I'm Leigh Perreault, I'm an endocrinologist and I'm Professor of Medicine at the University of Colorado.

What is the importance of this study?

The importance of our study is that we did not test a weight loss programme, we basically built the infrastructure into our medical system to facilitate and expedite patients receiving care for their weight. So people love to call PATHWEIGH a programme—it's not a programme, it's a process.

It's basically the road for people to receive care. So if you can imagine something like a referral to a dietitian or a prescription of a medication, those are cars that drive on the road. But the problem all along with obesity care is there's never been a road.

The process that's really been very fragmented has lacked a unified approach and it hasn't ever had the real infrastructure it's needed to provide routine weight management in primary care.

Could you tell us about the PATHWEIGH process and how this works?

So the process starts with really activating the patients, letting them know that they can receive care for their weight with their primary care provider. Then that patient then approaches the front desk in their usual primary care clinic and they ask for a weight-prioritised visit type with their regular primary care provider.

Once that happens, there is an intake questionnaire that gets pushed to the patient through our healthcare portal 72 hours before their visit. They complete that and that effectively becomes our documentation as clinicians. We also offer lots of educational support, technical support to the providers, the clinics, the clinic managers etc.

And then when the patient eventually shows up to the clinic for their weight-prioritised visit type, the note template really turns into effectively a large menu that consolidates anything that we might do for weight management into one place.

So the provider doesn't spend their time typing, they spend their time talking to the patient and effectively having fewer clicks through our electronic medical record to be able to deliver the care to the patient that they need. So it becomes a very time efficient, very effective way to deliver care.

Could you tell us about the study design and the patient population?

So we have 274,182 patients in our data set. It is a very large trial, and we have 56 primary care clinics that were randomised in a cluster randomised stepped-wedge design, meaning that they were covariate constrained into three groups that looked very similar in terms of patient volume, insurance mix, geographical location, and practise type.

And then they underwent staggered starts into the intervention for a one-way crossover from usual care into intervention. So one group of clinics received the intervention, one year later, the second group did and then a year after that, the third group did, such that everybody ended up in the intervention by the end.

What was the primary outcome?

The primary outcome was patient weight trajectory from 0 to 6 months and then their weight trajectory maintenance from 6 to 18 months, both in the usual care compared to the intervention.

How can these findings inform prevention strategies in diabetes care?

Well the most important finding from our study is simply the fact that we eliminated the weight gain trajectory that's normally seen. So multiple studies have shown that population weight gain is attributable to only a half of a kilo gain per year, both in the US and other places throughout the world.

And PATHWEIGH was able to completely eliminate population weight gain, which was something that was kind of amazing. And so this care process was really built to be very feasible, affordable, low cost, pragmatic, and highly scalable. So it's something that we absolutely expect to export to other healthcare systems.

Of our eligible patients, which were adults that had a body mass index of at least 25, 75% of them never received any weight-related care over four years, and PATHWEIGH increased the likelihood of a patient receiving weight-related care by 23%.

It actually accentuated weight loss for people who received care and it mitigated weight gain even when people did not receive weight-related care. So these are also super important findings from the study.

Where are the knowledge gaps, and what are the next steps?

Yeah, the two knowledge gaps, or I say the biggest gap, is probably in just trying to facilitate the adoption of the care process by providers.

So we are in the process of bolstering our implementation strategies as well as redesigning the clinician interface at the time of the visit, and also we want to disseminate it outside of our healthcare system to see how it works outside of Colorado.