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The author makes a great point. In addition to primary care clinics not having the capacity to deliver 26 appointments per patient per year (even if with assistance of LCSW or RD), there are very few parent & child who are able and willing to do 26 contact hours/year. And the obesity rate is higher in our underserved communities. To expect families from this population mostly with government health insurances to attend 26 contact hours/year is nothing more than a PIE in the sky thinking whether it is delivered in the tertiary pediatric obesity center or primary care settings. WE need a different model of care.
Primary care physicians (FP and Peds) lack training in obesity medicine and lack the time to deliver this care. The tertiary Peds Obesity centers often bill high specialty copays for these many visits (and sometimes facility fees) and are often out of reach for many socially vulnerable families.
Here is a different model of care. I am board certified in Family Medicine and Obesity Medicine. At our institution, we created a decentralized community-based weight management program. We embedded obesity certified primary care physicians within primary care offices. They were given extended time to properly provide evidence-based obesity care. A needs assessment identified high cost of specialty copay rates as one of the biggest barriers for vulnerable population. Thus, we started billing primary care copay rates. Reducing this financial barrier opened the floodgates of patients seeking this care. We paired simplified targeted lifestyle counseling strategies with use of pharmacotherapies (metformin, topiramate, phentermine and if covered, GLP1-RAs). Our program does not require 26 contact hours. We started with 3 clinics in 2019 in central NC. 5 years later, 2000 adult patients later, 200 children later (mostly severe obesity), we have expanded to 11 communities in central and eastern NC (including rural communities). We currently have 13 American Board of Obesity Medicine certified physicians in 13 different primary care clinics in our network.
Our model of care has been financially sustainable for our institution. Our data was published in Family Medicine journal: https://journals.stfm.org/media/5522/lackey.pdf We will be presenting our latest data at Obesity Week 2024 in San Antonio.
Practice guidelines are exactly that. Guidelines. Impracticality, financial inaccessibility, and inappropriate abstract nutrition language all adds to our patients not receiving evidence-based obesity care. I applaud the author's bold challenge. We need to explore new models of care that breaks down these barriers so ALL patients who need and seek this care can access them.