title: Examining the Dose-Response Relationship in the Veterans Health Administration's MOVE!®Weight Management Program: A Nationwide Observational Study.
abstract: BACKGROUND
  For more than a decade, the Veterans Health Administration (VHA) has offered MOVE!, a comprehensive lifestyle intervention for weight management. However, there is limited knowledge to inform resource allocation decisions at the health system level-for example, the choice between reaching new veterans with weight management treatment, re-engaging veterans who have stopped attending, and/or increasing contact with current MOVE!
  
  
  METHODS
  
  
  
  OBJECTIVE
  To inform VHA policy and planning, this VHA-wide study examines the relationship between MOVE! participation and weight outcomes.
  
  
  METHODS
  A longitudinal observational study of veterans across VHA who participated in MOVE!.
  
  
  METHODS
  Veterans who initiated their most recent episode of MOVE! care between 2004 and 2014.
  
  
  METHODS
  Weight measurements were abstracted from VHA electronic health records. The primary outcome was the proportion of veterans with clinically relevant weight loss. The predictor of interest was number of MOVE! contacts during the 12 months following MOVE! initiation.
  
  
  RESULTS
  The cohort consisted of 237,577 veterans (87.4% male; mean age 54.4 years), who had 5.3 contacts on average in the 12 months following initiation. Veterans with 2-5 contacts had the same odds of achieving clinically relevant weight loss as veterans with only one contact (adjusted OR: 1.00, 95% CI: 0.98-1.03). Veterans with 6-9, 10-13, 14-17, and 18 or more contacts had significantly higher odds of clinically relevant weight loss (adjusted OR: 1.17, 95% CI: 1.13-1.20; adjusted OR: 1.53, 95% CI: 1.47-1.59; adjusted OR: 1.84, 95% CI: 1.74-1.94; adjusted OR: 2.21, 95% CI: 2.12-2.31, respectively).
  
  
  CONCLUSIONS
  Veterans with ≥6 MOVE! contacts in the year following treatment initiation were significantly more likely to achieve clinically relevant weight loss than those with one contact, with greater participation further increasing the odds of clinically relevant weight loss. While further characterization of weight loss predictors is needed, the VHA should provide policy guidance that supports increasing participation among veterans who have initiated MOVE!.
authors.affiliation: National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA. stephanie.chan4@va.gov.
authors.forename: Stephanie H
authors.initials: SH
authors.lastname: Chan
authors.affiliation: National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Raffa
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008019:Life Style; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000503:physiopathology / Q000628:therapy*; D000073319:Obesity Management / Q000379:methods*; D015397:Program Evaluation; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000458:organization & administration*
keywords: behavioral science; veterans; weight management