestyle group had 16 initial sessions, with monthly follow-ups for two years and quarterly classes for a decade. The study started before GLP-1 drugs hit the market, so it couldn’t compare a lifestyle program to that type of medication.

People can replicate parts of the program by exercising with friends or changing their diet as a family, but that only works if they choose specific goals and support each other toward success, Edmondson said. For people who have prediabetes, which affects about two in five adults, joining an existing prevention program is probably easier, he said.

While an intensive program worked for reducing chronic conditions in high-risk people, society would get more benefit by making healthy choices the default, Dabalea said. For example, taxing unhealthy foods and subsidizing produce would help everyone improve their diet, hopefully reducing the number of people who need intensive support, she said.

“I don’t think it’s feasible for every individual in Colorado to have a lifestyle coach that you engage with weekly,” she said.

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