Abstract

Purpose/Aims

The purpose of this DNP project is to implement a 10-week Lifestyle Intervention Shared Medical Appointment (LISMA) program in primary care to improve obesity outcomes. Aims include increasing structured visit frequency, enhancing multidisciplinary engagement, and improving metabolic indicators, mindful eating behaviors, and self-efficacy.

Background of Problem & Description of Current Practice

Obesity affects over 40% of U.S. adults and is associated with cardiometabolic morbidity, reduced quality of life, and rising healthcare costs. Guidelines recommend intensive, multicomponent behavioral interventions with frequent contact. Current practice primarily offers one-on-one visits at insufficient frequency with limited team integration, contributing to suboptimal management. LISMAs provide a scalable, guideline-aligned approach to increase visit frequency, support team-based care, and facilitate sustainable behavior change.

Supporting Evidence

Obesity is a chronic, adiposity-based disease requiring intensive, team-based care. Current Literature and guidelines recommend at least 12 structured encounters annually that combine medical and behavioral interventions. Shared Medical Appointments improve access, metabolic outcomes, and self-efficacy while addressing provider time constraints, training gaps, and weight bias in primary care.

The EBP/QI Process Approach Used

The project used the Johns Hopkins Nursing Evidence-Based Practice Model and the PET process (Practice question, Evidence review, Translation) to appraise the literature, engage stakeholders, and implement sustainable obesity management practices.

Implementation

18 adults with BMI ≥30 kg/m² or ≥27 kg/m² with comorbidities were enrolled in the 10-week structured LISMA led by an advanced practice nurse and health coach.

Anticipated Outcomes/Measures Achieved

Outcomes were assessed pre- and post-intervention using electronic medical record data and validated instruments, including the Mindful Eating Behavior Scale, Weight Efficacy Lifestyle Questionnaire–Short Form, and PROMIS Global Health-10. Measures included visit frequency, metabolic and biometric indicators, mindful eating, self-efficacy, and overall physical, mental, and social well-being.

Conclusion

LISMAs offer a feasible, patient-centered model to improve access, engagement, and multidisciplinary support in obesity care. This approach aligns with guidelines and provides a sustainable framework for enhancing obesity outcomes in primary care.

Keywords: obesity, BMI ≥30, adults, shared medical appointments, group medical visits, lifestyle medicine, primary care, outpatient clinic, team-based care, behavior counseling, weight loss, metabolic outcomes, self-efficacy

LLU Discipline

Nursing

School

School of Nursing

First Advisor

Robin Dudley Pueschel

Second Advisor

Salem Dehom

Degree Name

Doctor of Nursing Practice (DNP)

Year Degree Awarded

2026

Date (Title Page)

Spring 5-15-2026

Language

English

Type

Doctoral Project

Page Count

155 p., 1p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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