HealthyTogether: RCT of a Dyadic Weight Management Intervention

Four in five Veterans have overweight or obesity. However, few eligible Veterans achieve meaningful weight loss in VA's national MOVE! Weight Management Program. Family and friends strongly influence a person's health behaviors and weight. Including a close family member or friend in weight management may improve weight management outcomes. This study will test whether an 8-week, virtual weight management program that includes Veterans and a support person (e.g., family member or friend) leads to weight loss. The investigators will also test whether the program leads to improvements in weight-related health behaviors, including physical activity and diet, and relationship quality.

The prevalence of overweight and obesity is more than 80% among VA users, increasing risk of morbidity and mortality. In 2006, VA nationally implemented the MOVE! Weight Management Program, an evidence-based behavioral weight management program. Effectiveness of MOVE! is suboptimal: \<20% of all participants and only 30% of those with intense and sustained participation achieve clinically meaningful weight loss. Furthermore, only 8-9% of eligible Veterans attend any MOVE! sessions and, among those who do, half attend only a single session. Taken together, \<2% of the 3.2 million eligible Veterans lose clinically meaningful weight in MOVE!. Therefore, additional weight management approaches are needed to address obesity at the VA population-level.

One strategy to improve behavioral weight management effectiveness is by leveraging social relationships. Social support improves weight management program initiation, retention, and short and long-term weight loss and is also a major driver of weight-related behaviors, such as physical activity and diet quality. However, social relationships can also impede weight management, for example, when close others (e.g., family and friends) undermine or do not support behavior change. The key to addressing this double-edged sword of social relationships may be through dyadic approaches that include close others in behavioral weight management with a focus on improving communication and relationship quality.

HealthyTogether is a brief, virtual weight management program for Veterans and a close other ("partner"). Over 8 weeks, individual dyads receive six hour-long and two 30-minute video sessions. Session content includes physical activity, diet, and weight management medication education; goal setting; and relationship and communication skills training and practice, informed by evidence-based dyadic treatments. This study is a two-site hybrid type I effectiveness-implementation randomized controlled trial with a primary focus on evaluating effectiveness of HealthyTogether and a secondary focus on understanding determinants of implementation. The aims of the trial are:

1. Test whether HealthyTogether results in greater weight loss than usual care at 6 months among Veterans (primary).
2. Examine differences between HealthyTogether and usual care groups in secondary Veteran and partner outcomes, including health behaviors (i.e., diet, physical activity) and relationship quality.
3. Examine Veteran and partner contributions to changes in their own and each other's outcomes using dyadic analyses, informing potential future intervention targets.
4. Assess determinants of implementation, including cost, feasibility, acceptability, and appropriateness, guided by the Consolidated Framework for Implementation Research, to inform future implementation.

Considering the burden of overweight and obesity in VA and the limited reach and effectiveness of MOVE!, HealthyTogether has the potential to address multiple VA priorities: mitigate obesity-related chronic disease and involve family in Veterans' care. Study findings will inform VA National Center Health for Health Promotion and Disease Prevention efforts to expand effective, evidence-based weight management services for Veterans.

Eligibility Criteria:
Inclusion Criteria:

Veteran participants:

* Veterans ages 18-74 with at least 1 primary care visit at a study site in the past year.
* Must have a BMI of at least 30 or a BMI of at least 25
* plus an overweight or obesity-related condition such as

  * hypertension,
  * type 2 diabetes, or
  * dyslipidemia.

Partner participants: Must be at least 18 years of age and willing to participate in all study activities.

Exclusion Criteria:

Veteran participants: Veterans are excluded if they:

* are not fluent in English
* have severe hearing loss prohibiting participation
* have a dementia diagnosis
* currently or have recently (within the past 3 months) participated in a clinical or research behavioral weight management program
* have a history of or plans (within 6 months) to have bariatric surgery
* are pregnant, postpartum, nursing, or planning to become pregnant within 6 months
* are receiving cancer (non-skin) treatment
* have drug or alcohol dependence not in remission, a recent suicide attempt, or active psychosis
* are currently experiencing homelessness
* are receiving hospice or palliative care
* are enrolled in VA home-based primary care
* have had an inpatient hospitalization in the past 3 months
* weigh more than 440 pounds (this is the upper limit of the study's scales)

Partner participants are excluded if they:

* are not fluent in English
* have severe hearing loss prohibiting participation