Principal Investigators: Theodore Friedman (CDU), Jasmine Eugenio (DHS) UCLA CTSI-Los Angeles County Department of Health Services (DHS) Projects The overall objective of the study is to test the effect on body weight of attending a group weight loss program that serve an underserved population. The group setting is more likely to be successful than traditional physician patient encounters as it incorporates two crucial aspects of the patient’s health experience: the patient’s own effectiveness in managing medical problems together with his or her health care team, and the patient’s own community for support in integrating medical recommendations into his or her daily life. Our experience has found that the group setting is well received by patients and enhances access to care.

1. Theodore C. Friedman, M.D., Ph.D.
Professor of Medicine - Charles R. Drew
University/UCLA
Chairman, Department of Internal Medicine
Lead Physician-Endocrinology-MLK-MACC
Jasmine Eugenio, M.D.
Lead Physician-Pediatrics-MLK-MACC
Professor of Pediatrics - Charles R. Drew University
CERP Faculty and Community Partners Meetings
Obesity group visits: An innovative program to deliver
obesity services at DHS facilities
December 19, 2013

2. UCLA CTSI/DHS pilot grant
• Funded May 2013
• Partnership between CDU (Friedman) and
MLK-MACC (Dr. Nossett, replaced by Dr.
Eugenio)

3. UCLA CTSI/DHS pilot grant
• Aim 1: To increase the obesity group visit at MLK-MACC from
an average of 10 patients per week to an average of 30-40
patients per week.
• Aim 2: To implement a data base to track body weight, HgbA1c
and other parameters related to weight loss
• Aim 3: To implement obesity group visits at 2 other DHS
facilities (Hubert H. Humphrey Comprehensive Health Center
and Harbor-UCLA Medical Center) via videoconference.
• Aim 4: To use surveys and focus groups to determine how to
improve the obesity group visit.
• Aim 5: To set up a group of stakeholders, including patients and
community members, as required for a PCORI proposal.

4. Obesity is a big problem-What can we do
about it?
• The prevalence of obesity (BMI> 30 kg/m2) in LA County
has risen from 13.6% in 1997 to 23.6% in 2011 (a 74%
increase), with prevalence of diabetes increasing from
6.6% in 1997 to 9.9% in 2011.
• Both obesity and diabetes are more common in Hispanics
and African Americans compared to whites.
• Diabetes is the 5th leading cause of death in LA County.

5. Obesity is a big problem-What can we do
about it?
• Los Angeles County is more populous than 42 individual
states.
• 800,000 patients are served by LA County DHS
• Because of the volume of patients treated by Los Angeles
County DHS, innovative, high-volume, high-quality, low-
cost programs are needed to address the obesity epidemic.

6. Group Visits
• Group models for care of patients began in 1907 at the
Massachusetts General Hospital, when Pratt developed the
first group program for tuberculosis.
• More recently, the “shared medical care” model, also
known as a “group medical visit” as first described by
Scott or “shared medical appointment” as described by
Noffsinger have received increased attention.
• Randomized trials have shown that group interventions are
associated with clinical significant improvement in a
variety of medical, psychological, and behavioral
outcomes, when compared with standard individual
medical visits.

7. Group Visits
• Patients treated through group visits have shown decreased
emergency department and outpatient utilization, increased
quality of life, improved self-efficacy, and higher
satisfaction with care.
• Group visits stress the power of the group-increased
motivation and peer-support.
• Little literature on obesity group visits, but the increased
motivation and peer-support
• May help address access to care and transportation
problems (see the doctor, dietician, learn how to cook and
get some exercise) all in one visit

8. Group Visits
• Two crucial aspects of the patient’s health experience:
• The patient’s own effectiveness in managing medical
problems together with his or her health care team
• The patient’s own community for support in integrating
medical recommendations into his or her daily life.

