University of Pennsylvania

POWER-UP at the University of Pennsylvania (UP) recruited participants from six primary care practices within the Penn Medicine system. Individuals were randomized to one control, or one of two interventions: Usual Care; Brief Lifestyle Counseling; or Enhanced Brief Lifestyle Counseling.

Participants in the Usual Care condition received educational materials (i.e., NHLBI's "Aim for a Healthy Weight") that were distributed at quarterly visits with their primary care provider (PCP).

Those in the Brief Lifestyle Counseling intervention received the same PCP visits, plus monthly brief (10-15 minute) counseling sessions with an auxiliary health care provider (e.g., a medical assistant).

Participants in the Enhanced Brief Lifestyle Counseling condition received the same treatment as those in the Brief Lifestyle Counseling group, plus the choice of adjunctive meal replacement products or pharmacotherapy (i.e., orlistat or sibutramine; until sibutramine was removed from the market in October 2010).

PCPs and auxiliary health care providers (the latter referred to as lifestyle coaches) were trained and certified in implementing the protocol. Attention was devoted to educating PCPs about the use of pharmacotherapy.

At the start of the intervention, physicians reviewed with participants the potential benefits and risks of both meal replacements and weight loss medications and asked participants to choose the approach they preferred (i.e., meal replacements vs. medications).

Participants did not begin their adjunctive treatment until completing the first month of counseling with their lifestyle coach, to allow time to consider their choices.