Discussion
This current study demonstrates that single physician-led weight loss program can be successfully implemented in a primary care setting and supports the hypothesis that patients with obesity are able to achieve 5% and 10% weight loss goals in such program. About one third (28.2%) of our patients achieved 5% weight loss within 90 days. These findings align with several previous studies of similar results, yet we describe the unique effectiveness of a single physician-led, personalized, weight loss program with minimal resources. Davis Martin et al. performed a study to determine the effectiveness of a primary care weight loss intervention African American women with obesity where the intervention group received monthly 15 minutes visits for six months and during which physicians provided tailored health, exercise and dietary recommendations assembled by a multidisciplinary group with the intervention group (12.5%) achieving ≥5% weight loss vs. 3 (5.2%) of standard care participants [14]. Bowerman et al. compared the effectiveness of a ten-minute primary care physician- led intervention plus dietician-led telephone counseling session versus usual care on patients’ satisfaction and weight loss. They concluded that their program was effective and resulted in about 9.5% and 6.5% weight loss from baseline for women and men at 6 months follow-up, respectively, when considering the averages [15]. These studies parallel our statement that the primary care setting is a successful area to implement weight management interventions. Our novel description underscores the effectiveness of a single physician trained in obesity medicine, without the help of a multidisciplinary team, achieving clinically significant weight loss within a year. This highlights the potential for primary care physicians to be trained in obesity medicine and positively intervene for weight control, even with limited time and resources.
Weight loss is a long-term process, and as we see in this study, majority of patients achieved significant weight loss in about 200 days. Those who stayed in the program longer were more likely to achieve significant weight loss (5% weight loss when follow up visits were within 90 days period). Therefore, patients’ retention in the weight loss program remains a key to the success and this should be emphasized to the patients at each visit. For adults with overweight or obesity, the longer follow-up period the better weight loss outcomes not only in achieving goals but also maintaining weight [16-17]. In Cohen et al.’s study investigating weight loss in patients with obesity and hypertension, those who lost weight saw their physicians more frequently, whether in the intervention group or not, and also ended up with less antihypertensive medications at the end of the study [18]. It is evident that patient’s engagement, even with minimal intervention, results in more positive patient’s outcomes. This follow-up period is essential for ongoing supervision, continued education, and positive reinforcement to reap the long-term benefits of clinically significant weight loss. More primary care physicians should be trained in obesity medicine and be supported by hospital management and insurance companies to schedule patients with obesity more frequently. This will create accountability to patients and improve the outcome.
Obesity is directly related with multiple metabolic comorbidities, significant mortality and tremendous healthcare costs. Weight loss studies demonstrated that improvement in all metabolic components of obesity can be seen with 5-10% weight loss [19]. Higher weight loss goals may be required to improve mortality outcomes [20]. In view of healthcare costs related to overweight and obesity, significant reduction in hospitalizations, medications cost in patients with diabetes was observed with again 5-10% weight loss [21]. Sustained remission of type 2 diabetes has been achieved in more than third of patients who maintained at least 10 kg weight loss [22]. Our study found similar impact of 5% weight loss on hemoglobin A1c which decreased from average 6.4% at the first visit to 5.8% at the last visit. Hence, the greater the weight loss, the better improvement in metabolic components and complications of obesity which, as we prove, can be successfully achieved in single physician-led weight loss program.
Finally, it is important to note the challenge of adherence to weight loss intervention and maintain scheduled follow up visits throughout this study due to the ongoing uncertainty of COVID-19 and visit cancellations. In our study nearly half patients visited the clinic only once. Patient’s dropout rates differ among studies with attrition varying between 30-81.5% [23-24]. This particular challenge has many underlying reasons. Factors affecting attendance and adherence to interventions include psychosocial (stress, depression, social support), socio-demographic (age, employment, education) and behavioral (previous failed weight loss attempts) aspects [24]. To improve the efficiency of physician-led weight loss, these barriers to compliance need to be addressed. High adherence was observed in the interventions incorporating social support (peer coaches, involving family, and buddy programs) [25]. With the recent burst of telemedicine, the availability of telephone and video visits have a great potential to overcome access or resource barriers. Motivation as an important factor, can be monitored by questionnaire at each visit to identify these patients who may need more time spent on coaching, positive reinforcement and finding psychosocial aspects that interfere with adherence. Improving self-monitoring by behavioral strategies like electronic diet diaries may also improve attendance and patients’ engagement. In future studies, there are grounds for better understanding attrition barriers and improvement in patients’ engagement in the weight loss program.