Weight loss in primary care: A pooled analysis of two pragmatic cluster‐randomized trials

Abstract

ObjectiveThe aim of this study was to report the results of five weight‐loss interventions in primary care settings in underserved patients and to compare the level of pragmatism across the interventions using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS‐2) tool.MethodsData from 54 primary care clinics (2,210 patients) were pooled from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) and Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER) cluster‐randomized trials. Clinics were randomized to one of five comparators: PROPEL usual care, PROPEL combination of in‐clinic and telephone visits, REPOWER in‐clinic individual visits, REPOWER in‐clinic group visits, or REPOWER telephone group visits.ResultsAt 24 months, weight loss (kilograms) was −0.50 (95% CI: −1.77 to 0.76), −3.05 (−4.10 to −2.01), −4.30 (−5.35 to −3.26), −4.79 (−5.83 to −3.75), and −4.80 (−5.96 to −3.64) in the PROPEL usual care, REPOWER in‐clinic individual visits, REPOWER telephone group visits, REPOWER in‐clinic group visits, and PROPEL in‐clinic and telephone visits arms, respectively. At 24 months, percentage of weight loss was −0.360 (−1.60 to 0.88), −3.00 (−4.02 to −1.98), −4.23 (−5.25 to −3.20), −4.67 (−5.69 to −3.65), and −4.69 (−5.82 to −3.56), respectively, in the five arms. The REPOWER in‐clinic individual visits intervention was the most pragmatic and reflects the current Centers for Medicare and Medicaid Services funding model, although this intervention produced the least weight loss.ConclusionsClinically significant weight loss over 6 months in primary care settings is achievable using a variety of lifestyle‐based treatment approaches. Longer‐term weight‐loss maintenance is more difficult to achieve.

An Assessment of Weight Loss Management in Health System Primary Care Practices

“…12,20 With structures and supports in place, patients are achieving weight loss outcomes that have potential to slow the public health trends toward increasing obesity and the resulting comorbid conditions. [21][22][23][24][25][26] Understanding more about what motivates primary care practice members toward providing obesity care and what steps could be taken to overcome perceived barriers is needed. This study reports on a survey completed by practice members at 18 diverse primary care practices in Colorado regarding their perceptions of the importance of obesity care in their practice, what services are currently provided, satisfaction with the care provided, challenges with providing obesity care, and interests in overcoming these challenges.…”

Comparison of weight loss data collected by research technicians versus electronic medical records: the PROPEL trial

“…In support of this contention, two recent pragmatic trials demonstrated that weight loss approaches conducted in primary care settings are feasible and effective ( 6 , 7 ). While these trials were conducted in the context of primary care, data collection was conducted using a “gold standard” approach by having trained research technicians measure the outcomes at fixed intervals ( 8 ). Recently, there has been increasing interest in collecting outcome data in pragmatic trials conducted in healthcare settings from existing electronic medical record (EMR) platforms ( 9 , 10 ).…”