Referral to Weight Loss Clinic for Adult Inpatients With Obesity Leads to Action on Excess Weight

Background: Given the obesity epidemic, in this study a novel approach to connect inpatients with obesity to outpatient weight loss clinic (WLC) was evaluated. Methods: In a single-arm interventional study performed at an academic health center in 2021, a WLC referral was placed for adults with obesity (BMI > 30 kg/m2 or BMI > 25 kg/m2 if Asian/South Asian) admitted to an inpatient medical ward, with intact decision making capacity and whose acute medical condition had stabilized. Those already followed in a WLC clinic, with history of metabolic/ bariatric surgery (MBS), those on active treatment for malignancy, and hospice/comfort care patients were excluded. The primary outcome was percentage of patients seen in a WLC within 6 month of hospital discharge, assessed via survey. For comparison, hospitalized patients with obesity, from 2014-2019, who had primary care based in the same healthcare system were assessed for the primary outcome (historical control). Results: 89 patients were assessed for eligibility and 50 were enrolled (mean age 50 (SD 15); 54% female; 66% WHITE; BMI 39 (12)). 22 (44%) completed the 6 month survey, 11 (22%) patients died, and 17 (34%) were lost to follow-up. Out of 22 completing the survey, 23% reported being seen in a WLC, 41% reported discussing weight loss with PCP, and 23% reported seeing a dietitian. 6 patients were started on anti-obesity medications (AOM) and 1 underwent MBS. 76% reported making changes to eating patterns, 67% reported changing physical activity patterns, and 82% felt that it was helpful to discuss weight management during the hospital visit. Among those not seen in a WLC, common barriers included: scheduling, insurance coverage, transportation, other medical issues taking priority, and change of mind about importance of weight loss. 1278 patients met criteria for the historical control (mean age 55 (SD 16); 51% female; 81% WHITE; BMI 37 (8)). 0.1% were seen in WLC, 3% were started AOMs, 0.3% had MBS, and 33% died within 6 months of discharge. The consent process, including discussion about obesity, explanation of study protocol, and obtaining signatures, took a median of 10 minutes. Conclusions: A brief discussion about obesity and referral to WLC before hospital discharge, likely to take about 5-10 minutes, may lead interested patients to take actions on excess weight.