Journal Article

A Toolbox Approach to Obesity Treatment in Urban Safety-Net Primary Care Clinics: a Pragmatic Clinical Trial

Bessesen, Daniel H, Tsai, Adam G, Chaussee, Erin L, Iwamoto, Sean J, Speer, Rebecca B, Kealey, Elizabeth H, Saxon, David R, Heyn, Hilde, Juarez-Colunga, Elizabeth

2019

Overview

BackgroundThere is a need for new strategies to improve the success of obesity treatment within the primary care setting.ObjectiveTo determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care.DesignTwelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital.ParticipantsFrom a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention.InterventionsMedical weight management tools—partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program—for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months.Main MeasuresThe primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss.Key ResultsOverall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was − 3.15% ± 6.41% for on-treatment participants and − 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes.ConclusionsAccess to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity.Trial Registrationhttps://clinicaltrials.gov/ct2/show/NCT01922934

• Publisher: Springer Nature B.V
• Subject: Body weight / Body weight loss / Clinical trials / Comparators / Drug therapy / Health care / Internal medicine / Intervention / Management / Management tools / Obesity / Patients / Pharmacology / Primary care / Recreation / Safety / Vouchers / Weight control / Weight loss / Weight measurement