Background/Introduction:

Disparities in obesity and related cardiometabolic disease prevalence and treatment are widespread.1 Driven in-part by social determinants of health (SDOH), there is also limited access to intensive lifestyle programs that address these factors in multiethnic populations.2 These disparities are evident in Los Angeles where the average obesity rate is 24.3%,3 but in multiethnic patients in one sample safety net hospital the rate is 48% for those seen in the primary care with 11% having class III obesity (BMI>40 kg/m^2) and 53% also reporting food insecurity.4 In the safety net hospital, group medical visits improve access and quality goals.5-6 They also provide a means to manage patients with complex care needs5, and yet few have been studied for their feasibility and effectiveness.6 LA VIDA, a weight-loss clinic at Olive View Medical Center, sought to address these needs.

Methods:

A pilot interdisciplinary weight management program was started for patients with obesity and cardiometabolic disease (diabetes, hypertension, hyperlipidemia). Enrolled patients participated in 12 in-person group medical visits over the course of 6 months led by a team of kinesiologists, dieticians, physicians, and social workers. These visits focused on exercise, nutrition, and lifestyle medicine instruction. Monitoring of patient’s metabolic comorbidities, including HbA1C, SBP, LDL-cholesterol along with their BIA body composition (waist circumference, total weight, fat mass, and skeletal muscle mass) were done in the program and later collected for review.

Results:

A total of 68 patients with an age range of 20-75 years old (average 49), 82% of whom identified as Latino were enrolled in the first year of the pilot clinic. Out of the 12 visits, patients attended an average of 60% of the visits, with transportation and illness being reported as the most common barriers to higher attendance. Patients in the program experienced an average percent of weight loss of 6.3% (-17.6%, +1.9%). The average reduction in HbA1C and LDL were 0.5 and 11.7 respectively.

Conclusion:

Patients in the safety net have higher rates of obesity and related cardiometabolic disease. They also have limited access to resources to treatments that have been proven to be successful. These preliminary results show that interdisciplinary weight management programs can be successfully implemented in the safety net setting and subsequently decrease barriers to weight loss. The LA VIDA program can serve as a model for broader implementation in similar healthcare settings to mitigate health disparities and improve cardiometabolic health.

References

1. Anekwe, C.V., Jarrell, A.R., Townsend, M.J. et al. Socioeconomics of Obesity. Curr Obes Rep 9, 272–279 (2020). https://doi.org/10.1007/s13679-020-00398-7.
2. Byrd AS, Toth AT, Stanford FC. Racial Disparities in Obesity Treatment. Curr Obes Rep. 2018Jun;7(2):130-138. doi: 10.1007/s13679-018-0301-3. PMID: 29616469; PMCID: PMC606659
3. Centers for Disease Control and Prevention. (2013, October 25). Obesity and Tobacco Use Prevention. Community Profile: Los Angeles County, California.
4. OVMC patient EHR data. Obesity Statistics Among OVMC Primary Care Patients. 2022.
5. Safety Net Medical Home Initiative. Neal R, Moore LG, Powell J. Enhanced Access: Providing the Care Patients Need, When They Need It. In: Phillips KE, Weir V, eds. Safety Net Medical Home Initiative. Implementation Guide Series. 2nd ed. Seattle, WA: Qualis Health and The MacColl Center for Health Care Innovation at the Group Health Research Institute; 2013.
6. Albert SL, Massar RE, Kwok L, et al. Pilot Plant-Based Lifestyle Medicine Program in an Urban Public Healthcare System: Evaluating Demand and Implementation. American Journal of Lifestyle Medicine. 2022;0(0). doi:10.1177/15598276221113507.