Giving high-risk patients access to an obesity specialist through their regular primary care clinic increased their chances of receiving at least one evidence-based weight-management treatment and led to more weight lost in just a year, a University of Michigan study has reported.
Primary care clinicians commonly struggle to help patients develop an individualised weight-management treatment plan during short clinic visits. Previous University of Michigan research showed that most primary care patients with obesity do not lose at least 5% of their body weight, a goal that's been shown to reduce obesity-related health risks.
The University of Michigan’s Michigan Medicine, developed the Weight Navigation Program (WNP), which teams up patients with obesity and their primary care provider with a board-certified obesity specialist.
The new study shows that on average, patients who enrolled during the first year of the WNP lost about 12 pounds or about 4.4% of their body weight, in the year after they received an individualised obesity treatment plan from an obesity specialist.
That's compared with very little weight lost by patients similar to the WNP patients who went to a similar University of Michigan primary care clinic that didn't yet offer the programme.
On average, all the patients started with a body mass index (BMI) around 40 kg/m2. To qualify for WNP, patients have to have a BMI above 30 kg/m2 and have at least one weight-related health condition, such as high blood pressure, sleep apnoea, type 2 diabetes, or high cholesterol.
Over 40% of those in the WNP lost at least 5% of their body weight, a goal that's been shown to reduce obesity-related health risks. In comparison, less than 20% of similar patients not in the WNP lost at least 5% of their body weight. In addition, 22% of patients in the WNP lost at least 10% of their body weight compared to less than 4% of similar patients. The authors say the study suggests that the WNP approach should be tested in a larger clinical trial.
Meanwhile, the WNP is now available to all eligible adult patients who receive primary care through University of Michigan’s Health clinics, acting as a gateway to multiple treatment options. It's part of a wide range of weight management programmes available by referral in multiple areas of University of Michigan Health.
"The WNP is based in the idea that safe and effective obesity care can be integrated into the primary care settings where most Americans with obesity receive the vast majority of their care," said Dr Dina Hafez Griauzde, first author of the study and an internal medicine assistant professor at the University of Michigan’s Medical School. "Having an obesity specialist work as part of a collaborative team to evaluate patients, help them understand their options, including potential costs, and act as a gateway to specialised care and primary care follow-up, is a model that we hope others will adopt."
The WNP builds on the previous success of other kinds of chronic disease programmes that involve closer partnership between specialists and primary care providers. One key difference: Two-thirds of current obesity medicine specialists are also primary care physicians, including Griauzde and several of her co-authors.
WNP
Patients referred to the WNP meet with an obesity specialist who has in-depth familiarity with all the obesity treatment options offered at University of Michigan’s Health as well as community diabetes prevention programmes. The obesity specialists also understand insurance coverage and costs such as copays for the different options.
After meeting with the patient, the obesity specialist provides customised treatment recommendations that address the patient's medical situation, finances and preferences.
Treatments can range from specialised dietary plans to anti-obesity medications to bariatric surgery. The team monitors progress and coordinates ongoing care with the primary care provider.
The new study tracked the care of 132 people who went through the WNP at a single primary care clinic during the program's first year, and 132 people with similar health and demographic characteristics who received usual care at a similar University of Michigan’s Health primary care clinic in that timeframe. Both groups' records were studied for a full year, and nearly all had weight measurements available at the end of the year.
Two-thirds of both groups were female; the average age was 49 and nearly two-thirds had high blood pressure while about 60% had obstructive sleep apnoea and just over 20% had type 2 diabetes.
Of all patients at the clinic offering the WNP who qualified for it, 19% of were referred to it by their primary care provider, and 11% enrolled. This is much higher than the very low percentage of University of Michigan’s Health primary care patients who received a weight management treatment from their primary care provider or were referred for specialty obesity care in a previous study published by the team based on data from before the WNP launched.
When comparing the WNP patients with the usual care group, WNP patients were more likely to be directed toward health system obesity care resources, with more than twice as many patients in the WNP referred for bariatric surgery evaluations (18% vs. 9%). In all, 4% of the WNP patients had bariatric surgery within a year of starting the programme, compared with none of the comparison group.
WNP patients were also much more likely to receive a referral to a program that treats patients through a low-calorie meal replacement plan, or to a program that counsels patients on following a Mediterranean-style diet, which has been shown to have benefits for weight and health.
The percentages receiving a prescription for any obesity medication were similar, at 14% of the WNP patients and 10% of control group patients.
However, the study period was before the FDA’s approval of semaglutide and tirzepatide for weight management and may not reflect current prescribing practices. Therefore, the researchers are doing a follow-up assessment of weight-management treatment use and patients' weight loss since the availability of these medications.
The findings were reported in the paper, ‘A Primary Care–Based Weight Navigation Program’, published in JAMA Network Open. To access this paper, please click here
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