Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial

Perreault, L; Pan, Q; Rodriguez, C; Gritz, RM; Smith, PC; Kramer, ES; Tolle, L; Connelly, L; Tietbohl, C; Williams, J; Holtrop, JS

doi:10.1038/s41591-025-04051-5

Obesity

Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial

Nat MedPublished 11 Dec 2025Stepped-wedge cluster-randomised trial

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Authors' conclusion

Thus, PATHWEIGH is a pragmatic, scalable approach showing favorable impact on population weight.

Study context

Population: Adults with BMI ≥25 kg m² with ≥2 measured weights in 56 primary care clinics, Colorado, USA, March 2020–March 2024
Participants: 274,182 adults56 clinics

Comparison: PATHWEIGH vs usual care
Primary endpoint: Coprimary: average patient weight loss at 6 months and weight loss maintenance from 6 to 18 months
Follow-up: 6 months; 6 to 18 months

Methodological detailspragmatic, one-way crossover from usual care to intervention

Pragmatic
One-way crossover from usual care to intervention

Primary result

As reported in the abstract

Weight difference (counterfactual analysis)

PATHWEIGH vs Usual careEstimate (95% CI)P value

First weight to 6 months; weight decreased with PATHWEIGH

difference 0.29 kg(0.27 kg, 0.32 kg)

P < 0.001

6 to 18 months; weight decreased with PATHWEIGH

difference 0.28 kg(0.26 kg, 0.31 kg)

P < 0.001

Total; weight decreased with PATHWEIGH

total difference 0.58 kg(0.54 kg, 0.61 kg)

P < 0.001

Further findings

Outcome	← Lower odds with PATHWEIGH ←→ Higher odds with PATHWEIGH →	OR (95% CI)	P value
Receiving weight-related care	0.512	1.23 (1.16–1.31)	P < 0.001
	0.512Odds ratio (log scale)

Outcome	← Lower with PATHWEIGH ←→ Higher with PATHWEIGH →	Adjusted difference (kg) (95% CI)	P value
Weight, patients receiving weight-related care · 18 monthsGreater weight loss with PATHWEIGH	−10123	2.36 (2.31 kg, 2.42 kg)	P < 0.001
Weight, patients not receiving weight-related care · 18 monthsWeight gain mitigated with PATHWEIGH	−10123	0.32 (0.30 kg, 0.35 kg)	P < 0.001
	−10123Difference, kg (linear scale)

Original publication

Implementation and effectiveness of a care process to prioritize weight management in primary care: a stepped-wedge cluster-randomized trial. Nat Med. Published 11 December 2025. doi:10.1038/s41591-025-04051-5

Read the original article ↗

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