Developing weight navigation program to support personalized and effective obesity management in primary care settings: protocol for a quality improvement program with an embedded single-arm pilot study

Griauzde, Dina H.; Othman, Amal; Dallas, Chris; Oshman, Lauren; Gabison, Jonathan; Markel, Dorene S.; Richardson, Caroline R.; Kullgren, Jeffrey T.; Piatt, Gretchen; Heisler, Michele; Kilbourne, Amy M.; Kraftson, Andrew

doi:10.1017/s1463423621000906

Cited by 4 publications

(8 citation statements)

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“…To overcome barriers and capitalize on opportunities indicated by PCPs in this study, we are developing and testing a Weight Navigation Program (WNP) [ 55 ]. The WNP aims to integrate an ABOM Diplomate into primary care teams to serve as an obesity medicine consultant and enhance the delivery of personalized, effective obesity treatment through use of health system, community, and pharmacotherapeutic weight management resources.…”

Section: Discussionmentioning

confidence: 99%

Primary care providers’ perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study

et al. 2023

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Background Primary care patients with obesity seldom receive effective weight management treatment in primary care settings. This study aims to understand PCPs’ perspectives on obesity treatment barriers and opportunities to overcome them. Study design This is an explanatory sequential mixed methods study in which survey data was collected and used to inform subsequent qualitative interviews. Settings and participants PCPs who provide care to adult patients in an academic medical center in the Midwestern US. Methodology PCPs (n = 350) were invited by email to participate in an online survey. PCPs were subsequently invited to participate in semi-structured interviews to further explore survey domains. Analytic approach Survey data were analyzed using descriptive statistics. Interviews were analyzed using directed content analysis. Results Among 107 survey respondents, less than 10% (n = 8) used evidence-based guidelines to inform obesity treatment decisions. PCPs’ identified opportunities to improve obesity treatment including (1) education on local obesity treatment resources (n = 78, 73%), evidence-based dietary counseling strategies (n = 67, 63%), and effective self-help resources (n = 75, 70%) and (2) enhanced team-based care with support from clinic staff (n = 53, 46%), peers trained in obesity medicine (n = 47, 44%), and dietitians (n = 58, 54%). PCPs also desired increased reimbursement for obesity treatment. While 40% (n = 39) of survey respondents expressed interest in obesity medicine training and certification through the American Board of Obesity Medicine, qualitative interviewees felt that pursuing training would require dedicated time (i.e., reduced clinical effort) and financial support. Conclusions Opportunities to improve obesity treatment in primary care settings include educational initiatives, use of team-based care models, and policy changes to incentivize obesity treatment. Primary care clinics or health systems should be encouraged to identify PCPs with specific interests in obesity medicine and support their training and certification through ABOM by reimbursing training costs and reducing clinical effort to allow for study and board examination.

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Section: Discussionmentioning

confidence: 99%

Primary care providers’ perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study

et al. 2023

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“…The WNP was previously described . Briefly, PCPs at the intervention clinic were informed of WNP eligibility criteria through email and brief presentations.…”

Section: Methodsmentioning

confidence: 99%

“…A subset of WNP patients (n = 52) was invited to participate in a single-arm pilot study including weight reporting by text message; 27 patients enrolled. This protocol was previously described 24 and will be fully evaluated separately. Visits were billed using the 99215 Evaluation and Management code for a 60-minute visit.…”

Section: Interventionmentioning

confidence: 99%

“…To address this gap, our team developed and tested a primary care–based weight navigation program (WNP) . The WNP draws on principles from the Collaborative Chronic Care Model and aims to integrate ABOM diplomates into primary care teams.…”

Section: Introductionmentioning

confidence: 99%

“…To address this gap, our team developed and tested a primary care–based weight navigation program (WNP). 24 The WNP draws on principles from the Collaborative Chronic Care Model 25 , 26 , 27 and aims to integrate ABOM diplomates into primary care teams. Diplomates offer weight-focused consultation visits and support patients’ selection of preference-sensitive WMTs.…”

Section: Introductionmentioning

confidence: 99%

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A Primary Care–Based Weight Navigation Program

Griauzde,

Turner,

Othman

et al. 2024

JAMA Netw Open

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ImportanceEvidence-based weight management treatments (WMTs) are underused; strategies are needed to increase WMT use and patients' weight loss.ObjectiveTo evaluate the association of a primary care–based weight navigation program (WNP) with WMT use and weight loss.Design, Setting, and ParticipantsThis cohort study comprised a retrospective evaluation of a quality improvement program conducted from October 1, 2020, to September 30, 2021. Data analysis was performed from August 2, 2022, to March 7, 2024. Adults with obesity and 1 or more weight-related condition from intervention and control sites in a large academic health system in the Midwestern US were propensity matched on sociodemographic and clinical factors.ExposureWNP, in which American Board of Obesity Medicine–certified primary care physicians offered weight-focused visits and guided patients’ selection of preference-sensitive WMTs.Main Outcomes and MeasuresPrimary outcomes were feasibility measures, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss, percentage of patients achieving 5% or more and 10% or more weight loss, referral to WMTs, and number of antiobesity medication prescriptions at 12 months.ResultsOf 264 patients, 181 (68.6%) were female and mean (SD) age was 49.5 (13.0) years; there were no significant differences in demographic characteristics between WNP patients (n = 132) and matched controls (n = 132). Of 1159 WNP-eligible patients, 219 (18.9%) were referred to the WNP and 132 (11.4%) completed a visit. In a difference-in-differences analysis, WNP patients lost 4.9 kg more than matched controls (95% CI, 2.11-7.76; P &lt; .001), had 4.4% greater weight loss (95% CI, 2.2%-6.4%; P &lt; .001), and were more likely to achieve 5% or more weight loss (odds ratio [OR], 2.90; 95% CI, 1.54-5.58); average marginal effects, 21.2%; 95% CI, 8.8%-33.6%) and 10% or more weight loss (OR, 7.19; 95% CI, 2.55-25.9; average marginal effects, 17.4%; 95% CI, 8.7%-26.2%). Patients in the WNP group were referred at higher rates to WMTs, including bariatric surgery (18.9% vs 9.1%; P = .02), a low-calorie meal replacement program (16.7% vs 3.8%; P &lt; .001), and a Mediterranean-style diet and activity program (10.6% vs 1.5%; P = .002). There were no between-group differences in antiobesity medication prescribing.Conclusions and RelevanceThe findings of this cohort study suggest that WNP is feasible and associated with greater WMT use and weight loss than matched controls. The WNP warrants evaluation in a large-scale trial.

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