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Observational Study
. 2017 Apr;32(Suppl 1):18-23.
doi: 10.1007/s11606-017-3992-3.

Examining the Dose-Response Relationship in the Veterans Health Administration's MOVE!® Weight Management Program: A Nationwide Observational Study

Stephanie H Chan  1 , Susan D Raffa  2
Affiliations
Observational Study

Examining the Dose-Response Relationship in the Veterans Health Administration's MOVE!® Weight Management Program: A Nationwide Observational Study

Stephanie H Chan et al. J Gen Intern Med. 2017 Apr.

Abstract

Background: For more than a decade, the Veterans Health Administration (VHA) has offered MOVE!, a comprehensive lifestyle intervention for weight management. However, there is limited knowledge to inform resource allocation decisions at the health system level-for example, the choice between reaching new veterans with weight management treatment, re-engaging veterans who have stopped attending, and/or increasing contact with current MOVE!

Objective: To inform VHA policy and planning, this VHA-wide study examines the relationship between MOVE! participation and weight outcomes.

Design: A longitudinal observational study of veterans across VHA who participated in MOVE!.

Participants: Veterans who initiated their most recent episode of MOVE! care between 2004 and 2014.

Main measures: Weight measurements were abstracted from VHA electronic health records. The primary outcome was the proportion of veterans with clinically relevant weight loss. The predictor of interest was number of MOVE! contacts during the 12 months following MOVE! initiation.

Key results: The cohort consisted of 237,577 veterans (87.4% male; mean age 54.4 years), who had 5.3 contacts on average in the 12 months following initiation. Veterans with 2-5 contacts had the same odds of achieving clinically relevant weight loss as veterans with only one contact (adjusted OR: 1.00, 95% CI: 0.98-1.03). Veterans with 6-9, 10-13, 14-17, and 18 or more contacts had significantly higher odds of clinically relevant weight loss (adjusted OR: 1.17, 95% CI: 1.13-1.20; adjusted OR: 1.53, 95% CI: 1.47-1.59; adjusted OR: 1.84, 95% CI: 1.74-1.94; adjusted OR: 2.21, 95% CI: 2.12-2.31, respectively).

Conclusions: Veterans with ≥6 MOVE! contacts in the year following treatment initiation were significantly more likely to achieve clinically relevant weight loss than those with one contact, with greater participation further increasing the odds of clinically relevant weight loss. While further characterization of weight loss predictors is needed, the VHA should provide policy guidance that supports increasing participation among veterans who have initiated MOVE!.

Keywords: behavioral science; veterans; weight management.

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Conflict of interest statement

Conflict of Interest

Ms. Chan and Dr. Raffa are employees of the Department of Veterans Affairs, and have no additional conflicts of interest to declare.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans of Affairs or the United States government.

Figures

Figure 1
Figure 1
Cohort inclusion and exclusion flow chart. A total of 588,839 veterans initiated their most recent MOVE! episode of care during the 10-year period between October 1, 2004, and September 30, 2014. After excluding veterans with bariatric surgery and insufficient weight measurements, the final sample included 237,577 veterans.
Figure 2
Figure 2
Odds of achieving clinically relevant weight loss at 12 months post-initiation, comparing veterans in categories of increasing participation in MOVE! to those with one contact, are shown by the bars, with error bars representing 95% CI. Adjusted odds ratios included covariates for age, gender, race, marital status, TeleMOVE! participation, history of obesogenic medication use, and history of leptogenic medication use. Online Appendix D contains point estimates and 95% CI corresponding to this figure.
See this image and copyright information in PMC

References

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