For a long time, endocrinologist Leigh Perreault, MD, felt uneasy about how weight management was handled in routine medical care. Too often, patients were sent home with the same advice to eat better and exercise more, even when it clearly was not enough.
"There was a moment I put my face in my hands and thought, 'What am I doing?' I would write a lot of prescriptions for patients' diabetes, their blood pressure, their lipids and all these other conditions," says Perreault, a professor of endocrinology, metabolism and diabetes at the University of Colorado Anschutz School of Medicine who practices in Westminster alongside primary care physicians.
She realized that many of those medications addressed symptoms rather than the root problem. "None of these people want to be on these medications and I thought if I could just help them with their weight, many of these health concerns would probably go away," she says.
That realization set the stage for a new approach that would soon reshape how weight care could work in primary care settings.
A New System Called PATHWEIGH
Perreault and her colleagues created PATHWEIGH, a structured process that helps patients and primary care teams focus directly on weight management. The program introduces dedicated clinic visits where providers can concentrate specifically on weight related care instead of squeezing it into a standard appointment.
With funding from the National Institutes of Health (NIH), PATHWEIGH was rolled out across UCHealth's 56 primary care clinics throughout Colorado to evaluate its impact. The pilot included 274,182 patients, making it one of the largest randomized trials ever conducted in this area.
Results published by Perreault and her team in Nature Medicine showed that the program reduced population weight gain by 0.58 kg over 18 months and shifted the overall trend from steady gain to weight loss -- an outcome with major implications for public health.
The program also made patients more likely to receive help for weight issues. Participation increased the chances of receiving weight related care by 23%.
"With PATHWEIGH, we showed that we absolutely eliminated population weight gain across all of our primary care, which has never been done previously," Perreault says.
As a result, obesity specialists are now pointing to PATHWEIGH as a possible standard of care, and several health systems around the country are exploring how to adopt it.
Building a Clear Path to Weight Care
Perreault describes PATHWEIGH as a way to align patients and clinicians around a shared plan.
"If you think about weight loss medicine or surgery or a weight loss program, those are all vehicles to weight loss," she says. "We built a highway that we could put all the vehicles on, so there's actually a process for people to receive weight related care if they wanted it."
The process began with something simple. Clinics posted signs letting patients know they could request an appointment focused entirely on weight management by asking at the front desk.
That request automatically activated a workflow in the electronic health record. Patients received a survey, and once completed, their responses flowed directly into the clinician's notes. This allowed visits to focus less on background information and more on practical next steps.
"It made the whole process really efficient, and then effectively turned our note template into a menu of anything that we might do," Perreault says. "It really made it extremely time efficient and consolidated everything we might do for a patient into one interface."
Removing Barriers and Awkward Conversations
Data collected over 18 months showed that about one in four eligible patients received some form of weight related care at least once during the trial. Most of that care involved lifestyle counseling, but prescriptions for anti-obesity medications doubled during the intervention.
Unlike many one-size-fits-all weight loss programs, PATHWEIGH allowed treatment to be customized to each patient. It also reduced the discomfort that often surrounds conversations about weight in medical settings.
"Most people who want or need weight related care never get it. Either they don't ask for it or the providers don't bring it up, and if they do, the patient usually gets told to go home and eat less and exercise more, and then nothing happens," Perreault says. "The person gets frustrated and they learn to not ask for help anymore, because it's kind of embarrassing and it doesn't help. This was a safe space to say, 'Hey, if you would like medical assistance with your weight, we actually have a process for you to receive that now.'"
Why Small Changes Matter at Scale
Experts estimate that rising obesity rates are driven by an average population weight gain of about .5kg per year. Stopping that increase and turning it into even modest weight loss could make a meaningful difference in slowing the obesity epidemic.
"While it's not a significant difference on an individual patient level, it's a huge deal on a population and public health level," Perreault says.
Researchers also found that patients who received clear weight related care through PATHWEIGH experienced greater weight loss. Even patients who did not receive direct interventions saw reduced weight gain compared with what would normally be expected.
Expanding Beyond Colorado
Perreault says the program's success has opened the door to wider adoption. Plans are underway to expand PATHWEIGH beyond Colorado. The Obesity Association, which is developing its first standards of care for obesity, is highlighting the program as a recommended care process.
Five health systems across seven states are also considering PATHWEIGH as its creators work toward licensing the model.
"I'm really proud that PATHWEIGH was home-grown and built and tested here in Colorado," Perreault says. "This is the blueprint that moves us forward."
