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Introduction to the POWER-UP supplement

International Journal of Obesity volume 37, pages S1–S2 (2013)Cite this article

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Primary care practitioners (PCPs) have been encouraged to screen all adults for obesity and to offer intensive lifestyle intervention to affected individuals, either by providing such treatment themselves or by referral to appropriate programs or practitioners. Consistent with this call, the Centers for Medicare and Medicaid Services (CMS) recently approved the provision of intensive behavioral counseling to obese beneficiaries in primary care practice when delivered by physicians, nurse practitioners and physician assistants from the practices. Calls for PCPs to become more involved in obesity management are laudable, given the scope of this problem and a practitioner’s opportunity to discuss weight control with patients during routine office visits. However, there has been little research on the management of obesity in primary care, and evidence-based guidelines are lacking.

In response to this research gap, in 2006 the National Heart, Lung, and Blood Institute (NHLBI) funded three randomized controlled trials to examine the management of obesity in patients recruited from primary care practices. The trials were conducted at Harvard University/Washington University, Johns Hopkins University and the University of Pennsylvania. Each trial was designed and implemented independently of the others, but all three shared several common characteristics, such as the eligibility criteria for age and body mass index, as well as the use of ’kg lost at year 2’ as the primary outcome measure. Significant latitude was allowed in designing the weight loss interventions, both in terms of the frequency of contact (for example, weekly vs monthly visits) and the medium used to deliver the intervention (for example, face-to-face vs telephone and web-based contacts). The formal training and credentials of the treatment providers also differed markedly across the three studies, as did the role played by PCPs in delivering the intervention.

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Acknowledgements

We thank the health-care providers who delivered the POWER-UP intervention at the six primary care sites and, who with the study’s investigators and research coordinators, comprised the POWER-UP Research Group. GlaxoSmithKline and Unilver are acknowledged for providing orlistat and SlimFast products, respectively. We also thank colleagues from National Institutes of Health/National Heart, Lung, and Blood Institute who contributed to the design and administration of the three POWER trials. We particularly wish to acknowledge Dr Barbara Wells, the Project Officer for the POWER trials, who contributed in innumerable ways, as a colleague and advisor, to the successful completion of this research. We also thank her colleagues, Drs Catherine Stoney (Executive Secretary), Jungnam Joo, Peter Kaufmann and Caye Loria. We are pleased to acknowledge members of the Data, Safety, and Monitoring Board who oversaw the conduct of the study. They include Drs David Goff (chair), Robert Kushner, Gbenga Ogedegbe, Amelie Ramirez, Nathan Stimson and Barbara Tilley. We also acknowledge Drs Hsin-Chieh Yeh (Chair) and Gerald Jerome from the Resource Coordinating Unit at Johns Hopkins University. We thank Dr Delia West for sharing the weight loss maintenance protocol developed by the PRIDE Research Group. Electronic copies of the training and intervention materials may be obtained from the first author. This supplement is dedicated to the memory of our dear friend and colleague, Dr Thomas Ten Have. 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.

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

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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 & M Vetter

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  1. T A Wadden
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  2. S Volger
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  3. D B Sarwer
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Corresponding author

Correspondence to T A Wadden.

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Competing interests

TW 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. TW 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). DS discloses relationships with the following companies: Allergan, BariMD, BaroNova, Enteromedics and Galderma. DS 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; Gail Rudnitsky, MD (primary care providers); Angela Monroe (lifestyle coach); and 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, M.D. (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); and 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; Dianne Rittenhouse (lifestyle coaches); and Joanne Colligan (practice administrator).

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Wadden, T., Volger, S., Sarwer, D. et al. Introduction to the POWER-UP supplement. Int J Obes 37 (Suppl 1), S1–S2 (2013). https://doi.org/10.1038/ijo.2013.89

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