{"id":29081,"date":"2020-02-07T11:50:34","date_gmt":"2020-02-07T18:50:34","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=29081"},"modified":"2023-03-03T09:58:15","modified_gmt":"2023-03-03T16:58:15","slug":"weight-management-program-primary-care","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/weight-management-program-primary-care\/","title":{"rendered":"In a first, primary care doctors incorporate weight management program into patient health care plans; see positive results."},"content":{"rendered":"
<\/div>
\"woman
Her weight loss, made possible by a primary care weight management program, has changed Blank\u2019s outlook on life. (Photos by Cyrus McCrimmon for UCHealth)<\/figcaption><\/figure>\n

Crystal Blank had tried all sorts of diets and was well familiar with spending more money on various shakes and supplements than she did on the food she ate. She worked hard at the gym twice a day. She lost 20 pounds more than once. She always gained it back.<\/p>\n

In March 2018, she and the family \u2013 husband, Jonathan, and their four kids ranging in age from 9 to 16 \u2013 took a break from home life in Brighton to spend a few days in Laguna Beach, California. Jonathan snapped a cell-phone photo of Crystal and her two daughters at the beach and posted it on Facebook. \u201cYou\u2019re never in pictures with the kids,\u201d he told her.<\/p>\n

Despite being down 20 pounds at the time, Blank was mortified. \u201cI didn\u2019t realize how huge I was,\u201d she recalled. She insisted that Jonathan pull the photo and resolved to take a drastic step to get her weight under control.<\/p>\n

At UCHealth Family Medicine \u2013 Westminster<\/a>, she sat down with Dr. Julie Paranka<\/a>, her primary care physician. Blank was in tears. She told Paranka about all the dieting and exercise and how none of it seemed to stick. She wanted to have bariatric surgery<\/a>, which reduces the size of the stomach and routinely brings sustained weight loss of 100 pounds or more.<\/p>\n

Paranka listened, then told her, \u201cDr. Perreault has a program that might work for you.\u201d<\/p>\n

Obesity as diagnosis<\/strong><\/h2>\n

Dr. Leigh Perreault<\/a> is a UCHealth and University of Colorado School of Medicine endocrinologist based at the UCHealth Family Medicine \u2013 Westminster clinic. The program was called Pathweigh. It was a pilot study Perreault had designed to see if integrating weight loss into primary care could help patients not only lose weight but also address the various health problems that can accompany obesity.<\/p>\n

\"Women
Crystal Blank with family. From left, Joslyn, 11; Aidan, 15; husband Jonathan; and Tristan, 17. Daughter Myranda, 18, was off at college. (Photo by Cyrus McCrimmon for UCHealth)<\/figcaption><\/figure>\n

\u201cThe bias in our society and the medical profession is that obesity is something people should be able to control on their own,\u201d Perreault said. \u201cIt\u2019s crazy that it\u2019s entrenched in our thinking.\u201d<\/p>\n

Perreault felt that the status quo of treating often-serious health problems related to obesity in primary care \u2013 type 2 diabetes, sleep apnea, cellulitis, hypertension, osteoarthritis, liver problems, depression, reproductive issues, the list goes on \u2013 was failing patients.<\/p>\n

With Pathweigh, Perreault said, \u201cWe\u2019re doing something that no one has done before, which is prioritizing weight in the clinic, as opposed to everything else.\u201d<\/p>\n

She persuaded UCHealth\u2019s Epic electronic health record team to create a Pathweigh tool in Epic that involved adding \u201cobesity\u201d and \u201cweight management\u201d as diagnoses as well as several questions to ask of patients who receive such diagnoses. She then set up a study that would involve herself and Dr. Erik Kramer<\/a> treating the Pathweigh group in Westminster and two doctors at UCHealth Internal Medicine \u2013 Lowry<\/a> who would serve patients in the control group. On Jan. 1, 2018, the 18-month pilot study launched. It was rolling along when Crystal Blank sat down with Perreault that spring.<\/p>\n

Blank brought up bariatric surgery. Perreault told her she wasn\u2019t a candidate \u2013 she wasn\u2019t heavy enough for it. Blank started to cry. \u201cBut I can help you,\u201d Perreault said. \u201cI want you to be healthy and happy and the best version of you. And this isn\u2019t the best version of you. So let\u2019s get you there.\u201d<\/p>\n

A weight management program within primary care<\/strong><\/h2>\n
\"profile
Dr. Leigh Perreault and colleague Dr. Erik Kramer started Pathweigh to bring weight loss into primary care.<\/figcaption><\/figure>\n

Blank joined the study\u2019s Pathweigh group. Perreault reviewed Blank\u2019s bloodwork and asked questions about her history of weight gain and loss (someone who gains weight after childrearing \u2013 as had been the case with Blank \u2013 may respond to different treatments than someone who has been obese since childhood, for example) and how her weight affected quality of life. She screened Blank for binge eating, depression, anxiety, and attention deficit disorder. She also asked Blank if she had weight-related health issues, which she didn\u2019t. Then she asked her what her target weight might be.<\/p>\n

\u201cI want to get back to when I felt my healthiest,\u201d Blank told her. If I can get to a size 12, that\u2019s where I felt happy.\u201d<\/p>\n

