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Multimodal Interventions for Obesity

CE / CME

Incorporating Multimodal Interventions to Improve Obesity Care

Physician Assistants/Physician Associates: 0.50 AAPA Category 1 CME credit

Nurses: 0.50 Nursing contact hour

Physicians: maximum of 0.50 AMA PRA Category 1 Credit™

Pharmacists: 0.50 contact hour (0.05 CEUs)

Released: November 29, 2023

Expiration: November 28, 2024

CME/CE Information

Activity

Progress
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Course Completed

Background

In 2023, Clinical Care Options launched a national obesity QI program called “Obesity Change Makers,” and more than 20 practices joined this initiative and worked to improve obesity care for their patients. One of the practices aimed to increase the use of multimodal interventions when treating patients with obesity. 

Discussing Obesity Care With Patients

Feirtag and Ramos PA is an internal medicine practice in Baltimore, Maryland. After performing a baseline assessment and evaluating how they are providing obesity care, the team began implementing interventions to engage patients in more effective discussions about weight loss and leverage multimodal therapies. Their first step was to equip healthcare professionals (HCPs) with the skills and knowledge to feel more comfortable introducing the topic of obesity and educating patients about lifestyle modifications and weight loss interventions. Before participating in this initiative, some HCPs were not being proactive about speaking with patients about obesity interventions. By participating in the education program, they gained the knowledge and confidence to incorporate motivational interviewing skills and speak confidently with patients about obesity care recommendations. 

The practice also developed patient education handouts to promote physical activity, provide examples of healthy eating tips, and explain how antiobesity medications may be used. In addition, the practice evaluated how they would use patient education materials from organizations such as the Obesity Society, Obesity Action Coalition, and other organizations. 

Setting Realistic Goals

When discussing obesity care with patients, HCPs speak about the importance of setting specific and realistic goals. For example, all patients are encouraged to increase their physical activity based on their willingness and ability to make changes in their daily routines. Patients also are reminded to set specific goals and to recognize that small steps eventually can lead to long-term changes. A simple step might be to use a portion size cheat sheet at every meal. Once this becomes a habit, patients may find it easier to limit their portion sizes. Through coaching and motivational interviewing, HCPs have seen patients gaining confidence in their abilities to make incremental lifestyle modifications and increase physical activity, eat healthier, and lose weight. 

Multimodal Obesity Care

The practice also has been referring some patients to commercial weight loss programs in the area. This has been especially useful for patients who are eager to try something new and desire more structured multimodal interventions. One of the local programs includes access to a registered dietitian, an exercise specialist, and a mental health professional. The program is covered by health insurance, and patients gain access to a fitness center, so this gives them something new to try. In addition to the intensive lifestyle modifications, appropriate patients are started on antiobesity medications. 

When HCPs explain how antiobesity medications may be used, they review how dosing titration may help prevent certain adverse events. The clinic has seen that most patients who start antiobesity medications are eager to return for follow-up visits so dosing can be adjusted for optimal efficacy. Patients are reminded that lifestyle modifications also are required to sustain weight loss and promote healthy living. 

Obesity care needs to be personalized because patients respond differently to treatment recommendations, and some do not have access to certain therapies. Access to antiobesity medications remains an ongoing challenge for some patients based on their insurance coverage. Despite these challenges, the HCPs at the clinic aim to provide patient-centered treatment by developing comprehensive, personalized obesity care plans that include:

  • Nutrition interventions
  • Physical activity interventions
  • Behavioral interventions
  • Pharmacologic treatments (when appropriate)
  • Surgical treatments (when appropriate)

Several members of the same family may receive obesity care at the practice, but HCPs work to ensure that each care plan is personalized based on patients’ goals, preferences, comorbidities, and other factors. 

Future Direction

Through this QI program, HCPs at the practice have been equipped and empowered to develop personalized obesity care plans and follow patients closely. Leveraging local resources such as lifestyle modification programs, HCPs feel equipped to customize treatment plans and incorporate multimodal interventions. The practice hopes that access to antiobesity medications will improve in the future by reducing their costs or having more insurance companies provide coverage for these treatments. Patients receiving these therapies are highly motivated to lose weight and adhere well to follow-up visit schedules. The practice also recognizes that patients may want to join support groups or participate in group physical activities led by HCPs, so these are some ideas for the practice to consider as they continue their journey toward continuous QI.

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