A Toolbox Approach to Obesity Treatment in Primary Care
Status:
Completed
Trial end date:
2016-08-01
Target enrollment:
Participant gender:
Summary
Obesity is common, causing many medical problems in adults (e.g., diabetes, hypertension,
high cholesterol, sleep apnea, heart attack, strokes). A range of treatments have shown to be
effective for treating obesity. Treatments include lifestyle modification, meal replacements,
and weight loss medication. Most primary care settings do not provide much obesity treatment,
though, as primary care providers (PCPs) are not well trained and because reimbursement for
treatments is not consistent.
Hypothesis: If PCPs have training in weight management and if most costs of treatment are
reimbursed, we surmise that a "toolbox" of treatments can produce a clinically important
weight loss amount in a large group of patients.
Design: We propose to establish a registry of obese patients with at least one common medical
condition related to their weight. From the registry, we will randomly select 350 people to
be offered treatments to assist with weight loss. The remainder of the registry's patients
can still receive obesity treatment but will not be reimbursed. We will conduct the study at
Denver Health, a large public health care system that treats a low income, ethnically diverse
population. All 350 patients will be offered some self-monitoring tools for weight management
and the chance to do a computer assessment to select the right treatment for weight loss.
Patients who complete this and record their food intake and physical activity for 1 week will
be offered a "Level 2" treatment for weight loss. Level 2 treatments include: a voucher for a
commercial weight loss program; intensive group weight loss counseling; meal replacements;
gym membership; or weight loss medication. Patients will choose which treatment they want,
with the approval of their PCP. Researchers at Denver Health will help with the computer
assessment and dispensing the treatments. We are interested in what percentage of patients
lose at least 5% of their starting weight. We will also explore changes in glucose, blood
pressure, and cholesterol, and we will look at how much this intervention costs and whether
patients need less medication for their weight-related conditions at the end of the study.
Impact: If the study is successful, we plan to take the results to the leaders at Denver
Health to see if they will make obesity treatment more broadly available for all patients
there.