While many people across the country seeking treatment for obesity have access to providers in major metropolitan areas, there are still more rural communities where that level of help is not readily available.  

Researchers looked at whether treatment approaches, including in-clinic group sessions and telephone-based group visits, can help these patients address their serious health issues.  

Christie Befort, PhD, a professor of population health at the University of Kansas Medical Center, told MD/Alert that with obesity being a growing problem nationwide, they wanted to look at alternative care delivery models for helping these patients.  

“There’s been a lot of movement from professional societies and, you know, some from the insurance industry and medical education institutions to really try to increase the amount of services that are offered in primary care to address obesity. It’s actually the number one chronic medical condition in our country, but it just has not happened to date because the primary care system doesn’t have the right infrastructure and workflows to make it happen,” Christie Befort, PhD, said in an interview.
 
“Rural populations are one of those groups that have higher rates, and they have less access to interventions that work,” she added. “Primary care is a trusted resource, and the clinics in this study were almost all family medicine. Most of these docs really care as well. These are people that many times they’ve known across multiple generations. They want to help. They just don’t have the infrastructure to make it happen.” 

The researchers used 36 primary care facilities throughout the Midwest to evaluate patients between the ages of 20 and 75 who had a BMI between 30 and 45.  

According to results published in JAMA, all participants received a lifestyle intervention that focused on diet, physical activity, and behavioral changes.  

One group received 15-minute individual in-clinic visits “at a frequency similar to that reimbursed by Medicare,” or weekly for a month, biweekly for five months, and monthly after that. The in-clinic group met weekly for three months, biweekly for three months, and monthly after that, with the phone group having a similar schedule.  

The mean weight loss at 24 months was 9.7 pounds for the in-clinic group, 8.6 pounds in the telephone group, and 5.73 pounds in the individual arm.   

The authors noted that compared to the in-clinic individual group, the mean difference in weight change was 4.19 pounds for the in-clinic group arm and 3.09 pounds for the individual telephone group.  

Befort said that while obesity is a well-known problem, there has been a significant amount of debate about whether it can or should be addressed in the primary care setting or is it better treated in “community or commercial based programs.” 

She said their findings showed it can work in primary care, even in parts of the country that might be considered “under-resourced settings.” 

Their findings could provide hope for patients who might not have previously turned to their primary care providers for help.  

“Patients almost always know they need the help. They don't necessarily have very high expectations that they're going to get the help that they need, just based on their experience when they go to see their doctor,” Befort continued. “It's a hard conversation for both providers and patients to have a lot of times. But what we have found is patients want to have the conversation. It doesn't mean they're necessarily ready at that moment in time to jump into something. But with a trusted relationship and a conversation with their provider, that's not only encouraging and non-judgmental but also one that says we have something for you.”  

“That’s what we have found patients really want is they want to know that there are treatment options. What they don't want is just simple advice that they know is not really going to work for them because 9 times out of 10, they've already tried it. So, if they know that that provider has something that could work for them, even if they're not ready at that particular moment in time, chances are they will be at some point in time.”  

Despite the positive findings, Befort said there are still barriers to bringing this type of treatment to rural populations on a larger scale. One, she said, is payment. While Medicare covers this form of treatment, she said private payers are “kind of all over the board,” leaving local clinics to figure out who covers it and who doesn’t.  

“The other barrier is a training gap. And, you know, a couple years ago, all the professional societies got together and put out some competencies for what providers of all types really need to be trained in order to address obesity and behavioral weight loss. But we still have a lot of work to do to make sure we have a trained workforce to do this,” Befort added.


By Adam Hochron