Lifestyle modification is urgently recommended to combat obesity and diabetes, yet very little is known about the implementation of large-scale lifestyle change programs in real-world clinical settings. The VA's MOVE program is the largest lifestyle change program nationwide, with over 400,000 participants since 2005. We will address three Aims: (1) To determine the extent to which disparities affect enrollment and participation in MOVE;(2) To determine the extent to which participation in MOVE improves cardiometabolic risk;and (3) To determine the impact of participation on healthcare system resource use and costs. National data are available from the VA's Corporate Data Warehouse, and analyses will be conducted using SAS within the VA Informatics and Computing Infrastructure (VINCI), a high-performance secure computing environment. Veterans who meet eligibility criteria for MOVE participation, with at least 3 consecutive years of VA primary care between 2005-2012, will be included. Multiple modeling strategies, including generalized estimating equations, will be used to appropriately analyze longitudinal data. This research has the potential to profoundly impact the field of diabetes prevention. Expected results include groundbreaking knowledge of a national, clinically-based program's reach and impact on patient health and the health system. The work is unique in several key areas: (1) MOVE is the largest weight loss program nationwide;(2) MOVE is implemented within a clinical setting, unlike more common community-based approaches;(3) MOVE is a real-world program in which participants are patients recommended for weight loss by their primary care providers, rather than """"""""study volunteers"""""""";(4) the proposed research examines MOVE's impacts on both individual-level health outcomes and health system-level costs and resource use. While outcomes are expected to be more modest in MOVE than in the Diabetes Prevention Program (DPP), preliminary data indicate that MOVE participation substantially reduces diabetes incidence. The proposed work will examine improvements in BMI, CVD risk factors, diabetes and CVD incidence, medication usage, and health system costs and resource use. This research will also inform future work, such as an expected-benefits algorithm and EHR tool to provide healthcare professionals and patients with individualized recommendations. Nearly three quarters of veterans in the VA health system are overweight or obese;thus, approximately 6 million veterans stand to benefit from MOVE if it is found to be effective. In addition to evaluating the program's health and health system impacts, the proposed research will inform improvements in MOVE implementation by identifying disparities in program participation as well as provider- and facility-level factors associated with reduced disparities. This work is also relevant outside of the VA, as lessons learned from these analyses will inform other health care systems where many more millions of Americans could benefit from lifestyle change programs similar to MOVE.

Public Health Relevance

The dual epidemics of obesity and diabetes present serious health and economic challenges, and the US needs to know if weight loss programs can be successful in real-world, healthcare- based settings. We propose to investigate the largest such program nationwide, including disparities in reach and effectiveness, as well as the program's impacts on cardiovascular risk factors, diabetes incidence, cardiovascular disease, and health system costs and resource use.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Exploratory/Developmental Grants (R21)
Project #
1R21DK099716-01A1
Application #
8702295
Study Section
Kidney, Nutrition, Obesity and Diabetes Study Section (KNOD)
Program Officer
Kuczmarski, Robert J
Project Start
2014-07-01
Project End
2016-06-30
Budget Start
2014-07-01
Budget End
2015-06-30
Support Year
1
Fiscal Year
2014
Total Cost
Indirect Cost
Name
Emory University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
City
Atlanta
State
GA
Country
United States
Zip Code
30322
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Yang, Yihan; Long, Qi; Jackson, Sandra L et al. (2018) Nurse Practitioners, Physician Assistants, and Physicians Are Comparable in Managing the First Five Years of Diabetes. Am J Med 131:276-283.e2
Bliwise, Donald L; Greer, Sophia A; Scullin, Michael K et al. (2017) Habitual and Recent Sleep Durations: Graded and Interactive Risk for Impaired Glycemic Control in a Biracial Population. Am J Med 130:564-571
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Watts, Nelson B; Cauley, Jane A; Jackson, Rebecca D et al. (2017) No Increase in Fractures After Stopping Hormone Therapy: Results From the Women's Health Initiative. J Clin Endocrinol Metab 102:302-308
Jackson, Sandra L; Safo, Sandra; Staimez, Lisa R et al. (2017) Reduced Cardiovascular Disease Incidence With a National Lifestyle Change Program. Am J Prev Med 52:459-468
Jackson, S L; Safo, S E; Staimez, L R et al. (2017) Glucose challenge test screening for prediabetes and early diabetes. Diabet Med 34:716-724
Kancherla, Vijaya; Elliott Jr, John L; Patel, Birju B et al. (2017) Long-term Metformin Therapy and Monitoring for Vitamin B12 Deficiency Among Older Veterans. J Am Geriatr Soc 65:1061-1066
Cespedes, Elizabeth M; Hu, Frank B; Tinker, Lesley et al. (2016) Multiple Healthful Dietary Patterns and Type 2 Diabetes in the Women's Health Initiative. Am J Epidemiol 183:622-33
Jackson, Sandra L; Long, Qi; Rhee, Mary K et al. (2015) Weight loss and incidence of diabetes with the Veterans Health Administration MOVE! lifestyle change programme: an observational study. Lancet Diabetes Endocrinol 3:173-80

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