Quality improvement, obesity, weight loss, weight maintenance, behavior competency



  1. Brunacini, Kevin DNP, APRN, FNP-C (Owner)


Background: Evidence shows that 95%-98% of individuals who undergo a diet for weight loss purposes will gain back their weight within 5 years.


Local problem: No standardized method exists to assess weight loss maintenance (WLM) behavior competencies in patients who lose weight within a telehealth nutritional counseling private practice. Incorporating this assessment can be used to increase patient self-efficacy and predict a patient's likelihood of long-term weight success.


Methods: A quality improvement project, implementing four rapid plan-do-study-act cycles, was conducted. Each cycle included tests of change related to team and patient engagement, implementation of a WLM assessment, and an audit adherence. Data were analyzed using run charts to evaluate the impact of interventions on outcomes.


Interventions: The clinical team submitted a weekly WLM competency survey. A patient intake form was completed to identify behavior risks, followed by implementation of a WLM assessment in weekly follow-ups. A team adherence audit was completed and submitted every week.


Results: Team WLM competency levels increased 32%, averaging 82% at study conclusion. Completion of the patient intake form reached and held at 100% for the entire duration. Team usage of the WLM assessment peaked at 97%, correlating to increased patient behavior competence by 27.5% as the patient advanced. Team adherence gradually increased, peaking at 100%.


Conclusions: Patient screening forms and audit logs created a standardized process to collect, deliver, and better coordinate care. The findings suggest that patients who embodied higher behavioral competence will have a greater likelihood of sustaining their weight results and become the successful 2%-5% of weight maintainers.