PATHWEIGH is the first intervention scaled to 274,182 patients to mitigate population weight gain. In a stepped-wedge cluster-randomized pragmatic trial in Colorado, USA, 56 primary care clinics were randomly assigned to three clusters with staggered start dates for a one-way crossover from usual care to the intervention phase. The intervention (PATHWEIGH) included: health system primary care leadership endorsement, an electronic health record (EHR)-driven care process designed to prioritize, facilitate and expedite weight management, and implementation strategies to support use of the care process and educate clinicians on obesity treatment. The objective of the current analysis was to identify mediators and moderators associated with successful population-level weight management in primary care. The majority of subgroups (moderators) benefited from the intervention because they either lost more weight, gained less weight or switched from weight gain to weight loss compared to usual care. Patient and/or provider use of an EHR component of the intervention mediated 37% of additional patient weight loss and use of an anti-obesity medication mediated 4% over 18 months (p < 0.001 for all comparisons). Altogether, the intervention had favorable effects on patient weight across the subgroups, particularly when a patient or provider used ≥1 EHR component of PATHWEIGH.
Perreault et al. (Thu,) studied this question.