Obesity Is a Weight-Loss Maintenance Problem

The prevalence of obesity has reached 39.8% among Americans, affecting 93.3 million of US adults.¹ The related consequences of the obesity epidemic are no secret either. Certain types of cancer, heart disease, stroke, and type 2 diabetes are some of the leading causes of preventable death, and their incidence is rising.²

The root of the issue, however, is not that America has a weight loss problem. Rather, we have a weight loss maintenance problem. We are really good at losing weight, but keeping it off long term is another story. Research shows that after 1 year, 98% of people who have lost weight, regain some of it, and at the 5-year mark, all of it.³ With the booming supplement and weight loss industry, fad diets, and supposed nutrition breakthroughs, what actually works? Which should patients focus on, so that implemented changes with the support of science to instill lasting change for weight loss maintenance?

A new quality improvement study⁴ conducted by Kevin Brunacini, DNP, APRN, implemented and tested a weight-loss-maintenance assessment that reinforced key behavioral competencies supported by individuals looking to sustain their weight loss long term. The study has major implications for all sectors of health care, as projections can help to implement changes in obesity treatment and management.

Discussion

The overall focus of this study was to assess participants’ relative strength of the MASTER behaviors to weight loss: monitoring statistics, accessing support, self-control/self-regulation, tame food choices/trigger awareness, emotional intelligence, and reflection.⁴ They were scored by a team of licensed and trained clinicians, from a baseline level to 1 of 5 ratings: novice, advanced beginner, competent, proficient, and expert. The aim of the study was to increase patient self-efficacy by 30% in a 90-day period.⁵

Using the WLM assessment correlated to a 27.5% increased likelihood of a patient maintaining their weight. Completion of the patient intake form was 100% during the study, and this served as a method to identify and quantify patient WLM behavioral risk, which ranged from 60% to 100%, with a mean of 87%. Utilization of the WLM assessment averaged 84%, and peaked at 97%, and this was also seen among the patients’ competency scores (mean, 43%; range, 0%-59%) as they advanced.

Interpretation

Both the team and patients influenced our results. After the initial onboarding process, WLM competency scores trended up as the ratio of established patients to new patients grew. The intake form was modified to better identify risk and continue collecting weekly results on the patient scorecard. Keeping the processes practical and simple carried over into patient care, which permitted for better teaching opportunities and more specific support. When the patients made lifestyle changes, it reduced the risk of regaining weight within a few years.^6-8

One patient remarked, “This was a true mentorship. The honesty, time to educate, optimism, sincerity to help me. I feel better already.”

Another patient shared, “I’m impressed by the intensity of compassion to help me lose weight and understand how to keep it off.”

Open communication was critical for effective and timely teaching.^9,10 Being able to stratify patient behavioral risks on intake forms allowed the clinicians to begin teaching and formulating a plan early in the process and provide patient-centered care with the WLM assessment during weekly follow-ups. Weekly competency grading also resulted in reinforcing the understanding, application, and overall competence of the WLM behaviors for both the patients and team. Throughout this project, the power of collaboration and trust was affirmed, and this is the essence of primary care.^11-16 The potential role we can play as pharmacists in this process as being the most accessible health care provider is profound in helping patients make lasting changes toward optimal health.

Figure 1 (Brunacini, 2018) shows that as patients were being “graded” on their weight loss management competence, so were the clinicians’ understanding of the concepts.

Figure 2 (Brunacini, 2018) shows that initiating a baseline competency score allowed for clinicians to better use the weight loss management assessment in patient follow-ups to serve as a weekly snapshot of progress. Once patient inclusion criterion expanded, patient volume was more evenly dispersed throughout the week to consistently stratify patient behavior risk during consults and weekly follow-ups.

(Brunacini, 2018) shows that after the onboarding process was complete, another hurdle was getting patients to complete a weekly competency survey as it related to the weight loss assessment concepts. Clinicians used a weekly scorecard to grade patients during follow-ups. Based on these updated scores, the clinicians referred the patients to the weight loss management assessment as guidance to strengthen needed areas.

Adam Martin, PharmD, ACSM-CPT, is the founder of TheFitPharmacist movement, which strives to empower pharmacists and pharmacy students to thrive in their careers by overcoming stress and unhealthy habits using science-based principles and unmatched support. He also created “TheFitPharmacist” podcast on the PharmacyPodcast network. In addition, he is the owner and nutrition consultant at The Diet Doc Pittsburgh North in Pennsylvania.

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