Association between shared medical appointments and weight loss outcomes and anti‐obesity medication use in patients with obesity

Abstract

Objective: In shared medical appointments (SMAs), multiple patients with a similar clinical diagnosis are seen by a multidisciplinary team for interactive group sessions.Very few studies have specifically studied SMAs and weight loss in patients with obesity. This study compared weight loss outcomes and anti-obesity medication (AOM) access between patients with obesity managed through (SMAs) versus individual appointments.Methods: Retrospective study of adults seen for obesity between September 2014and February 2017 at Cleveland Clinic Institute of Endocrinology and Metabolism.Percent weight loss from baseline was compared between two propensity scorematched populations: patients who attended ≥1 SMA and patients managed with individual medical appointments.Results: From all eligible patients identified (n=310 SMA, n=1,993 non-SMA), 301 matched pairs were evaluated for weight loss. The SMA group (n=301) lost a mean of 4.2%, 5.2% and 3.8% of baseline weight over 6, 12 and 24 months; the non-SMA group (n=301) lost significantly less weight (1.5%, 1.8% and 1.6%, respectively) (paired t-test, P<.05). All patients were eligible for US Food and Drug Administrationapproved AOMs based on obesity diagnosis; however, 49.8% (150/301) of matched SMA patients were prescribed an AOM versus 12.3% (37/301) of matched non-SMA patients. Conclusion:This study suggests that SMAs may offer a promising alterative for obesity management and one that may facilitate greater utilization of AOMs. In propensity score-matched cohorts, SMAs were associated with greater weight loss outcomes when compared to usual care facilitated through individual medical appointments alone.

Program for Reducing Obesity (PRO): An institutional review of an insurance‐based weight loss program utilizing shared medical appointments

“…Our findings are consistent with prior studies implementing SMAs for weight management 18–20,24 . A longitudinal retrospective cohort study comparing patients who attended SMAs (n = 310) to patients provided usual care (n = 1993) showed statistically significant weight loss of 5.2% in the SMA group versus 1.8% in the non‐SMA group after one year 18 .…”

“…Utilization of SMA in obesity management has not been extensively studied. Previous studies show that patients attending SMAs were more likely to be prescribed anti‐obesity medications 18 and to achieve sustained significant weight loss after 9 months, 19 12 months, 20 and 24 months 18 . SMAs were estimated to be four times more cost effective and seven times more time efficient than individual weight loss consultations 20 .…”

Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study

“… 38 Recently, Shibuya et al reported mean weight loss of 4.2% at 6 months for those participating in an obesity-specific SMA compared with 1.5% in an individual setting. 11 Whether such weight loss is sustained is an important question for future studies.…”

Associations of weight loss with obesity‐related comorbidities in a large integrated health system

“…Models utilizing a patient's longitudinal weight trajectory, in conjunction with other clinical data in the EHR, could help minimize the risk of disease onset by helping clinicians determine which patients are at highest risk of weight‐related comorbidities and are most likely to benefit from lifestyle, pharmacological or surgical interventions. Our data suggest that significant decreases in obesity comorbidities, including T2D, eating disorders, NAFLD/NASH, OSA, HTN, male reproductive effects and heart failure, are possible, regardless of pre‐existing disease, with even a 5% reduction in weight—a reasonable goal with available lifestyle weight loss programmes 45 and pharmacotherapy. Furthermore, these findings may help to inform guidelines for community‐ and enterprise‐initiated weight management programmes designed to promote healthy lifestyle modification for people with obesity.…”