Systematic Review of Behavioral Weight Management Program MOVE! for Veterans

Objective The aim of this study was to examine the association of county‐level food access, recreational opportunities, and natural amenities with participant engagement in a weight management program. Methods In this cohort study, participants in the Veterans Health Administration MOVE! weight management program between October 1, 2007, and September 30, 2013, were observed for 12 months after enrollment. Engagement was measured as the number of program visits per year at 12 months. Cross‐sectional analysis and spatial regression were used to examine county characteristics associated with greater participant engagement at 12 months. Results A total of 321,624 participants in 2,708 counties were included. Greater engagement was associated with older age, female sex, white race, being married, and being retired. After accounting for similarities between nearby communities, engagement at 12 months was 3.1 visits higher for each additional farmers’ market per 1,000 population (P = 0.01). Engagement was highest for participants living in counties with the most natural amenities (P < 0.001). Recreational opportunities had only a small effect on engagement in the program (β = 0.02 visits at 12 months; P = 0.002). Conclusions Consideration of a participant’s county characteristics in addition to other known demographics and program factors may help to explain variation in engagement in weight management programs.

Section: Discussionsupporting

confidence: 76%

“…Eligibility was originally defined as BMI ≥ 30 kg/m 2 . Additional qualifications for individuals with lower BMI, such as the presence of certain comorbidities or a high waist circumference (defined as > 35 inches for women and > 40 inches for men), were added as the program evolved over time .…”

Section: Methodsmentioning

confidence: 99%

Association of Food Access, Recreational Opportunities, and Natural Amenities with Engagement in the Veterans MOVE! Weight Management Program

Graham

Malone

Richman

et al. 2019

“…Prior work indicated that only 2% to 12% of eligible veterans participate in MOVE!, and weight change associated with MOVE! is modest (mean loss of 0.13‐3.3 kg) .…”

Section: Introductionmentioning

confidence: 98%

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

Maciejewski

Arterburn

Berkowitz

et al. 2018

Self Cite

Objective This study aims to describe geographic variation in veterans’ prevalence of obesity, participation in Veterans Health Administration’s behavioral weight management program (MOVE!), and receipt of bariatric surgery in fiscal year (FY) 2016. Methods In this retrospective cohort study of veterans with obesity who received Veterans Health Administration care in FY2016, electronic health record data were obtained on weight, height, outpatient visits to the MOVE! program, and bariatric surgeries. For each Veterans Integrated Service Network (VISN) region, the prevalence rate of veterans with obesity (BMI ≥ 30 kg/m2), MOVE! participation rates, and bariatric surgery rates are presented. Results The prevalence of obesity in veterans ranged from 30.5% to 40.5% across VISNs in FY2016. MOVE! participation among veterans with obesity was low (2.8%‐6.9%) across all VISNs, but veterans with class II and III obesity (BMI ≥ 35) had higher MOVE! participation rates (4.3%‐10.8%) than veterans with class I obesity. There was 20‐fold variation across VISNs in receipt of bariatric surgery among veterans with BMI ≥ 35, ranging from 0.01% to 0.2%. Among veterans with BMI ≥ 35 participating in MOVE!, there was 46‐fold variation in bariatric surgery provision, ranging from 0.07% to 3.27%. Conclusions Despite veterans’ high prevalence of obesity, behavioral and surgical weight management participation is low and varies across regions.

“…A systematic review found that average 12‐month weight loss among MOVE! participants ranged from 0.13 to 3.3 kg .…”

Section: Introductionmentioning

confidence: 99%

Patient Characteristics Associated with Receipt of Prescription Weight‐Management Medications Among Veterans Participating in MOVE!

Thomas

Waring

Ameli

et al. 2019

Objective: Weight-management medications (WMM) are recommended for the treatment of obesity. This study examined characteristics associated with initial receipt of WMM among eligible veterans in the first year following enrollment in the Veterans Health Administration (VHA) MOVE! behavioral weight-management program. Methods: We conducted a retrospective cohort study of VHA patients with obesity or overweight and obesity-related comorbidities who enrolled in MOVE! from October 2013 to September 2016 (N =153,939). Multivariable logistic regression models estimated predictors of having a filled prescription for WMM and for orlistat. Results: A total of 1.1% of these veterans received WMM. The most common WMM included orlistat (70.4%), phentermine/topiramate (11.2%), and bupropion/naltrexone (9.7%). Female sex, higher BMI, obstructive sleep apnea, osteoarthritis, depression, lower back pain, and alcohol abuse were associated with greater odds of use of WMM, whereas age over 65 years, Hispanic ethnicity, and required co-payments were associated with lower odds. Among patients receiving WMM, older age, black race, female sex, higher BMI, cardiovascular disease, lower back pain, and congestive heart failure were associated with use of orlistat versus any other WMM. Conclusions: Of patients engaged in MOVE! in the VHA, 1.1% received WMM. WMM are underutilized among veterans. Additional research is needed to understand barriers to incorporating WMM into comprehensive obesity treatment plans.