ABS 050: Barriers to obesity management in primary care and opportunities for improvement

Varalakshmi Niranjan ¹ , Remya Meethal Veetil ²

¹ Stanford University School of Medicine
² COMET, Stanford Medicine

Van Wickle (2025) Volume 1, ABS050

Introduction: Prevalence of obesity is increasing as one of the major global health problems with high risk for serious comorbidities. Primary care physicians (PCPs) are usually the first in line to provide care so we wanted to study their confidence, knowledge and barriers in managing obesity, and the need for continuous education.

Methods: A survey was sent to 30 PCPs at Stanford university internal medicine clinic. There was a 63% response rate (n=19) to this survey. Out of the 19 respondents, 17 of them were physicians (89%) and 2 of them were advanced practitioners (11%). 53% of the respondents had >10 years practice and 69% of them had >5 years practice.
Goal of this survey to providers was to assess their current obesity management practices, confidence in managing obesity, familiarity with weight loss medications, and their barriers to care.

Results: This survey validated a need for a weight loss program embedded within Primary Care. Based on these findings we will launch SMILES (Stanford Medical Intervention with Lifestyle Education Sessions) within Primary Care that will include a board certified obesity medicine specialist with a team that covers support services (RN educators, dieticians, behavioral therapists, diabetes prevention program). PCPs will refer to this SMILES program when the patients meet the criteria of BMI >27 kg/m2 with comorbidities. The patients would then graduate from this program back to PCP when the 10% weight loss goal is met.

Discussion: We identified a few key improvements for obesity management practices namely streamlining prior authorization processes, creating a template (dot phrase) for prior authorization letters, creating a standardized letter (dot phrase) as policy against using compounded pharmaceutical agents for GLP-1 agonists, creating obesity care pathway for referral to other available resources, offering continued medical education sessions to enhance providers' skills and knowledge in obesity care. Finally we will conduct a follow-up survey in 1 year to assess the impact of the SMILES program, its interventions and improvements in obesity management.