Methods
A novel weight management program was established in a University-based primary care practice in 2018. The practice includes a group of 47 primary care providers who were encouraged to refer patients to this program. Patients age above 18 and BMI more than 30 kg/m2 were referred to the program. This program was managed by a primary care physician who is board-certified in obesity medicine. The program was scheduled for one specific day every week and patients were scheduled for 40 minutes for the initial consultation. During this initial visit, patients had a detailed history, physical examination, and body composition assessment with InBody 270® scale and necessary laboratory tests like Hemoglobin A1c, Basic metabolic panel, Thyroid Stimulating Hormone. At the end of this visit, the physician provided them with individualized meal plans, food journal app education, exercise ideas, and strategies to control cravings. An individualized treatment plan was outlined based on the four pillars of obesity management namely Nutrition, Physical activity, Behavioral therapy and Pharmacotherapy. Patients were given a follow up in 4-8 weeks for a subsequent visit. Follow up visits were scheduled for 20 minutes. During these follow up visits, patients were reassessed on a body composition scale and goals were discussed. Counselling was provided based on the need. The reported comorbidities included pre-diabetes, diabetes, hypertension, hyperlipidemia, cardiovascular disease, sleep apnea, osteoarthritis, malignancy, depression, and polycystic ovarian syndrome. Pharmacotherapy of obesity included metformin, phentermine, topiramate, bupropion, naltrexone, and GLP-1 agonists.
Weight loss interventions included motivational interviewing, dietary and exercise counseling, behavioral training. Treatment was escalated with pharmacotherapy to treat obesity when appropriate.