Improving Weight Management at the VA
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      Compared to the general public, a higher percentage of Veterans are obese or overweight with
      a weight-related medical condition. The VA currently offers an effective weight management
      program called MOVE!, but the majority of eligible patients do not attend. Veterans see their
      primary care providers (PCPs) very frequently, making it an important place to receive
      information on weight management. However, PCPs often fail to discuss weight management with
      patients, so interventions are needed to encourage weight management counseling within the
      team-based care model used in primary care at the VA. Investigators used focus groups,
      interviews, and other research methods to develop the MOVE! Toward Your Goals (MTG)
      intervention. This intervention combines online tools, counseling by a health coach, and the
      team-based care model to deliver weight management information to patients.

      Investigators will conduct a randomized controlled trial of 320 Veteran patients and their
      providers at two VA sites (Manhattan and Brooklyn campuses, New York Harbor Healthcare
      System) to study the impact of the 12-month MTG intervention when compared to Enhanced Usual
      Care. Veterans in the MTG intervention arm will take the MTG tool, receive personalized
      weight management materials, health coach counseling, and go to their scheduled primary care
      (PC) visit. After the initial visit, MTG-arm Veterans will receive follow up telephone
      coaching over 12 months. All Veterans will attend follow-up visits at 3, 6 and 12 months to
      assess body mass index, diet and physical activity, and goal attainment.

      The objectives of this study are to: (a) test the impact of the MTG intervention on weight
      and behavior changes; (b) identify predictors of weight loss in Veterans who use goal setting
      techniques; and (c) determine the impact of the MTG intervention on primary care team
      obesity-related counseling practices and attitudes.
    

Detailed description: 
      Veterans shoulder a disproportionate burden of obesity and its co-morbidities, including
      diabetes, hypertension, and hyperlipidemia. Modest weight loss in obese patients through diet
      and exercise improves health and prevents chronic disease, but primary care providers (PCPs)
      often fail to adequately counsel patients about their weight due to lack of time and
      training. Thus, tools and brief interventions are needed to support providers' behavior
      change counseling. The VA currently offers the MOVE! program to treat overweight and obese
      patients, but only 9% of eligible patients attend. At the same time, Veterans on average see
      their PCPs 3.6 times per year, which supports the importance of developing primary care
      (PC)-based interventions. The United States Preventive Services Task force (USPSTF)
      recommends the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange [5A]) for
      counseling patients about weight.

      Interactive behavior change technologies utilizing expert system software programs are an
      innovative way to facilitate 5As counseling to promote behavior change in primary care. These
      programs perform computerized risk, lifestyle, and theory- based, behavioral assessment to
      provide computer-generated, tailored advice to patients. They also can provide information to
      healthcare teams.

      Collaborative goal setting can be used to achieve behavior change in this intervention. This
      construct, a critical component of several behavior change theories and models and
      corresponding to "agree" in the 5As model, has been widely recommended for health promotion
      in primary care. Investigators did formative work using key informant interviews with several
      VA Patient Aligned Care Teams (PACT), MOVE! staff, and focus groups with Veterans
      demonstrated that goal setting is feasible and acceptable to patients and PACT teamlets, and
      provided insight on barriers to goal setting, and ways to facilitate goal-setting
      conversations.

      During the development phase of this project, investigators developed a primary care-based
      intervention called MOVE! Toward Your Goals (MTG) to facilitate weight management within
      primary care and increase adoption of intensive VA programs such as MOVE!. The MTG
      intervention uses a new MTG software tool (that the investigators developed) delivered on
      tablets to facilitate 5As-based weight management counseling with a health coach and
      healthcare team to promote goal-setting, behavior change, and weight loss in the primary care
      setting. The Veteran also receives follow up with 12 health coaching calls over 1 year.

      Investigators will conduct a large, multicenter (Manhattan and Brooklyn campuses, New York
      Harbor Healthcare System) randomized controlled trial of 320 subjects, who will be randomized
      to receive either Enhanced Usual Care or the MTG Intervention.

      The objectives of this study are to: (a) test the impact of the MTG intervention on weight
      and behavior changes; (b) identify predictors of weight loss in Veterans who use goal setting
      techniques; and (c) determine the impact of the MTG intervention on primary care team
      obesity-related counseling practices and attitudes.
    

Intervention name(s): MOVE! Toward Your Goals; Enhanced Usual Care
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Patients will take an online tool accessing weight management and lifestyle behaviors, and will meet with a health coach regularly to establish SMART goals to help them in their weight loss journey. The goals may be supported by the patients' PACT members; Patients will be given information on "healthy living messages" that were created by the VA, and given more information on specific messages they are interested in from the health coaches, but will not receive official coaching. These messages are the current standard of care at the VA for obesity counseling.
Other intervention name(s): MTG arm; EUC arm
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomized Controlled Trial
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Health Services Research
Keywords: Obesity; Weight Management; Primary Care; Health Coach; iPad; Goal Setting; 5As; technology