Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study

Abstract

Background Lifestyle change programs are aimed to improve health, yet little is known about their impact once translated into clinical settings. The Veterans Health Administration (VA) MOVE! program is the largest lifestyle change program in the U.S., and our objective was to determine whether participation in MOVE! is associated with reduced diabetes incidence. Methods This retrospective analysis used VA databases to examine patients with ≥3 years of continuous outpatient care during 2005–2012, who were overweight or obese. We used generalized estimating equations to examine characteristics associated with MOVE! participation, and Cox proportional hazards regression to analyze the association between participation and diabetes incidence (defined by ICD-9 code or diabetes prescription). Findings Of 1·8 million eligible individuals, 238,540 (13%) participated in MOVE! between 2005–2012, and19,367 (1% overall, 8% of participants) met criteria for “intense and sustained” participation. Intense and sustained participation was associated with greater weight loss at three years compared to less active participation and nonparticipation (−2·2% vs. −0·64% and +0·46%, respectively). Among patients who did not have diabetes at baseline, MOVE! participation was associated with lower diabetes incidence: the hazard ratio comparing less active participants to non-participants was 0·80 (95% CI, 0·77–0·83), and comparing intense and sustained participants to non-participants was 0·67 (95% CI, 0·61–0·74). These patterns were consistent across sex, race/ethnicity, and age. Participation appeared to be most beneficial among patients with higher BMI or random glucose (p-values <0·0001). Interpretation Participation in this large-scale, healthcare-based lifestyle change program was associated with weight loss and lower diabetes incidence. However, the observed impact may have been exaggerated by selection bias, as the program reached only a fraction of the eligible population. Funding VA HSR&D IIR 07-138 and NIH R21DK099716.

Effects of a Weight Loss Program on Metabolic Syndrome, Eating Disorders and Psychological Outcomes: Mediation by Endocannabinoids

“…This weight loss, corresponding to 8.2% of baseline weight, resulted in significant improvement of cardiometabolic and psychological parameters, ED, and QoL (tables 1, 2, 3). These results confirm previous observations reporting clinically meaningful health improvements after a moderate weight loss [29,30,31]. …”

“…lifestyle change program showed a mean weight change of -2.8% and a 33% reduction of diabetes incidence among 238,000 veterans with 12-month data [31]. …”

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

“…Given their long horizon for VHA care, the benefits of behavioral interventions (e.g., MOVE! use is associated with decreased diabetes incidence 28 ), and the fact that men veterans are less likely to use MOVE! than women veterans, 23,24 understanding and increasing weight loss treatment engagement in this group could prevent the onset of costly and debilitating chronic conditions later in life.…”

Knowledge, attitudes and management skills of medical practitioners regarding weight management

“…Weight loss in overweight and obese patients has been associated with improvement of chronic conditions such as asthma, 49 CVD (including heart failure), 50 and diabetes mellitus. 51 …”