CardioExchange Archive

CardioExchange, an NEJM practice community for medical professionals dedicated to improving cardiac patient care, was active from 2009 to 2015. CardioExchange fostered discussion between clinicians from across the globe.

November 16th, 2011

POWER to the People

Several Cardiology Fellows who are attending AHA.11 this week are blogging together on CardioExchange.  The Fellows include Revathi Balakrishnan, Eiman Jahangir, John Ryan (moderator), and Amit Shah. Read the previous post here. Check back often to learn about the biggest buzz in Orlando.

Tuesday, I heard the presentation of the Practice-Based Opportunities for Weight Reduction (POWER) trial, which was concurrently published with accompanying editorial in The New England Journal of Medicine.

It is important to delineate the three arms of this study them clearly before I comment on the results:

  • Remote support through a website and telephone and email contact
  • Remote support, plus individual and group in-person weight counseling sessions
  • Self-directed weight loss, which included meeting with a weight-loss coach at the beginning of the study and after 24 months

At 6 months, the average weight loss in the remote and in-person groups was significantly greater than in the self-directed group. More important, the improvement in the intervention groups was well maintained in the two years of follow-up (about 11 lbs, vs. < 2 lbs in the control group).

This study demonstrates to me two key lessons:

  • Simply telling patients they need to lose weight does not work. We need to do more.
  • Internet technology and user comfort with it have improved enough that we can now direct our patients to online, personally convenient counseling.

How do you counsel your patients regarding weight management?

Will you be directing your patients to a website such as the one developed for this trial?

Categories: Prevention
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4 Responses to “POWER to the People”

  1. Eiman Jahangir, MD says:
    November 16, 2011 at 10:19 am

    Interesting study John. I have always wondered if verbal reinforcement was enough. I guess this answers that question. I, unfortunately, fall into the self-directed group, telling my patients to try and walk 30 minutes a day….I should probably change my pattern of practice.

  2. Sandeep Goyal, MD says:
    November 16, 2011 at 3:23 pm

    Eiman, VA at least has a weight loss counselling group. But I think only people who get refered there are usually morbidly obese and unlikely to improve with just exercise or diet.

  3. John Ryan, MD says:
    November 16, 2011 at 3:32 pm

    Sandeep, thanks for bringing up the group counseling- the patients in this study preferred the email and telephone counseling compared to the group session. They also missed much fewer phone appointments than group sessions. The convenience of getting counseled on your own schedule was preferable and did not compromise the results- this goes against the grain of traditional weight management counseling.

  4. Eiman Jahangir, MD says:
    November 22, 2011 at 12:16 pm

    Thanks for that info on both counts, Sandeep for informing me of some available resources for my patients at the VA, and John for clarifying that the telephone/email counseling is preferable to group counseling.