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2011 HSR&D National Meeting Abstract

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2011 National Meeting

1050 — Implementation of a VA Weight Management Program: Who Enrolls and is There a Benefit?

Littman AJ (Seattle Epidemiologic Research and Information Center (ERIC)), McDonell M (HSR&D Northwest Center of Excellence), Boyko EJ (Seattle ERIC), Fihn SD (HSR&D Northwest Center of Excellence)

Objectives:
Veterans carry a similar, if not greater burden of obesity as non-Veterans. The aims of this study were to: 1) estimate the proportion of eligible patients who enrolled in the VA weight management program ("MOVE!"), and examine how program enrollees differ from non-enrollees in terms of sociodemographic, behavioral, and health characteristics; 2) assess whether enrollment in the MOVE! program was associated with weight loss; and 3) describe the extent of MOVE! activities and programs offered in VISN 20 facilities, and the barriers and facilitators to implementation.

Methods:
We extracted data from the VISN 20 Data Warehouse to identify MOVE! enrollees (2006-2008) and MOVE! program eligible non-enrollees. We compared the enrollees to the non-enrollees in terms of medical history characteristics, demographics, and behavioral risk factors. We conducted a longitudinal cohort study to evaluate changes in weight over an approximately 1-year period among MOVE! enrollees compared with non-enrollees.

Results:
Of approximately 91,800 VISN 20 patients who were eligible for the MOVE! program, 4475 (4.9%) enrolled in the program. A greater proportion of MOVE! enrollees were 60-69 years old (vs. 50-59), female, African American, and had a service-connected disability > 70% and a chronic illness (e.g., diabetes, coronary artery disease, hypertension, and osteoarthritis). A smaller proportion of MOVE! enrollees were < 40 years of age (vs. 50-59 years), current smokers, and OEF/OIF Veterans. Overall, 15.5% of enrollees achieved clinically significant weight loss ( > = 5% body weight loss) vs. 12.2% of eligible non-enrollees (p < 0.0001), though the mean weight loss difference was small (-0.6 pounds, 95% CI -1.0, -0.1). Barriers to wide-scale implementation of the program were identified, including limited resources, time, space, and physical activity offerings.

Implications:
Only a small proportion ( < 5%) of those who were eligible for VA’s weight management program enrolled. More than half of those who enrolled in the program only had a single MOVE!-related encounter. MOVE! enrollment was associated with reductions in weight, although the reductions were small and of questionable clinical significance. The limited resources available to implement the program were likely a major contributing factor to the enrollment and the limited evidence of effectiveness.

Impacts:
Data from this study will help VA leadership and policymakers better understand who is enrolling into the program and the outcomes associated with enrollment. This information will help identify areas for improvement in terms of implementation and dissemination of behavior change initiatives.


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