During a recent PW Podcast episode, we spoke with Christie Befort, MD, Associate Director of Cancer Prevention and Control at the University of Kansas Cancer Center, and lead author of a study that assessed diff erent models of care delivery for rural patients with obesity. Following is a summary of that interview:
What did your study entail?
We assessed the integration of obesity treatment into clinical practice with a specifi c focus on rural communities to bridge the gap in access to evidence-based weight loss interventions and try to decrease the disparity in obesity across rural and urban communities. For the study, 36 clinics were randomized to one of three care delivery approaches, with local clinicians often delivering the intervention in two of the three arms and only excluding patients with major compounds, like pregnancy, bariatric surgery, or serious medical conditions that may be contraindicated by weight loss. Clinic group visits was one of our alternatives to the traditional individual offi ce visit approach, and phone group visits was the other alternative.
At 2 years, the in-clinic group visits resulted in signifi cantly greater weight loss than in-clinic individual offi ce visits, with a diff erence of almost 2 kg. e phone group visits had a statistically signifi cant diff erence in weight loss compared with in-clinic individual visits at 6 and 18 months, but by 24 months, the diff erence was no longer signifi cant. Our fi ndings highlight the benefi ts of group visits and the additional benefi ts of having local clinicians involved in that care.
Prior studies have also shown that group treatment tends to produce greater weight loss, even among individuals who say they prefer individual care, and we think it has to do with the accountability, support, and additional learning and problem solving people get from interacting with others who are going through something very similar.
The next step is to try to determine how to make group visits more sustainable in small, rural clinical practices. With COVID, the capacity of homebased telemedicine has expanded tremendously, so a group approach over telemedicine that still involves the local physician is an obvious next step. I try to emphasize to clinicians the importance of treating obesity as a medical condition in your practice. We’ve had a lot of patient advocacy and patient involvement in our research, and we hear over and over again that patients with obesity need encouragement, support, and optimism, but they especially want to go to their doctor and discuss the health implications of their weight. Even though it can be not the most pleasant topic to discuss, they do want to discuss it by and large, especially if they’re off ered an actual treatment plan or a referral that gives them something that they can then act on with some hope. And in rural communities, I think this is even more important, because there is a lack of alternatives like commercial programs.
