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. 2024 May 1;7(5):e2412192.
doi: 10.1001/jamanetworkopen.2024.12192.

A Primary Care-Based Weight Navigation Program

Dina H Griauzde  1   2   3 , Cassie D Turner  1   2   4 , Amal Othman  5 , Lauren Oshman  3   5 , Jonathan Gabison  5 , Patricia K Arizaca-Dileo  1 , Eric Walford  1 , James Henderson  1   3 , Deena Beckius  6 , Joyce M Lee  2   7 , Eli W Carter  1 , Chris Dallas  1   6 , Kathyrn Herrera-Theut  1   7 , Caroline R Richardson  8 , Jeffrey T Kullgren  1   2   3   9 , Gretchen Piatt  4   10 , Michele Heisler  1   2   3 , Andrew Kraftson  1
Affiliations

A Primary Care-Based Weight Navigation Program

Dina H Griauzde et al. JAMA Netw Open. .

Abstract

Importance: Evidence-based weight management treatments (WMTs) are underused; strategies are needed to increase WMT use and patients' weight loss.

Objective: To evaluate the association of a primary care-based weight navigation program (WNP) with WMT use and weight loss.

Design, setting, and participants: This cohort study comprised a retrospective evaluation of a quality improvement program conducted from October 1, 2020, to September 30, 2021. Data analysis was performed from August 2, 2022, to March 7, 2024. Adults with obesity and 1 or more weight-related condition from intervention and control sites in a large academic health system in the Midwestern US were propensity matched on sociodemographic and clinical factors.

Exposure: WNP, in which American Board of Obesity Medicine-certified primary care physicians offered weight-focused visits and guided patients' selection of preference-sensitive WMTs.

Main outcomes and measures: Primary outcomes were feasibility measures, including rates of referral to and engagement in the WNP. Secondary outcomes were mean weight loss, percentage of patients achieving 5% or more and 10% or more weight loss, referral to WMTs, and number of antiobesity medication prescriptions at 12 months.

Results: Of 264 patients, 181 (68.6%) were female and mean (SD) age was 49.5 (13.0) years; there were no significant differences in demographic characteristics between WNP patients (n = 132) and matched controls (n = 132). Of 1159 WNP-eligible patients, 219 (18.9%) were referred to the WNP and 132 (11.4%) completed a visit. In a difference-in-differences analysis, WNP patients lost 4.9 kg more than matched controls (95% CI, 2.11-7.76; P < .001), had 4.4% greater weight loss (95% CI, 2.2%-6.4%; P < .001), and were more likely to achieve 5% or more weight loss (odds ratio [OR], 2.90; 95% CI, 1.54-5.58); average marginal effects, 21.2%; 95% CI, 8.8%-33.6%) and 10% or more weight loss (OR, 7.19; 95% CI, 2.55-25.9; average marginal effects, 17.4%; 95% CI, 8.7%-26.2%). Patients in the WNP group were referred at higher rates to WMTs, including bariatric surgery (18.9% vs 9.1%; P = .02), a low-calorie meal replacement program (16.7% vs 3.8%; P < .001), and a Mediterranean-style diet and activity program (10.6% vs 1.5%; P = .002). There were no between-group differences in antiobesity medication prescribing.

Conclusions and relevance: The findings of this cohort study suggest that WNP is feasible and associated with greater WMT use and weight loss than matched controls. The WNP warrants evaluation in a large-scale trial.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Oshman reported having stock holdings in Eli Lilly that were sold in 2022. Dr Lee reported receiving personal fees from GoodRx, Tandem Diabetes Care, and Sanofi Digital Advisory Board outside the submitted work. Dr Kullgren reported receiving personal fees from the American Diabetes Association outside the submitted work, and support was also provided by the Department of Veterans Affairs, Veterans Health Administration, and Health Services Research and Development Service. Dr Kullgren reported receiving grant funding from the US National Institutes of Health, the US Department of Veterans Affairs, the Robert Wood Johnson Foundation, the Donaghue Foundation, the Healthwell Foundation, the State of Michigan Department of Military and Veterans Affairs, and the Michigan Health Endowment Fund. Dr Kullgren also reported receiving consulting fees from SeeChange Health, HealthMine, the Kaiser Permanente Washington Health Research Institute, and the Washington State Office of the Attorney General; and honoraria from the Robert Wood Johnson Foundation, AbilTo Inc, the Kansas City Area Life Sciences Institute, the American Diabetes Association, the Luxembourg National Research Fund, the Donaghue Foundation, the National Science Foundation, the University of California Los Angeles, and the University of Pennsylvania. No other disclosures were reported.

Figures

Figure.
Figure.. Study Flow Diagram
Results of the screening, selection, and analysis processes for the eligible patients at the control and pilot sites. PCP indicates primary care practitioner; WNP indicates weight navigation program.
See this image and copyright information in PMC

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