Overweight and obesity are problems for Veterans to a similar or greater extent than they are for the general population. Over 70% of Veterans are overweight or obese. Modest weight losses of 5-10% could mitigate the burden of obesity-related illnesses. In 2006, the VA launched the Managing Overweight and/or Obesity for Veterans Everywhere (MOVE!) program to promote weight loss and physical activity in VA patients. The extent to which the program has been implemented, the barriers to implementation, the characteristics of program enrollees (compared to eligible non-enrollees), and the estimated clinical benefits in terms of weight and cardiovascular risk factors are not known.
The aims of this study were to: 1) estimate the proportion of eligible patients who enrolled in the program and examine how program enrollees differ from non-enrollees in terms of sociodemographic, behavioral and health characteristics, 2) assess whether enrollment in the program was associated with improvements in health, specifically weight loss, and 3) describe the extent of MOVE! activities and programs offered in Veterans Integrated Service Network (VISN) 20 facilities, and the barriers and facilitators to implementation that have been encountered.
For Aims 1 and 2, we extracted data from the VISN 20 Data Warehouse to define two cohorts: 1) MOVE! enrollees (2006-2008) and 2) MOVE! program eligible non-enrollees. Individuals were considered eligible for MOVE! based on a BMI>= 25 kg/m^2 and the absence of clinical diagnoses or procedures for which weight loss and physical activity would be contraindicated. Enrollees were defined as those with at least one MOVE! program-related encounter, identified by stop codes. We compared the enrollees to the non-enrollees in terms of medical history characteristics, demographics, and behavioral risk factors. For Aim 2, we conducted a longitudinal cohort study, comparing MOVE! enrollees to non-enrollees, in terms of changes in weight and cardiovascular disease risk markers over an approximately 1-year period. For Aim 3, we conducted phone interviews with MOVE! program coordinators and staff in VISN 20 to ascertain implementation activities and barriers to implementation efforts.
Preliminary analyses suggest that of approximately 91,800 individuals who were eligible for the MOVE! program in VISN 20, 4475 (4.9 percent) enrolled in the program. A greater proportion of MOVE! enrollees were 60-69 years old (vs. 50-59), female, African American, had a BMI >= 30 kg/m^2 (vs. <30), a service-connected disability >=70 percent, and a chronic illness (e.g., diabetes, coronary artery disease, hypertension, and osteoarthritis). A smaller proportion of MOVE! enrollees were <40 or >=70 years of age (vs. 50-59 years), current smokers, and OIF/OEF Veterans. Overall, 15.5 percent of enrollees achieved clinically significant weight loss (>=5 percent body weight loss) vs. 12.2 percent of eligible non-enrollees (p<0.0001), though the mean weight loss difference was small (-0.6 pounds, 95 percent CI -1.0, -0.1). Barriers to wide-scale implementation of the program were identified, including limited resources, time, space, and physical activity offerings.
Data from this study will help VA leadership and policy makers 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.
- Goodrich DE, Klingaman EA, Verchinina L, Goldberg RW, Littman AJ, Janney CA, Kim HM, Maguen S, Hoerster KD, Owen RR, Holleman RG, Roman P, Lai Z, Bowersox NW. Sex Differences in Weight Loss among Veterans with Serious Mental Illness: Observational Study of a National Weight Management Program. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2016 Jul 1; 26(4):410-9.