Coaching Veterans to Healthy Weights and Wellness

Background and Rationale:

Over 70% of veterans are overweight or obese, imposing a tremendous burden on the VHA
healthcare system due to increased need for treatment of obesity-related chronic disease and
disability. The MOVE! 5-level Weight Management Program for Veterans has been promoted in
VHA to address this problem. Data suggest that engagement in ongoing treatment is low,
clinically significant weight loss is not being achieved by many patients, and weight regain
is likely. Although the MOVE! program description includes phone-based self-management
support, most facilities have focused resources on developing facility-based group programs.

Project Objective:

To fill the gap in phone-based self-management support and to increase the number of
patients who achieve a clinically significant amount of weight loss, we will examine the
impact of an innovative approach to weight loss ("Aspiring to Lifelong Health in VA", aka
"ASPIRE-VA"). ASPIRE-VA has 3 key features: 1) lifestyle coaches who encourage behavior
change through a "small steps" approach; 2) a simplified "Stoplight" diet; and 3)
user-friendly "enhanced" pedometers to help participants monitor their physical activity.
ASPIRE-VA is not an alternative program to MOVE!; rather, it is a more structured approach
within the existing MOVE! framework that is potentially more convenient and satisfying for
patients, particularly those unable to participate in facility-based programs.

Project Methods:

468 VA patients eligible for the MOVE! program at two VAMCs will be invited to participate
in this 12-month randomized control trial. Willing participants will be randomized to one of
3 study arms: 1) ASPIRE-VA delivered only by phone; 2) ASPIRE-VA delivered through
center-based group visits; or 3) the "usual care" MOVE! program in place at each VAMC. Our
primary outcome is change in weight between baseline and 12 months. Secondary outcomes are
changes in functional exercise capacity, nutrition, glucose levels, serum lipid levels,
blood pressure, and health-related quality of life. We will also conduct exploratory
analyses of cost and differences in response and experience by different races and genders,
and formative evaluation.

Progress:

Recruitment began in January of 2010 and, as of the end of 2010, we have enrolled 264
patients, approximately 56% of our goal.