Veterans shoulder a disproportionate burden of obesity and its co-morbidities, and modest weight loss improves health outcomes. The Veterans Affairs (VA) New York Harbor Healthcare System offers the MOVE! program, but only 8% of eligible patients attend. However, Veterans see their primary care providers (PCPs) 3.6 times per year supporting the importance of developing primary care-based interventions. The United States Preventive Services Task force (USPSTF) recommends the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange) for counseling patients about weight. Interactive behavior change technologies can facilitate delivery of the 5As in primary care.
We developed a primary care-based intervention called Move Towards Your Goals (MTG) Peer-Assisted Lifestyle intervention (referred to as Peer-Assisted Lifestyle (PAL) Study to avoid confusion with the VA MOVE! Program) to facilitate delivery of 5As weight management counseling and increased adoption of intensive VA programs such as MOVE!. The intervention uses a novel software tool delivered on tablets to facilitate 5As-based weight management counseling with a health coach and the VA PACT healthcare team to promote goal-setting, behavior change, and weight loss in primary care. The intervention includes 15 health-coaching calls delivered by trained Veteran Peer Coaches to the patient over 12 months.
As part of a cluster-randomized controlled study, we will randomize 10 PACT teams at the Brooklyn VA to receive either the MTG Intervention or an Enhanced Usual Care control. The primary aim of the study is to explore differences in feasibility, acceptability, and intermediate, behavioral, and weight loss outcomes at 6 and 12 months of 520 patients recruited from the randomized PACTs
1) Test the impact of the MTG intervention on weight change, clinical and behavioral outcomes
2) Identify predictors of weight loss in Veterans participating in the intervention arm related to intervention components and goal-setting processes
3) Determine the impact of the MTG Intervention on provider and nurse obesity-related counseling practices and attitudes
We will recruit up to 520 overweight/obese primary care patients from the 10 PACTs to participate. Patient participants within PACT teams randomized to PAL will use the goal-setting tool and meet with a peer coach to create weight management and lifestyle behavior change goals. They will also receive brief counseling by their PCPs and PACTs at their next regularly scheduled visit. This will be followed by 15 health coaching calls over the next 12 months. The Enhanced Usual Care arm will receive weight management handouts and information about MOVE! programs. Baseline data will be collected via surveys, chart review, and blood tests. All participants will come to 6 and 12-month study visits to evaluate intermediate, behavioral, and weight outcomes.
We have trained PACT teams and started recruiting patients.
If the MTG intervention is shown to be effective, then it will inform improvement of weight management in VA primary care settings with peer coaches.
External Links for this Project
Grant Number: I01HX002119-01A2
- Wittleder S, Smith S, Wang B, Beasley JM, Orstad SL, Sweat V, Squires A, Wong L, Fang Y, Doebrich P, Gutnick D, Tenner C, Sherman SE, Jay M. Peer-Assisted Lifestyle (PAL) intervention: a protocol of a cluster-randomised controlled trial of a health-coaching intervention delivered by veteran peers to improve obesity treatment in primary care. BMJ open. 2021 Feb 26; 11(2):e043013. [view]