Insights from the POWER Practice-Based Weight Loss Trial: A Focus Group Study on the PCP’s Role in Weight Management

Bennett, Wendy L.; Gudzune, Kimberly A.; Appel, Lawrence J.; Clark, Jeanne M.

doi:10.1007/s11606-013-2562-6

Cited by 36 publications

(67 citation statements)

References 26 publications

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“…Past studies focused on providers' self-reported barriers to obesity management, 3,24,25 assessment of providers' existing obesity management ability, 26,27 providers' views on the utility of obesity management interventions, 28 and providers' biases regarding weight and attitudes toward obesity management. 29 The current literature does not describe processes of provider change and development for supporting obesity management in response to an intervention.…”

Section: Discussionmentioning

confidence: 99%

Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

et al. 2017

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“…Two focus group studies have explored physicians' perceptions of providing support for patients using an online intervention. 59,60 However, in both these studies the physicians provided infrequent support to patients (every 3-6 months), whereas a coach provided patients with weekly intensive support. Coaches were not interviewed in these studies, meaning that only the perceptions of physicians who provided relatively sparse support were explored.…”

Section: Health Economic Analysesmentioning

confidence: 99%

“…Coaches were not interviewed in these studies, meaning that only the perceptions of physicians who provided relatively sparse support were explored. Still, these studies usefully show that some physicians perceive that they lack the skills to support patients losing weight 59 and that others use dubious motivational strategies, such as expressing frustration to patients who are not making progress. 60 These findings suggest that a more structured approach to providing support, such as the CARe approach, may be a useful tool for practitioners wanting to support patients using online weight-loss interventions.…”

Section: Health Economic Analysesmentioning

confidence: 99%

Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Little

Stuart

Hobbs

et al. 2017

Health Technol Assess

151

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BackgroundBehavioural counselling with intensive follow-up for obesity is effective, but in resource-constrained primary care settings briefer approaches are needed.ObjectivesTo estimate the clinical effectiveness and cost-effectiveness of an internet-based behavioural intervention with regular face-to-face or remote support in primary care, compared with brief advice.DesignIndividually randomised three-arm parallel trial with health economic evaluation and nested qualitative interviews.SettingPrimary care general practices in the UK.ParticipantsPatients with a body mass index of ≥ 30 kg/m2(or ≥ 28 kg/m2with risk factors) identified from general practice records, recruited by postal invitation.InterventionsPositive Online Weight Reduction (POWeR+) is a 24-session, web-based weight management intervention completed over 6 months. Following online registration, the website randomly allocated participants using computer-generated random numbers to (1) the control intervention (n = 279), which had previously been demonstrated to be clinically effective (brief web-based information that minimised pressure to cut down foods, instead encouraging swaps to healthier choices and increasing fruit and vegetables, plus 6-monthly nurse weighing); (2) POWeR+F (n = 269), POWeR+ supplemented by face-to-face nurse support (up to seven contacts); or (3) POWeR+R (n = 270), POWeR+ supplemented by remote nurse support (up to five e-mails or brief telephone calls).Main outcome measuresThe primary outcome was a modelled estimate of average weight reduction over 12 months, assessed blind to group where possible, using multiple imputation for missing data. The secondary outcome was the number of participants maintaining a 5% weight reduction at 12 months.ResultsA total of 818 eligible individuals were randomised using computer-generated random numbers. Weight change, averaged over 12 months, was documented in 666 out of 818 participants (81%; control,n = 227; POWeR+F,n = 221; POWeR+R,n = 218). The control group maintained nearly 3 kg of weight loss per person (mean weight per person: baseline, 104.4 kg; 6 months, 101.9 kg; 12 months, 101.7 kg). Compared with the control group, the estimated additional weight reduction with POWeR+F was 1.5 kg [95% confidence interval (CI) 0.6 to 2.4 kg;p = 0.001] and with POWeR+R was 1.3 kg (95% CI 0.34 to 2.2 kg;p = 0.007). By 12 months the mean weight loss was not statistically significantly different between groups, but 20.8% of control participants, 29.2% of POWeR+F participants (risk ratio 1.56, 95% CI 0.96 to 2.51;p = 0.070) and 32.4% of POWeR+R participants (risk ratio 1.82, 95% CI 1.31 to 2.74;p = 0.004) maintained a clinically significant 5% weight reduction. The POWeR+R group had fewer individuals who reported doing another activity to help lose weight [control, 47.1% (64/136); POWeR+F, 37.2% (51/137); POWeR+R, 26.7% (40/150)]. The incremental cost to the health service per kilogram weight lost, compared with the control group, was £18 (95% CI –£129 to £195) for POWeR+F and –£25 (95% CI –£268 to £157) for POWeR+R. The probability of being cost-effective at a threshold of £100 per kilogram was 88% and 98% for POWeR+F and POWeR+R, respectively. POWeR+R was dominant compared with the control group. No harms were reported and participants using POWeR+ felt more enabled in managing their weight. The qualitative studies documented that POWeR+ was viewed positively by patients and that health-care professionals generally enjoyed supporting patients using POWeR+.Study limitationsMaintenance of weight loss after 1 year is unknown.Future workIdentifying strategies for longer-term engagement, impact in community settings and increasing physical activity.ConclusionClinically valuable weight loss (> 5%) is maintained in 20% of individuals using novel written materials with brief follow-up. A web-based behavioural programme and brief support results in greater mean weight loss and 10% more participants maintain valuable weight loss; it achieves greater enablement and fewer participants undertaking other weight-loss activities; and it is likely to be cost-effective.Trial registrationCurrent Controlled Trials ISRCTN21244703.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 4. See the NIHR Journals Library website for further project information.

