title: Behavioral Treatment for Veterans with Obesity: 24-Month Weight Outcomes from the ASPIRE-VA Small Changes Randomized Trial.
abstract: BACKGROUND
  Small Changes (SC) is a weight management approach that demonstrated superior 12-month outcomes compared to the existing MOVE!®Weight Management Program at two Veterans Affairs (VA) sites. However, approaches are needed to help graduates of treatment continue to lose or maintain their weight over the longer term.
  
  
  OBJECTIVE
  The purpose of the present study was to examine the effectiveness of a second year of low-intensity SC support compared to support offered by the usual care MOVE! programs.
  
  
  METHODS
  Following participation in the year-long Aspiring to Lifelong Health in VA (ASPIRE-VA) randomized controlled trial, participants were invited to extend their participation in their assigned program for another year. Three programs were extended to include six SC sessions delivered via telephone (ASPIRE-Phone) or an in-person group (ASPIRE-Group), or 12 sessions offered by the MOVE! programs.
  
  
  METHODS
  Three hundred thirty-two overweight/obese veterans who consented to extend their participation in the ASPIRE-VA trial by an additional year.
  
  
  METHODS
  Twenty-four-month weight change (kg).
  
  
  RESULTS
  Twenty-four months after baseline, participants in all three groups had modest weight loss (-1.40 kg [-2.61 to -0.18] in the ASPIRE-Group, -2.13 kg [-3.43 to -0.83] in ASPIRE-Phone, and -1.78 kg [-3.07 to -0.49] in MOVE!), with no significant differences among the three groups. Exploratory post hoc analyses revealed that participants diagnosed with diabetes initially benefited from the ASPIRE-Group program (-2.6 kg [-4.37 to 0.83]), but experienced significant weight regain during the second year (+2.8 kg [0.92-4.69]) compared to those without diabetes.
  
  
  CONCLUSIONS
  Participants in all three programs lost weight and maintained a statistically significant, though clinically modest, amount of weight loss over a 24-month period. Although participants in the ASPIRE-Group initially had greater weight loss, treatment was not sufficient to sustain weight loss through the second year, particularly in veterans with diabetes. Consistent, continuous-care treatment is needed to address obesity in the VA.
authors.affiliation: Department of Psychology, University of British Columbia, 3187 University Way, Kelowna, BC, V1V 1V7, Canada. lesley.lutes@ubc.ca.
authors.forename: Lesley D
authors.initials: LD
authors.lastname: Lutes
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Robin
authors.initials: R
authors.lastname: Masheb
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.|Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Hyungjin Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Leah
authors.initials: L
authors.lastname: Gillon
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Holleman
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
authors.affiliation: VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
authors.forename: Julie C
authors.initials: JC
authors.lastname: Lowery
authors.affiliation: Department of Epidemiology and Biostatistics, Michigan State University College of Human Medicine, Midland Regional Campus, Midland, MI, USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Janney
authors.affiliation: Louis Stokes Veterans Affairs Medical Center, Cleveland, OH, USA.
authors.forename: Susan
authors.initials: S
authors.lastname: Kirsh
authors.affiliation: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Caroline R
authors.initials: CR
authors.lastname: Richardson
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D000073319:Obesity Management / Q000379:methods*; D010349:Patient Compliance; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D014728:Veterans; D015431:Weight Loss
keywords: behavioral medicine; clinical trials; obesity; veterans; weight management