Background

Obesity is a complex, multifactorial disease leading to increased morbidity and mortality. Evidence-based interventions for obesity are often costly and unresponsive to individual needs. We provide rationale and proof-of-concept for a stepped care shared decision-making approach, which tailors treatment to each patient's specific needs.

Methods

Family medicine patients complete an 11-item measure assessing diet, physical activity, and motivations for and barriers to health behavior change. Eligible patients (Age >=18; BMI >=25) are screened for interest and meet with a patient navigator via telehealth to develop a comprehensive treatment plan using shared decision-making tools. Levels of care include: educational resources; enrollment in an mHealth platform, Noom; behavior coaching; prescription medications; and, when indicated, bariatric surgery. Weight and waist circumference are assessed weekly. Non-responders are offered additional care from above listed treatment options.

Results

Of 177 patients screened, 85 were eligible (M BMI=31.89+-6.05). To date, 8/85 are enrolled, while 76 are being scheduled for their navigation visit. All enrolled participants completed baseline measures of psychosocial functioning, and 67% completed >=1 weekly report of weight and waist circumference. Average length of participation has been 6.88+-0.06 weeks, with an average weight loss of 3.35+-2.46 lbs. Participants engaged with Noom completed logs of weekly activities (M=53.12+-24.50), food (M=25.68+-8.33), and exercises (M=3.44+-3.03).

Conclusions

Pilot data suggest that our stepped care program is feasible and acceptable, justifying additional data collection. The stepped care program may serve as an effective pathway for weight loss and increase access to evidence-based interventions, including medically assisted care and bariatric surgery.