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“…However, in practice, only about one-third of obese adults receive an obesity diagnosis, less than half are advised to lose weight, and approximately one-fifth receive counseling for weight reduction (11, 12). Despite barriers to translating behavioral weight loss programs into practice (13, 13–16), many PCPs are interested in developing sustainable, practical strategies to promote and support patients’ weight loss efforts (16). …”

Section: Introductionmentioning

confidence: 99%

Satisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial

Bennett

Wang

Gudzune

et al. 2015

Patient Education and Counseling

Self Cite

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Objective To evaluate the association between the patient-provider relationship, satisfaction with primary care provider’s (PCP) involvement and weight loss in a practice-based weight loss trial. Methods POWER was a practice-based randomized controlled behavioral weight loss trial. Participants completed questionnaires about patient-provider relationship and satisfaction with their PCPs’ involvement in the trial. PCPs completed a demographics and practice survey. The main outcome was the mean weight change from baseline to 24 months. We created mixed-effect models, accounting for the random effects of patients clustering with the PCP and the repeated outcome assessments within patient over time, and adjusted for randomization assignment, age, gender, race and clinical site. Results 347 (of 415) were included. Mean age was 54.8 years, mean BMI was 36.3 kg/m2. Participants reported high quality patient-provider relationships (mean summary score=29.1 [range 14–32]). Patient-provider relationship quality was not associated weight loss in either the intervention or control groups. Among intervention participants, higher ratings of the helpfulness of the PCPs’ involvement was associated with greater weight loss (p=0.005). Conclusion Patient-provider relationship quality was not associated with weight loss in a practice-based weight loss trial but rating PCPs as helpful in the intervention was associated with weight loss. Practice Implications Partnering with PCPs to deliver weight loss programs may promote greater participant satisfaction and weight loss.

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Insights from the POWER Practice-Based Weight Loss Trial: A Focus Group Study on the PCP’s Role in Weight Management

Cited by 36 publications

References 26 publications

Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

Randomised controlled trial and economic analysis of an internet-based weight management programme: POWeR+ (Positive Online Weight Reduction)

Satisfaction with primary care provider involvement is associated with greater weight loss: Results from the practice-based POWER trial

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