Research ArticleOriginal Research

Baseline Characteristics of PATHWEIGH: A Stepped-Wedge Cluster Randomized Study for Weight Management in Primary Care

Leigh Perreault, Krithika Suresh, Carlos Rodriguez, L. Miriam Dickinson, Emileigh Willems, Peter C. Smith, Johnny Williams, R. Mark Gritz and Jodi Summers Holtrop
The Annals of Family Medicine May 2023, 21 (3) 249-255; DOI: https://doi.org/10.1370/afm.2966

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  • Table 1.

    Patient Demographic Characteristics at Baseline

    CharacteristicMissing
    n (%)    		Overall
    N = 20,383    		Sequence 1
    n = 7,001    		Sequence 2
    n = 6,082    		Sequence 3
    n = 7,300
    Age, mean (SD), yNA      52 (16)      53 (16)      52 (16)      52 (16)
    Sex, No. (%)1 (<0.1)
        Female11,844 (58)  3,903 (56)  3,790 (62)4,151 (57)
        Male  8,538 (42)  3,098 (44)  2,291 (38)  3,149 (43)
    Race/ethnicity, No. (%)NA
        Hispanic or Latine  2,673 (13)    859 (12)      872 (14)      942 (13)
        Non-Hispanic Asian    281 (1.4)    111 (1.6)        76 (1.2)        94 (1.3)
        Non-Hispanic Black or African American  1,091 (5.4)    312 (4.5)      368 (6.1)      411 (5.6)
        Non-Hispanic White15,520 (76)  5,440 (78)  4,529 (74)    5,551 (76)
        Non-Hispanic other    680 (3.3)    235 (3.4)      191 (3.1)      254 (3.5)
        Unknown    138 (0.7)      44 (0.6)        46 (0.8)        48 (0.7)
    Insurance, No. (%)NA
        Commercial13,015 (64)  4,535 (65)    3,915 (64)    4,565 (63)
        Medicaid  1,729 (8.5)    467 (6.7)      465 (7.6)      797 (11)
        Medicare  5,388 (26)  1,910 (27)    1,634 (27)  1,844 (25)
        Self-pay    251 (1.2)        89 (1.3)        68 (1.1)        94 (1.3)

    • NA = not applicable.

  • Table 2.

    Patient Health Metrics at Baseline

    CharacteristicMissing
    No. (%)    		Overall
    n = 20,383    		Sequence 1
    n = 7,001    		Sequence 2
    n = 6,082    		Sequence 3
    n = 7,300
    Height, mean (SD), cm    2 <0.1)170 (10)170 (10)169 (10)170 (10)
    Weight, mean (SD), kgNA107 (23)107 (23)107 (23)107 (23)
    BMI, mean (SD), kg/m2NA37 (7)37 (7)38 (7)37 (7)
    Heart rate, mean (SD), beats/min1,411 (6.9)79 (13)79 (13)79 (13)80 (13)
    Respiratory rate, mean (SD), breaths/min4,686 (23)16 (2)17 (2)16 (2)16 (2)
    Systolic BP, mean (SD), mm Hg1,218 (6.0)126 (15)128 (15)126 (14)126 (15)
    Diastolic BP, mean (SD), mm Hg1,221 (6.0)79 (10)80 (10)79 (10)79 (10)
    Body temperature, mean (SD), °F2,304 (11)        97.78 (0.72)        97.80 (0.71)        97.67 (0.74)        97.84 (0.70)
    Laboratory values of interest
        TSH, mean (SD), mIU/L5,487 (27)2.48 (4.79)2.60 (4.85)2.46 (5.50)2.39 (4.01)
        Triglycerides, mean (SD), mg/dL3,600 (18)168 (117)170 (111)165 (98)168 (135)
        HDL cholesterol, mean (SD), mg/dL3,634 (18)45 (14)45 (14)45 (15)45 (14)
        ALT, mean (SD), U/L2,780 (14)33 (41)32 (24)33 (63)33 (26)
        AST, mean (SD), U/L2,780 (14)30 (32)30 (26)31 (47)30 (21)
        HbA1c, mean (SD), %5,420 (27)          6.06 (1.26)          6.13 (1.32)          6.02 (1.20)          6.04 (1.26)
        eGFR, mean (SD), mL/min/1.73m28,568 (42)77 (19)80 (20)77 (18)75 (18)
    Drug regimen that causes weight gain, No. (%)NA2,427 (12)829 (12)724 (12)874 (12)
    Drug regimen that causes weight loss, No. (%)NA2,212 (11)709 (10)640 (11)863 (12)
    Using O2/CPAP/BPAP, No. (%)NA3,550 (17)1,108 (16)1,143 (19)1,299 (18)
    PHQ-2 completed, No. (%)NA17,133 (84)6,002 (86)5,041 (83)6,090 (83)
    Score on screen for depression/anxiety, mean (SD)
        PHQ-81,520 (7.5)      1 (4)      1 (4)      2 (4)      1 (4)
        PHQ-915,939 (78)      9 (7)      9 (7)      8 (7)      9 (7)
        GAD-716,955 (83)      8 (6)      8 (6)      7 (6)      9 (6)
    Smoking status, No. (%)868 (4.3)
        NeverNA12,211 (63)4,117 (63)3,759 (63)4,335 (62)
        FormerNA5,823 (30)1,972 (30)1,754 (30)2,097 (30)
        CurrentNA1,481 (7.6)449 (6.9)421 (7.1)611 (8.7)

