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Journal of General Internal Medicine

, Volume 29, Issue 1, pp 50–58 | Cite as

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

  • Wendy L. BennettEmail author
  • Kimberly A. Gudzune
  • Lawrence J. Appel
  • Jeanne M. Clark
Original Research

ABSTRACT

BACKGROUND

Despite U.S. Preventive Services Task Force recommendations, few primary care providers (PCPs) counsel obese patients about weight loss. The POWER practice-based weight loss trial used health coaches to provide weight loss counseling, but PCPs referred their patients and reviewed their patients’ progress reports. This trial provided a unique opportunity to understand PCPs’ actual and desired roles in a multi-component weight loss intervention.

OBJECTIVE

1) To explore the PCP role, inclusive of and beyond the trial’s intended role, in a practice-based weight loss trial; and 2) to elicit recommendations by PCPs for wider dissemination of the successful multi-component program.

DESIGN

Qualitative focus group study of PCPs with ≥ 4 patients enrolled in trial.

PARTICIPANTS

Twenty-six out of 30 PCPs from six community practices participated between June and August 2010.

MAIN MEASURES

We used a semi-structured moderator guide. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently coded transcripts for thematic content, identified meaningful segments within the responses and assigned codes using an editing style analysis. Atlas.ti software was used for organization/analysis.

MAIN RESULTS

We identified five major themes related to the PCP’s role in patients’ weight management: (1) refer patients into program, provide endorsement; (2) provide accountability for patients; (3) “cheerlead” for patients during visits; (4) have limited role in weight management; and (5) maintain the long-term trusting relationship through the ups and downs. PCPs provided several recommendations for wider dissemination of the program into primary care practices, highlighting the need for specific feedback from coaches as well as efficient, integrated processes.

CONCLUSIONS

Weight loss programs have the potential to partner with PCPs to build upon the patient–provider relationship to improve patient accountability and sustain behavior change. However, rather than directing the weight loss, PCPs preferred a peripheral role by utilizing health coaches.

KEY WORDS

qualitative research obesity primary care provider 

Notes

Acknowledgements

This work was supported with a grant from the Johns Hopkins University Osler Center for Clinical Excellence at Johns Hopkins. POWER Hopkins was supported by a grant from the National Heart, Lung and Blood Institute (5U01HL087085-05). The original trial’s clinical trials.gov registration number was NCT00783315. Dr. Wendy Bennett is supported by a career development award from the National Heart, Lung, and Blood Institute, 5K23HL098476– 02.

The original trial involved a collaboration with Healthways, Inc., a disease management company. Healthways provided coaching effort for the transtelephonic intervention and developed the website used in the intervention. Healthways provided some research funding to supplement NIH support. Under an institutional consulting agreement with Healthways, the Johns Hopkins University received fees for advisory services to Healthways during the POWER trial. Faculty members who participated in the consulting services received a portion of the University fees.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Supplementary material

11606_2013_2562_MOESM1_ESM.pdf (76 kb)
ESM 1 (PDF 76 kb)

