Background

With 40% of Americans affected by obesity, at high costs to the U.S. health system, a learning collaborative approach may be effective in designing care programs for patients with obesity, particularly when evidence-based non-pharmacologic interventions are lacking.

Methods

An observational pre/post intervention study was conducted on ~200,000 patients with overweight or obesity seen at 9 health care organizations (HCOs) from 10/1/2016–12/31/2018 that implemented programs to improve the management of patients with obesity in primary care. Interventions addressed patient/family, care team, organization, and community; with a focus on services, roles & education, tools & workflow, measurement & evaluation, and reimbursement.

Results

Prevalence of overweight or obesity remained at ~73% (66–82% across HCOs). Documentation of an obesity diagnosis increased 4% from baseline among patients with class 3 obesity (p < 0.001). After 1 year, among patients with class 3 obesity, identification of obesity-related complications, i.e., diabetes, dyslipidemia, hypertension, obstructive sleep apnea, osteoarthritis, and nonalcoholic fatty liver disease, increased from 1.5 to 1.8 complications per patient (p < 0.001). Laboratory assessments for obesity complications increased from 27% of patients receiving 7 tests at baseline to 35% in 2018 Q4 (p < 0.001). From baseline, an 8% increase was observed in the proportion of patients who lost ≥ 1% of weight (range −2%–7%); patients who gained weight decreased by 9%.Only 3.6% (range 0.5%–8.2%) of eligible patients (class 1–3 obesity) received anti-obesity medications in 2018 Q4.

Conclusions

One year following implementation of obesity management programs in 10 HCOs, identification of obesity-related complications increased, and documentation of obesity diagnoses improved. A shift in weight changes was observed with near equal increases in the proportion of patients who lost weight and decreases in the proportion who gained weight.