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.