Receipt of Weight Management Services Among Patients With OSA and Obesity

<h3>Background</h3> Obesity is the single greatest driver of OSA severity, and clinical practice guidelines recommend weight management services for all patients with OSA and obesity. <h3>Research Question</h3> How often do patients with obesity and newly diagnosed OSA receive weight management services as part of the initial management strategy for OSA? What are the patient- and site-level predictors of receipt of these services? <h3>Study Design and Methods</h3> National electronic health record data from the Veterans Health Administration were used to identify patients with a BMI ≥ 30 kg/m² and a new sleep study diagnostic of OSA. Patients with prior sleep studies, positive airway pressure therapy, or weight management services prior to OSA diagnosis were excluded. The primary study outcome was the receipt of new weight management services in the first 3 to 12 months following diagnosis of OSA. A mixed-effects logistic regression analysis was performed evaluating for patient- and site-level predictors of the receipt of weight management care. <h3>Results</h3> Among 152,976 patients included in our analysis, 15,304 (10.0%) received a weight management service following OSA diagnosis. Of these, 14,146 (9.2%) received a lifestyle-based weight management intervention, 1,790 (1.2%) received a weight management medication, and 29 (0.2%) underwent bariatric surgery. Female sex, Black race, higher BMI, comorbidity burden, and nonrural location were associated with greater receipt of weight management services. The odds of receiving weight management services were also greater among patients cared for at sites that reported greater proportions of patients receiving weight management care in the prior year. <h3>Interpretation</h3> A new OSA diagnosis is an opportunity to consider new treatments. Despite existing guidelines and the availability of services, our results show that patients with OSA and obesity rarely receive weight management care following diagnosis. New strategies are needed to overcome existing barriers to effective weight management care in patients newly diagnosed with OSA.