To the Editor,
In the United States, the prevalence of obesity has increased and it is projected that obesity will be more than 50% in 29 states by 2030 [1, 2]. Multidisciplinary team of nutritionists, behavioral psychologists, endocrinologists and bariatric surgeons leads the current gold standard to successful management of obesity. However, access to such care is very limited. Almost two-thirds of patients with obesity during primary care visit in U.S.A were not offered or referred to weight loss management and the care to patients with obesity for weight loss remains suboptimal. [3, 4].
With this background, we created a novel weight management program in a University-based academic primary care practice with limited resources. This program runs once a week to treat patients aged above 18 and BMI more than 30 kg/m2 referred by a group of 47 primary care providers and is managed by a single primary care physician who is board-certified in obesity medicine. The physician provides patients with individualized meal plans, food journal app education, exercise ideas, and strategies to control cravings and follows up with them every 4-6 weeks. Pharmacotherapy of obesity were used when appropriate.
We had 300 patients enrolled in the program from September 2018 to December 2020. In Table 1, among the142 patients who had more than one visit in the program, 5% weight loss was statistically significant in the groups who had more visits in the program (p < 0.0001), as was 10% weight loss (p<0.0001).
Table 1. Characteristics of patients who attended an obesity program more than once within 90 days (N=142).
| 2-3 visits (N=93) | 4-5 visits (N=23) | 5+ visits (N=26) | |
| Mean (SD) | Mean (SD) | Mean (SD) | p-values |
Age (in years) | 48.6 (12.4) | 47.7 (12.7) | 53.8 (13.5) | 0.15 |
Gender | | | | 0.56 |
Female Male | 85.0% (79) 15.0% (14) | 82.6% (19) 17.4% (4) | 92.3% (24) 7.7% (2) | |
Comorbidity | 2.2 (1.7) | 2.6 (1.2) | 2.6 (1.6) | 0.30 |
Medication | 1.9 (1.4) | 2.9 (1.5) | 3.2 (1.6) | <0.0001 |
5% Weight Reduction | 16.1% (15) | 43.5% (10) | 57.7% (15) | <0.0001 |
10% Weight Reduction | 4.3% (4) | 8.7% (2) | 42.3% (11) | <0.0001 |
Moreover, 60% of patients achieved 5% of weight loss in about 200 days, and 40% achieved 10% weight loss in 350 days. Among patients who achieved 5% weight loss, their average A1C was reduced to 5.8 at their last visit from 6.4 at the first visit.
Weight reduction as low as 5-10% of body weight have shown to achieve health benefits clinically such as better control of diabetes, hypertension and hyperlipidemia. [5] Our results demonstrate the effectiveness of a single-physician led obesity clinic without access to a multidisciplinary team, achieving clinically significant 5-10% weight loss within a year. With limited resources, there are many obstacles including poor follow up rate, no shows and cancellations. In future studies, there are grounds for better understanding attrition barriers and improvement in patients’ engagement in the weight loss program.
Nonetheless, with increasing obesity, a better obesity care model that can be delivered by primary care physicians is essential by training more primary care physicians in obesity medicine.
References
1. Smith KB, Smith MS. Obesity Statistics. Prim Care. 2016;43(1):121-ix.
2. Ward ZJ, Bleich SN, Cradock AL, et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019;381(25):2440-2450.
3. Ma J, Xiao L, Stafford RS. Adult obesity and office-based quality of care in the United States. Obesity (Silver Spring). 2009;17(5):1077-1085.
4. Fitzpatrick SL, Stevens VJ. Adult obesity management in primary care, 2008-2013. Prev Med. 2017;99:128-133.
5. Rena R. Wing, Wei Lang, Thomas A. Wadden, Monika Safford, William C. Knowler, Alain G. Bertoni, James O. Hill, Frederick L. Brancati, Anne Peters, Lynne Wagenknecht, the Look AHEAD Research Group. Diabetes Care Jul 2011, 34 (7) 1481-1486