Primary Care Patient and Practice Member Perspectives on Weight Loss Medications: Challenges and Opportunities

Context: PATHWEIGH is a toolset embedded into the EPIC electronic health record to help primary care practices and their teams provide weight management assistance to their patients.

Objective: The objective of this portion of the study was to examine factors important to implementation of PATHWEIGH including contextual and perceptual features of weight management implementation.

Setting/Population Studied: First two cohorts of primary care practices in the study in one Colorado health system (n=37 practices). Participants were practice members and their patients.

Study Design and Analysis: Qualitative study involving key informant interviews over 2 years. Thematic analysis was used to triangulate responses from patients and practice members.

Instrument: Semi-structured interview guide including questions about perspectives on weight management, current approaches to weight management, and considerations for tailoring weight management approaches to individual clinics.

Outcome measures: Themes related to benefits of and barriers to providing weight management assistance to patients.

Results: The availability of new medications for obesity was identified as an unexpected, but key factor posing both benefits and challenges to weight management. GLP-1R agonist medications (brand names Wegovy, Ozempic) became widely available June 2021, and interviewees reported that these medications significantly impacted both patient interest in weight loss assistance and medical providers’ perceived ability to provide more effective treatment. Key factors impacting their implementation and use included intermittent medication scarcity due to increasing demand and supply chain disruptions, high cost (about $1300/month out of pocket), inconsistent insurance coverage, ambivalence about potential lifelong use of a weekly injectable medication to manage weight, and implications for the practice of primary care regarding obesity treatment with a highly effective medication for weight loss. The conceptualization of obesity as a disease appears to be evolving based on the availability of these treatments.

Conclusions: The arrival of highly effective weight loss medications may invigorate efforts to integrate weight management into primary care, but the implications of this shift are still unknown. Further exploration of the long-term effects on patients, providers and care paradigms is warranted.