Association of Food Access, Recreational Opportunities, and Natural Amenities with Engagement in the Veterans MOVE! Weight Management Program

Abstract

Objective The aim of this study was to examine the association of county‐level food access, recreational opportunities, and natural amenities with participant engagement in a weight management program. Methods In this cohort study, participants in the Veterans Health Administration MOVE! weight management program between October 1, 2007, and September 30, 2013, were observed for 12 months after enrollment. Engagement was measured as the number of program visits per year at 12 months. Cross‐sectional analysis and spatial regression were used to examine county characteristics associated with greater participant engagement at 12 months. Results A total of 321,624 participants in 2,708 counties were included. Greater engagement was associated with older age, female sex, white race, being married, and being retired. After accounting for similarities between nearby communities, engagement at 12 months was 3.1 visits higher for each additional farmers’ market per 1,000 population (P = 0.01). Engagement was highest for participants living in counties with the most natural amenities (P < 0.001). Recreational opportunities had only a small effect on engagement in the program (β = 0.02 visits at 12 months; P = 0.002). Conclusions Consideration of a participant’s county characteristics in addition to other known demographics and program factors may help to explain variation in engagement in weight management programs.

Social and Structural Determinants of Health and Social Injustices Contributing to Obesity Disparities

“…1 Social and structural determinants of health and social injusticies that contribute to obesity disparities the results of a study using data from the Behavioral Risk Factor Surveillance System showed that regardless of race and ethnicity, residents of low-income communities with food and physical activity deserts have higher BMI levels than residents of high income communities that have access to active commuting and fewer unhealthy food outlets [31]. In addition, Graham et al [32] found that veterans living in counties with fewer farmer's markets and natural amenities were less likely to be engaged in the Veterans Health Administration MOVE! Program.…”

“…Added sugar intake, including sugar-sweetened beverage (SSB), is associated with a greater risk of incident obesity among young adults [32]. Racial and ethnic minorities and individuals with low incomes have significantly higher Community-level intervention focused on increasing accessing to affordably priced fruits and vegetable in rural communities [74] Expanded acceptance of nutrition benefits programs Increase the number of farmer's markets that accept nutrition benefits programs…”

The Varying Effects of the Food, Built, and Socioeconomic Environment on BMI

“…In yet another study of veterans, Graham et al (7), showed that greater engagement in the Veterans Health Administration's MOVE! weight management program was associated with older age, female sex, white race, being married, and being retired.…”

“…Graham et al(7) A cross-sectional analysis of the number of visits per person (outcome measure) at 12 months after Veterans Health Administration MOVE! program enrollment was conducted to examine the distribution and relationships between participant demographics, program attributes, and county-level characteristics.…”