Background

The Dartmouth Weight & Wellness Center in Lebanon, NH, offers a comprehensive, team-based medical management of obesity at a rural academic medical center. Health coaches, dietitians, a nurse exercise trainer, a psychologist, and a team of ABOM-certified providers deliver individual and group visits. Programs supporting behavioral change are patient-centered and are designed to maximize patient contact. Care pathways include medical management (+/- medications), pre-surgical care, behavioral health, and a Diabetes Prevention Program certified lifestyle program.

Methods

Data was collected from patients completing at least six months of clinical care between January 2016 and April 2019. All objective and encounter data were collected as part of routine clinical care and extracted from the medical record. Change in body mass index (BMI) between baseline and six months was assessed using paired t-tests controlling for age, gender, race, ethnicity, and insurance type. Linear regression models predicted BMI at six months based on the frequency of patient contacts, and controlled for patient age, sex, and baseline BMI.

Results

A total of 976 patients completed at least six months of care between January 2016 and April 2019 (mean age 49.7±14.3 years, 78% female, 97% white). Over this interval, patients had a median of 7 [IQR 3,16] clinical care contacts. Of the 416 patients (42.6%) with both baseline and six-month BMI data, mean weight loss was 4.51 kg [95% CI:-4.71,-4.31] with a mean BMI reduction of 1.34 kg/m2 [95%CI:-1.44,-1.24]. In addition, 21% moved to a lower BMI class. Higher frequency of contact with WWC staff was significantly associated with a lower BMI at six months post-program initiation (β=-0.052kg/m2 per visit [95%CI:-0.087,-0.018]).

Conclusions

Tailored obesity care was associated with decreased BMI. Greater frequency of clinical care contact was positively associated with decreased weight loss and BMI reduction. Future analyses should assess which treatments are more effective.