Peer Reviewed: Design and Dissemination of the MOVE! Weight-Management Program for Veterans (original) (raw)
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Design and dissemination of the MOVE! Weight-Management Program for Veterans
Preventing chronic disease, 2009
Practitioners in the Veterans Health Administration (VHA) identified comprehensive weight management as a high priority in early 2001. The MOVE! Weight-Management Program for Veterans was developed on the basis of published guidelines from the National Institutes of Health and other organizations. Testing of program feasibility occurred at 17 VHA sites, and the program was refined during early implementation throughout 2005. MOVE! was disseminated nationally in January 2006. Local program coordinators and physician champions were named, and toolkits, online training, marketing materials, and ongoing field support were provided. MOVE! has been implemented at nearly all VHA medical centers. By June 2008, more than 100,000 patients had participated in MOVE! during more than 500,000 visits. An evaluation based on an established framework is under way. MOVE! is an example of the large-scale translation of research into practice. It has the potential to reduce the burden of disease from o...
RE-AIM evaluation of the Veterans Health Administration’s MOVE! Weight Management Program
Translational Behavioral Medicine, 2011
Over one-third of patients treated in the Veterans Health Administration (VHA) are obese. VHA introduced the MOVE! Weight Management Program for Veterans in 2006 to provide comprehensive weight management services. An evolving, periodic evaluation using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) has been conducted to gauge success and opportunities for improvement. Key metrics were identified in each Implications Practice: Weight management treatment can be delivered at VHA medical centers and community-based outpatient clinics with modest but positive impact on short-term weight loss outcomes. Intensity and span of treatment are key drivers of clinical success.
Weight Management for Veterans: Examining Change in Weight Before and After MOVE!
Obesity, 2011
According to data from NHANES 1999-2008, the national prevalence rates for overweight and obesity combined (BMI ≥25 kg/ m 2 ) increased from 64.5 to 68% and for obesity (BMI ≥30 kg/ m 2 ) from 30.5 to 33.8% among adults living in the United States (1). The high prevalence of overweight and obesity has also been observed among military veteran populations. Based on measured height and weight in 2000, 31% of women and 40% of men receiving outpatient care at Veterans Affairs (VA) medical facilities were overweight; 37.4% of women and 32.9% of men were obese (2). Obese veterans who use VA medical facilities are more likely to describe their overall health as fair or poor and report higher rates of arthritis, hypertension, and diabetes compared to overweight and normal weight veterans (3). Specifically, over 400,000 veterans have been diagnosed with diabetes and 10.7% of these veterans have renal disease (4). Obesity-related illnesses (e.g., diabetes and heart disease) create a major financial burden given the increasing costs of health care. Weight management programs aimed at helping individuals make lifestyle changes have been shown to result in sustained weight loss as well as reduced risks for chronic diseases (5), which may have implications for veterans' health and quality of life as well as the costs of providing long-term care.
BMC Health Services Research, 2013
Background: Health care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE! W Weight Management Program, but it is unclear if veterans most in need of MOVE! W services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE! W utilization (defined as 1 or more visits) across all VHA facilities. Methods: Using national administrative data in a retrospective cohort study of eligible overweight (25 < = body mass index (BMI) < 30 and at least one obesity associated comorbidity) and obese (BMI > =30) VHA outpatients, we examined variation in and predictors of MOVE! W utilization in fiscal year (FY) 2010 using generalized linear mixed models. Results: 4.39% (n = 90,230) of all eligible overweight and obese patients using VHA services utilized MOVE! W services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE! W visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity.
Preventing Chronic Disease, 2011
One-third of US veterans receiving care at Veterans Health Administration (VHA) medical facilities are obese and, therefore, at higher risk for developing multiple chronic diseases. To address this problem, the VHA designed and nationally disseminated an evidence-based weight-management program (MOVE!). The objective of this study was to examine the organizational factors that aided or inhibited the implementation of MOVE! in 10 VHA medical facilities.
