Integrating obesity experts into primary care clinics enhances patient weight loss outcomes

A novel study conducted by the University of Michigan reveals significant benefits in integrating obesity specialists into primary care settings, resulting in substantial weight loss for high-risk patients. This approach, piloted by Michigan Medicine’s academic medical centre through the Weight Navigation Program (WNP), has been proven to facilitate access to evidence-based weight management treatments and support patients in achieving notable weight reduction within a year.

Primary care practitioners often find it challenging to devise personalised weight management plans during brief consultations. Earlier investigations by the University have indicated that a majority of primary care patients with obesity fail to lose at least 5% of their body weight—an outcome that substantially decreases obesity-related health risks.

To address this, the Weight Navigation Program was established in the autumn of 2020, pairing obesity specialists with patients and their primary care providers to collaboratively develop tailored obesity treatment plans. The effectiveness of this initiative was evaluated in a study recently published in JAMA Network Open, carried out by a multidisciplinary team responsible for initiating the WNP.

Results from the first year of the programme indicated an average weight loss of about 12 pounds (approximately 4.4% of body weight) among participants, compared to minimal weight loss in a similar group from another clinic without access to the WNP. Participants typically started with a body mass index (BMI) around 40 kg/m^2, with eligibility for the WNP requiring a BMI over 30 kg/m^2 and at least one weight-related health condition such as high blood pressure, sleep apnea, type 2 diabetes, or high cholesterol.

More than 40% of WNP participants succeeded in losing at least 5% of their body weight, contrasting sharply with less than 20% in the non-WNP group. Additionally, 22% of WNP participants lost at least 10% of their body weight, compared to less than 4% in the comparison group. These outcomes suggest the potential for wider application and testing of the WNP approach in larger clinical trials.

Currently, the WNP is accessible to all eligible adult patients receiving primary care through U-M Health clinics, serving as an entry point to a variety of treatment options. This programme is a part of an extensive array of weight management services offered across various U-M Health departments.

Dr. Dina Hafez Griauzde, the study’s lead author and an assistant professor of internal medicine at U-M Medical School, emphasised the programme’s foundation on safe and effective obesity care integration into primary care settings. This model promotes a collaborative team approach to evaluate patients, explore treatment options including cost considerations, and facilitate access to specialised care and follow-up.

Senior author Dr. Andrew Kraftson, an endocrinologist specialising in obesity medicine, highlighted the need for such programmes due to a shortage of obesity specialists. The WNP builds upon the successes of other chronic disease programmes by fostering a closer partnership between specialists and primary care providers. Notably, two-thirds of the current obesity medicine specialists also serve as primary care physicians.

Patients referred to the WNP consult with obesity specialists knowledgeable about the comprehensive treatment offerings at U-M Health, including community diabetes prevention programmes and understanding of insurance coverage. Following these consultations, specialists provide personalised treatment recommendations tailored to each patient’s medical needs, financial situation, and preferences.

The WNP team closely monitors progress and coordinates ongoing care, offering treatments ranging from specialised dietary plans and anti-obesity medications to weight loss surgery. The initial study tracked 132 people enrolled in the WNP and a matched group of 132 receiving usual care, studying their health outcomes over a year.

This extensive research, backed by funding from the National Institute of Diabetes and Digestive and Kidney Diseases and other grants, supports the feasibility and efficacy of integrating specialised obesity care within primary care frameworks, aiming to enhance overall patient outcomes in weight management.