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.