Developing a Weight Management and Metabolic Health Program to support patient-centred, effective, and efficient...

Veterans Affairs Medical Centers offer multiple weight-loss treatments, including a comprehensive lifestyle intervention program (i.e., MOVE!), anti-obesity medications (AOMs) and bariatric surgery. Yet, most eligible veterans do not receive these treatments.

To describe the design, rationale, and planned evaluation of a comprehensive Weight Management and Metabolic Health program (WMMHP), consisting of (1) weight-focused visits with physicians or pharmacists trained in obesity medicine; (2) patient-centered use of available weight-loss treatments; and (3) coordinated, team-based care.

This is a quality improvement program implemented within the VA Ann Arbor Healthcare System. WMMHP eligibility criteria include body mass index (BMI) ≥ 30 kg/m² or BMI ≥ 27 kg/m² and ≥ 1 weight-related condition and participation in the MOVE! program. We plan to conduct an 18-month retrospective program evaluation using a propensity-matched cohort analysis to estimate the added benefit of WMMHP vs. MOVE! alone. The primary outcome will be mean change in weight at 18 months after baseline. Secondary outcomes will include mean weight loss at 6, 12, and 24 months, percentage of patients achieving thresholds of ≥ 5%, ≥ 10%, and ≥ 15% weight loss, initial prescriptions for and refilled prescriptions as a measure of adherence to AOMs, and referrals to, engagement with, and completion of bariatric surgery. We will also examine between-group differences in health system resource utilization.

The WMMHP is an innovative approach to improving treatment and outcomes for veterans with overweight and obesity. If effective, its components may inform obesity care delivery in VA and non-VA settings.