Introduction
Obesity continues to be devastating public health, economic, and health
care challenge. The increasing obesity among adults, children, and
adolescents since 1980 is becoming a global health concern [1]. Over
the past four decades, the prevalence of obesity worldwide has nearly
doubled [2]. In the United States, the prevalence of obesity has
increased from 1999-2000 through 2017-2018, from 30.5% to 42.4%
[3]. It is projected at the current rate the prevalence of obesity
will be more than 50% in 29 states by 2030 [4].
Obesity is a chronic, recurrent multifactorial disease and the outcome
depends on genetic, economic, environmental, and behavioral determinants
[5]. With a multidisciplinary team as the gold standard, a weight
management team (including nutritionists, behavioral psychologists,
endocrinologists, bariatric surgeons) is a key to successful management.
With strong patient engagement, early intervention by referring to
weight loss programs can offer clinically beneficial success [6].
However, access to such care is very limited. Compounding with less
availability of obesity treatment and increasing obesity in our society,
data further showed that only 25% patients with obesity were offered
dietary counselling, less than 5% referral, and 2% weight reducing
medications [7]. Based on National Survey between 2005 and 2006,
almost two-thirds of patients with obesity in the USA were not offered
or referred to weight loss management during their primary care visit
[8]. Thus, despite the evidence-based guidelines, the care to
patients with obesity for weight loss in primary care remains suboptimal
[9].
Barriers to effective screening, diagnosis, and management are
extensive, in part due to previous lack of success in weight loss,
patient’s dissatisfaction with care, and limited time during regular
visits. [10]. Even though studies have demonstrated that primary
care interventions for weight management are effective, only few
evaluated how overweight and obese patients are being managed in the
primary care setting [11-12]. Of all primary care visits, less than
30% were visits associated with obesity diagnosis, and up to 90% of
patients with obesity have not received formal diagnosis [9, 13].
Further, weight management counseling declined from 33% to 21% between
from year 2008 to 2013 [13]. At the current rate of increasing
obesity prevalence and less availability of weight management
counseling, a better obesity care model that can be delivered by primary
care physicians is essential since the evaluation of patients with
obesity is a complex process, requiring time and diligence from
healthcare providers. With this background, a weight management program
was created in a University-based academic primary care practice with
limited resources. This retrospective study will examine the
effectiveness of the program and will discuss the challenges and success
of the program.