Primary care physicians are not addressing obesity with patients, researchers say

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Primary care physicians need a weight loss tool to help their patients manage obesity.

A new study examined weight management in primary care – and, like other reports, found it is uncommon, according to the researchers.

In the study period ending in March 2021, 12% of patients had weight-related visits to 57 health system primary care clinics. That means 88% did not, the researchers said.

“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,” the study said. “These results unmask an enormous unmet need to develop pragmatic approaches to implementing weight management in primary care.”

The study, “Baseline Characteristics of PATHWEIGH: A Stepped-Wedge Cluster Randomized Study for Weight Management in Primary Care,” aimed to establish baseline standard of care (SOC) for obesity. It may not exist, the researchers said, so future PATHWEIGH study will compare results to usual care.

Usual care

The usual care for obesity needs to change, the researchers said, noting physicians have been slow to do so.

“Obesity is increasingly recognized not only as a risk factor for disease, but a disease unto itself,” the study said. “Despite this fact, <1% of people with any degree of overweight or obesity are offered anything other than lifestyle advice, suggesting that the medical community at large has yet to embrace its designation as a disease state.”

Primary care already serves as a treatment setting for disorders caused by obesity, such as diabetes and hypertension. Many primary care patients note weight management is a priority, the researchers said.

Study results

In the study period, there were 164,904 adult patients with a BMI of 25 that visited at least one of the 57 primary clinics involved through University of Colorado Health and University of Colorado Health Medical Group. Of those, 20,383 patients had 32,306 weight-prioritized visits, based on billing codes or patient complaints.

Among the 20,383 patients, there were only 334 prescriptions for antiobesity drugs. No physicians, physician assistants, or nurse practitioners used a patient obesity questionnaire created for the study, “which raises the question of whether any SOC actually exits for weight management, and if so, how it might be captured in the electronic medical record.”

The researchers noted the study happened during the COVID-19 pandemic, when there was limited access to in-person health care and patient might have gained weight.

Planning for PATHWEIGH

What would PATHWEIGH do differently? The researchers said the program “aims to be the first pragmatic, scalable, and sustainable approach to weight management, with aspirations to disseminate nationally and internationally. We strive to shift the prevailing paradigm from treating weight-related complications to treating weight in primary care.”

The earliest form of the program used placards in clinics to inform patients they could request weight-related visits. Then, 72 hours before their visits, patients would receive electronic questionnaires through their patient portals to offer personal information such as history of weight gain, current behaviors, barriers, and goals.

That information guided patient visits and treatment plans, the researchers said.

An 18-month pilot program resulted in a 7.2% body weight decrease for patients using the PATHWEIGH program, compared to 2.1% weight loss for patients receiving standard of care. Those results inspired the larger study, which was funded by the U.S. National Institutes of Health.

“Baseline Characteristics of PATHWEIGH: A Stepped-Wedge Cluster Randomized Study for Weight Management in Primary Care,” was published in The Annals of Family Medicine. It was announced May 23, 2023.