Late Breaking News
VA’s MOVE! Initiative Plagued by Lack of Participation
The researchers noted that, “evaluating the effectiveness of MOVE! is challenging because it is not clear that the program was implemented as intended. Sustained and intensive treatments are associated with better outcomes. Participants in the Diabetes Prevention Program and Look AHEAD trials met with interventionists an average of 23.6 and 35.4 times, respectively, in the first year, nearly an order of magnitude more than was observed for VA Northwest Region patients.”
The authors compared MOVE! results with multicenter randomized clinical trials beyond the VA, the Diabetes Prevention Program (DPP) and Look AHEAD; both were designed at least in part to evaluate the effects of intensive lifestyle interventions to reduce weight of obese patients through decreased caloric intake and increased exercise. Participants in the lifestyle intervention arm of the DPP lost 7% of body weight in the first 12 months and, on average, had a weight loss of 4% when the study terminated at roughly three years. In the Look AHEAD trial, patients in the intensive lifestyle intervention group achieved an average weight loss of more than 6% over four years.
“MOVE! is not a clinical trial, so those with more visits may be more motivated,” said Littman. “And the intent of the program may not have been to replicate a trial, as it may not be practical, [given the number of patients in the VA system who are candidates for the program.] … We found, though, that participants in MOVE! had fewer encounters than needed to have a beneficial effect.”
One conclusion was clear from the report: Overall, “facilities did not have the resources necessary to offer the program at an intensity that might be most beneficial,” added Littman. Lack of resources likely contributed to low participation rates and the program’s limited effectiveness.
VA facilities implemented MOVE! in a variety of ways, according to the study. In some locations, group sessions accounted for nearly all the encounters; in others, most of the visits were one-on-one consultations. Frequency also varied, with some facilities offering only one educational seminar a month and others providing 12-session, group-based classes at least twice a week, plus weekly maintenance sessions. Participation rates ranged from 0.4% to 8.2%.
The program also was at different points in development at each facility during the study period. Some had implemented MOVE! when it was initially introduced, while others launched their versions two years later. Despite these differences, the research team found, “no consistent associations between facility and clinically important weight loss.”
The study period ended in 2008, the same year the VA rolled out a performance measure that requires annual screenings for obesity, as well as counseling, and comprehensive weight-management treatment for at-risk patients.
A second study published in Preventing Chronic Disease looked at patient retention in 12 MOVE! programs throughout the United States two years later. Five of the centers had high participant retention rates, and seven had low rates 2
On average, 42% of MOVE! participants dropped out of the program after only one session in 2010, consistent with retention rates seen in other settings. Clinical trials of obesity treatment programs typically lose 30% to 50% of participants, while a study of the Jenny Craig weight loss program reported a 58% dropout rate.
VA researchers from the Hines, IL, VAMC found several factors important in retention, including:
• Physical activity during meetings, such as stretching and chair exercises that accommodate participants of varying ability and mobility levels,
• A physician champion who actively promoted change, advocated for the program and used a collaborative approach to behavior change,
• Provider knowledge,
• Program reputation,
• Multiple meeting times, and
• Clearly communicating the nature and benefits of the MOVE! program to patients at the time of referral.
1.Littman AJ, Boyko EJ, McDonell MB, Fihn SD. Evaluation of a weight management program for veterans. Prev Chronic Dis. 2012;9:E99. Epub 2012 May 17. PubMed PMID: 22595323.
2. Locatelli SM, Sohn M-W, Spring B, Hadi S, Weaver FM. Participant Retention in the Veterans Health Administration’s MOVE! Weight Management Program, 2010. Prev Chronic Dis 2012;9:120056. DOI: http://dx.doi.org/10.5888/pcd9.120056
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