Does Effectiveness of Weight Management Programs Depend on the Food Environment?

Abstract

Objective To estimate the causal effects of a population‐scale behavioral weight management program and to determine whether the program's effectiveness depends on participants’ geographic access to places to purchase healthy and less healthy foods. Data Sources Secondary data from U.S. Department of Veterans Affairs clinical and administrative records (2008–2014), retail food environment measures from commercial databases (2008–2014), and the American Community Survey (2009–2014). Study Design We estimated the effect of the VA's MOVE! weight management program on body mass index after 6 months using difference‐in‐difference regressions to compare participants with a propensity score‐matched control group. We estimated treatment effects overall and in subgroups with different access to supermarkets, fast‐food restaurants, and convenience stores. Principal Findings MOVE! reduced BMI by about 0.71 units among men and 0.70 units among women. The program was slightly less effective for men living near fast‐food restaurants or convenience stores. We found no evidence that treatment effects varied with the food environment among women. Conclusions The residential food environment modestly alters MOVE! effectiveness among men. A greater understanding of environmental barriers to and facilitators of intentional weight loss is needed. This study highlights important potential intersections between health care and the community.

Long-Term Weight Loss Effects of a Behavioral Weight Management Program: Does the Community Food Environment Matter?

“…The analytic sample consisted of 560,173 male veterans and 52,577 female veterans 20–80 years of age at baseline who received primary healthcare services in the VA 2009–2014 and lived in metropolitan counties of the continental U.S. The cohort from which the sample is drawn excludes people without at least one VA healthcare encounter in the two years prior to baseline; with long-stay nursing home residence at baseline; without at least one home address geocoded to the street or ZIP + 4 level; and without valid and clinically plausible height (at least one) and weight (at least two) measurements [ 18 , 27 ]. For this analysis, we defined MOVE!…”

“…We continued the process until all covariates had standardized differences of less than 0.05 standard deviations, indicating an excellent match between the intervention and control groups. More information on the propensity score analysis is provided elsewhere [ 18 , 27 ].…”

“…Additionally, there is not much research on whether the community food environment alters the treatment effects of behavioral weight management interventions. In particular, there are no studies that examine whether the community food environment might help people maintain the effects of a weight management program over a period of more than one year [ 25 , 26 , 27 ].…”

“…In a prior WAVES analysis, we found that male MOVE! participants with greater access to convenience stores within one mile lost less weight at 6-month relative to controls [ 27 ]. Our central hypothesis for the analysis in this study was that the short-term treatment effects of the intervention would survive longer for people living in more supportive community food environments.…”

Differences in the sugar content of fast-food products across three countries

“…Several factors inherent to fast food, including excessive portion sizes, palatability, and high solid fat and added sugar content, may contribute to associations between fast-food consumption, obesity and other unfavourable health outcomes (14) . Lowering fast-food consumption is therefore a key component of public health efforts to combat obesity, yet living in an area with a high density of fast-food outlets challenges the effectiveness of weight management programmes (15,16) . Reducing fast-food intake is particularly difficult as it is widely pervasive and highly palatable (17) .…”