Weight Loss Treatment and Longitudinal Weight Change Among Primary Care Patients With Obesity.
JAMA Netw Open
; 7(2): e2356183, 2024 Feb 05.
Article
en En
| MEDLINE
| ID: mdl-38358738
ABSTRACT
Importance Among individuals with obesity, 5% or greater weight loss can improve health. Weight management treatments (WMT) include nutrition counseling, very low-calorie meal replacement (MR), antiobesity medications (AOM), and bariatric surgery; however, little is known about how these WMT are associated with weight change among individual patients and populations. Objective:
To characterize weight status and WMT use among primary care patients and assess associations between WMT and weight trajectories. Design, Setting, andParticipants:
Retrospective, population-based cohort study of primary care patients from 1 academic health system in Michigan between October 2015 and March 2020 using cross-sectional analysis to compare obesity prevalence and WMT utilization. For patients with obesity and WMT exposure or matched controls, a multistate Markov model assessing associations between WMT and longitudinal weight status trajectories was used. Data were analyzed from October 2021 to October 2023. Exposures Cross-sectional exposure was year 2017 or 2019. Trajectory analysis exposures were WMT nutrition counseling, MR, AOM, and bariatric surgery. Main Outcomes andMeasures:
Cross-sectional analysis compared mean body mass index (BMI), obesity prevalence, and, among patients with obesity, prospective WMT use. The trajectory analysis examined longitudinal weight status using thresholds of ±5% and 10% of baseline weight with primary outcomes being the 1-year probabilities of 5% or greater weight loss for each WMT.Results:
Adult patients (146â¯959 participants) consisted of 83â¯636 female participants (56.9%); 8940 (6.1%) were Asian, 14â¯560 (9.9%) were Black, and 116â¯664 (79.4%) were White. Patients had a mean (SD) age of 49.6 (17.7) years and mean (SD) BMI of 29.2 (7.2). Among 138â¯682 patients, prevalence of obesity increased from 39.2% in 2017 to 40.7% in 2019; WMT use among patients with obesity increased from 5.3% to 7.1% (difference 1.7%; 95% CI, 1.3%-2.2%). In a multistate model (10â¯180 patients; 33â¯549 patient-years), the 1-year probability of 5% or greater weight loss without WMT exposure was 15.6% (95% CI, 14.3%-16.5%) at reference covariates. In contrast, the probability of 5% or greater weight loss was more likely with year-long exposures to any WMT (nutrition counseling 23.1%; 95% CI, 21.3%-25.1%; MR 54.6%; 95% CI, 46.5%-61.2%; AOM 27.8%; 95% CI, 25.0%-30.5%; bariatric surgery 93.0%; 95% CI, 89.7%-95.0%). Conclusions and Relevance In this cohort study of primary-care patients with obesity, all WMT increased the patient-level probability of achieving 5% or greater weight loss, but current rates of utilization are low and insufficient to reduce weight at the population level.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Fármacos Antiobesidad
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Trayectoria del Peso Corporal
Tipo de estudio:
Etiology_studies
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Incidence_studies
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Observational_studies
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Prevalence_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Adult
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Female
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Humans
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Middle aged
Idioma:
En
Revista:
JAMA Netw Open
Año:
2024
Tipo del documento:
Article