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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3091 — Impact of a Small-Changes Treatment Approach with Veterans: 3-Month Results from the ASPIRE-VA RCT

Damschroder LJ, Ann Arbor VA Center for Clinical Management Research; Lutes LD, East Carolina University; Richardson CGoodrich DRonis D, and Lowery JC, Ann Arbor VA Center for Clinical Management Research; Kirsh S, Louis Stokes VA Medical Center; Dinatale E, East Carolina University;

Objectives:
Traditional behavioral therapy is an effective treatment for helping individuals lose 5-10% of their total body weight within 6 months. However, weight regain is common even with long-term follow-up. In contrast, a small-changes approach focuses on individuals making small but manageable changes in daily nutrition and physical activity. While clinical trials suggest that this is a promising strategy to prevent weight regain, less is known about its effectiveness in promoting weight loss and maintenance over the long-term. ASPIRE-VA is a multi-site, randomized control trial to test effectiveness of a theoretical small-changes treatment approach focused on patient-driven changes, relative to baseline behaviors, to encourage slower initial but continuous weight loss over time.

Methods:
481 Veterans were recruited from two VA healthcare systems and randomized to one of three 12-month programs: 1) ASPIRE-VA via phone, 2) ASPIRE-VA via face-to-face group, or 3) usual care VA weight management via MOVE!. We report results for the first 3 months of treatment which consisted of weekly sessions with a lifestyle coach (in the ASPIRE arms) or a multidisciplinary treatment team headed by a registered dietician (in the MOVE! arm).

Results:
Results are based on 356 participants (full data will be available in February 2012). Participants included a relatively high proportion of women (13%) and non-white (44%) Veterans, were obese (BMI = 36.44 kg/m2), and reported an average of 4.6 health conditions, including 31% who reported diabetes. At 3 months, all three arms experienced significant weight loss (-1.49kg or -1.39% of baseline weight for ASPIRE-VA Phone; -2.0kg or -1.69% for ASPIRE-VA Group; and -1.45kg or -1.25% for MOVE!; p’s <.001), with no significant differences between groups (p’s >.62). However, participants in the two ASPIRE-VA treatment arms completed significantly more sessions compared to MOVE! (7.8, 6.8, and 3.5 sessions, respectively; p <.001).

Implications:
3-month results suggest that ASPIRE-VA promotes significant but modest weight loss. Veterans in ASPIRE-VA completed significantly more sessions compared to MOVE!, showing a high degree of engagement.

Impacts:
High engagement in ASPIRE-VA may indicate the potential for clinically significant and sustained weight loss and maintenance over the long-term.


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