Despite the prevalence of obesity in the U.S. and its contribution to costly chronic conditions such as diabetes and hypertension, seasoned primary-care physicians often lack the education and resources to adequately address the condition among their patients.
A 2017 survey from the medical association AMGA found 68% of its members weren’t following any guidelines for obesity care management in their practices. There were several reasons for this, including stigma among health professionals about obesity being a lifestyle choice rather than a chronic condition, said Elizabeth Ciemins, AMGA vice president of research and analytics. Additionally, physicians weren’t adequately trained until recently on obesity management and were often uncomfortable broaching the topic with patients. Providers “don’t know how to have those conversations,” Ciemins said.
The AMGA recognized the need for a care model specifically for primary-care practices to identify and manage obesity among their patients. With funding from pharmaceutical company Novo Nordisk, the AMGA developed the model and enrolled 10 healthcare organizations to participate and refine it. Organizations in the Obesity Care Model Collaborative focused on obesity management by following core competencies, tracking obesity-related quality measures and sharing data and best practices with peer organizations. The collaborative concluded in August 2019 and since then the AMGA has shown positive outcomes from the work.
A recent study by Ciemins and colleagues found obesity diagnosis rates increased by the end of the collaborative. And in a separate study, Ciemins found a diagnosis of obesity was associated with at least a 5% weight loss. The former study also found the best-performing healthcare organizations saw a 5% absolute improvement in the proportion of patients who lost weight, with weight loss observed in all weight classes.
The collaborative involved four competencies: partnering with community organizations and local businesses; getting buy-in and support from leadership; building relationships with patients and families; and involving and training the care team.
The providers could apply the competencies as they saw fit for their organization and the resources available, said Danielle Casanova, senior director of population health initiatives at the AMGA.
The collaborative involved a 12-month period when the organizations implemented interventions. The organizations met regularly via webinars and even in person. AMGA staff would check in quarterly with each site, visiting them in person and tracking progress on seven quality measures. The AMGA developed the measures with guidance from the National Quality Forum. Ciemins said there weren’t validated measures on obesity, therefore the organizations were testing them. Two of the measures assess obesity-related complications and prescribe anti-obesity medications. Patient-reported outcome measures are also included and ask patients questions about quality of life such as ease of doing daily activities or confidence in social settings.
Dr. Kara Mayes, medical director of Mercy Clinic’s Weight and Wellness center, said the patient-reported outcome measures were valuable and are still in use today. Mayes said it’s helpful for patients to see how their responses on certain questions changed when they are disappointed about not meeting a weight-loss goal.
When St. Louis-based Mercy joined the AMGA collaborative, the health system was launching the weight loss center. Mayes said the AMGA framework helped guide development of the clinic including the treatment protocols, referral policies and data tracking.
Additionally, Mayes said the collaborative helped educate primary-care staff. A Mercy Clinic continuing medical education event that addressed obesity as a chronic condition and treatment options was well attended by physicians. Additionally, Mayes spoke at staff meetings.
The results were more referrals to the weight-loss clinic and increases in obesity diagnoses.
Dr. Andrew Toth, a physician manager at Confluence Health in Washington state, added he will be using the lessons from the collaborative as he builds out a weight-loss center at the health system. He said it became clear working with the collaborative that the center was needed at Confluence to serve as a resource and referral source for obesity care.
