Weight Management Treatments Underused among Primary Care Patients with Obesity Despite Their Effectiveness

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Weight management treatments (WMTs) greatly improved the odds of ≥5% weight loss within 1 year, yet only a small number of primary care patients with obesity use them, according to new research published in JAMA Network Open.

According to researchers, several WMTs can support ≥5% weight loss, such as bariatric surgery, antiobesity medications (AOM), nutrition counseling, and very low-calorie meal replacement.

“However, less than 5% of eligible individuals receive these WMT, and little is known about their clinical potential to support weight loss among individual patients and populations,” wrote first author James Henderson, PhD, assistant research scientist, University of Michigan, and colleagues.

Henderson and coauthors conducted the current retrospective, population-based cohort study to characterize weight status and WMT use among primary care patients and analyze associations between WMT and weight trajectories. Main outcomes included mean body mass index, point prevalence of obesity, and prospective use of WMT.

“The trajectory analysis examined longitudinal weight status using thresholds of ±5% and 10% of baseline weight with primary outcomes being the 1-year probabilities of 5% or greater weight loss for each WMT,” noted Henderson and colleagues.

Investigators examined the electronic health records of 146 959 adults (mean age, 49 years; 56.9% women) who had weight measurements taken in 2017 or 2019. The cohort was eventually narrowed down to 138 682 participants, and among those, obesity prevalence increased from 39.2% in 2017 to 40.7% in 2019, whereas WMT use among patients with obesity increased from 5.3% to 7.1%.

In a multistate model that examined weight trajectories of 10 180 patients with obesity, researchers found that the 1-year probability of ≥5% weight loss without WMT exposure was 15.6% (95% CI, 14.3%-16.5%). In comparison, the 1-year probability of ≥5% weight loss was:

• 23.1% (95% CI, 21.3%-25.1%) with nutrition counseling;
• 27.8% (95% CI, 25%-30.5%) with antiobesity medications;
• 54.6% (95% CI, 46.5%-61.3%) with meal replacement; and
• 93% (95% CI, 89.7%-95%) with bariatric surgery.

“These estimates reflect idealized circumstances, as most patients in real-world settings do not remain continuously engaged in WMT for 1 year,” wrote researchers. “Efforts to help patients with obesity achieve and maintain 5% or greater weight loss should focus on increasing initial uptake and sustaining engagement in WMT.”

Investigators concluded that health systems and insurers “should consider novel strategies to enhance preference-sensitive use of WMT to optimize achievement of 5% or greater weight loss among individuals and populations with obesity.”

Source: Henderson J, Ehlers AP, Lee JM, et al. Weight loss treatment and longitudinal weight change among primary care patients with obesity. JAMA Netw Open. Published online February 5, 2024. doi:10.1001/jamanetworkopen.2023.56183