Evaluation of a Weight Management Program for Veterans
Preventing Chronic Disease, 2012
Introduction To improve the health of overweight and obese veterans, the Department of Veterans Affairs (VA) developed the MOVE! Weight Management Program for Veterans. The aim of this evaluation was to assess its reach and effectiveness. Methods We extracted data on program involvement, demographics, medical conditions, and outcomes from VA administrative databases in 4 Western states. Eligibility criteria for MOVE! were being younger than 70 years and having a body mass index (BMI, in kg/m) of at least 30.0, or 25.0 to 29.9 with an obesity-related condition. To evaluate reach, we estimated the percentage of eligible veterans who participated in the program and their representativeness. To evaluate effectiveness, we estimated changes in weight and BMI using multivariable linear regression. Results Less than 5% of eligible veterans participated, of whom half had only a single encounter. Likelihood of participation was greater in women, those with a higher BMI, and those with more primary care visits, sleep apnea, or a mental health condition. Likelihood of participation was lower among those who were younger than 55 (vs 55-64), widowed, current smokers, and residing farther from the medical center (≥30 vs <30 miles). At 6-and 12-month follow-up, participants lost an average of 1.3 lb (95% confidence interval [CI], −2.6 to −0.02 lb) and 0.9 lb (95% CI, −2.0 to 0.1 lb) more than nonparticipants, after covariate adjustment. More intensive treatment (≥6 encounters) was associated with greater weight loss at 12 months (−3.7 lb; 95% CI, −5.1 to −2.3 lb). Conclusion Few eligible patients participated in the program during the study period, and overall estimates of effectiveness were low.
Military Medicine, 2015
The Veterans Health Administration's MOVE! Program is the largest health care-delivered weight loss intervention in the United States. As a referring clinician's perceptions and knowledge of health programs may impact implementation, examining perceptions of MOVE! may inform improvements to this and other programs. This study investigated primary care clinician perceptions of MOVE! (n = 754, 50% nurses). Perceived effectiveness ratings were highest for groups with 11 to 25 group members (p < 0.01) and for a combined lecture and support group format (p = 0.026), though session length and several other aspects of delivery were not associated with perceptions of effectiveness. MOVE! staff also rated the program as more effective than did other clinicians (p < 0.01). Many respondents lacked knowledge about program specifics, especially those not involved with MOVE! delivery (vs. those directly involved; p < 0.01). These findings indicate that variety in group size and format is related to perceptions of MOVE! effectiveness,. Also, clinicians not involved with MOVE! may lack knowledge about the program and underestimate its effectiveness, which could negatively affect referral likelihood or enthusiasm expressed to referred patients. Findings highlight opportunities for clarifying perceptions of a weight control program among clinicians in a large health care system.
Military Medicine
The Veterans Health Administration's MOVE! Program is the largest health care-delivered weight loss intervention in the United States. As a referring clinician's perceptions and knowledge of health programs may impact implementation, examining perceptions of MOVE! may inform improvements to this and other programs. This study investigated primary care clinician perceptions of MOVE! (n = 754, 50% nurses). Perceived effectiveness ratings were highest for groups with 11 to 25 group members ( p < 0.01) and for a combined lecture and support group format ( p = 0.026), though session length and several other aspects of delivery were not associated with perceptions of effectiveness. MOVE! staff also rated the program as more effective than did other clinicians ( p < 0.01). Many respondents lacked knowledge about program specifics, especially those not involved with MOVE! delivery (vs. those directly involved; p < 0.01). These findings indicate that variety in group size and format is related to perceptions of MOVE! effectiveness, . Also, clinicians not involved with MOVE! may lack knowledge about the program and underestimate its effectiveness, which could negatively affect referral likelihood or enthusiasm expressed to referred patients. Findings highlight opportunities for clarifying perceptions of a weight control program among clinicians in a large health care system.
Journal of general internal medicine, 2017
Small Changes (SC) is a weight management approach that demonstrated superior 12-month outcomes compared to the existing MOVE!(®) Weight Management Program at two Veterans Affairs (VA) sites. However, approaches are needed to help graduates of treatment continue to lose or maintain their weight over the longer term. The purpose of the present study was to examine the effectiveness of a second year of low-intensity SC support compared to support offered by the usual care MOVE! programs. Following participation in the year-long Aspiring to Lifelong Health in VA (ASPIRE-VA) randomized controlled trial, participants were invited to extend their participation in their assigned program for another year. Three programs were extended to include six SC sessions delivered via telephone (ASPIRE-Phone) or an in-person group (ASPIRE-Group), or 12 sessions offered by the MOVE! programs. Three hundred thirty-two overweight/obese veterans who consented to extend their participation in the ASPIRE-VA...