PDF TOOLBOX CLINICAL TRIAL

A random sample of registry patients was selected for the “toolbox” intervention, but for logistical reasons, only patients from 4 clinics were designated to the intervention arm (intervention clinics). The registry consisted of patients from 9 primary care clinics. Inclusion criteria were age > 18, BMI 30–45 kg/m 2, ≥ 1 weight-related comorbidity (defined by ICD-9 codes for diabetes, prediabetes, osteoarthritis, back pain, hypertension, hyperlipidemia, metabolic syndrome, coronary artery disease, atherosclerosis, cerebrovascular disease, sleep disorder, or congestive heart failure), and receipt of primary care at DH at least twice within the previous 12 months and once within the previous 6 months. In May 2014, an obesity registry was created from a computerized data warehouse.

We aimed to test whether a greater proportion of patients offered low out-of-pocket cost tools would achieve ≥ 5% weight loss compared to those receiving usual primary care, as well as to determine tool uptake and utilization.

PDF TOOLBOX CLINICAL TRIAL

Mindful of flexibility, we conducted a pragmatic trial offering a “toolbox” of weight management options to a randomly selected group of racially and ethnically diverse patients. Like other medical treatments, weight management may be more successful when treatments are tailored to individual needs. 8, 9, 10, 11 Yet, little evidence exists to inform patients, providers, payers, and administrators about the potential clinical impact of providing affordable evidence-based medical weight management services within primary care. Several medical organizations advocate for wider availability of weight management tools and obesity treatment. Little is known about how patients might engage, and their potential weight loss achieved, when systems allow for improved access to intensive medical weight loss interventions in primary care. 5, 6, 7 Furthermore, reimbursement remains limited for intensive weight management services. As US obesity rates have climbed, weight loss counseling in primary care has declined and the majority of primary care providers (PCPs) rarely counsel on diet and exercise. Trial Registrationĭespite known health benefits, 1, 2, 3, 4 weight management treatment infrequently occurs within routine clinical settings. ConclusionsĪccess 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. The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes. Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. 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). Overall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss. The primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. Patients chose their tools, could switch tools, and could add a second tool at 6 months.

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.

Participantsįrom a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention. Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital. To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care. There is a need for new strategies to improve the success of obesity treatment within the primary care setting.

Pdf toolbox clinical