Study Compares VA Weight Loss Interventions for Veterans

BACKGROUND:
Because four out of five Veterans who receive VA healthcare meet the criteria for overweight or obesity, VA patients exemplify the challenging populations for whom effective weight management interventions are needed. In 2006, VA implemented an evidence-based obesity treatment program called MOVE!. However, despite high obesity screening rates across the VA healthcare system (95%), only 10-12% of Veterans who screen positive for obesity enroll in MOVE!. The Aspiring for Lifelong Health (ASPIRE) small-changes weight loss intervention was developed to address the need for effective weight loss treatment for vulnerable populations. This randomized clinical trial evaluated the effectiveness of the ASPIRE intervention by randomly assigning 481 obese Veterans to one of three treatment programs: 1) the ASPIRE-Group program, delivered via in-person groups; 2) the ASPIRE-Phone program, delivered to Veterans via phone; or 3) VA's MOVE! usual care weight management program, delivered primarily in a group format. Veterans were enrolled at two Midwestern VA medical centers starting in January 2010. Investigators assessed data at baseline, 3- and 12-months. Data included: height, weight, and waist measurements; blood pressure; demographics; cholesterol and glucose; and comorbidities, as well as self-reported eating frequency and satisfaction with life.

FINDINGS:

• All three programs resulted in significant weight loss 12 months afer baseline. Though weight loss was relatively small, ASPIRE-Group resulted in twice the weight loss (-2.8 kg) compared to the other two programs (-1.4 kg each).
• 20-24% of participants lost 5% of their body weight; with no differences between programs.
• Both ASPIRE programs (Group and Phone) resulted in more than twice the level of engagement compared to the MOVE! program; ASPIRE-Phone was associated with the greatest engagement.
• With a few exceptions, there were no differences in secondary outcomes between the three programs. At 12 months, Veterans in all three programs experienced a significant improvement in life satisfaction, HDL, and functional exercise capacity.

LIMITATIONS:

• Comorbidity information relied on diagnosis codes in administrative data that are often inaccurate.
• Assessors were not blinded to participant randomization, and might have been unknowingly biased in their collection or recording of data.

AUTHOR/FUNDING INFORMATION:
This study was funded through VA/HSR&D's Diabetes Quality Enhancement Research Initiative (IBB 09-034). Dr. Damschroder is part of Diabetes-QUERI and HSR&D's Center for Clinical Management Research, both located in Ann Arbor, MI.

Damschroder L, Lutes L, Kirsh S, et al. Small-Changes Obesity Treatment among Veterans: 12-Month Outcomes. American Journal of Preventive Medicine. September 9, 2014;e-pub ahead of print.