Improving Weight Management at the VA

Veterans shoulder a disproportionate burden of obesity and its co-morbidities, including
diabetes, hypertension, and hyperlipidemia. Modest weight loss in obese patients through diet
and exercise improves health and prevents chronic disease, but primary care providers (PCPs)
often fail to adequately counsel patients about their weight due to lack of time and
training. Thus, tools and brief interventions are needed to support providers' behavior
change counseling. The VA currently offers the MOVE! program to treat overweight and obese
patients, but only 9% of eligible patients attend. At the same time, Veterans on average see
their PCPs 3.6 times per year, which supports the importance of developing primary care
(PC)-based interventions. The United States Preventive Services Task force (USPSTF)
recommends the use of the 5As framework (Assess, Advise, Agree, Assist, Arrange [5A]) for
counseling patients about weight.

Interactive behavior change technologies utilizing expert system software programs are an
innovative way to facilitate 5As counseling to promote behavior change in primary care. These
programs perform computerized risk, lifestyle, and theory- based, behavioral assessment to
provide computer-generated, tailored advice to patients. They also can provide information to
healthcare teams.

Collaborative goal setting can be used to achieve behavior change in this intervention. This
construct, a critical component of several behavior change theories and models and
corresponding to "agree" in the 5As model, has been widely recommended for health promotion
in primary care. Investigators did formative work using key informant interviews with several
VA Patient Aligned Care Teams (PACT), MOVE! staff, and focus groups with Veterans
demonstrated that goal setting is feasible and acceptable to patients and PACT teamlets, and
provided insight on barriers to goal setting, and ways to facilitate goal-setting
conversations.

During the development phase of this project, investigators developed a primary care-based
intervention called MOVE! Toward Your Goals (MTG) to facilitate weight management within
primary care and increase adoption of intensive VA programs such as MOVE!. The MTG
intervention uses a new MTG software tool (that the investigators developed) delivered on
tablets to facilitate 5As-based weight management counseling with a health coach and
healthcare team to promote goal-setting, behavior change, and weight loss in the primary care
setting. The Veteran also receives follow up with 12 health coaching calls over 1 year.

Investigators will conduct a large, multicenter (Manhattan and Brooklyn campuses, New York
Harbor Healthcare System) randomized controlled trial of 320 subjects, who will be randomized
to receive either Enhanced Usual Care or the MTG Intervention.

The objectives of this study are to: (a) test the impact of the MTG intervention on weight
and behavior changes; (b) identify predictors of weight loss in Veterans who use goal setting
techniques; and (c) determine the impact of the MTG intervention on primary care team
obesity-related counseling practices and attitudes.

Inclusion Criteria:

- Has not participated in MOVE! in the past year

- Age 18-69 (this age range represents MOVE! eligibility)

- BMI of 30kg/m2 or a BMI of 25 kg/m2 with obesity-associated condition

- Under the care of PCP with at least 1 prior visit with the provider in the past 12
months

- Access to a telephone

- Able to travel to Brooklyn or Manhattan VA for in-person evaluations at 3, 6, and 12
months

Exclusion Criteria:

- Non-Veterans

- A documented current history of active psychosis or other cognitive issues via
International Classification of Diseases (ICD-9) codes

- Diabetes diagnosis via ICD-9 code

- Primary care provider recommends that the patient should not participate

- Severe arthritis, valvular disease, cardiac arrhythmia, pregnancy, and/or other
conditions (indicated by PCP) limiting moderate PA

- Self-reported inability to read at a 5th grade level due to literacy level or vision
problems