BACKGROUND

Evidence-based weight loss treatments are rarely offered in routine primary care practice owing in part to lack of reimbursement, lack of provider training and experience in discussing treatment options, and the difficulties inherent in discussing all available options. Little evidence exists about the effect of addressing these common barriers to optimal practice in real-world settings.

OBJECTIVES

We sought to determine what fraction of randomly selected patients with obesity and weight-related comorbidities who were offered evidence-based medical weight management interventions achieved clinically meaningful weight loss (ie, ≥5% of initial weight) at 12 months. Additionally, we sought to measure the uptake and use of specific weight loss services when patients in a low-resource setting were given the opportunity to choose among a variety of options and obtain them at a relatively low out-of-pocket cost.

METHODS

We conducted a pragmatic randomized controlled weight loss trial in primary care clinics in an integrated health care organization that serves an ethnically diverse and medically underserved low-income urban population. The primary outcome we measured was whether patients lost 5% of their initial body weight at 12 months. Five different evidence-based weight loss treatment options were offered for a $5 or $10 monthly copay to 309 patients randomly selected from a registry of patients with obesity (body mass index ≥30 and <45) and at least 1 weight-related comorbidity. Participants were allowed to choose their initial intervention and to switch interventions at any point during the study, and they could add a second tool 6 months into the study. Patients in the registry who were not selected for the intervention and for whom 2 weights were available served as an observational comparator group. Study design was guided in part by patient stakeholder feedback before and during the trial.

RESULTS

In the intervention group, 119 people (38.5% of those contacted) sought and received treatment. The primary outcome of ≥5% weight loss was achieved in 34.5% of the intervention group compared with 15.7% of the usual care observational registry-based control group (n = 2930; < .001). Mean ± SD percentage weight loss was −3.15% ± 6.41% in the intervention group and −0.30% ± 6.10% in the control group ( < .001). Of the subjects, 35.3% chose meal replacements, 27.7% weight loss medications, 21.8% recreation center passes, 6.7% Weight Watchers vouchers, and 5.0% group behavioral weight loss class, and 1.7% simply wanted monthly clinical visits. Those who attended more intervention visits, those who used phentermine/topiramate extended release, and those who used a second tool during the last 6 months of the intervention were more likely to lose ≥5% of baseline weight than those who did not.

CONCLUSIONS

More than a third of randomly selected patients with obesity and a weight-related comorbidity sought medically supervised weight loss treatments when they were offered modest copays and support. At 1 year, these patients had lost and maintained the loss of ≥5% of their baseline weight (10 lbs for a 200-lb person).

LIMITATIONS AND SUBPOPULATION CONSIDERATIONS

The study was not powered to determine the effects of each tool, and the results apply only to an ethnically diverse, medically underserved population that received care in a single integrated health system.