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

Abstract

Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer behavioral weight loss counseling to 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 (NHLBI) 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 prior to 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 web-site. 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.

Modern Obesity Pharmacotherapy: Weighing Cardiovascular Risk and Benefit

“…2 Intensive lifestyle interventions have produced clinically relevant weight loss, 3 but modest interventions that are feasible in the primary-care setting are less successful. 4 Many efforts to develop an effective and safe weight-loss pill have failed. In fact, the history of obesity pharmacotherapy has been notable for cardiovascular side effects, not benefits.…”

Multimodal Lifestyle Intervention: Outlines and Outcomes

“…Internet intervention generally produces mean weight losses about one-third of the traditional face-to-face programs and about three times of the self-help controls. These commercial interventions proved their efects via RCTs against self-help controls [13,19].…”

“…Training of PHC practitioners on implementation of the basic components of multimodal lifestyle intervention especially dietary, physical activity, and behavioral counseling is mandatory. In the year 2006, the National Heart, Lung, and Blood Institute (NHLBI) funded practice-based opportunities for weight reduction (POWER) trials for this purpose [19]. Three clinical trials [20][21][22] proved that PHC practitioners produced mean weight losses ranged from 3.6 to 9.7 at 6 to 12 months when they provided a brief behavioral counseling to obese patients in their daily practices.…”

The relationship between early weight loss and weight loss at 1 year with naltrexone ER/bupropion ER combination therapy

“…1,2 Weight management medications are appropriate treatment options for individuals who are overweight or obese and have been unable to achieve weight loss with lifestyle intervention alone. When combined with a reduced-calorie diet and increased physical activity, weight management medications can facilitate achievement and maintenance of clinically meaningful weight loss (that is, weight loss of at least 5%) and lead to corresponding improvements in cardiovascular and metabolic risk factors.…”