Implementing an Interprofessional, Enhanced Psychosocial Approach to Weight Loss: The Empower Program

Background: Obesity is a social justice issue with complex social determinants. Two-thirds of US adults experience overweight or obesity and lower SES and minoritized groups are disproportionately affected. Conditions such as depression, anxiety, trauma history, weight stigma, food insecurity, and poor body image increase risk of obesity and complexity of treatment, yet standard approaches in primary care focus on advice to “eat less, exercise more,” with insufficient attention or time to address emotional, social, and structural determinants. Social work frameworks and values are sorely needed in the design and implementation of obesity care. The purpose of this study was to examine acceptability and feasibility of adding psychosocial lifestyle components to a traditional weight loss program.

Method: Participants (n=30) were recruited from two primary care clinics to a 12-month weight loss intervention, EMPOWER. Mean age was 53.4 years (SD=15.2), 73% were female, and baseline BMI was 35.8 (SD=5.9). Anthropomorphic measures were completed in-person at intake and 6 months. Participants were given wi-fi-enabled scales for daily weighing and completed standardized dietary and psychosocial measures. EMPOWER consisted of weekly online educational sessions; six out of 20 were developed by the Social Work (SW) team and each session had four 15-minute psychoeducational modules. Participants met with a nutrition student at least four times and three SW services were added to the intervention: 1-hr initial psychosocial assessment interviews, individual coaching sessions, and bi-weekly community call-ins, all telehealth. SW standardized measures at baseline and 6mo included the Perceived Stress Scale (PSS) and Six-Factor Questionnaire (6FQ) to monitor stress and lifestyle barriers and tailor services to needs. The SW team met weekly and the larger interprofessional team met monthly to review participant progress. To explore acceptability and feasibility we examined perceived stress and lifestyle factors at baseline and 6 months, utilization of SW services, and weight loss progress.

Results: At 6 months, two-thirds lost at least 3% of body mass and over half lost 5% or more, with mean weight loss of 14.8 pounds (SD=12.9). Four showed no change or weight gain. At baseline, participants’ average PSS scores indicated moderate stress (M=17.2, SD=7.2). Barriers endorsed on the 6FQ included: Convenient dining (CD; 17%), Fast-paced eating (FP; 20%), Easily Enticed Eating (EEE; 30%), Exercise Struggling (ES; 10%), Self-criticism (SC; 6.7%). Paired sample t-tests found a significant reduction in number who endorsed EEE at 6mo (3.3%) compared to baseline; and numerical reductions in PSS scores and endorsements of all but one barrier were noted but not significant. Acceptability and engagement: Twenty-nine of 30 participants completed the initial 1-hr interview with SW team. At 6mo, participants completed 11.8 intervention sessions out of 16 possible; 10 participants utilized 18 individual SW coaching sessions (M=1.8, SD=1.5) and 15 attended one or more of the 8 bi-weekly community call-ins (M=2.5, SD=1.8).

Conclusion/Implications: Implementation of a team-based approach to weight loss is feasible and acceptable to patients, social work clinicians, and other health professionals. Incorporating psychosocial components to an online weight loss intervention via telehealth contributes to successful weight loss and interprofessional practice.