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Abstract

Background: Obesity affects 1 in 3 United States adults is associated with several chronic diseases. Disparities in obesity are seen in many vulnerable populations such as low-income groups, racial and ethnic minorities, and rural residents. Although primary care is often presented as a solution to the obesity crisis, management of obesity is complex and numerous challenges in helping patients achieve weight loss are still present. The U.S. Preventive Services Task Force recommended in 2018 that primary care providers screen for obesity and offer obese patients to intensive, multicomponent behavioral obesity treatment. However, there is little research involving primary care physicians or practices providing intensive behavioral counseling. Our study compares three independently created Federally Qualified Health Care (FQHC)-based weight loss clinical programs in order to further address gaps in medical knowledge around best practices for successful weight loss programming in the FQHC setting.

Methods: A retrospective chart review was conducted on a total 581 patients that were referred to any one of the three Center for Family Medicine FQHC clinics from August 2017 to August 2021. Patient demographics, weight change, percent weight change, medical history, weight loss medications, and several other variables were collected during the review. Comparisons between clinics was done using Fisher’s Exact test or Analysis of Variance. Logistic regression models were used to determine the association between clinically significant weight change and study variables.

Results: A majority of patients were female (83.4%), white (71%), and had private insurance (37%). Across all sites, approximately 34% of the patient population showed clinically significant weight loss during the study period. There was a significant difference in percent weight change among the weight loss clinics (p=0.0024). Regression models showed that patients from Clinic 3 were more likely to show clinically significant weight loss compared to Clinic 2 (OR 1.85, CI: 1.03-3.35; p=0.0406), and black patients were less likely to show clinically significant weight loss compared to white patients (OR 0.57, CI: 0.35-0.93; p=0.023).

Conclusion: This study highlights that despite a difference in composition of weight loss clinic, resources available, and patient populations, one in three patients were able to achieve clinically meaningful weight loss. Also, when there is intentionality and management, this study shows that other FQHCs can be successful in offering weight loss clinics, even when resources and staff are limited.

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