The VA launched the MOVE! Weight Management Program for Veterans (MOVE!) across the Veterans Health Administration (VHA) in 2006. It is a multidisciplinary approach to helping overweight/obese patients manage their weight through self-management. Almost all VA facilities have implemented MOVE! at some level and more than 100,000 patients were enrolled by mid-2008. MOVE! utilization data so far suggests that one of the most important challenges this program faces is the high attrition rate. According to the Evaluation Report by the national MOVE! program office (NCP), only 18% of patients enrolled in the program made six or more visits, a threshold the NCP considers as the minimum treatment intensity for clinically meaningful impact.
The objectives of this pilot study are (1) to identify individual, facility and provider factors that affect attrition rates in the MOVE! Group Program through a secondary data analysis and (2) to identify best practices in the VAs with the highest retention rates in MOVE! in general and the Group Program in particular.
To pursue the first objective, we used a retrospective cohort design in this study. The study cohort consisted of all new users of the MOVE! Group Program in the fiscal year 2008. MOVE! enrollment and attendance were identified through patient records in the outpatient records for 2005 - 2009. We used the earliest date on which a patient attended a MOVE! group session and called it the index date. All individuals whose index date fell between October 1, 2007 and September 30, 2008 (fiscal year 2008) and survived until the end of the six-month follow-up from the index date were included in the study cohort. For multivariable analyses, we identified individual (age, sex, race/ethnicity, BMI, marital status, and comorbidities), facility and accessibility (volume, staffing, distance, and copayment), and program (provider type of the group leader, strategies) factors that are likely to affect retention.
We classified MOVE! group participants into three groups: early dropouts ( 3 visits), late dropouts (4-5 visits), and completers (6 or more visits). We used a generalized ordered logistic regression to examine factors associated with short-term and long-term retention in the MOVE! Group Program.
For the second objective, we interviewed coordinators of 12 MOVE! (5 high-retention and 7 low-retention) programs to learn how MOVE! group was implemented at their facility and explore components affecting retention.
More than 60% of enrollees in the group program dropped out before the fourth session and 74% before the sixth visit.
Because high attrition diminishes the effectiveness of weight management programs, our analysis was focused on understanding factors that affect attrition. Of the individual, person-level factors we examined, we found that older age, higher number of comorbidities, and higher BMI were all associated with greater retention, whereas male sex and non-Hispanic black race were associated with lower retention.
We also found that both financial and geographic accessibility to the program were strongly related to retention. Having required co-payments for any VA service and living more than 10 miles away from the nearest MOVE! clinic were both associated with greater attrition.
We found that facilities with lower program staffing had decreased retention and that retention was reduced when the first session was led by a dietitian.
Among 10 common weight loss strategies we examined, only two were associated with retention. Regular on-site physical activity program was uniformly associated with 43% greater short-term and long-term retention (OR = 1.43; 95% CI, 1.02 - 2.00). Behavior modification was associated with reduced retention in the short term (OR = 0.36; 95% CI, 0.14 - 0.91) but was not significantly associated with the long-term retention.
MOVE! coordinators we interviewed identified as factors that affect retention provider knowledge of and referral to the program, class schedule, inclusion of physical activity in group sessions, and involvement by the MOVE! physician champion. Our interviews with MOVE! coordinators indicated that further education of both providers and patients is needed to improve participation and intensity of MOVE! intervention.
A non-completion rate of 74% for in-person group obesity treatment poses a major challenge to reducing the population prevalence of obesity within the VHA. Greater attention to individualized consultation, accessibility to the program, facility factors including staffing and physical activity resources, and further education of both providers and patients on the importance of weight management in general and the MOVE! program in particular could improve retention and weight loss outcomes.
- Spring B, Sohn MW, Locatelli SM, Hadi S, Kahwati L, Weaver FM. Individual, facility, and program factors affecting retention in a national weight management program. BMC public health. 2014 Apr 15; 14(1):363.
- Locatelli SM, Sohn MW, Spring B, Hadi S, Weaver FM. Participant Retention in the Veterans Health Administration's MOVE! Weight management program, 2010. Preventing chronic disease. 2013 Jul 12; 9:E129.