Effectiveness of the MOVE! Program Among African American Veterans: Weight Loss and Quality of Life

Global rates of obesity and overweight diagnoses have reached epidemic levels in the last 20 years.1 At even greater risk for these diagnoses are veterans of the U. S. military.2 Veterans receiving services with the VA health care system are significantly more likely to be overweight than veterans who do not use the VA health care system2-5 and the general population.2 Factors that contribute to increases in body mass index (BMI) among veterans include changes in dietary behavior as a result of military service,6 having a diagnosis of posttraumatic stress disorder,7 and no activity due to physical disability.2 Race is also related to increases in BMI with racial minority groups at least 2 times more likely to be overweight and report having diabetes than are whites. These combined factors suggest that African American veterans are at a significant risk for developing obesity and obesityrelated illness. Overweight or obese individuals increase the risk for weight-related illness while also adversely affecting their health-related quality of life (HRQOL). 10 Physical aspects of HRQOL, such as bodily pain, vitality, and physical functioning tend to be impacted more than mental health.11-16 Several individual and group treatment programs have emerged to attempt to offset increases in obesity rates. Many of these use a behavioral or cognitive-behavioral paradigm.17-19 The effectiveness of using a traditional cognitive-behavioral treatment approach within minority populations has received attention.20 Caution has been advised when using this form of treatment with emphasis placed on providing culturally relevant treatments to racial minorities for certain conditions,20 including weight management.21 Although obesity-related HRQOL has been evaluated in other populations, minimal data exist pertaining to perceptions of personal changes in HRQOL among veterans, despite the documented high-prevalence rates of obesity in this population. To reduce veteran obesity, the Jesse Brown VAMC (JBVAMC) implemented the customized 8-week, multidisciplinary, cognitive-behavioral, weight-management program “MOVE! ” in 2006. MOVE! is a “national weight management program designed by the VHA National Center for Health Promotion and Disease Prevention (NCP). to help veterans lose weight, keep it off and improve their health. ”22 Data on the effectiveness of MOVE! are still in preliminary stages,25-29 and the present study is one of the first to evaluate this program among racial minority veterans at an urban VAMC. This study evaluated the effectiveness of an evidence-based, cognitive-behavioral treatment approach in improving HRQOL in obese veterans from a predominantly African American racial background. Effectiveness was evaluated for improvements in HRQOL measurement as well as changes in veterans’ BMI. We hypothesized that veterans with regular and consistent attendance will achieve greater weight loss and that weight loss will be influenced by sociodemographic and clinical variables. We also hypothesized that participation in MOVE! will improve veterans’ HRQOL, specifically in the physical functioning domains. Finally, we hypothesized that participation in MOVE! will yield improvements in HRQOL that are independent of actual weight lost during the program.