Not Enough Primary Care Clinicians Address Obesity with Patients, According to New Research

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In a new study of adults with overweight or obesity, results showed that referral from primary care clinicians to any weight-related service or for prescriptions of antiobesity drugs was uncommon.

Among more than 164 000 participants aged ≥18 years with overweight or obesity seen in at least 1 of the 57 primary care clinics included in the study, 12% had a weight-prioritized visit between March 2020 and March 2021. Therefore, 88% of patients who were eligible for a weight-prioritized visit did not have one, according to the findings published in the Annals of Family Medicine.

“Even for those patients who were seen for their weight, very little was done in terms of medical treatment or referral to someone specializing in weight management. These results unmask an enormous unmet need to develop pragmatic approaches to implementing weight management in primary care,” wrote first author Leigh Perreault, MD, of the University of Colorado Anschutz Medical Campus in Aurora, and colleagues.

Perreault and colleagues conducted the present study to examine the baseline characteristics of patients, clinicians, and clinics for 57 primary care sites in which PATHWEIGH – a weight management tool that they developed to remove clinician barriers in providing patient care that addressed weight – will be deployed in the future.

“To support primary care clinicians in using evidence-based treatments for obesity, our team, comprising physicians (primary care and endocrinology) and behavioral health professionals, developed a set of disease prioritization tools for weight management in primary care called PATHWEIGH,” wrote researchers.

Due to early success with the tool, PATHWEIGH was implemented in 57 primary care clinics in a large regional health system in Colorado.

“To date, no program has been able to show widespread reach, effectiveness, adoption, implementation, and maintenance. PATHWEIGH aims to be the first pragmatic, scalable, and sustainable approach to weight management, with aspirations to disseminate nationally and internationally,” wrote investigators. “To address our ultimate aim, it was essential to first capture information about the state of usual care, to which the intervention will eventually be compared.”

All 57 primary care clinics were enrolled and randomized to 3 sequences. Patients included in the analysis were aged ≥18 years, had a body mass index (BMI) ≥25 kg/m², and had a weight-prioritized visit between March 17, 2020, and March 16, 2021.

FINDINGS

During the study period, a total of 164 904 participants had a visit at 1 of the 57 primary care clinics. Of these, 20 383 (12%) had a weight-prioritized visit.

Overall, patients who had a weight-prioritized visit had a mean age of 52 years and a mean BMI of 37 kg/m²; 58% were women, 76% were non-Hispanic White, and 64% were commercially insured.

Researchers found that documented referral for any weight-related service (eg, dietician, bariatrics, endocrinology) was low (<6%), and 334 unique prescriptions of an antiobesity medication were noted across all 3 sequences.

“Our findings are consistent with other reports that comprehensive weight management is uncommon in primary care,” wrote Perreault et al.

One of the limitations to the study was the fact that investigators could not establish baseline standard-of-care (SOC) because SOC for weight management does not “truly exist,” so PATHWEIGH will be compared with usual care instead of SOC in practice. Also, patients who met the age and BMI criteria who did not have a weight-prioritized visit were excluded, “which might create selection bias in the data,” stated authors.

Reference: Perreault L, Suresh K, Rodriguez C, et al. Baseline characteristics of PATHWEIGH: A stepped-wedge cluster randomized study for weight management in primary care. Ann Fam Med. 2023;21:249-255.