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. 2024 Jun 19:11:1338727.
doi: 10.3389/fnut.2024.1338727. eCollection 2024.

Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program

Kyleigh Kirbach  1 , Imani Marshall-Moreno  2 , Alice Shen  1 , Curtis Cullen  3 , Shravya Sanigepalli  2 , Alejandra Bobadilla  4 , Lauray MacElhern  4 , Eduardo Grunvald  5 , Gene Kallenberg  4 , Maíra Tristão Parra  6 , Deepa Sannidhi  7
Affiliations

Implementation of a virtual, shared medical appointment program that focuses on food as medicine principles in a population with obesity: the SLIM program

Kyleigh Kirbach et al. Front Nutr. .

Abstract

Background: Multimodal lifestyle interventions, employing food as medicine, stand as the recommended first-line treatment for obesity. The Shared Medical Appointment (SMA) model, where a physician conducts educational sessions with a group of patients sharing a common diagnosis, offers an avenue for delivery of comprehensive obesity care within clinical settings. SMAs, however, are not without implementation challenges. We aim to detail our experience with three implementation models in launching a virtual integrative health SMA for weight management.

Methods: Eligible patients included individuals 18 years of age or older, having a body mass index (BMI) of 30 kg/m2 or 27 kg/m2 or greater with at least one weight related comorbidity. The Practical, Robust Implementation and Sustainability Model (PRISM), Plan, Do, Study, Act (PDSA), and the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) models were applied to guide the implementation of the Supervised Lifestyle Integrative Medicine (SLIM) program, a virtually delivered, lifestyle medicine focused SMA program, in a weight management clinic within a major health system. We describe how these models, along with attendance for the initial cohorts, were used for decision-making in the process of optimizing the program.

Results: 172 patients completed the SLIM program over two years. Attendance was lowest for sessions held at 8:00 AM and 4:00 PM compared to sessions at 10:00 AM, 1:00 PM, and 3:00 PM, leading to only offering midday sessions (p = 0.032). Attendance data along with feedback from patients, facilitators, and administrative partners led to changes in the curriculum, session number and frequency, session reminder format, and intake visit number.

Conclusion: The use of implementation and quality improvement models provided crucial insight for deployment and optimization of a virtual, lifestyle medicine focused SMA program for weight management within a large healthcare system.

Keywords: food as medicine; implementation science; lifestyle medicine; obesity; shared medical appointment.

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Conflict of interest statement

MT was employed by International Consulting Associates, Inc. Arlington, VA, United States. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

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Figure 1
Application of implementation science frameworks.
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