Coordinating Pragmatic Primary care Population management for Obesity (C3PO)

Prior studies such as the Diabetes Prevention Program, LookAHEAD, and numerous other lifestyle intervention trials provide a strong evidence-base for the minimum necessary elements of behavioral programs aiming to achieve clinically meaningful weight loss (such as 5% or more of baseline weight) by overweight or obese adults with cardiometabolic risk factors. Although prior research has focused on scalable implementation of these interventions in a wide array of real-world settings, most of these studies show very low uptake (less than 5 to 10%) of eligible individuals when a singular intervention format or channel is offered. The individual, social, environmental influences that underlie this low uptake is only partly understood, but it is certain that there will never be a one-size-fits-all approach to lifestyle intervention support. We will undeniably need a “portfolio approach” to maximize the population reach of evidence-driven lifestyle interventions, and we will need pragmatic implementation approaches for managing and coordinating this portfolio across patients and over time. This is the focus of the proposed research. Approximately 600 million primary care encounters each year are opportunities to leverage the health system’s rapidly shifting focus toward health promotion and disease prevention to target the population-level burden of obesity. Though available in many communities today, there remains very limited patient and provider awareness of existing evidence-based obesity management resources or how to access them. The goals of different patients toward weight loss also vary among individuals and over time. This context requires novel strategies to coordinate more proactive and recurring outreach to patients to raise awareness, assess expectations, and offer resources in more targeted and patient-centered ways. The proposed Coordinating Pragmatic Primary care Population management for Obesity (C3PO) Study will address these prevailing gaps between evidence and practice by engaging stakeholders to implement and evaluate a pragmatic, and generalizable framework for population management of obesity that leverages existing primary care professionals and technologies. This planning grant will provide a critical demonstration of feasibility and provide preliminary testing of this novel population management framework. We will use findings from this pilot phase to refine the intervention and maximize its efficiency and potential for cost-effectiveness before it is evaluated in a future, larger, and more definitive comparative effectiveness trial.