    • ALT = alanine aminotransferase; AST = aspartate aminotransferase; BMI = body mass index; BP = blood pressure; BPAP = bilevel positive airway pressure; CPAP = continuous positive airway pressure; eGFR = estimated glomerular filtration rate; GAD-7 = 7-item Generalized Anxiety Disorder scale; HbA1c = glycated hemoglobin; HDL = high-density lipoprotein; NA = not applicable; PHQ-2 = 2-item Patient Health Questionnaire; PHQ-8 = 8-item patient health questionnaire; PHQ-9 = 9-item patient health questionnaire; TSH = thyroid-stimulating hormone.

  • Table 3.

    Weight-Related Comorbidities Present in ≥3% of Patients

    Comorbidity,
    No. (%)    		ICD-10-
    CM     Code    		Overall
    N = 20,383    		Sequence 1
    n = 7,001    		Sequence 2
    n = 6,082    		Sequence 3
    n = 7,300
    HypertensionI108,790 (43)3,130 (45)2,607 (43)3,053 (42)
    DyslipidemiaE78.x7,942 (39)2,984 (43)2,297 (38)2,661 (36)
    Type 2 diabetesE11.x4,095 (20)1,428 (20)1,224 (20)1,443 (20)
    AnxietyF41.x3,901 (19)1,392 (20)1,201 (20)1,308 (18)
    Obstructive sleep apneaG47.3x3,873 (19)1,334 (19)1,033 (17)1,506 (21)
    Low back painM54.x3,000 (15)1,023 (15)    892 (15)1,085 (15)
    GERDK21.x2,829 (14)1,007 (14)    876 (14)    946 (13)
    DepressionF32.x2,333 (11)    902 (13)    631 (10)    800 (11)
    OsteoarthritisM15.x-M19.x1,295 (6.4)    501 (7.2)    374 (6.1)    420 (5.8)
    CADI25.x    835 (4.1)    321 (4.6)    228 (3.7)    286 (3.9)
    CKDN18.x    810 (4.0)    296 (4.2)    205 (3.4)    309 (4.2)
    NAFLDK76.0    676 (3.3)    256 (3.7)    187 (3.1)    233 (3.2)

    • CAD = coronary artery disease; CKD = chronic kidney disease; GERD = gastroesophageal reflux disease; ICD-10-CM= International Classification of Diseases, 10th Revision, Clinical Modifications; NAFLD = nonalcoholic fatty liver disease.

  • Table 4.

    Patient Referrals and Treatment

    CharacteristicOverall
    N = 20,383    		Sequence 1
    n = 7,001    		Sequence 2
    n = 6,082    		Sequence 3
    n = 7,300
    Referrals, No. (%)
        Bariatrics  366 (1.8)  122 (1.7)    94 (1.5)  150 (2.1)
        Behavioral health  448 (2.2)  133 (1.9)  248 (4.1)    67 (0.9)
        Dietician1,144 (5.6)  407 (5.8)  396 (6.5)  341 (4.7)
        Endocrinology1,070 (5.2)  321 (4.6)  356 (5.9)  393 (5.4)
        Health and wellness  832 (4.1)  239 (3.4)  325 (5.3)  268 (3.7)
    Bariatric procedure performed, No. (%)    68 (0.3)    23 (0.3)    23 (0.4)    22 (0.3)
    Prescriptions, No. (%)
        Bupropion-naltrexone (Contrave)    44 (0.2)    15 (0.2)    16 (0.3)    13 (0.2)
        Phentermine (Pondin/Fastin)  258 (1.3)    94 (1.3)    68 (1.1)    96 (1.3)
        Liraglutide (Saxenda)        5 (<0.1)        1 (<0.1)        1 (<0.1)        3 (<0.1)
        Lisdexamfetamine (Vyvanse)     14 (<0.1)        6 (<0.1)        3 (<0.1)        5 (<0.1)
        Orlistat (Xenical/alli)        1 (<0.1)        1 (<0.1)     0 (0)     0 (0)
        Phentermine-topiramate (Qsymia)     12 (<0.1)        5 (<0.1)        4 (<0.1)        3 (<0.1)
  • Table 5.

    Baseline Clinician Demographic Characteristics and Treatment Patterns

    CharacteristicOverall
    N = 514    		Sequence 1
    n = 172    		Sequence 2
    n = 152    		Sequence 3
    n = 190
    Clinician sex, n (%)
        Female308 (60)95 (55)96 (63)117 (62)
        Male203 (39)77 (45)55 (36)  71 (37)
        Unknown    3 (0.6)  0 (0)  1 (0.7)    2 (1.1)
    Weight-prioritized visits, mean (SD)  62 (92)    63 (113)64 (80)  58 (81)
    Total visits (including WPV), mean (SD)1,229 (955)1,300 (999)1,319 (936)1,094 (917)

    • WPV = weight-prioritized visit.

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