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: 315 VA patients eligible for the MOVE! program at the Ann Arbor VAMC 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 with follow-up phone support; or 3) the 'usual care' MOVE! program in place at the Ann Arbor VAMC. Our primary outcome is change in weight from baseline to 3 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 an exploratory cost analysis and formative evaluation.
The high prevalence of overweight or obese veterans has a significant negative impact on individual lives and the VA health system. ASPIRE-VA has the potential to reduce this epidemic and, in turn, reduce the prevalence of chronic conditions related to obesity, including diabetes and heart disease. ASPIRE-VA is designed to help veterans lose weight and engage in more physical activity using an approach that minimizes the likelihood of weight regain over the long- term.
