Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial

Authors

Leigh Perreault, Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA. Leigh.perreault@CUAnschutz.edu.
Qing Pan, Department of Biostatistics and Bioinformatics, Milken School of Public Health, George Washington University, Washington DC, USA.
Carlos Rodriguez, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
R Mark Gritz, Division of Health Care Policy and Research, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Peter C. Smith, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
E Seth Kramer, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Lauren Tolle, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Lauri Connelly, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Caroline Tietbohl, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Johnny Williams, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Jodi Summers Holtrop, Department of Family Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.

Document Type

Journal Article

Publication Date

12-11-2025

Journal

Nature medicine

DOI

10.1038/s41591-025-04051-5

Abstract

Scalable, pragmatic approaches to obesity implemented in primary care have the potential to curtail population weight gain. In a stepped-wedge cluster-randomized pragmatic trial in the state of Colorado, USA, 56 primary care clinics were randomly assigned to three clusters with staggered start dates for a one-way crossover from usual care to the intervention phase. The intervention (PATHWEIGH) included three components: (1) health system primary care leadership endorsement; (2) an electronic health record-driven care process designed to prioritize, facilitate and expedite weight management; and (3) implementation strategies to support use of the care process and educate clinicians on obesity treatment. The coprimary outcomes were average patient weight loss at 6 months and weight loss maintenance from 6 months to 18 months. In total, 274,182 adults with a body mass index ≥25 kg m had at least 2 measured weights in one of the clinics between March 2020 and March 2024. A counterfactual analysis comparing differences in weight between the intervention and usual care suggests that PATHWEIGH decreased average weight by 0.29 kg (95% confidence interval (CI): 0.27 kg, 0.32 kg) from the first weight to 6 months later (P < 0.001) and 0.28 kg (95% CI: 0.26 kg, 0.31 kg) from 6 months to 18 months (P < 0.001) for a total difference of 0.58 kg (95% CI: 0.54 kg, 0.61 kg; P < 0.001). PATHWEIGH increased the likelihood of receiving weight-related care during the intervention (OR = 1.23; 95% CI 1.16, 1.31; P < 0.001). The intervention was associated with greater weight loss for those receiving weight-related care (adjusted difference of 2.36 kg over 18 months; 95% CI: 2.31 kg, 2.42 kg, P < 0.001), and weight gain was mitigated in the intervention even when patients did not receive weight-related care (adjusted difference of 0.32 kg over 18 months, 95% CI: 0.30 kg, 0.35 kg; P < 0.001). Thus, PATHWEIGH is a pragmatic, scalable approach showing favorable impact on population weight. ClinicalTrials.gov registration: NCT04678752 .

APA Citation

Perreault, Leigh; Pan, Qing; Rodriguez, Carlos; Gritz, R Mark; Smith, Peter C.; Kramer, E Seth; Tolle, Lauren; Connelly, Lauri; Tietbohl, Caroline; Williams, Johnny; and Holtrop, Jodi Summers, "Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial" (2025). GW Authored Works. Paper 8416.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/8416

Department

Biostatistics and Bioinformatics