She was wearing a size 24 as she spoke. Blank added that, when she got to a 12, she\u2019d splurge on a good photographer for family portraits.<\/p>\n

Perreault prescribed Blank two obesity medications \u2013 appetite suppressants phentermine and topiramate \u2013 and told her that she might think of them as statins: once you\u2019re on them, you stay on them. There were no concrete dietary limitations besides the common-sense suggestions to control portions and avoid junk food, soft drinks, and sugar fixes. Blank was already exercising plenty. Perreault and Blank met to monitor progress every three months at first, and later, every six months,<\/p>\n

As Blank\u2019s clothing, as she put it, \u201cstarted getting bigger,\u201d she put money away to pay a photographer. When her kids hugged her, they said things like \u201cit\u2019s so weird to hug you, mom \u2013 we can put your arms around you now!\u201d By the summer of 2019, Blank was back in a size 12. It rained the summer day the photographer came; she smiled right through it. Jonathan was more than welcome to post the winning shots on Facebook.<\/p>\n

Striking results<\/strong><\/h2>\n

For lunch at Panera in early January 2019, Blank ordered half a Caesar salad with an apple for a side. She was in a size 9-10 now. She ate about half the salad and saved the apple for an afternoon snack at the Westminster memory care facility where she runs the human resources department. The medicine helps her recognize when she\u2019s full, and she just stops eating, she explained.<\/p>\n

\u201cBefore, I could eat as much as my husband,\u201d she said.<\/p>\n

Blank didn\u2019t actually know how much weight she\u2019d lost \u2013 she doesn\u2019t own a scale. Perreault says it was around 100 pounds. While her results have been extraordinary, many in the Pathway group lost 30, 40, 50 pounds or more and kept it off, Perreault says. Among the 109 Pathway patients, the average weight loss was 17.4 pounds \u2013 as compared to 5.3 pounds among the control group at the UCHealth Lowry clinic.<\/p>\n

\"woman
Crystal Blank went from a size 24 to a size 12 \u2013 and lower yet \u2013 on UCHealth\u2019s new Pathweigh program, a weight management program in primary care. (Photo by Cyrus McCrimmon for UCHealth)<\/figcaption><\/figure>\n

The numbers tell only part of the story. The Pathweigh pilot study showed that working on an ongoing basis with a primary care doctor (as well as onsite resources such as behavioral health specialists) and harnessing the power of an electronic medical record can bring sustained weight loss and the mental and physical health benefits that come with it.<\/p>\n

\u201cI didn\u2019t feel good about myself. I didn\u2019t want to shop. I didn\u2019t want to do anything,\u201d Blank said. \u201cNow I want to look good, and I feel good, and I want to wear chic clothes.\u201d<\/p>\n

She\u2019s also more active \u2013 and not just \u201ckilling myself trying to lose weight,\u201d as she put it, at the gym.<\/p>\n

\u201cI feel like I\u2019m more active in a different way. I\u2019ve always loved hiking and being outdoors. But I didn\u2019t want to get into activewear at all. And I would overheat, and that wasn\u2019t a good thing,\u201d Blank said. \u201cI like being outdoors a lot more, doing stuff with the kids, shooting hoops outdoors with the boys.\u201d<\/p>\n

The Pathweigh pilot\u2019s results are awaiting publication in the journal Obesity<\/em>. UCHealth has already seen enough: it has trademarked PATHWEIGH and is rolling the program out to all 54 of its primary care clinics over the next five years. Perreault hopes that other health systems start using it too. Hundreds of UCHealth Family Medicine \u2013 Westminster patients have joined the voluntary program, she says. She and colleagues see about 10% of them for bariatric surgery; about 80% are prescribed medication.\"graphic<\/p>\n

\u201cNot everybody has to have surgery to lose a lot of weight. People need the right medicine, the right coaching, and an ongoing relationship with a person who\u2019s going to be their mentor, coach, and someone who can help them deal with speed bumps along the way \u2013 because it\u2019s a journey,\u201d Perreault said.<\/p>\n

Over time, Perreault expects trends that emerge in anonymized data from Pathweigh\u2019s past to feed back into the clinic and help doctors see what medicines and approaches seem to work best with different sorts of future patients. For Blank, Perreault seems to have gotten it right already.<\/p>\n

\u201cThis definitely works,\u201d Blank said. And it\u2019s about more than pounds lost or sizes shrunk: \u201cI think people don\u2019t realize that, if you get your weight under control, a lot of the things that you\u2019re feeling will start to go away. Your body just starts to feel good and everything starts to work right again.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

Crystal Blank had tried all sorts of diets and was well familiar with spending more money on various shakes and supplements than she did on the food she ate. She worked hard at the gym twice a day. She lost 20 pounds more than once. She always gained it back. In March 2018, she and […]<\/p>\n","protected":false},"author":23,"featured_media":29087,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[351,551],"class_list":["post-29081","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-primary-care","tag-weight-and-metabolism"],"acf":[],"yoast_head":"\nPrimary care weight management program gets results - UCHealth Today<\/title>\n<meta name=\"description\" content=\"Integrating weight management program into primary care helps patients lose weight and address health problems accompanying obesity.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/weight-management-program-primary-care\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"In a first, primary care doctors incorporate weight management program into patient health care plans; 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