9. P.O.W.E.R.
– Obesity Group Visit
– Encouraged by Dr. Angela Nossett, based
on diabetes group visit.
– Work smarter, not harder.
– Replaced traditional obesity clinic at MLK-
MACC started in 2009 by Dr. Friedman.
Group Visit

10. P.O.W.E.R.
– Preventing
– Obesity
– With
– Eating
– Right
Group Visit

11. POWER format
• 1 to 1:30 registration, pretest, surveys and consents
• 1:30 to 2 Dr. Friedman’s overview lecture with audience
participation and questions (breakout groups with dietician
for return patients)
• 2 to 2:15 Instant Recess calisthenics video
• 2:15 to 2:40 Champions for Change-Cooking
demonstration (funding ended)
• 2:40 to 3-Special topic: Dr. Zodkovitch-stress reduction,
Dr. Eugenio-fast foods, YMCA, personal trainers,
orthopedics, motivational speaker
• 3 to 3:20-Elizabeth Driscoll dietician
• 3:20 to 3:30 wrap up-setting goals, post-test, prizes and
pairing up

12. POWER group visit-data
• started in January 2013
• 4 cadres of patients, each cadre meets weekly on Monday
afternoon
• now about 25 patients per group visit
• 247 unique patients
• 471 patient visits
• 24 patients lost at least 8 pounds and came to at least 3
visits
• About 60% African American, 35% Hispanic, 5%
Caucasian.
• Better group dynamic with bigger group

13. Outcomes
• Aim 1: To increase the obesity group visit at MLK-MACC from
an average of 10 patients per week to an average of 30-40
patients per week. Now at about 25 patients and will open up to
econsult January 2014 to increase numbers.
• Aim 2: To implement a data base to track body weight, HgbA1c
and other parameters related to weight loss. Done
• Aim 3: To implement obesity group visits at 2 other DHS
facilities (Hubert H. Humphrey Comprehensive Health Center
and Harbor-UCLA Medical Center) via videoconference. Will
start at Humphrey soon. Hoping Harbor will be interested. Also
exploring Olive View
• Aim 4: To use surveys and focus groups to determine how to
improve the obesity group visit. Done-excellent feedback
• Aim 5: To set up a group of stakeholders, including patients and
community members, as required for a PCORI proposal. 5
stakeholder meetings have occurred, will continue them in
preparation for PCORI submission in May 2014.

14. POWER group visit-quality care
• This non-traditional patient visit model has resulted in
1. improved patient access
2. increased provider productivity
3. improved patient outcomes and life style changes
4. high patient satisfaction scores-overall satisfaction score >
90%

15. POWER PR
• Featured in Los Angeles Times "Group
meetings turn doctor visits inside out"
September 17, 2013, p. 1, 9, http://
www.latimes.com/local/la-me-group-
doctor-visits-20130917,0,5085574,full.story
• Interviewed on Univision Evening News
(Los Angeles Channel 34) October 10,
2013, Obesity Group Visits,
http://losangeles.univision.com/videos/
video/2013-10-08/citas-medicas-en-grupo-
un

16. Future Plans
• Expand the number of patients-open up to
econsult January 2014
• Develop resource guide for exercise facilities
around MLK-MACC-done
• Partner with Ys-exploring
• Walking groups-started
• More personalized and structured diet
• Video-conference to other DHS facilities.
• POWER staff program to start in January 2014
• Centinela Valley grant due January 2014

17. Future Plans
• Mobile texting-partnering with Anjna-
startup mobile texting company in SF
• Patient appointment reminders, surveys
and goal reminders
• Several meetings with county council
and county HIPAA officer.
• Pilot for larger county-wide use

18. PCORI Grant
• Patient-Centered Outcomes Research Institute
• Requires stakeholder input-patients, researchers,
community members
• Ours will be based on our group visit model
• We have had 5 very helpful stakeholder meetings
• RFA-Obesity Treatment Options in Diverse
Populations-only 2 grants, 5 million each
• Instead will apply for Addressing Disparities RFA
• Due May 2014

19. Thanks
• CTSI for funding
• POWER staff for all their hard work
• Dr. Angela Nossett for her vision and support
• Dr. Elizabeth Driscoll for dietician contribution
• Judy, Maria, Vangie, Laura for assistance with
vital signs and tracking