The article describes the PATHWEIGH study, a pragmatic process of weight management in primary care, tested in a stepped-wedge cluster-randomized trial in 56 primary care practices in Colorado in 274,182 patients[1][2][3]. The intervention consists of three components: health system leadership support, an electronic health record-driven process to prioritize and accelerate weight management, and implementation strategies to promote use and educate clinicians[1][2]. The main results show a population mean weight reduction of 0.58 kg over 18 months, which changed the trajectory from weight gain to weight loss[2][3]. The intervention increased the likelihood of receiving weight-related care by 23%[2]. Patients who received clear weight-related care achieved greater weight loss, while even those without direct intervention had less weight gain than expected[2][3]. The study was funded by the NIH and published in Nature Medicine in December 2025[1][2]. PATHWEIGH leverages existing resources and workflows to engage patients, clinicians, and the health system[1][2].