Pounds Off With Empowerment (POWER)

Pounds Off With Empowerment (POWER) is a lifestyle intervention for diabetic persons in rural communities. The prevalence of overweight, obesity, and diagnosed diabetes in South Carolina is among the highest in the nation, and 75% of counties are diagnosed as medically underserved. Moderate weight loss has been shown to improve glycemic control and lipoprotein profile and reduce blood pressure among those who have type 2 diabetes; the American Diabetes Association emphasizes the importance of weight management in medical nutrition therapy for diabetes. POWER participants have a clinical diagnosis of diabetes, are aged 45 or older, and have a body mass index (BMI: weight in kilograms divided by height in meters squared) of 25 kg/m2, are primarily African American, and live in rural areas. Participants were given the goal of achieving and maintaining a 10% weight loss over 12 months. An intensive lifestyle intervention derived from the Diabetes Prevention Program (DPP) lifestyle intervention focuses on weight loss through dietary control and 150 minutes of physical activity per week. The intervention participants meet in individual and group sessions with a nutritionist weekly for the first 4 months, every other week for the next 2 months, and once a month for the following 6 months. The program consists of regionally and culturally appropriate suggestions for physical activity and dietary changes, as well as individually tailored goals.

The goal of POWER is to promote weight loss and glycemic control among individuals diagnosed with type 2 diabetes living in rural communities.

When compared with a standard intervention (a single individual intervention) and a reimbursable-lifestyle intervention (an intensive intervention delivered in 4 one hour sessions, the time allotted for Medicare reimbursement for diabetes education) the POWER intensive-lifestyle intervention showed the greatest success. As early as 6 months into the program POWER participants showed significantly greater weight loss than those in the standard care group (2.6 kg vs 0.4 kg; P<0.01) and by 12 months a greater proportion had lost 2 kg or more (49% vs 25%; P<0.05). Even greater average weight loss was recorded among “high attenders,” or those that attended at least 50% of the intervention sessions. Glycated hemoglobin was also reduced, but was not different between groups. There were no statistical differences seen between the standard-care group and the reimbursable-lifestyle intervention group, showing that a more intensive program than that provided by Medicare reimbursement is necessary.