DIPLOMATE LOOKS AT
At last month’s American College of Preventive Medicine national meeting, ABOM Diplomates Scott Kahan, Kimberly Gudzune, Robert Kushner, and Christopher Still, and ABOM Master Donna Ryan led an all-day institute on obesity medicine for a standing room-only crowd.
After the meeting, Scott Kahan MD, MPH caught up with Kimberly Gudzune MD, MPH to talk about her recent publication on weight loss programs. The study found that patients and health care providers alike face significant challenges when it comes to finding weight loss programs that align with accepted obesity guidelines. Below is a transcript of their Q and A:
Scott Kahan (SK): Kim, this is very important and needed research on the lack of correlation between weight loss programs practices and published obesity guidelines. Would you tell us a bit more about what motivated you to do this study?
Kimberly Gudzune (KG): We now have these excellent clinical guidelines published by The Obesity Society, American Heart Association, and American College of Cardiology, but we were curious as to whether they were being followed by most weight management programs and clinics.
So we started with internet research to identify programs that offered weight loss interventions and looked at their websites to try to abstract what they include. Are they following evidence-based guidelines? Do they offer physical activity support? Do they offer behavioral counseling? Do they promote non-FDA approved supplements? And so forth. We initially identified 191 programs in the local DC-Maryland-Virginia area. From just looking at the websites, only about 1% of the programs had all the elements contained in the guidelines, and only about 9% clearly identified some of the elements.
SK: Yes, I actually remember when you called me to answer questions like this about my clinic. Though I can tell you that our website is pretty basic and doesn’t include many details that would be relevant to your study.
KG: Exactly. We didn’t want to rely on just the websites alone, in part because you can’t disclose everything online. So then we called a subset of 52 out of 191 to verify their specific program practices. That brought the numbers up to 19% that followed the guideline recommendations, and about 30% that followed some of the recommendations.
SK: Better, certainly, but still very low.
KG: Yes, unfortunately. In fairness, some of these programs aren’t well developed. For example, some are just thrown together at a local gym or “wellness center.” But with obesity now largely falling under the medical umbrella it’s important that programs follow evidence-based recommendations.
I’m hoping that this research begins to raise awareness for consumers, to prompt them to ask questions of programs they are thinking about joining, and making sure that the programs are science-based. And, frankly, it also raises the question of whether these community programs and commercial programs even know that these guidelines exist, and if not, then it may prompt them to learn about the guidelines and adjust their practices to be more in line with the science.
SK: That would be great. Did you look at any predictive factors of whether a given program is more or less consistent with the guidelines? For example, I would assume that academic-based programs follow more stringent evidence-based practices, compared with community or commercial programs, but I’m not aware of any research proving this.
KG: We haven’t done this analysis yet, but it’s on our list. We have all sorts of data to look at. For example, we assume that programs that have a physician on staff are more rigorous; we’d like to formally answer that question. We’d like to look at whether programs that have been in existence longer have better practices. Do programs that advertise non-evidence based practices, such as “cool sculpting,” depart from the guidelines in other ways, as well?
SK: These are such important questions that could offer guidance to patients in their decision-making process. Beyond such predictors, any other next steps for this research?
KG: I’d love to replicate the study process in another year or two to compare with the initial data. We collected our data only about 6-7 months after the guidelines were published, so it’s possible that many programs weren’t aware of the guidelines at that time. It would be nice to see a shift in the data after the guidelines are out for a couple of years, now that they’ve gotten good media attention.
SK: I’d love to see that. And if practices aren’t changing, perhaps we need to think about how we go about the guidelines process. We put so much effort and resources into creating great, evidence-based guidelines, but perhaps we’re giving short-shrift to their communication and dissemination.
KG: Absolutely. If we can move the needle forward even a bit, it’ll be worth it.