State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions

Abstract

This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care delivery, research, and policy arenas, participated. The work group reviewed current evidence of efficacy, effectiveness, and implementation of behavioral interventions for weight management, participated in phone-and online-based consensus processes, generated key questions to address gaps, and attended an in-person conference in March 2016. The work group agreed that there is strong evidence for efficacy and effectiveness of core behavioral intervention components and processes, but insufficient evidence to determine the comparative effectiveness of multiple cliniciandelivered weight management modalities, as well as technologies that may or may not supplement cliniciandelivered treatments. Effective strategies for implementation of weight management services in VHA were identified. The SOTA work group's foremost policy recommendations are to establish a system-wide culture for weight management and to identify a population-level health metric to measure the impact of weight management interventions that can be tracked and clearly communicated throughout VHA. The work group's top research recommendation is to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans.

Geographic Variation in Obesity, Behavioral Treatment, and Bariatric Surgery for Veterans

“…Coach mobile application to expand the reach of MOVE! by making it available in more convenient modes . Data on veterans’ utilization of these modalities is not yet available and was therefore not included in our results.…”

“…by making it available in more convenient modes. 20 Data on Veterans’ utilization of these modalities is not yet available and so was not included in our results. The content and structure of the MOVE!…”

Improving Weight Management among Veterans

“…The Workgroup's top research recommendation was to determine how to deploy and scale the most effective behavioral weight management interventions for Veterans across the diverse medical facilities (168 medical centers and over 1000 community clinics) that make up the VHA. 5 Compared to overweight and obese non-Veterans, obese or overweight patients in VHA are more likely to have underlying mental health problems that may complicate efforts to achieve clinically meaningful weight loss. In a paper examining weight management designed for these patients, Erickson and colleagues investigated behavioral weight management interventions for Veterans with mental illness across four VA medical centers.…”

Reach, engagement and effectiveness of in-person and online lifestyle change programs to prevent diabetes

“…Existing studies examining the comparability of online and in-person LCP delivery have been single-site studies [ 10 ] and/or smaller studies funded by online LCP providers [ 11 – 13 ]. Studies comparing technology-based vs in-person delivery of similar types of interventions, such as weight loss [ 14 , 15 ] and diabetes self-management [ 16 ] programs, have been inconclusive. Therefore, we sought to examine the real-world delivery of both in-person and online LCP by reach, engagement and effectiveness within a large, multi-state registry.…”