The Obesity Program is a value-based healthcare (VBHC) initiative designed to deliver integrated, outcome-driven care for adults with obesity (BMI ≥30 kg/m²) within Brazil’s private health system. Established in August 2023, the program restructures obesity management around a single medical condition, operationalizing key principles of an Integrated Practice Unit (IPU). Although aligned with the IPU framework, it does not constitute a formally established IPU in its organizational structure. The program aims to improve clinical outcomes and quality of life while optimizing resource allocation and ensuring appropriate treatment escalation.
The initiative is distinguished by its structured medical stratification, predefined therapeutic targets, multidisciplinary governance, formal surgical board oversight, digital monitoring, and systematic outcome transparency. The program serves privately insured adults, predominantly women (68%), primarily aged 28–48 years. At baseline, 98% presented with obesity (43% Grade I, 35% Grade II, and 20% Grade III). Cardiometabolic comorbidities were common: 21% had dyslipidemia, 20% systemic arterial hypertension, and 13% diabetes or prediabetes at enrollment.
Patients are actively engaged in shared decision-making, particularly regarding treatment selection and surgical indication. Care pathways are stratified according to BMI, comorbidity profile, and treatment response. Participants receive structured multidisciplinary follow-up (endocrinology, nutrition, and psychology) with predefined weight-loss targets (≥5% at 3 months, ≥7% at 6 months, and ≥10% at 12 months). Escalation to bariatric surgery follows objective criteria and requires approval by a multidisciplinary surgical board. Digital tools, telemedicine, and coordinated case management support patient engagement and longitudinal continuity of care.From July 2023 to January 2026, 877 patients were enrolled.
Between July 2025 and January 2026, 192 patients met surgical eligibility criteria; however, 179 surgeries were avoided through optimized medical management, reflecting appropriate allocation of high-cost interventions. Clinical outcomes demonstrate sustained weight reduction (mean 8% at 6 months and 11% at 12 months in the pharmacological pathway). Quality of life improved significantly (EQ-VAS increased from 64 to 79 at one year, while psychosocial burden decreased from 45.7% to 27.1%). Dyslipidemia prevalence declined by 11.95%. Patient experience was strong (NPS 81.9; 86.6% promoters).By improving outcomes while reducing unnecessary procedural intensity, the initiative demonstrates a measurable increase in patient value (ΔHealth Outcomes / ΔCosts) and represents a scalable model for high-value obesity care grounded in IPU principles.