Project Summary
Obesity has been steadily increasing in prevalence and now affects more than 4 in 10 U.S. adults, leading to
many adverse health outcomes including myocardial infarction, stroke, type 2 diabetes (T2DM), hypertension,
sleep apnea, arthritis, and others. Effective surgical, pharmaceutical, and behavioral treatments for obesity are
available, and the evidence to support the broad use of these treatments for obesity is very well established.
However, active management of obesity defined as prescribing or referring adults with obesity for lifestyle,
pharmaceutical, or surgical treatment of obesity, is greatly underused. Major underlying reasons for
underutilization of effective obesity treatments include: (a) both patients and primary care clinicians (PCCs)
frequently underestimate the effectiveness and potential benefits of obesity treatments; and (b) both patients
and clinicians typically lack access to evidence-based, patient-specific estimates of the potential benefits and
risks of appropriate patient-specific obesity treatment options.
To address this problem, we integrate externally validated prediction equations that estimate benefits and risk
of various obesity treatment options in adults with T2DM into a widely-used and successful clinical decision
support system in order to deliver appropriate patient-specific obesity treatment suggestions at the point of
care. We implement a scalable, web-based point-of-care decision-support intervention in a randomized trial in
40 primary care clinics with 15,814 eligible patients, and assess intervention impact on the following primary
outcomes: (a) appropriate referral of eligible patients for evaluation for metabolic bariatric surgery (MBS); (b)
appropriate initiation of FDA-approved medications for weight loss; (c) weight trajectories; and (d) patient-
reported conversations with their PCC about weight loss and intentions to engage in weight loss. In addition,
we collect and analyze clinician-reported and patient-reported data to identify factors that may impede or
facilitate broad dissemination of this intervention strategy to other care delivery settings.
This innovative project will (a) provide state-of-the-art scientific evidence on obesity treatment to large numbers
of obese American adults with T2DM and their PCCs at the point of care; (b) help PCCs identify appropriate
patient-specific obesity treatment options; (c) implement in primary care a web-based EHR-linked obesity
treatment clinical decision support model that uses state-of-the-art HIT standards, is broadly scalable, easy to
update as evidence changes, and optimized for clear communication of information to patients and PCCs; and
(d) improve the clinical return on ongoing massive private and public investments in outpatient health
information systems.
