Statistics suggest that 70% of Americans have overweight or obesity, which puts more people at risk for developing additional chronic illnesses. Obesity is a chronic relapsing condition but has only been deemed so in the last decade. A lack of clarity on how to frame obesity, coupled with the staggering prevalence, has hampered the provision of evidence-based treatments to address obesity.
When the Affordable Care Act passed in 2010, health systems leaned into team-based care. At this time, disease management approaches made the transition to population based care. This move was also aided by increasing penetration of electronic medical records (EMR) to support care delivery. Having access to a comprehensive EMR data also supports the development of more sophisticated population segmentation strategies.
The evidence shows that intensive behavioral treatment (IBT) effectively produces the gold standard of 5% weight loss. IBT includes face-to-face visits, weight tracking, and meal monitoring, paced with learning and support. An example of IBT includes the Diabetes Prevention Program (DPP) is a year-long program consisting of 16 weekly sessions in-person or online, followed by monthly check-ins.
A new paper in JAMA by Heather Baer and colleagues from Brigham and Women’s Healthcare in Boston examines the potential benefit of pairing weight management programming with population health strategies. The study consisted of 840 participants, randomized into usual care, an online-only program, or a program that combined weight management and population health. The usual care arm care received a letter from their doctor with information about weight management. Participants were sourced from 15 primary care practices and were aged 20-70 years old, with a BMI between 27 and 40, and they had either Type 2 Diabetes or hypertension.
Findings suggest that a combination of traditional weight management and population health support was modestly superior to online weight management or usual care. Overall, at the 12-month follow-up mark, the combination approach yielded 3.1 kg weight loss on average, compared to traditional weight management, which produced 1.9 kg weight loss and usual care at 1.2 kg weight loss. While these numbers may seem modest, bear in mind that data suggest a 1-2 lb annual weight gain at a population level – so halting that increase is a very positive outcome.
Augmenting online weight management with population health is a program configuration that could scale better than in-person programming. Participants in the combination program had higher rates of seeing a registered dietician, 99% having one visit compared with 61% in the online-only group.
Overall additional contacts over the study period supported more significant weight loss. This extra support has also been shown beneficial in other studies. This study’s value shows that weight loss can be supported by clinical care, in large part with non-clinical staffing as primary care doctors were not directly involved in delivering any part of the intervention. New models of care are possible with this configuration and offers new paths to support people who want to engage in weight loss to improve their health.
Thanks for reading – Trina
(Opinions are my own)
References
Baer HJ, Rozenblum R, De La Cruz BA, et al. Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial. JAMA.2020;324(17):1737–1746. doi:10.1001/jama.2020.18977
