Hopkins POWER Trial
The Johns Hopkins POWER Trial was funded by the National Heart, Lung and Blood Institute of the National Institutes of Health as an effectiveness trial of weight loss interventions in primary care settings. The acronym POWER stands for "Practice-based Opportunities for Weight Reduction." The principal investigator of the study is Lawrence Appel, MD, MPH, Professor of Medicine, Epidemiology and International Health (Human Nutrition), and Director of the Welch Center for Prevention, Epidemiology, and Clinical Research at The Johns Hopkins Medical Institutions.
The Johns Hopkins POWER Trial recruited participants from six primary care practices in the Baltimore area. Participants were obese individuals with hypertension, hypercholesterolemia or diabetes. Participants were randomized to one of the following three arms:
Self-directed Control - Those assigned to the self-directed control condition received written materials, as well as ongoing access to a static web page.
Remote Support Only -Participants assigned to the Remote Support Only condition received a multi-channel, behavioral intervention with telephone, web, and email contacts, without in-person visits, implemented by trained coaches of Healthways, a disease management company.
In-Person Support - Those assigned to the In-Person Support condition received a multi-channel behavioral intervention with in-person, group and individual sessions, along with telephone, web, and email contacts. The In-Person Support condition was delivered by coaches from Hopkins.
Both active interventions used established behavioral techniques to achieve weight loss (i.e., frequent contact, selfmonitoring of weight and physical activity, use of food records, accountability), and a web-based hub to facilitate communication among counselors, participants, and the primary care provider (PCP), as well as to promote behavior change in participants. At Hopkins, PCPs had a supportive, rather than a primary role, in delivering the interventions. At routinely scheduled visits, the PCP reviewed participants' weight loss reports and encouraged participants in the Remote and In-Person support conditions to remain active in the weight loss program.
|Weight Loss at 24 Months|
|Average weight loss (in pounds)||1.8||10.1||11.2|
|Lost at least 5% of body weight||19%||38%||41%|
Johns Hopkins Medicine and Healthways have developed Innergy (TM), a commercially available version of the call center-directed weight-loss program pioneered and studied by Lawrence J. Appel, MD, MPH, and his colleagues.
Appel, LJ., Clark, JM., Yeh, HC, Wang, NY, Coughlin, JW, Daumit, G, Miller, ER, Dalcin, A, Jerome, GJ, Geller, S, Noronha, G, Pozefsky, T, Charleston, Reynolds, JB, Durking, N, Rubin, RR, Louise, TA, Brancati, FL (2011). Comparative Effectiveness if Weight-Loss Interventions in Clinical Practice. New England Journal of Medicine. 2011 Nov 24;365(20):1959-68. doi: 10.1056/NEJMoa1108660. (Link)
Yanovski SZ. Obesity treatment in primary care--are we there yet? New England Journal of Medicine. 2011 Nov 24;365(21):2030-1. [Commentary on article above] (Link)
Mitka M. Remote interventions may facilitate weight loss. JAMA. 2011 Dec 28;306(24):2660. [Commentary on article above] (Link)
Glasgow RE, Gaglio B, Bennett G, Jerome GJ, Yeh HC, Sarwer DB, Appel L, Colditz G, Wadden TA, Wells B. Applying the PRECIS Criteria to Describe Three Effectiveness Trials of Weight Loss in Obese Patients with Comorbid Conditions. Health Services Research. 2011 Nov 2. doi: 10.1111/j.1475-6773.2011.01347.x. [Epub ahead of print].(Link)
Yeh HC, Clark JM, Emmons KE, Moore RH, Bennett GG, Warner ET, Sarwer DB, Jerome GJ, Miller ER, Volger S, Louis TA, Wells B, Wadden TA, Colditz GA, Appel LJ. Independent but coordinated trials: insights from the practice-based Opportunities for Weight Reduction Trials Collaborative Research Group. Clinical Trials. 2010 Aug;7(4):322-32. (Link)
Jerome GJ, Yeh H-C, Dalcin A, Reynolds J, Gauvey-Kern ME, Charleston J, Durkin N, Appel LJ. Treatment of obesity in primary care practice: The Practice BasedOpportunities for Weight Reduction (POWER) Trial at Johns Hopkins. Obesity and Weight Management. 2009 Oct;5(5):216-21. (Link)