A new obesity care delivery system deployed across primary care in a single health system, PATHWEIGH, eliminated population-level weight gain observed during usual care and increased the likelihood of patients with overweight or obesity to receive weight-related care over 18 months. The pragmatic trial used a weight-prioritized visit (WPV) type and pre-visit questionnaires (PVQ) to focus provider and patient attention. Patients who received weight-related care lost 2.37 kg more than those who did not receive weight-elated care during the intervention.

“Changing population weight is like moving mountains,” said Ildiko Lingvay, MD, MPH, MSCS, Professor of Endocrinology, University of Texas Southwestern Medical Center. “The intervention was hugely successful.”

Dr. Lingvay chaired the symposium, PATHWEIGH Trial—Building the Highway for Weight Management in Primary Care, on Friday afternoon, June 20, the opening day of the 85^th Scientific Sessions.

Primary care is the only practical point of obesity care for most patients, noted Peter C. Smith, MD, Associate Professor of Family Medicine, University of Colorado (CU) School of Medicine, and Medical Director for Primary Care, CU Medicine. About 100 million U.S. adults are living with some degree of overweight with just 9,100 endocrinologists and 9,800 American Board of Obesity Medicine diplomates to care for them.

That equates to about 5,000 patients living with obesity for each provider.

“The good news is we have over a quarter-million primary care providers in the United States, more like 350 patients for each provider, and they’re better distributed geographically,” Dr. Smith said.

PATHWEIGH is not a weight-loss program, he emphasized. It is a care delivery process designed to integrate obesity management into busy primary care practices using existing resources and workflow. The trial followed about 274,000 patients across all 56 CU primary care clinics.

All patients in the trial had a baseline body mass index (BMI) ≥25. The integrated, multimodal interventions used modifications to the electronic health record, training and education for the clinic staff and providers to focus both patients and providers on weight issues.

The delivery addresses lack of provider time, available resources, and self-efficacy by optimizing electronic medical record use, practice engagement, and training.

“Real-world evidence is much more effective at having a real-world impact than a controlled trial,” said Mark Gritz, PhD, the Peter W. Shaughnessy Endowed Chair in Health Care Policy and Research, and Associate Professor of Medicine, CU School of Medicine “We wanted an affordable care delivery process that is feasible to be implemented in a broad range of settings.”

The CU outpatient clinics were randomized into three clusters with one-way crossover from usual care to the intervention phase over four years. Patients were about 54 years old, 54% female, and 78% non-Hispanic white. About 60% had commercial health insurance, and the mean BMI was 31.

Patients on usual care gained 0.47 kg over 18 months, reported Leigh Perreault, MD, Professor of Endocrinology, Metabolism, and Diabetes, CU School of Medicine, while patients in the intervention group lost 0.10 kg.

“Our analysis indicated that the intervention eliminated the weight gain seen in usual care, making our data the first to scale an intervention to more than a quarter-million people and prevent population weight gain,” Dr. Perreault said.

Patients in the usual care group who received no weight-related care gained the most weight, a mean of 0.55 kg. Those in the intervention group who received no weight-related care gained 0.18 kg, suggesting the care delivery intervention mitigated weight gain even when patients received no weight-specific care.

Cost was not an issue, Dr. Perreault reported. Implementation costs were negligible and providers needed no additional time. But providers used more than twice the number of weight-related International Classification of Diseases, Tenth Revision (ICD-10) billing codes during implementation than usual care, generating an additional $15 million in health system revenue.

“PATHWEIGH provided a means for primary care clinicians to deliver weight management by invigorating interest, providing training and support, and embedding EHR (electronic health record) tools in a financially sustainable way,” explained Jodi Summers Holtrop, PhD, Professor and Vice Chair for Research in Family Medicine and Co-Director of the Dissemination and Implementation Science Program.

The PATHWEIGH model closely tracks the familiar critical care model (CCM) that has been used to address other chronic diseases in the primary care setting, said Robert Kushner, MD, MS, Professor of Medicine and Medical Education, Northwestern University Feinberg School of Medicine. CCM creates practical, supportive, evidence-based interactions between activated patients and prepared, proactive, primary care teams—very much the PATHWEIGH approach.

“I think they’re on the right track regarding the importance of having a patient-prioritized visit having a diagnosis,” Dr Kushner said.

On-demand access to recorded presentations from the 85^th Scientific Session will be available to registered participants following the conclusion of the meeting in Chicago, from June 25–August 25.