Impact of a Community-Based Weight Management Program in a North Carolina Health Care System

Abstract

Background and Objectives: Current strategies for obesity management in primary care leave many patients inadequately treated or unable to access treatment entirely. We aimed to evaluate a comprehensive, primary care clinic-based weight management program’s clinical effectiveness in a community practice setting. Methods: This was an 18-month pre/postintervention study. We collected demographic and anthropometric data on patients enrolled in a primary care-based weight management program. The primary outcomes were percent weight loss postintervention and the proportion of patients who achieved a clinically significant total body weight loss (TBWL) of 5% or greater. Results: Our program served 550 patients over 1,952 visits from March 2019 through October 2020. A total of 209 patients had adequate program exposure, defined as four or more completed visits. Among these, all received targeted lifestyle counseling and 78% received antiobesity medication. Patients who attended at least four visits had an average TBWL of 5.7% compared to an average gain of 1.5% total body weight for those with only one visit. Fifty-three percent of patients (n=111) achieved greater than 5% TBWL, and 20% (n=43) achieved greater than 10% TBWL. Conclusion: We demonstrate that a community-based weight management program delivered by obesity medicine-trained primary care providers effectively produces clinically significant weight loss. Future work will include wider implementation of this model to increase patient access to evidence-based obesity treatments in their communities.

A Primary Care–Based Weight Navigation Program

“… 36 While such interventions can support modest weight loss, they generally lack preference sensitivity and may be difficult to sustain due to use of study-specific personnel and other resources not available in most practice settings. Limited prior work has observed the outcomes of weight-focused visits with primary care–based ABOM diplomates 21 , 37 and with nondiplomate PCPs assisted by EHR-based tools to support obesity treatment decision-making. 38 …”

“…The American Board of Obesity Medicine (ABOM) continuing medical education pathway can address PCPs knowledge gaps . Currently, there are approximately 8200 ABOM diplomates, most (65%) are PCPs, and evidence suggests that they use the full range of WMTs, often in the context of weight-focused visits . Yet, the overall number of diplomates remains low relative to the many patients who may desire and benefit from preference-sensitive use of WMTs .…”

“…16 , 17 Currently, there are approximately 8200 ABOM diplomates, most (65%) are PCPs, and evidence suggests that they use the full range of WMTs, 18 often in the context of weight-focused visits. 19 , 20 , 21 Yet, the overall number of diplomates remains low relative to the many patients who may desire and benefit from preference-sensitive use of WMTs. 22 , 23 Moreover, little is known about how to incorporate diplomates into primary care teams to enhance the reach of their expertise.…”

“…For example, a recent systematic review and metaanalysis of randomized clinical trials of weight management interventions in primary care settings reported predominant use of lifestyle counseling interventions 36. While such interventions can support modest weight loss, they generally lack preference sensitivity and may be difficult to sustain due to use of study-specific personnel and other resources not available in most practice settings.Limited prior work has observed the outcomes of weight-focused visits with primary care-based ABOM diplomates21,37 and with nondiplomate PCPs assisted by EHR-based tools to support obesity treatment decision-making 38.…”

Stories Are the Heart of Family Medicine

“…It is not just the topic 6,10,11 and context [12][13][14] of papers that communicate values. At a foundational level, the 7 Cs 15 are reflected in the methods we publish.…”