For obese people, losing just 5% of your body weight can make a huge difference to your health, especially if you can prevent it from gaining back.
Now, a new study of tens of thousands of obese patients shows the impact of different weight management treatments on achieving this goal.
People who receive any of these treatments, including nutritional counseling, medically supervised meal replacements, anti-obesity drugs, or bariatric surgery, are four times more likely to lose 5% or more of their body weight in just one year. There was almost one person. Depending on the treatment, it is almost certainly curable.
However, the study also suggests that most obese patients do not receive weight-related care from their regular healthcare providers. A research team at Michigan Medicine, an academic medical center at the University of Michigan, reported the following results: JAMA network open.
The research team hopes that the results of this study will inspire more primary care clinics, health systems, and insurance companies to increase the number of obese patients who receive support in choosing, starting, and continuing the treatment that is right for them. I hope it will increase. Members of the research team have spent the past several years building and testing a program that does just that for patients receiving primary care through UM Health.
Widely available treatments are underutilized
Effective weight management treatment does not necessarily require the use of GLP-1 drugs such as semaglutide and tirzepatide, which are often in short supply and not covered by insurance. In fact, this study included data from several years just before such drugs received FDA approval for treating obesity.
Rather, the study points to the power of providing patients with a wide range of evidence-backed options, from nutritional counseling and medications to meal replacements and bariatric surgery.
At both the individual and population level, taking any of these under the guidance of a health care provider can lead to weight loss of 5% or more in obese patients compared to doing it on their own. Studies have shown that it was much higher.
“These findings suggest that all weight management treatments are highly effective. The challenge is to help each individual patient find a treatment that works for them and is sustainable over time. to support,” said Dina Hafez Griauzde, MD, MSc. She is the new study's senior author and a board-certified obesity medicine specialist. She is an assistant professor of internal medicine at the UM Medical School and a primary care physician and co-director of the weight management program at the VA Ann Arbor Healthcare System.
The study's anonymous data were obtained from all obese patients who saw a primary care provider at any of UM's clinics in the five years prior to the COVID-19 pandemic. Only 5% of patients in this population with a BMI of 30 or higher received any of the weight management treatment options evaluated in 2017. That rose to about 7% in 2019.
Lead author Dr. James Henderson, a researcher in the Department of Internal Medicine who led the detailed statistical modeling and analysis of patient data, notes that the study focuses on populations as well as individuals.
The proportion of the study population eligible for a diagnosis of obesity increased over the study period. Without weight management treatment, obese patients in this population are equally likely to gain at least 5% of their baseline weight and achieve a weight loss of at least 5%, effectively 'offsetting' at the population level. ”
“Our model shows that even doubling the currently small proportion of patients receiving weight management treatment by their care team has the potential to upset the balance at the population level and counteract the overall trend in weight gain. That shows that there is,” Henderson said.
Learn more about the research
Of the approximately 54,000 obese patients who participated in the study, approximately 49,000 had no record of working with a UM provider to try the weight management therapies targeted in the study.
The research team matched data from each of the 5,090 patients who received weight management treatment from the UM team with data from patients who were similar in many respects, including BMI, but who did not receive such treatment at UM. did. They then tracked their weight changes over time.
The most common treatment was nutritional counseling, with 3,364 patients seeing a registered dietitian at least once. Only 189 patients had attended at least one meal replacement program, 520 had bariatric surgery, and 1,428 had taken any anti-obesity medication.
The drugs studied as a group in the study were orlistat (available as a generic drug or under the names Xenical and Alli), liraglutide (sold as Victoza or Saxenda), a combination drug containing naltrexone and bupropion (Contrave), or phentermine and topiramate (Qsymia). ), and GLP-1 drugs approved for diabetes management at the time of the study.
After one year, the researchers calculated that those who did not use WMT under the supervision of a UM provider had about a one-in-six chance of losing 5% or more of their body weight.
In contrast, people who receive nutritional counseling have a more than one in five chance of losing more than 5% of their nutrients. The odds of losing at least this much weight while taking anti-obesity drugs were slightly more than one in four.
If you were able to follow a medically prescribed alternative diet for a year (not an easy task for many people), you have a 1 in 2 chance of losing 5% of your weight. And those who choose bariatric surgery have a nine-in-ten chance of losing at least 5 percent of their body weight, and an eight-in-10 chance of losing at least 10 percent of their body weight.
Navigate weight management in a new way
Over the past two years, UM Health has ramped up broad efforts to enhance weight management care. It recognizes the complex nature of obesity, and research from UM and other leading centers shows that obesity is shaped by genetics, life experiences, dietary environments, physical and mental health conditions, and more. I am.
UM's primary care-based program is called the Weight Navigation Program. Griauzde serves as principal investigator and collaborates with endocrinologist Andrew Craftson, M.D., medical director. WNP addresses all aspects of weight management in collaboration with primary care physicians and other health care professionals who may not have time during routine visits or specialty training. process.
Patients in the program see a primary care physician board-certified in bariatric medicine to learn about and choose treatments tailored to their needs. The patient's progress is then tracked through ongoing support, including regular check-ins via text messages, and treatment plans are adjusted as needed if they are not responding to the initially selected treatment.
The program is supported by the Departments of Family Medicine and Internal Medicine, including General Internal Medicine, Metabolism, Endocrinology, and Diabetes, and the Elizabeth Weiser Caswell Diabetes Institute. In addition to working with individual patients, the program leverages data science to track its performance and is preparing to publish initial findings on its impact.
The program also partners with researchers across UM conducting weight-related research, including a diet and lifestyle study based in the School of Nursing and a two-year structured weight management program.
In addition to Henderson, Griausde, and Craftson, the new study's authors include Ann P. Ehlers, MD, MPH; Joyce M. Lee, MD, MPH. Kenneth Peel, BS; and Caroline R. Richardson, MD. Griauzde, Henderson, Ehlers, and Lee are members of the UM Institute for Health Policy Innovation, whose data and methods his team collaborated with researchers on his hub. Mr. Richardson is a former faculty member of family medicine, a member of IHPI, and currently at Brown University.
This research was funded by multiple grants (DK123416, DK092926, DK089503, DK020572, DK092926) from the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. This includes funding for the Michigan Diabetes Translational Research Center. Michigan Nutritional Obesity Research Center.
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Michigan Medicine – University of Michigan
