How to Use Group Visits to Manage Obesity

 

Clinic and community resources combine to support patients in this unique group-visit model.

Fam Pract Manag. 2019 Sep-Oct;26(5):20-25.

Author disclosure: no relevant financial affiliations disclosed.

Physicians face many complications when helping patients manage their chronic conditions, including limited time and resources. The group-visit model helps deal with those conflicting demands by allowing physicians to offer extensive education and self-management instruction to patients with similar conditions in a group setting while still providing individual evaluation. With skillful planning and community support, you can use group visits to improve care for patients with a wide range of chronic medical conditions. Our clinic used group visits to help adult patients with obesity and found that they significantly improved their weight, quality of life, mental health, and healthy lifestyle behaviors.

TARGETING OBESITY WITH GROUP VISITS

Obesity has become dramatically more prevalent in the past 20 years. More than 35 percent of U.S. adults are now considered obese.1 Conditions connected to obesity account for almost 10 percent of national health care expenditures, and per-capita medical spending by patients with obesity is 42 percent greater than for patients of normal weight.2 The U.S. Preventive Services Task Force recommends that clinicians offer or provide a referral for intensive multicomponent behavioral interventions to manage obesity for adults with a body mass index (BMI) of 30 or higher.3

Group visits are one option, providing high-quality care that may be more accessible to patients and increase patients' ownership of their conditions.4 In a group setting, physicians can refer clinical questions back to the group for discussion and feedback, which in turn can build confidence in self-care. Group visits can also reduce patients' emergency department and subspecialty visits, hospital readmissions, and phone calls to physicians (although phone calls to nurses may increase) while providing greater overall satisfaction with care.5

Primary care has begun to embrace the group-visit model for managing chronic disease, and evidence suggests that group visits reliably improve intermediate clinical outcomes for patients with type 2 diabetes6 and the management of blood pressure.7 However, there is little research nationally on using group visits for weight management.8 Group visits have been shown to improve childhood overweight and inactivity levels, however.4

Implementing group visits may initially require significant planning. This may include identifying and recruiting patients with chronic conditions, enlisting clinic resources for support, and developing a general format for longitudinal visits.9 Over time, you can easily apply these steps to different medical conditions and across different patient ages and locations. (See “Starting a group visit program.”)

ABOUT THE AUTHOR

Dr. Larson is a family physician and faculty member at the University of Wisconsin Department of Family Medicine and Community Health in Madison, Wis. She wishes to acknowledge Brian Arndt, MD, Thomas Hahn, MD, and Julia Yates, LCSW, MSSW, of the University of Wisconsin Department of Family Medicine and Community Health, each of whom made significant contributions to the development of the obesity group visit project at Verona Clinic.

Author disclosure: no relevant financial affiliations disclosed.

References

show all references

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA. 2014;311(8):806–814....

2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer-and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822–w831.

3. U.S. Preventive Services Task Force, Curry SJ, Krist AH, et al. Behavioral weight-loss interventions to prevent obesity-related morbidity and mortality in adults: U.S. Preventive Services Task Force recommendation statement. JAMA. 2018;320(11):1163–1171.

4. Theobald M, Masley S. A Guide to Group Visits for Chronic Conditions Affected by Overweight and Obesity. Leawood, KS: American Academy of Family Physicians; 2008. https://www.aafp.org/dam/AAFP/documents/patient_care/fitness/GroupVisitAIM.pdf. Accessed Aug. 7, 2019.

5. Beck A, Scott J, William P, et al. A randomized trial of group outpatient visits for chronically ill older HMO members: the cooperative health care clinic. J Am Geriatr Soc. 1997;45(5):543–549.

6. Edelman D, McDuffie JR, Oddone E, Gierisch JM, Nagi A, Williams JW Jr. Shared Medical Appointments for Chronic Medical Conditions: A Systematic Review. Washington, DC: Department of Veterans Affairs; 2012. http://www.ncbi.nlm.nih.gov/books/NBK99785/. Accessed July 9, 2019.

7. Axten K, Hawkins K, Tybor DJ, Bernhoff J, Altman W. Impact of a novel wellness group visit model on obesity and behavior change. J Am Board Fam Med. 2017;30(6):715–723.

8. LeCheminant JD, Covington NK, Smith J, Lox CL, Kirk EP, Heden TD. Evaluation of a university-based community outreach weight management program. Popul Health Manag. 2011;14(4):167–173.

9. Houck S, Kilo C, Scott JC. Group visits 101. Fam Pract Manag. 2003;10(5):66–68.

10. Jaber R, Braksmajer A, Trilling J. Group visits for chronic illness care: models, benefits, and challenges. Fam Pract Manag. 2006;13(1):37–40.

 
 

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