title: Small-changes obesity treatment among veterans: 12-month outcomes.
abstract: BACKGROUND
  Weight-loss trials tend to recruit highly selective, non-representative samples. Effective weight-loss approaches are needed for real-world challenging populations.
  
  
  OBJECTIVE
  To test whether a small-changes intervention, delivered in groups or via telephone, promotes greater weight loss than standard obesity treatment in a predominantly male, high-risk Veteran population. Data were collected in 2010-2012 and analyzed in 2013.
  
  
  METHODS
  A three-arm, 12-month randomized pragmatic effectiveness trial.
  
  
  METHODS
  Four-hundred eighty-one overweight/obese participants from two Midwestern Veterans Affairs (VA) Medical Centers were randomly assigned to one of three programs: the 12-month Aspiring to Lifelong Health (ASPIRE) weight-loss program delivered (1) individually over the phone (ASPIRE-Phone) or (2) in-person group sessions (ASPIRE-Group); compared to (3) VA's standard weight-loss program (MOVE!).
  
  
  METHODS
  Twenty-eight sessions with a non-clinician coach via telephone or in-person groups using a small-changes obesity treatment approach compared to a 15-30-session standard VA program.
  
  
  METHODS
  Twelve-month change in weight (kilograms).
  
  
  RESULTS
  Participants in all three arms lost significant (p<0.01) weight at 12 months. Participants in the ASPIRE-Group arm lost significantly more weight at 12 months than those in the other two treatment arms (-2.8 kg, 95% CI=-3.8, -1.9, in ASPIRE-Group vs -1.4 kg, 95% CI=-2.4, -0.5, in ASPIRE-Phone and -1.4 kg, 95% CI=-2.3, -0.4) in MOVE!(®). ASPIRE-Group resulted in greater improvements in all other anthropometric measures compared to MOVE! at 12 months (p<0.05) and for all (p<0.05) but waist circumference (p=0.23) compared to ASPIRE-Phone.
  
  
  CONCLUSIONS
  Group-based delivery of the ASPIRE weight management program is more effective than MOVE! and the phone-based version of ASPIRE at promoting sustained weight loss in a predominantly male population with multiple comorbidities. The incremental benefits of group-based ASPIRE over the current MOVE! program could yield significant population-level benefits if implemented on a large scale.
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: Department of Psychology, East Carolina University, Greenville, North Carolina.
authors.forename: Lesley D
authors.initials: LD
authors.lastname: Lutes
authors.affiliation: Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio.
authors.forename: Susan
authors.initials: S
authors.lastname: Kirsh
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan.
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Leah
authors.initials: L
authors.lastname: Gillon
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holleman
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lowery
authors.affiliation: Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan. Electronic address: caroli@med.umich.edu.
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D037001:Directive Counseling / Q000379:methods; D005260:Female; D006040:Goals; D006801:Humans; D008297:Male; D008875:Middle Aged; D015146:Midwestern United States; D009765:Obesity / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D061217:Weight Reduction Programs / Q000379:methods*; D055815:Young Adult