A Toolbox Approach to Obesity Treatment in Urban Safety-Net Primary Care Clinics: a Pragmatic Clinical Trial
- PDF / 859,656 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 26 Downloads / 156 Views
Division of Endocrinology, Metabolism and Diabetes, University of Colorado School of Medicine, Aurora, CO, USA; 2Denver/Seattle Center of Innovation for Veteran-Centered and Values Driven Care, VA Eastern Colorado Health Care System, Denver, CO, USA; 3Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA; 4Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine, Aurora, CO, USA; 5Kaiser Permanente, Denver, CO, USA; 6Division of Endocrinology, Rocky Mountain Regional Veterans Affairs Medical Center, Aurora, CO, USA; 7Denver Health Medical Center, Denver, CO, USA; 8 Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, CO, USA.
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-ofpocket 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. INTERV ENTIONS: 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
Prior Presentations Oral presentation, ObesityWeek, October 29– November 2, 2017, Oxon Hill, MD. 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. Received April 23, 2018 Revised December 4, 2018 Accepted June 26, 2019
(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. TRIAL REGISTRATION: http
Data Loading...
