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26.08.2019 | Original Research | Ausgabe 11/2019

Journal of General Internal Medicine 11/2019

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

Zeitschrift:
Journal of General Internal Medicine > Ausgabe 11/2019
Autoren:
MD David R. Saxon, MS Erin L. Chaussee, Elizabeth Juarez-Colunga, Adam G. Tsai, Sean J. Iwamoto, Rebecca B. Speer, Hilde Heyn, Elizabeth H. Kealey, Daniel H. Bessesen
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s11606-019-05222-0) contains supplementary material, which is available to authorized users.

Prior Presentations

Oral presentation, ObesityWeek, October 29–November 2, 2017, Oxon Hill, MD.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Abstract

Background

There is a need for new strategies to improve the success of obesity treatment within the primary care setting.

Objective

To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care.

Design

Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital.

Participants

From a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention.

Interventions

Medical 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 Measures

The 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 Results

Overall, 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.

Conclusions

Access 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.

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