A Toolbox Approach to Obesity Treatment in Urban Safety-Net Primary Care Clinics: a Pragmatic Clinical Trial.
obesity
primary care
weight management
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
11 2019
11 2019
Historique:
received:
23
04
2018
accepted:
26
06
2019
revised:
04
12
2018
pubmed:
6
9
2019
medline:
18
11
2020
entrez:
6
9
2019
Statut:
ppublish
Résumé
There is a need for new strategies to improve the success of obesity treatment within the primary care setting. To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care. Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital. From a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention. Medical weight management tools-partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program-for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months. The primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss. Overall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was - 3.15% ± 6.41% for on-treatment participants and - 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes. Access to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity. https://clinicaltrials.gov/ct2/show/NCT01922934.
Sections du résumé
BACKGROUND
There is a need for new strategies to improve the success of obesity treatment within the primary care setting.
OBJECTIVE
To determine if patients offered low out-of-pocket cost weight management tools achieved more weight loss compared to usual care.
DESIGN
Twelve-month pragmatic clinical weight loss trial with a registry-based comparator group performed in primary care clinics of an urban safety-net hospital.
PARTICIPANTS
From a large clinical registry, we randomly selected 428 patients to have the opportunity to receive the intervention.
INTERVENTIONS
Medical weight management tools-partial meal replacements, recreation center vouchers, pharmacotherapy, commercial weight loss program vouchers, and a group behavioral weight loss program-for $5 or $10 monthly. Patients chose their tools, could switch tools, and could add a second tool at 6 months.
MAIN MEASURES
The primary outcome was the proportion of intervention-eligible patients who achieved ≥ 5% weight loss. The main secondary outcome was the proportion of on-treatment patients who achieved ≥ 5% weight loss.
KEY RESULTS
Overall, 71.3% (305 of 428) had available weight measurement data/PCP visit data to observe the primary outcome. At 12 months, 23.3% (71 of 305) of intervention-eligible participants and 15.7% (415 of 2640) of registry-based comparators had achieved 5% weight loss (p < 0.001). Of the on-treatment participants, 34.5% (39 of 113) achieved 5% weight loss. Mean percentage weight loss was - 3.15% ± 6.41% for on-treatment participants and - 0.30% ± 6.10% for comparators (p < 0.001). The initially preferred tools were meal replacements, pharmacotherapy, and recreation center passes.
CONCLUSIONS
Access to a variety of low out-of-pocket cost weight management tools within primary care resulted in ≥ 5% body weight loss in approximately one quarter of low-income patients with obesity.
TRIAL REGISTRATION
https://clinicaltrials.gov/ct2/show/NCT01922934.
Identifiants
pubmed: 31485965
doi: 10.1007/s11606-019-05222-0
pii: 10.1007/s11606-019-05222-0
pmc: PMC6848318
doi:
Banques de données
ClinicalTrials.gov
['NCT01922934']
Types de publication
Journal Article
Pragmatic Clinical Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
2405-2413Subventions
Organisme : NIDDK NIH HHS
ID : P30 DK048520
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001082
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007446
Pays : United States
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