MOVE OUT: A Partnership With Veterans Groups to Enhance Weight Management in the Veterans Health Administration (VHA)
Condition: Obesity; Overweight; Hypertension; Diabetes Mellitus
MeSH terms: Overweight
Study type: Interventional

Summary: 
      Obesity has been linked to several serious medical conditions, including high blood pressure,
      diabetes, and poor cholesterol levels. For this reason, obesity is likely the most important
      single contributor to cardiovascular mortality in the United States. Fortunately, intensive
      weight management programs are an effective treatment for obesity. Such programs help people
      lose weight and improve their measures of cardiac risk. In response to the growing numbers of
      obese Veterans being treated at Veterans Health Administration (VHA) facilities, the VHA
      developed the MOVE! Program. Veterans who commit to MOVE! and participate actively do lose
      weight. Unfortunately, MOVE!, like other weight management programs, requires its
      participants to attend classes and to exercise, often at locations and times that are
      inconvenient. The investigators propose to make it easier for eligible patients at the
      Zablocki Veterans Affairs Medical Center (ZVAMC) to participate by offering MOVE-style
      classes and exercise groups at a variety of locations, days, and times. The investigators'
      program-MOVE OUT-may provide a model for VHA to use nationwide.
    

Detailed description: 
      Background: Obesity increases the prevalence and severity of cardiovascular risk factors such
      as hypertension, diabetes, and metabolic syndrome. It is also a leading contributor to cancer
      and osteoarthritis. Obesity and overweight are highly prevalent among VHA patients: As with
      the general population, over two-thirds of VHA users are either overweight or obese. There is
      good evidence that intensive weight reduction programs can have a modest-but clinically
      significant-impact on weight. VHA has developed a comprehensive weight management program
      known as MOVE! to address obesity among its patients. MOVE! evaluations to date have
      demonstrated success in helping Veterans lose weight, but participation is low. In the
      investigators' preliminary work, the investigators found that the timing (daytime) and
      location (ZVAMC) of MOVE! activities were viewed by eligible patients as barriers to
      participation. In addition, previous research has often demonstrated significant rebound in
      weight at the end of formal program activities, which may be mitigated if there is a
      convenient place for ongoing weight monitoring and healthy activities with peers.

      Objectives: The overall goal of the project is to increase participation in the ZVAMC MOVE!
      program by implementing an innovative community-based program known as MOVE OUT. MOVE OUT
      will incorporate the key elements of the proven MOVE! program (education, peer support, and
      planned physical activity), but in settings closer to the homes of eligible Zablocki
      patients. The investigators have the following objectives:

        1. To reduce the mean weight of high-risk overweight or obese Veterans who receive primary
           care at ZVAMC.

        2. To improve the physical activity and diet of high-risk overweight or obese Veterans who
           receive primary care at ZVAMC.

        3. To demonstrate that an innovative community-based program can increase the proportion of
           ZVAMC users who participate actively in a moderately intensive weight management program
           as recommended by the National Institutes of Health Consensus Conference on Obesity.

      Methods: The investigators will use a cluster randomized trial design. The investigators will
      allocate groups of eligible Veterans from ZVAMC to either a MOVE OUT invitation or a standard
      MOVE! invitation. The investigators will use clinically gathered weight data to determine
      overall rates of weight loss in the randomly assigned Veterans. In addition, the
      investigators will recruit a sample of Veterans from each randomized group to participate in
      a study of the effectiveness of the weight management program to which they are assigned. The
      investigators will use established methods to assess changes in diet, exercise and attitude,
      as well as physiologic outcomes including weight, blood pressure, Hemoglobin A1c, and lipid
      values. The investigators will use qualitative methods to learn what aspects of the two
      programs are most effective.

      Impact: The investigators will demonstrate that VHA can deliver effective weight management
      services in a community-based fashion. If this study finds that such a delivery approach
      leads to an increased number of at-risk Veterans participating in weight control programs, it
      will guide program design throughout VHA. Although weight management is particularly well
      suited to a disseminated delivery model, lessons learned from this research are likely to
      help VHA improve its ability to help patients self-manage a variety of chronic diseases.
    

Intervention name(s): MOVE OUT; MOVE!
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The MOVE OUT intervention builds on the high quality information provided by the nationally-developed MOVE program by adding 1) peer support; 2) convenient local access to educational sessions, which allows the material to be delivered in smaller, more easily retained aliquots; 3) convenient local exercise opportunities; and 4) open-ended availability of both education and exercise support.; As part of routine care at the ZVAMC, all patients who are eligible for the present study are identified by a "clinical reminder." This reminder prompts the PCP to determine if the person would benefit from a weight loss program, and to refer them to MOVE if they and the patient agree that it would be beneficial. The MOVE program in Milwaukee can be tailored by the patient and PCP, but includes dietitian assessment, education, weekly weigh-ins, follow-up classes, and exercise programs.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Obesity; Veteran; Self Care; Patient Education; Peer Group