REFERENCES

  1. 1.
    Hunt JR, Kristal AR, White E, Lynch JC, Fries E. Physician recommendations for dietary change: their prevalence and impact in a population-based sample. Am J Public Health. 1995;85(5):722–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Campbell MK, DeVellis BM, Strecher VJ, Ammerman AS, DeVellis RF, Sandler RS. Improving dietary behavior: the effectiveness of tailored messages in primary care settings. Am J Public Health. 1994;84(5):783–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Nawaz H, Adams ML, Katz DL. Weight loss counseling by health care providers. Am J Public Health. 1999;89(5):764–7.PubMedCrossRefGoogle Scholar
  4. 4.
    McTigue KM, Harris R, Hemphill B, et al. Screening and interventions for obesity in adults: summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 2003;139(11):933–49.PubMedCrossRefGoogle Scholar
  5. 5.
    Moyer VA, on behalf of the U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. preventive services task force recommendation statement. Ann Intern Med. 2012;157(5):373-8.Google Scholar
  6. 6.
    Huang J, Yu H, Marin E, Brock S, Carden D, Davis T. Physicians’ weight loss counseling in two public hospital primary care clinics. Acad Med. 2004;79(2):156–61.PubMedCrossRefGoogle Scholar
  7. 7.
    Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med. 1995;24(6):546–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Alexander SC, Ostbye T, Pollak KI, Gradison M, Bastian LA, Brouwer RJ. Physicians’ beliefs about discussing obesity: results from focus groups. Am J Health Promot. 2007;21(6):498–500.PubMedCrossRefGoogle Scholar
  9. 9.
    Forman-Hoffman V, Little A, Wahls T. Barriers to obesity management: a pilot study of primary care clinicians. BMC Fam Pract. 2006;7:35.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    Ko JY, Brown DR, Galuska DA, Zhang J, Blanck HM, Ainsworth BE. Weight loss advice U.S. obese adults receive from health care professionals. Prev Med. 2008;47(6):587–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Bleich SN, Pickett-Blakely O, Cooper LA. Physician practice patterns of obesity diagnosis and weight-related counseling. Patient Educ Couns. 2011;82(1):123–9.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    The Centers for Medicare and Medicaid Services (CMS). Decision Memo for Intensive Behavioral Therapy for Obesity (CAG-00423N) Intensive Behavioral Therapy for Obesity (CAG-00423N). http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?&NcaName=Intensive%20Behavioral%20Therapy%20for%20Obesity&bc=ACAAAAAAIAAA&NCAId=253. Accessed 7/12/13.
  13. 13.
    Elmer PJ, Obarzanek E, Vollmer WM, et al. Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-month results of a randomized trial. Ann Intern Med. 2006;144(7):485–95.PubMedCrossRefGoogle Scholar
  14. 14.
    Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the look AHEAD trial. Arch Intern Med. 2010;170(17):1566–75.PubMedGoogle Scholar
  15. 15.
    Tsai AG, Wadden TA. Treatment of obesity in primary care practice in the United States: a systematic review. J Gen Intern Med. 2009;24(9):1073–9.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Appel LJ, Clark JM, Yeh HC, et al. Comparative effectiveness of weight-loss interventions in clinical practice. N Engl J Med. 2011;365(21):1959–68.PubMedCrossRefGoogle Scholar
  17. 17.
    Yeh HC, Clark JM, Emmons KE, et al. Independent but coordinated trials: insights from the practice-based opportunities for weight reduction trials collaborative research group. Clin Trials. 2010;7(4):322–32.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Crabtree BF, Miller WL. Doing qualitative research. Newbury Park: Sage Publications; 1992:276.Google Scholar
  19. 19.
    Ockene IS, Hebert JR, Ockene JK, et al. Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester area trial for counseling in hyperlipidemia (WATCH). Arch Intern Med. 1999;159(7):725–31.PubMedCrossRefGoogle Scholar
  20. 20.
    Martin PD, Dutton GR, Rhode PC, Horswell RL, Ryan DH, Brantley PJ. Weight loss maintenance following a primary care intervention for low-income minority women. Obesity (Silver Spring). 2008;16(11):2462–7.CrossRefGoogle Scholar
  21. 21.
    Kumanyika SK, Fassbender JE, Sarwer DB, et al. One-year results of the think health! Study of weight management in primary care practices. Obesity (Silver Spring). 2012;20(6):1249–57.CrossRefGoogle Scholar
  22. 22.
    Carvajal R, Wadden TA, Tsai AG, Peck K, Moran CH. Managing obesity in primary care practice: a narrative review. Ann N Y Acad Sci. 2013;1281:191-206.Google Scholar
  23. 23.
    Scott JG, Cohen D, DiCicco-Bloom B, et al. Speaking of weight: how patients and primary care clinicians initiate weight loss counseling. Prev Med. 2004;38(6):819–27.PubMedCrossRefGoogle Scholar
  24. 24.
    Bennett GG, Warner ET, Glasgow RE, et al. Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Arch Intern Med. 2012;172(7):565–74.PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Wadden TA, Volger S, Sarwer DB, et al. A two-year randomized trial of obesity treatment in primary care practice. N Engl J Med. 2011;365(21):1969–79.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Tsai AG, Abbo ED, Ogden LG. The time burden of overweight and obesity in primary care. BMC Health Serv Res. 2011;11:191.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Tang JW, Kushner RF, Cameron KA, Hicks B, Cooper AJ, Baker DW. Electronic tools to assist with identification and counseling for overweight patients: a randomized controlled trial. J Gen Intern Med. 2012;27(8):933-9.Google Scholar
  28. 28.
    Bleich SN, Gudzune KA, Bennett WL, Cooper LA. Do physician beliefs about causes of obesity translate into actionable issues on which physicians counsel their patients? Prev Med. 2013;56(5):326–8.PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2013

Authors and Affiliations

  • Wendy L. Bennett
    • 1
    • 2
    Email author
  • Kimberly A. Gudzune
    • 1
    • 2
  • Lawrence J. Appel
    • 1
    • 2
    • 3
  • Jeanne M. Clark
    • 1
    • 2
    • 3
  1. 1.Welch Center for Prevention, Epidemiology and Clinical ResearchThe Johns Hopkins UniversityBaltimoreUSA
  2. 2.Division of General Internal MedicineThe Johns Hopkins University School of MedicineBaltimoreUSA
  3. 3.Department of EpidemiologyThe Johns Hopkins Bloomberg School of Public HealthBaltimoreUSA

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