Search

Presenters Leonard Finn, MD, Jacqueline Kiel, Tarin Clay, BA, Elisabeth Callen, PhD, Lauren Kiel, Elizabeth Staton, [...], Context: Metabolic syndrome, includes elevated fasting glucose, high triglycerides, hypertension, low HDL & abdominal obesity, affects 35% of adults in the United States. People with metabolic syndrome are at high risk for diabetes and cardiovascular disease and have higher all-cause mortality. Usual treatment for metabolic syndrome is weight loss through diet and exercise. Evidence supports the use of mindfulness as a strategy for effective weight management. Objective: Are group visits for mindful eating and healthy nutrition education feasible and acceptable across different primary care settings for patients, staff and clinicians? Study design: Pilot/feasibility study. Setting: Needham Wellesley Family Medicine PC, a physician-owned family medicine practice in Wellesley, MA and UC Health Integrative Medicine Center in Denver, CO. Population Studied: 3 primary care clinicians (1 in MA, 2 in CO), 3 mindfulness teachers (1 RN in MA, 2 clinical psychologists in CO); 15 patients 18+ years with obesity/overweight and metabolic syndrome or diabetes, cardiovascular disease, hypertension. actively enrolled in MA; able to consent, understand procedures; Patient exclusions: lack cognitive capacity, unable/unwilling to consent or complete study. Intervention: Group visits with mindful eating, healthy nutrition for adults with metabolic syndrome and related conditions. Curriculum: evidence-based principles of mindful eating, healthy nutrition, and activity to improve management of metabolic syndrome and related conditions. The curriculum seeks to foster sustainable lifestyle change related to eating behaviors, nutrition choices, activity, self-efficacy, goal setting. Physician, mindfulness teacher, patients meet for 13 weekly group visits during 3 months. Outcome measures: survey questions, semi-structured interviews for physicians and mindfulness teachers. feasibility & acceptability to clinicians learning and leading the curriculum. Results: Clinicians report: (5=best) helped patients acquire new skills 4.8/5; clinicians enjoyed leading the program 4.2/5; time to explore difficult issues more deeply, curriculum was very interesting. Challenges: learning complex curriculum, charting medical records for a group of patients; staffing/scheduling/locating group visits. Conclusions: Mindful eating healthy nutrition group visits are feasible. Clinicians report acceptability for leading group visits to enhance healthier eating & lifestyle change.

Presenters Jodi Summers Holtrop, PhD, MCHES, Erik Kramer, DO, MPH, Mark Gritz, Krithika Suresh, PhD, Leigh Perreault, MD, L. Miriam Dickinson, PhD, Lauren Tolle, PhD, Johnny Williams, MPH, Peter Smith, [...], CONTEXT: Despite the fact that obesity is both treatable and preventable, treating the comorbidities, rather than obesity per se remains the mainstay of therapy. OBJECTIVE: To evaluate the efficacy and implementation of a pragmatic approach to weight management in primary care that prioritizes treatment of weight rather than weight-related diseases (PATHWEIGH). STUDY DESIGN AND ANALYSIS: PATHWEIGH is a hybrid type 1 cluster randomized stepped wedge clinical trial. Clinics were enrolled and randomized to three sequences using covariate constrained randomization. Descriptive statistics were used to summarize clinic and patient characteristics with t-tests, Wilcoxon rank sums or Fisher's exact tests used to compare groups. SETTING: Fifty-seven primary care clinics in rural, suburban and urban Colorado in a single healthcare system were utilized. POPULATION STUDIED: Patients age >18 years and body mass index (BMI) >25 kg/m2 who had a weight-prioritized visit (WPV) in the prior year were enrolled. A WPV was defined as a chief complaint or reason for visit that included "weight", ICD-10 codes for weight or use of an intake questionnaire for weight. INTERVENTION: None. This abstract describes the baseline (pre-intervention) characteristics of the clinics and patients treated with standard-of-care (SOC) for weight management. OUTCOME MEASURES: Baseline characteristics of the clinics and patients undergoing a WPV from March 17, 2020-March 16, 2021. RESULTS: 20,410 patients met these eligibility requirements representing 12% of patients >18 years and body mass index (BMI) >25 kg/m2 seen at the clinic during this baseline period. The three randomization sequences of 20, 18, and 19 sites were similar with an overall median age of 53 years (IQR: 39- 65), 58% women, 76% non-Hispanic whites, 64% commercial insurance, and median BMI of 36 kg/m2 (IQR: 32-41). No sequence differences were seen for vital signs, relevant laboratory values, or numbers of comorbidities or medications that cause weight loss or weight gain. Referral for anything weight-related was low (18 years and body mass index (BMI) >25 kg/m2 seen in the 57 primary care clinics, 12% had a weight prioritized visit during the baseline period. Despite most being commercially insured, referral to any weight-related service or prescription of anti-obesity medication was uncommon.