Primary care doctors serve as the initial point of contact for patients with conditions that are often exacerbated by obesity, such as diabetes, hypertension and cardiovascular disease.
However, there is growing concern that primary care doctors lack the necessary training and resources to effectively assist patients who have overweight or obesity. Without adequate training in obesity management, primary care doctors are less equipped to provide comprehensive care, potentially leading to suboptimal health outcomes and increased healthcare costs.
A collaborative research study Involving researchers from Michigan Medicine's departments of Family Medicine, Internal Medicine, and Endocrinology examined the perspectives of primary care physicians (PCPs) on the barriers and opportunities for effective obesity treatment in primary care settings. The paper, “Primary care providers’ perceived barriers to obesity treatment and opportunity for improvement: a mixed methods study” was published recently in PLOS ONE. Associate Professor Lauren Oshman, MD, MPH and Assistant Professor Amal Othman, MD, both of the Department of Family Medicine, are co-first authors of the paper
The study revealed that many PCPs do not utilize evidence-based guidelines when making decisions about obesity treatment. Rather, PCPs often provide general advice on diet and physical activity without specific treatments or follow up care. Surveyed doctors from Michigan Medicine reported that they needed more education on local obesity treatment resources; evidence-based dietary counseling strategies; effective self-help resources for their patients; enhanced team-based care with support from clinic staff; help from peers trained in obesity medicine; and access to dietitians.
The recent paper's findings add to knowledge about specific difficulties primary care physicians (PCPs) face when treating obesity and suggest potential solutions to these challenges. The authors highlight that many PCPs feel ill-equipped to provide effective weight loss guidance due to insufficient training. Since the field of obesity medicine is constantly evolving, proper training often requires specialized certification, which can be time-consuming and expensive—resources that many doctors lack.
Furthermore, insurance reimbursement rates for weight management care in primary care settings are inadequate. Primary care doctors also find it challenging to navigate the insurance and eligibility requirements for various weight management services offered within the health system, making it difficult to refer patients to appropriate resources.
“For patients to really benefit from a comprehensive, individualized plan, we need to have physicians who are knowledgeable about weight management care,” Oshman said. “I’m confident that that the different programs at Michigan Medicine can provide this individualized care, but we wanted to help physicians select the right program for the right patient.
This study informed the researchers’ efforts to develop and implement Michigan Medicine’s Weight Navigation Program (WNP). In 2018, Othman, Dina Griauzde, MD, assistant professor in the Department of Internal Medicine, and Andrew Kraftson, M.D., of Endocrinology at U-M, began looking at ways to get patients who have weight concerns better quality care.
“We have many programs in the system but part of the barriers to these resources are that some are cash-based, some insurance-based. This was very difficult for primary care physicians to remember,” Othman said.
The physician-level barriers study builds upon the results and insights gained from the WNP’s creation. By incorporating American Board of Obesity Medicine (ABOM)-certified physicians as ‘weight navigators,’ the program offers expert guidance to both providers and patients with obesity.
The success of the WNP is evident, with its presence expanding to five primary care clinics within Michigan Medicine, resulting in over 1,600 referrals and nearly 700 completed visits.
Additionally, the researchers have focused on training healthcare professionals, including medical resident physicians at Michigan Medicine, as well as advocating for insurance coverage of weight loss medications. They’ve also promoted awareness and understanding of obesity as a chronic condition. Their efforts are transforming the culture of comfort within primary care, allowing for open discussions and reduced stigma surrounding weight-related issues.
“WNP is starting to create a culture of comfort in primary care doctors to bring this subject up,” said Othman, who holds an ABOM certification and is the WNP’s medical director for the Department of Family Medicine. “The WNP has created an awareness about obesity.”
Through their multidisciplinary approach, the collaborative team behind the WNP is making a profound impact, one patient and one healthcare provider at a time. Othman and Oshman (who also is ABOM certified), along with WNP Research Director Griauzde, published a paper in 2022 that outlines details about the WNP’s establishment. Co-author of that paper and the more recent paper about physician barriers, Kraftson serves as WNP program director.
“The Weight Navigation Program is addressing provider-level barriers and system-level barriers to weight management care,” Griauzde said. “Even if doctors had the training in weight management and medicine, there is no time to practice it with patients. We had the idea, let’s embed the program in the primary care setting and provide the opportunity for weight-focused consultation visits.”
Offering concrete clinical solutions to PCPs, such as the Weight Navigation Program, can help eliminate some of the trickle-down effects of obesity like diabetes, hypertension or cardiovascular disease. This can have far-reaching, real-world consequences in improving population health.
“We’ve seen a significant increase in patients’ referrals to services like bariatric surgery and endocrinology’s very low-energy meal replacement program,” Griauzde said. “This model supports patients’ weight loss by connecting them with existing weight-loss treatment options, including health system, community, and pharmacotherapeutic resources. We also use population health management tools, such as a panel management dashboard, to proactively support patients along their weight management journey. ”
Oshman, L., Othman, A., Furst, W., Heisler, M., Kraftson, A., Zouani, Y., Hershey, C., Cho, T.-C., Guetterman, T., Piatt, G., &; Griauzde, D. H. (2023). Primary care providers’ perceived barriers to obesity treatment and opportunities for improvement: A mixed methods study. PLOS ONE, 18(4). https://doi.org/10.1371/journal.pone.0284474
Griauzde, D. H., Othman, A., Dallas, C., Oshman, L., Gabison, J., Markel, D. S., Richardson, C. R., Kullgren, J. T., Piatt, G., Heisler, M., Kilbourne, A. M., &; Kraftson, A. (2022). Developing weight navigation program to support personalized and effective obesity management in Primary Care Settings: Protocol for a Quality Improvement Program with an embedded single-arm pilot study. Primary Health Care Research & Development, 23. https://doi.org/10.1017/s1463423621000906