VA’s MOVE! Initiative Plagued by Lack of Participation

Annette M. Boyle

SEATTLE — When it comes to weight loss, you have to play to lose — or at least that’s the conclusion of a study of the MOVE! Weight Loss Management Program for Veterans recently published in Preventing Chronic Disease.1

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“Just 5% of eligible veterans participated in the program, and only half of those had more than one encounter,” lead author Alyson J. Littman, PhD, MPH, of the Seattle Epidemiological Research and Information Center, VA Puget Sound Health Care System, told U.S. Medicine. On average, participants had three encounters during follow-up.

“We found greater weight loss in those who enrolled than in those who didn’t and more weight loss with more encounters,” Littman said. But the results were far from clear.

Participants and a coordinator preparing for the VISN 20 MOVE! Challenge 2012.

Researchers analyzed data on 76,599 eligible patients in the VA Northwest Region database who visited one of the the eight VISN 20 facilities in Alaska, Idaho, Oregon and Washington State at least once between Oct. 1, 2005, when MOVE! was implemented at the facility, and Dec. 31, 2008. Patients generally were considered eligible if they had a body mass index (BMI) of 30 or more or a BMI of 25.0 to 29.9 with an obesity-related condition and were younger than age 70. Of those eligible, 3,192 participated in the program, but only 942 had follow-up measures recorded during the study interval.

The study showed that participants had statistically significant weight loss, compared with non-participants at six months, dropping 1.3 pounds on average. By 12 months, however, the average difference in weight loss between participants and non-participants was statistically insignificant at less than 1 pound.

The relationship between the number of interactions with the program and weight loss was nonlinear, according to Littman.

“We created categories of encounters: one visit, two to five visits, and six or more visits. For the two to five visit group, there was no linear trend showing a correlation between number of visits and weight loss at six months. Those who had more than six encounters, though, had more weight loss than the other groups at six and 12 months,” Littman said.

One possible conclusion, she said, is that “there may be a threshold number of encounters required to see a benefit.”

Most of the approximately 150 VHA medical centers across the country offer a MOVE! program, which follows evidence-based obesity treatment guidelines and includes a comprehensive, multidisciplinary approach to weight management. Although MOVE! shares features with commercial weight-management programs — such as group meetings, self-management support via telephone or Internet and lessons about healthy living — it also has a strong clinical component.

VA requires that MOVE! program staff include a program coordinator to supervise staff, set local goals, ensure program compliance with national standards and track program outcomes as well as a physician champion responsible for patient safety, promoting outreach to other services in the VHA and the community and providing medical consultations for MOVE! participants. Otherwise, individual facilities are given significant flexibility in how they conduct the program.

In the VISN 20 study, only 13% of participants had six or more encounters during the research period. In some facilities, no patients had that many encounters. “Only a small fraction of participants achieved this level of intensity, resulting in a small overall impact of the program,” researchers concluded.

Overall, female patients with a BMI of 30 or greater, those with sleep apnea or any mental-health condition, and patients who had three or more primary-care visits during the study period were 30% more likely to participate. Individuals younger than 55, smokers and those who were widowed or lived more than 30 miles from a participating facility were less likely to participate than the reference group, which included veterans ages 55-64.

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