Study Examines Factors Associated with Use of VA MOVE! Program for Obese and Overweight Veterans
BACKGROUND:
The prevalence of obesity among the 5.5 million Veterans treated yearly in the VA healthcare system is similar (35%) to that of the general U.S. population. To help address the obesity epidemic among Veterans, MOVE! was developed in 2006 to provide evidence-based weight loss programs and a multifaceted approach to treating and managing obesity. Veterans are eligible for MOVE! if they are obese (BMI ≥30) or overweight (BMI 25 to 29.9) with obesity-related conditions, younger than age 70, and have no contraindication to weight loss. This retrospective cohort study sought to describe the facility-level variability in the utilization of MOVE! (defined as 1 or more visits) – and to examine patient- and facility-level correlates of program use. Using VA data, investigators identified all Veterans from 140 VAMCs who were overweight or obese (based on BMI) and had at least one obesity-associated comorbidity in 2010 (n = 2,084,231). Several patient characteristics were examined, including demographics, geographic location (urban, rural, or highly rural), and comorbidities (i.e., diabetes, hypertension, hyperlipidemia, heart disease). VA facility characteristics also were assessed, such as facility rates of male gender, minority status, psychiatric diagnosis, and provision of other obesity care.
FINDINGS:
- Although substantial variation exists across VA facilities in MOVE! utilization rates (0.05% to 16%), Veterans most in need of obesity management services were more likely to access the weight management program, although at a low level. Among the 2 million VA patients meeting criteria for obesity in 2010, 4.4% had at least one MOVE! visit.
- Among Veterans younger than 70, to whom the program is targeted, 6% had at least one visit.
- Veterans were more likely to have at least one MOVE! visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity.
- Veterans at facilities with a higher proportion of Veterans with home instability and lower obeseogenic drug prescription rates were more likely to access MOVE!.
LIMITATIONS:
- The number of MOVE! visits was not examined, which may result in very different findings from that of utilization based on at least one visit.
- There were several unmeasured variables, such as differential resource allocation across facilities, which may be associated with MOVE! utilization that could bias these study results.
NOTE:
- VA's Office of Quality and Performance chart review process found that 10% of "at-risk" Veterans had utilized MOVE! in 2010, which is a considerably higher rate than was found in this study
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AUTHOR/FUNDING INFORMATION:
Drs. Del Re and Harris are part of HSR&D's Center of Innovation to Implementation, Palo Alto, CA; Dr. Maciejewski is part of HSR&D's Center for Health Services Research in Primary Care, Durham, NC.
Del Re A, Maciejewski M, and Harris A. MOVE! Weight Management Program across the Veterans Health Administration: Patient- and Facility-Level Predictors of Utilization. BMC Health Services Research December 10, 2013;13(1):511.
