Shared medical appointments for obesity management associated with greater weight loss vs. usual care
Shared medical appointments may offer a favorable strategy for obesity management with greater weight loss and more access to antiobesity medications compared with individual medical visits alone, according to findings from a recent study.
“Our current approach to patients with obesity is rarely successful. An intensive lifestyle intervention program in the context of shared medical appointments ... seems to be more effective than our current approach to obesity,” Bartolome Burguera, MD, PhD, chair of the Endocrinology and Metabolism Institute at Cleveland Clinic, told Healio. “Shared medical appointments allow providers to increase their productivity by seeing more patients in a given timeframe, thus allowing for a more appropriate amount of time to specifically address obesity management.”
Between September 2014 and February 2017, researchers enrolled 310 adults aged at least 18 years with a BMI greater than 27 kg/m2 (mean age, 52 years; 83.9% women; mean BMI, 40.59 kg/m2) to participate in shared medical appointments at the Cleveland Clinic Institute of Endocrinology and Metabolism. Participants were matched 1:1 with similar adults assigned to attend individual medical appointments (mean age, 52 years; 82.7% women; mean BMI, 41.34 kg/m2). The groups had similar proportions of participants with diabetes, hypertension and dyslipidemia.
The shared appointment group attended at least one shared appointment to focus on key obesity treatment areas: nutrition, exercise, appetite control, sleep quality and stress management. The individual appointments group received usual care. For all participants, the researchers calculated weight-loss percentage from baseline weight and recorded other variables including age, sex, race and use of antiobesity medication.
The average weight loss at 1 year was 5.2% in the shared appointments group and 1.8% in the individual appointments group (paired t test, P < .05). Additionally, weight-loss proportions of 5% and higher from baseline were also greater in the shared appointments group (44.7%) vs. the individual appointments group (31.4%), according to the researchers.
“All the patients in our study were eligible to take an FDA-approved antiobesity medication due to their diagnosis of obesity,” the researchers wrote. “However, antiobesity medication prescriptions varied markedly between the shared medical appointments group (49.8% of patients prescribed an antiobesity medication) and the matched nonshared medical appointments group (12.3% of patients prescribed an antiobesity medication), possibly due to differences in provider experience in prescribing antiobesity medications.”
Although weight loss was superior in the shared appointments group, both groups displayed difficulty with continued weight loss after the first year, highlighting the need for long-term medical management in obesity treatment, according to the researchers.
“We need to be proactive taking care of our patients with obesity. Our current approach does not seem to be successful,” Burguera said. “Asking our patients to exercise more and eat healthier is clearly not enough. We need to provide tools to our patients so they may improve their diet and pursue a realistic physical activity-exercise program. We cannot forget the significant impact that lack of sleep, stress and psychological conditions, such as anxiety or depression, may cause increasing appetite. The use of FDA-approved antiobesity medication has to be individually evaluated and seriously considered. Obesity is a chronic disease that requires chronic treatment.” – by Kate Burba
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Bartolome Burguera, MD, PhD, can be reached at the Endocrinology and Metabolism Institute, Cleveland Clinic; email: BURGUEB@ccf.org
Disclosure: Burguera reports he received consultant fees and has ongoing research support from Novo Nordisk.