(Management Case Study) Implementation of an Interdisciplinary Weight Management Clinic Embedded in a Family Medicine Clinic

Purpose: The potential for improved disease state control with comprehensive interdisciplinary care has been well documented within literature. However, information on applying this approach to weight management remains limited. Data also indicates few individuals with obesity receive recommendations on care specific to weight loss, and there are clear barriers including health care bias, gaps in provider comfort with obesity medicine, and insurance cost/coverage limitations. The objective of our program was to implement a novel interdisciplinary clinic in the primary care setting to help decrease barriers and perceptions of receiving obesity care.

Methods: Our clinic was first piloted in September 2020. Patient are referred internally from providers in our practice, and the pharmacist is able to prescribe under a collaborative practice agreement. Our core care team includes: 1 pharmacist, 1 behavioralist, 2 physicians, 1 movement specialist, and 1 dietitian. Medical and pharmacy residents rotate through the clinic as part of their clinician education. Appointments range from 40-60 minutes, meeting individually with the behavioralist and pharmacist. The intent is for individuals to meet with the team for 6 appointments for the initial session with 4-6 weeks between appointments. "Maintenance" visits can be scheduled as needed at 3-6 month intervals. Appointments are asynchronous with the dietitian and movement specialist and based on the needs of the patient. We have also collaborated with a local food pantry if a patient is determined to have food insecurity as well as an eating disorder clinic (Hull Institute) if a new diagnosis like binge eating is established. Finally, we have also collaborated with our on-site pharmacy, utilizing pharmacy technicians to help initiate prior authorizations and the pharmacy team to help with drug shortage supply issues and patient education.

Results: From pilot launch (Sept 2020) to December 2023, 116 patients have been referred and attended at least one session with the weight management clinic. Fifty two of these patients were seen in 2023, 38 of which were new patients. Based on retrospective review, patients who followed with weight management clinic lost an average of 8.6 lbs (3.6% total weight loss from baseline) at 6 months (n=93) and 10.8 lbs (4.2% total weight loss from baseline) at 12 months (n=93). This weight loss data improved if patients attended at least 3 appointments with weight management [11.8 lb weight loss average at 6 months and 17.4 lb weight loss at 12 months (n=52)]. Twenty four patients lost at least 25 lbs; one patient lost 86 lbs at 12 months!

Conclusion: Embedding an interdisciplinary weight management program into a family medicine clinic is an effective method to provide obesity care; obesity medicine is frequently overlooked in healthcare. Pharmacists are in an ideal position to help with care coordination, and a team approach can provide significant benefits for weight loss.