MOVE: weight management program across the veterans health administration: patient- and facility-level predictors of utilization

Abstract

BackgroundHealth care systems initiating major behavioral health programs often face challenges with variable implementation and uneven patient engagement. One large health care system, Veterans Health Administration (VHA), recently initiated the MOVE!® Weight Management Program, but it is unclear if veterans most in need of MOVE!® services are accessing them. The purpose of this study was to examine patient and facility factors associated with MOVE!® utilization (defined as 1 or more visits) across all VHA facilities.MethodsUsing national administrative data in a retrospective cohort study of eligible overweight (25 < = body mass index (BMI) < 30 and at least one obesity associated comorbidity) and obese (BMI > =30) VHA outpatients, we examined variation in and predictors of MOVE!® utilization in fiscal year (FY) 2010 using generalized linear mixed models.Results4.39% (n = 90,230) of all eligible overweight and obese patients using VHA services utilized MOVE!® services at least once in FY 2010. Facility-level MOVE! Utilization rates ranged from 0.05% to 16%. Veterans were more likely to have at least one MOVE!® visit if they had a higher BMI, were female, unmarried, younger, a minority, or had a psychiatric or obesity-related comorbidity.ConclusionsAlthough substantial variation exists across VHA facilities in MOVE!® utilization rates, Veterans most in need of obesity management services were more likely to access MOVE!®, although at a low level. However, there may still be many Veterans who might benefit but are not accessing these services. More research is needed to examine the barriers and facilitators of MOVE!® utilization, particularly in facilities with unusually high and low reach.

Geographic Variation in Obesity, Behavioral Treatment, and Bariatric Surgery for Veterans

“…Prior work indicated that only 2% to 12% of eligible veterans participate in MOVE!, and weight change associated with MOVE! is modest (mean loss of 0.13‐3.3 kg) .…”

Improving Weight in People with Serious Mental Illness: The Effectiveness of Computerized Services with Peer Coaches

“…Participation is less than 5% of eligible veterans, 6 average weight loss is minimal, 1-2 pounds, 6 and MOVE is more likely to be utilized by those with a body mass index (BMI) above 30, indicating obesity. [6][7][8] Since people with SMI often have cognitive deficits, limited literacy, and challenging social situations, interventions need to be tailored for this population. Individual-and group-based behavioral interventions tailored for SMI have repeatedly been shown to result in weight reduction, [9][10][11][12][13][14][15] though a recent study showed no benefit of intervention.…”

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

“…Only 5% to 10% of eligible veterans opt to participate in the MOVE! program . Prior studies have shown that these patients are more likely to be women, unmarried, and younger and are more likely to have a higher baseline BMI .…”

“…Although more than 95% of eligible veterans are offered the MOVE! program each year, only 5% to 10% opt to participate, and the noncompletion rate is estimated to be as high as 74%, further stressing the importance of understanding and encouraging continued engagement after recruitment . When participants do complete the program, they see long‐term improvements in weight loss, diabetes, and hyperlipidemia .…”