Implementation in a Family Medicine Clinic of a Lifestyle Program Designed to Help Indigent, Obese Adult Patients Lose Weight

Abstract

Introduction. Efficacy of interventions in research settings may
not translate to usual-care settings. The impact of interventions
varies depending upon factors, such as the proportion and
composition of the population reached and engaged, as well as
participation and implementation characteristics of providers.

Methods. A lifestyle intervention meant to achieve a 5%
loss of body weight in six months was offered to obese, indigent
adult patients in a Family Medicine residency outpatient
clinic. Implementation variables were assessed, including
determination of individual patient penetration
and participation rate, demographic representativeness,
completion rate, outcomes, and differential impact, as well
as setting participation rates and implementation fidelity.

Results. From a population of 743 potentially eligible patients,
356 were invited to participate (48% penetration) and
158 were enrolled (44% participation). Those enrolled were
heavier (BMI of 42.6 vs 39.0), younger (43.5 vs 47.0 years)
and more likely female (87% vs 69%) than those not enrolled.
Individual completion rate was 81%; overall weight
loss was negligible. Setting participation was broad, but
fidelity to background standard of care was only 50%.

Conclusions. Providers were eager for a tool to help their obese,
indigent patients lose weight, but the intervention proved ineffective
and the usual care of enrolled patients was not strongly
supportive of their weight loss efforts. KS J Med 2016;9(4):77-82.