Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study

Abstract

Purpose: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. Design: Single-arm pre–post pilot to iteratively develop MOVE!+UP (2015-2018). Setting: Veterans Affairs Medical Center. Participants: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = “Development” and cohort 5 [n = 8] = “Final” MOVE!+UP). Intervention: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. Measures: To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. Analysis: Baseline to 16-week paired t tests and template analysis. Results: Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [ M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight ( M = −14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD ( M = −17.9 [SD = 12.2]) improvements, P < .05. Conclusions: The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.

Association of childhood abuse with behavioral weight‐loss outcomes: Examining the mediating effect of binge eating severity

“…However, limited efforts have attempted to extend trauma‐informed approaches to behavioral weight‐loss interventions. A recent proof‐of‐concept study by Hoerster and colleagues (41) supported the feasibility and potential effectiveness of delivering trauma‐informed obesity care. The authors adapted an established behavioral weight‐loss program to include cognitive behavioral therapy skills relevant for trauma‐ and stressor‐related symptoms and found that these adaptations led to significant weight loss among a sample of veterans with posttraumatic stress disorder.…”

Insomnia, Short Sleep, and Their Treatments: Review of Their Associations with Weight

“…Two other studies focused on special populations. Hoerster and colleagues [ 67 ] developed a tailored behavioral weight loss intervention for veterans with PTSD. Although not focused exclusively on sleep goals within the Veteran Affair’s MOVE behavioral weight loss program, a sleep assessment and “improvement plan” was included in one session.…”

“…Following the 16-week program with 8 participants, 71% had clinically meaningful weight loss ( ≥ 5% of baseline weight), with an average loss of 6.1% ( SD = 2.1). PTSD and insomnia symptom severity also improved at post-treatment [ 67 ]. Another study tested a 16-week multi-component intervention (nutrition, sleep, and physical activity) vs. waitlist control among airline pilots with overweight ( N = 125; 9.6% women) [ 68 ].…”