Specialized weight navigation program shows greater use of evidence-based treatments and greater weight loss than usual care

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 loss in just one year, according to a new study from the University of Michigan. .

Primary care physicians often struggle to help patients develop an individualized weight management treatment plan during short clinic visits. Previous UM research found that most primary care patients with obesity do not lose at least 5% of their body weight, a goal shown to reduce obesity-related health risks.

That’s why UM’s academic medical center, Michigan Medicine, developed the Weight Navigation Program, which pairs obese patients and their primary care provider with a board-certified obesity specialist.

The new study evaluating its results is published in JAMA network opened by the multidisciplinary team that launched the WNP in the autumn of 2020.

The new study shows that patients who enrolled during the first year of the program lost an average of about 12 pounds, or about 4.4% of their body weight, in the year after receiving an individualized obesity treatment plan from an obesity specialist.

That compares with very little weight loss in patients comparable to the WNP patients who went to a comparable UM primary care clinic that did not yet offer the program.

On average, all patients started with a body mass index (BMI) around 40 kg/m2². To qualify for WNP, patients must have a BMI of more than 30 kg/m2² and have at least one weight-related health condition, such as high blood pressure, sleep apnea, type 2 diabetes, or high cholesterol.

More than 40% of those in the WNP lost at least 5% of their body weight, a goal shown to reduce obesity-related health risks. In comparison, less than 20% of comparable patients who were not in the WNP lost at least 5% of their body weight. Furthermore, 22% of patients in the WNP lost at least 10% of their body weight, compared to less than 4% of comparable patients.

The authors say the study suggests the WNP approach should be tested in a larger clinical trial.

Meanwhile, the WNP is now available to all eligible adult patients receiving primary care through UM Health clinics, serving as a gateway to multiple treatment options. It is part of a wide range of weight management programs available by referral in multiple areas of UM Health.

“The WNP is based on 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 Dina Hafez Griauzde, M.D., M.Sc., first author of the study and an assistant professor of internal medicine at the UM Medical School. “Having an obesity specialist who is part of a collaborative team to evaluate patients, help them understand their options, including potential costs, and act as a gateway to specialty care and primary care is a model we hope others will follow.” will take over.”

Senior author, Andrew Kraftson, MD is an endocrinologist specializing in obesity medicine. But a shortage of such specialists means programs like WNP are needed to expand their reach.

The WNP builds on the previous success of other types of chronic disease programs that involve closer collaboration between specialists and primary care providers. One important difference: two-thirds of current specialists in obesity medicine are also general practitioners, including Griauzde and several of her co-authors.

More about the WNP

Patients referred to WNP meet with an obesity specialist who is intimately familiar with all obesity treatment options offered at UM Health, as well as community-based diabetes prevention programs. 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 tailored treatment recommendations, taking into account the patient’s medical situation, finances and preferences.

Treatments can range from specialized nutrition plans to anti-obesity medications to weight loss surgery. The team monitors progress and coordinates ongoing care with the primary care provider.

More about the study

The new paper follows the care of 132 people who completed the WNP at a single primary care clinic during the first year of the program, and 132 people with similar health and demographic characteristics who received usual care at a comparable UM primary care clinic during that time frame Health. . The data from both groups were studied for an entire year and at the end of the year weight measurements were available for almost all groups.

Two-thirds of both groups were women; the average age was 49 years and almost two-thirds had high blood pressure, while about 60% had obstructive sleep apnea and just over 20% had type 2 diabetes.

Of all eligible patients in the clinic offering the WNP, 19% were referred by their GP, and 11% registered. This is much higher than the very low percentage of UM Health primary care patients who received weight management treatment from their GP or were referred for specialist obesity care in a previous study published by the team using data from before the launch of the WNP.

When the WNP patients were compared to the usual care group, WNP patients were more likely to be referred to obesity care resources in the health care system, with more than twice as many patients in the WNP referred for bariatric surgery evaluations (18% vs. 9%). Overall, 4% of WNP patients underwent bariatric surgery within a year of starting the program, compared to none in 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 diet, which has been shown to have weight benefits. and health.

The percentages receiving a prescription for anti-obesity medications were similar, at 14% of WNP patients and 10% of control group patients.

However, the study period occurred before the U.S. Food and Drug Administration approval of semaglutide and tirzepatide for weight management and may not reflect current prescribing practices. Therefore, the researchers are conducting a follow-up assessment of patients’ use of weight management treatments and weight loss since the availability of these medications.

In addition to Griauzde and Kraftson, the study’s authors are Cassie D. Turner, LMSW; Amal Othman, MD; Lauren Oshman, MD, MPH; Jonathan Gabison, MD; Patricia K. Arizaca-Dileo, MD; Eric Walford, MD; James Henderson, Ph.D.; Deena Beckius, MPH; Joyce M. Lee, MD, MPH; Eli W. Carter, MPH; Chris Dallas, BBA; Kathyrn Herrera-Theut, MD; Caroline R. Richardson, MD; Jeffrey T. Kullgren, MD, MS, MPH; Gretchen Piatt, Ph.D., MPH; and Michele Heisler, MD, MPA.