Implementing obesity management in primary care: Linking evidence based guidelines with a nurse practitioner model of care
O'Connor, Nancy A.
Hasenau, Susan M.
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<p><strong>Background:</strong> Obesity is a rising epidemic, affecting over one third of U.S. adults and over 13% of the world’s population, carrying significant morbidity and mortality. There have been decreasing rates of obesity counseling documented in primary care despite readily available practice guidelines. Multiple barriers to implementing weight loss counseling into primary care exist including patient and provider lack of motivation, knowledge deficit, and inadequate resources. <p><strong>Aims:</strong> To utilize a nurse practitioner as the bridge linking evidence to practice for obesity management in primary care.</p> <p><strong>Methods:</strong> Evidence based practice was implemented in a cohort design, in a small, U.S. suburban, primary care practice over four months. The program included calculating caloric needs, instruction in calorie and exercise tracking, negotiated weight loss goals, weekly home weights, and office follow up every three weeks for weight checks and plan management.</p> <p><strong>Results:</strong> Of the patients who completed the program compliance with follow up was 96%, food and exercise diaries were used 95% of the time, BMI decreased from 35.5%-32.7% and average weight loss was 17.4 lbs. Comorbidities of hypertension, LDL cholesterol, and fasting blood sugar were improved. </p> <p><strong>Linking Evidence to Action:</strong> Guideline implementation fits within a typical provider schedule, and dedicated visits allow time for focused discussion on weight management. Initially, patients were given very basic goals – record calories and exercise, then gradually worked on improving healthy behaviors and food choices. Smart phone apps were the preferred method for calorie tracking. Creating a culture of partnership and accountability, shared decision making, and patient empowerment was done via use of a nurse practitioner.</p> <p><strong>Implication for Practice:</strong> Partnering with a nurse practitioner can bridge evidence to practice and provide an ideal model of care for a primary care weight loss intervention.</p>