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Managing obesity in primary care practice: an overview with perspective from the POWER-UP study

International Journal of Obesity volume 37, pages S3–S11 (2013)Cite this article

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Abstract

Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer behavioral weight loss counseling to the affected individuals. However, there is limited research and guidance on how to provide such intervention in primary care settings. This led the National Heart, Lung and Blood Institute in 2005 to issue a request for applications to investigate the management of obesity in routine clinical care. Three institutions were funded under a cooperative agreement to undertake the practice-based opportunities for weight reduction (POWER) trials. The present article reviews selected randomized controlled trials, published before the initiation of POWER, and then provides a detailed overview of the rationale, methods and results of the POWER trial conducted at the University of Pennsylvania (POWER-UP). POWER-UP’s findings are briefly compared with those from the two other POWER trials, conducted at Johns Hopkins University and Harvard University/Washington University. The methods of delivering behavioral weight loss counseling differed markedly across the three trials, as captured by an algorithm presented in the article. Delivery methods ranged from having medical assistants and PCPs from the practices provide counseling to using a commercially available call center, coordinated with an interactive website. Evaluation of the efficacy of primary care-based weight loss interventions must be considered in light of costs, as discussed in relation to the recent treatment model proposed by the Centers for Medicare and Medicaid Services.

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Acknowledgements

This research was supported by grants U01-HL087072 from the National Heart, Lung and Blood Institute and K24-DK065018 from the National Institute of Diabetes and Digestive and Kidney Disease. We thank Amos Odeleye for his assistance with statistical analysis.

This article is published as part of a supplement, sponsored by the Center for Weight and Eating Disorders—University of Pennsylvania.

Author information

Author notes

  1. T A Wadden, S Volger, A G Tsai, D B Sarwer, R I Berkowitz, L K Diewald, R Carvajal, C H Moran and M Vetter: Members are listed in the Appendix.

Authors and Affiliations

  1. Department of Psychiatry, Center for Weight and Eating Disorders, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    T A Wadden, S Volger, D B Sarwer, R I Berkowitz, L K Diewald, R Carvajal, C H Moran & M Vetter

  2. Department of Psychology, Haverford College, Haverford, PA, USA

    T A Wadden

  3. Division of General Internal Medicine and Anschutz Health and Wellness Center, University of Colorado School of Medicine, Aurora, CO, USA

    A G Tsai

  4. Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    D B Sarwer

  5. Department of Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    R I Berkowitz

  6. Division of Endocrinology, Department of Medicine, Diabetes, and Metabolism, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    M Vetter

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  1. T A Wadden
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for the POWER-UP Research Group

Corresponding author

Correspondence to T A Wadden.

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Competing interests

TAW serves on the advisory boards of Novo Nordisk and Orexigen Therapeutics, which are developing weight loss medications, as well as of Alere and the Cardiometabolic Support Network, which provide behavioral weight loss programs. TAW has also served as a consultant for Boehringer Ingelheim, and has received grant support from the National Institutes of Health (NIH/NIDDK and NIH/NHLBI). AGT has received grant support from the American Hospital Association (AHA), Agency for Healthcare Research and Quality (AHRQ), and American Academy of Family Physicians (AAFP) Foundation. DBS discloses relationships with the following companies: Allergan, BariMD, BaroNova, Enteromedics and Galderma. DBS has also received grant support from the National Institutes of Health (NIH). The remaining authors declare no conflict of interest.

Appendix

Appendix

POWER-UP Research Group: Investigators and Research Coordinators

Academic investigators at the Perelman School of Medicine at the University of Pennsylvania were Thomas A Wadden, PhD (principal investigator), David B Sarwer, PhD (co-principal investigator), Robert I Berkowitz, MD, Jesse Chittams, MS, Lisa Diewald, MS, RD, Shiriki Kumanyika, PhD, Renee Moore, PhD, Kathryn Schmitz, PhD, Adam G Tsai, MD, MSCE, Marion Vetter, MD and Sheri Volger, MS, RD.

Research coordinators at the University of Pennsylvania were Caroline H Moran, BA, Jeffrey Derbas, BS, Megan Dougherty, BS, Zahra Khan, BA, Jeffrey Lavenberg, MA, Eva Panigrahi, MA, Joanna Evans, BA, Ilana Schriftman, BA, Dana Tioxon, Victoria Webb, BA and Catherine Williams-Smith, BS.

POWER-UP Research Group: Participating Sites and Clinical Investigators

PennCare—Bala Cynwyd Medical Associates: Ronald Barg, MD, Nelima Kute, MD, David Lush, MD, Celeste Mruk, MD, Charles Orellana, MD and Gail Rudnitsky, MD (primary care providers); Angela Monroe (lifestyle coach); Lisa Anderson (practice administrator).

PennCare—Internal Medicine Associates of Delaware County: David E Eberly, MD, Albert H Fink Jr, MD, Kathleen Malone, CRNP, Peter B Nonack, MD, Daniel Soffer, MD, John N Thurman, MD and Marc J Wertheimer, MD (primary care providers); Barbara Jean Shovlin, Lanisha Johnson (lifestyle coaches); Jill Esrey (practice administrator).

PennCare—Internal Medicine Mayfair: Jeffrey Heit, MD, Barbara C Joebstl, MD and Oana Vlad, MD (primary care providers); Rose Schneider, Tammi Brandley (lifestyle coaches); Linda Jelinski (practice administrator).

Penn Presbyterian Medical Associates: Joel Griska, MD, Karen J Nichols, MD, Edward G Reis, MD, James W Shepard, MD and Doris Davis-Whitely, PA (primary care providers); Dana Tioxon (lifestyle coach); Charin Sturgis (practice administrator).

PennCare—University City Family Medicine: Katherine Fleming, CRNP, Dana B Greenblatt, MD, Lisa Schaffer, DO, Tamara Welch, MD and Melissa Rosato, MD (primary care providers); Eugonda Butts, Marta Ortiz, Marysa Nieves and Alethea White (lifestyle coach); Cassandra Bullard (practice administrator).

PennCare—West Chester Family Practice: Jennifer DiMedio, CRNP, Melanie Ice, DO, Brandt Loev, DO, John S Potts, DO and Christine Tressel, DO (primary care providers); Iris Perez, Penny Rancy, and Dianne Rittenhouse (lifestyle coaches); Joanne Colligan (practice administrator).

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Wadden, T., Volger, S., Tsai, A. et al. Managing obesity in primary care practice: an overview with perspective from the POWER-UP study. Int J Obes 37 (Suppl 1), S3–S11 (2013). https://doi.org/10.1038/ijo.2013.90

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