Weight Management Prioritization in Primary Care: Trial Results

Results

between March ⁢2020 and March 2024, 147,455​ eligible patients were​ identified.⁤ Of these,103,240 had never received weight-related ‍care and had care in both the usual care and‍ intervention phases,while 44,215⁤ had received prior‍ weight-related care and also had care ⁣in both⁢ phases. the intervention phase demonstrated a statistically meaningful increase in weight loss compared to⁤ usual care.

Weight Change

Patients experienced greater ⁢weight ‌loss during the intervention phase ⁤(mean change of −1.79 kg) compared to usual care (mean change ‌of −0.42 kg) over 6-18 months (P < 0.001).The intervention ⁣group also showed a greater reduction in weight over 6-18 months compared to what would be expected without weight-related care⁢ (P < 0.001). The adjusted ‌difference of 2.37 kg over 18 months⁢ (95% CI: 2.33 kg,⁢ 2.40 kg; P < 0.001) represents the difference in weight for those who did versus⁣ did not receive‌ weight-related care during the intervention phase⁤ (Fig. 2b).

Delivery of Weight-Related​ Care

Trackable weight-related care included referrals, bariatric procedures, and patient acknowledgement of anti-obesity medication use. Clinician counseling on lifestyle modification was presumed when a weight-related International Classification of Disease-10 code ‌was used for billing without ordering the‌ aforementioned treatments.‍ Chi-square tests (Table 2)⁤ revealed⁣ that referrals to the Health and Wellness Center were less frequent in the ‍intervention phase compared⁤ to usual care[[[[h²(1) = 8.38,‌ P = 0.004,‌ 95% CI (5.9%, 4.9%)],as were bariatric surgeries[[[[h²(1) = 7.22, P = .007, 95% CI (0.6%, 0.08%)].Conversely, reported use‍ of ⁢anti-obesity⁢ medications ⁤was higher in⁢ the intervention‌ phase[[[[h²(1) = 107.77,⁢ P < 0.001, 95% CI (6.5%, 4.4%)]. No other significant​ differences were observed in the proportions of patients receiving other referrals.

Engagement of the⁣ Clinics⁤ with the Implementation Strategies

Clinic engagement was estimated using a score from 0 to 8, based on ⁣participation in up to 8 implementation activities: (1) ‍virtual introductory meeting (55/56 clinics),⁢ (2) in-person all-clinic training (49/56), ​(3) individual consultation (29/56), (4) obesity e-learning module (35/56), (5) World Obesity Federation SCOPE training ‌(17/56), ‌(6) posted signage (18/56), (7) attending a learning community‍ meeting (14/56), and/or (8) identifying a champion for PATHWEIGH‌ (18/56). 36 clinics (64%) showed moderate engagement (score 3-5), 12 clinics (21%) showed ⁤greater ​engagement (score 6-8),​ and 8 clinics (14%) showed lesser engagement ⁣(score 0-2; Fig. 3).

Percentage of the ⁣56 clinics that participated ‌in each implementation activity. WOF ‍training,world Obesity Federation SCOPE training.

Safety

No health metric (Table 1) changed ≥1% in an ​unfavorable direction‌ during the intervention. Death rates were low, at 0.6%⁤ during usual care and 1.7% during the intervention (each over 3 years). The higher death rate during the intervention likely reflects the enrichment of patients‌ seen in both phases who were older ⁣in the intervention versus usual care (>50% of the population; Table​ 1). Given the trial’s timing (data capture began⁢ in March 2020, with the first intervention group starting in march 2021), COVID-related deaths became less common as more patients were exposed to‍ the intervention.