396 - Uncharted Territory: Evaluating the Discussion of Advanced Therapies for Obesity Management in Primary Care

Friday, April 28, 2023

5:15 PM – 7:15 PM ET

Poster Number: 396
Publication Number: 396.145

Clare A. Burchenal, Children's Hospital Colorado, Denver, CO, United States; Erica Poe, University of Colorado School of Medicine, Denver, CO, United States; Courtney Batt, University of Colorado School of Medicine, Aurora, CO, United States; Jeanelle Sheeder, University of Colorado School of Medicine, Aurora, CO, United States

Presenting Author(s)

Courtney Batt, MD (she/her/hers)

Assistant Professor
University of Colorado School of Medicine
Aurora, Colorado, United States

Background: Obesity leads to significant morbidity and mortality in adulthood and is difficult to treat; fortunately, both pharmacologic and surgical therapies are now approved for youth who are not able to lose weight through lifestyle modifications alone. While these advanced therapies are recommended to take place in tertiary care weight loss programs, there is an opportunity for primary care providers to introduce the concept of these therapies to their patients.

Objective: To identify practices of managing pediatric obesity in the Adolescent Medicine Clinic at Children’s Hospital Colorado with particular emphasis on discussion of pharmacological and surgical options. The hypothesis for this study is that providers are not routinely discussing these treatments, and that variation in practice exists based on provider and patient characteristics.

Design/Methods: A retrospective chart review was conducted on 423 patients aged 12-25 years seen in the Adolescent Medicine Clinic at Children’s Hospital Colorado between July 1, 2020 and June 30, 2021 who have a BMI >95th percentile or BMI > 30. In addition to demographic data, obesity class, presence of comorbidities, and discussion of medications and/or bariatric surgery were obtained.

Results:

Analysis reveals that discussion of weight loss medications in patients who meet criteria was low at 4.8%; although higher rates were associated with increased obesity severity (0.4%, 3.7%, and 18.3% (p=< 0.001), with class 1-3 listed respectively). Medications were more likely to be discussed with female patients (20.3% vs 7%, p=0.038); there were no significant differences by race, ethnicity, type of insurance or whether weight management had previously been addressed. Attending physicians were more likely to discuss medication use (p=0.001).

Bariatric surgery was discussed in 11% of patients who qualified for surgical intervention and was not discussed in patients who did not qualify. Attending physicians were more likely to discuss surgery (p=0.002), and there were no differences by patient sex, race, ethnicity or insurance type. While not significant, there was a trend towards discussing surgery in patients who had already received previous weight management (p=0.06).

Conclusion(s): This study suggests that providers are not routinely discussing available therapeutic options with eligible patients during weight loss discussions. Future research and interventions should focus on identifying and addressing barriers to provider discussion of these treatments in order to increase acceptance and overall uptake of these effective therapies in youth with obesity.