Small-Changes Obesity Treatment Among Veterans

• Published in: American journal of preventive medicine Vol. 47; no. 5; pp. 541 - 553
• Main Authors: Damschroder, Laura J., MS, MPH, Lutes, Lesley D., PhD, Kirsh, Susan, MD, MPH, Kim, Hyungjin Myra, ScD, Gillon, Leah, MSW, Holleman, Robert G., MPH, Goodrich, David E., EdD, Lowery, Julie C., PhD, Richardson, Caroline R., MD
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-11-2014
• Subjects: Internal Medicine
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2014.06.016

Background Weight-loss trials tend to recruit highly selective, non-representative samples. Effective weight-loss approaches are needed for real-world challenging populations. Purpose To test whether a small-changes intervention, delivered in groups or via telephone, promotes greater weight loss than standard obesity treatment in a predominantly male, high-risk Veteran population. Data were collected in 2010–2012 and analyzed in 2013. Design A three-arm, 12-month randomized pragmatic effectiveness trial. Setting/participants Four-hundred eighty-one overweight/obese participants from two Midwestern Veterans Affairs (VA) Medical Centers were randomly assigned to one of three programs: the 12-month Aspiring to Lifelong Health (ASPIRE) weight-loss program delivered (1) individually over the phone (ASPIRE-Phone) or (2) in-person group sessions (ASPIRE-Group); compared to (3) VA’s standard weight-loss program (MOVE!). Intervention Twenty-eight sessions with a non-clinician coach via telephone or in-person groups using a small-changes obesity treatment approach compared to a 15–30-session standard VA program. Main outcome measures Twelve-month change in weight (kilograms). Results Participants in all three arms lost significant ( p <0.01) weight at 12 months. Participants in the ASPIRE-Group arm lost significantly more weight at 12 months than those in the other two treatment arms (−2.8 kg, 95% CI=−3.8, −1.9, in ASPIRE-Group vs −1.4 kg, 95% CI=−2.4, −0.5, in ASPIRE-Phone and −1.4 kg, 95% CI=−2.3, −0.4) in MOVE!® . ASPIRE-Group resulted in greater improvements in all other anthropometric measures compared to MOVE! at 12 months ( p <0.05) and for all ( p <0.05) but waist circumference ( p =0.23) compared to ASPIRE-Phone. Conclusions Group-based delivery of the ASPIRE weight management program is more effective than MOVE! and the phone-based version of ASPIRE at promoting sustained weight loss in a predominantly male population with multiple comorbidities. The incremental benefits of group-based ASPIRE over the current MOVE! program could yield significant population-level benefits if implemented on a large scale.