Weight-loss program for veterans cut diabetes risk

CHICAGO – A low-cost lifestyle intervention program designed for real-world application in obese and overweight patients achieved sustained weight loss and a reduced risk of developing diabetes in a large 3-year observational study.

The MOVE! program (Managing Overweight and/or Obesity in Veterans Everywhere) was launched in 2005 in 130 hospitals and clinics in the Department of Veterans Affairs (VA) system, the nation’s largest integrated health care system. MOVE! is based upon principles proven effective in the National Institutes of Health’s landmark Diabetes Prevention Program (DPP), an intensive diet and exercise program that achieved a sustained 34% reduction in the incidence of diabetes at 10 years.

The problem, according to Sandra L. Jackson, is that the DPP and other successful research projects use patients who volunteer to participate and thus may be particularly highly motivated.

"We know little about the results that can be achieved in real-world health care settings, where participants are patients and their health care providers recommend a change in lifestyle," she noted in presenting the MOVE! results at the annual scientific sessions of the American Diabetes Association.

That was the impetus for her study of 3-year outcomes nationally in MOVE! The results were so impressive that MOVE! was named one of the five studies selected for an encore presentation at the ADA President’s Oral Session out of the more than 2,000 studies presented at the conference.

The MOVE! program consists of 8-12 weekly group sessions focused primarily on physical activity and nutrition. More than 400,000 veterans have participated in MOVE! since 2005. They signed up for one of two reasons: either they were obese, or they were overweight with a weight-related chronic health condition, such as osteoarthritis, coronary artery disease, diabetes, or sleep apnea. At their first MOVE! session, 38% of participants were known to have diabetes.

Ms. Jackson, a PhD candidate at Emory University, Atlanta, reported on the 135,686 MOVE! participants with 3-year follow-up data, comparing their outcomes with roughly 1.5 million VA patients who were MOVE! eligible but chose not to participate.

A total of 8.7% of participants were classified as intense and sustained in their involvement with the program based upon their having attended at least eight sessions within a 6-month period, with at least 129 days between the first and last session. Everyone else was categorized as "less involved."

Among the overall group of nearly 136,000 patients, mean body mass index dropped over the course of 3 years of follow-up from 36.3 kg/m² to 35.8 kg/m², representing a 1.3% loss in body weight. The intense and sustained participants lost an average of 2.5% of their initial body weight, compared with a 1% loss in the less-involved subjects.

The active participants typically experienced virtually all of their weight loss during the first 6 months, then maintained their new body weight for the next 2.5 years.

Overall, three-quarters of the intense and sustained participants lost any weight or maintained their baseline body weight over 3 years. In contrast, two-thirds of the less-active participants did so.

Diabetes risk moves down

In a multivariate analysis adjusted for baseline BMI, age, sex, and the use of medications that affect body weight, patients who lost any weight or remained weight stable over 3 years were 16% less likely to develop new-onset diabetes than those who gained weight.

The intense and sustained MOVE! participants were significantly more likely to experience a clinically meaningful weight loss of 5%. A total of 28% of them did so, compared with 16% of the less-active participants and 11% of MOVE!-eligible nonparticipants.

MOVE! enrollees with diabetes at baseline were more likely to become intense and sustained participants than those without baseline diabetes, by a margin of 9.6% to 7.8%. Overall, patients with diabetes also lost more weight: a mean of 1.7% body weight at 3 years, compared with a 0.9% drop in nondiabetic participants.

Among the 66,933 MOVE! participants without diabetes at baseline, the 3-year incidence of diabetes was 18.7%. A progressive relationship existed between weight change and diabetes incidence. At the extremes, participants who lost at least 10% of their initial body weight had a 3-year incidence of diabetes of 15%, while those with a 10% or greater weight gain had a 22% incidence of diabetes.

In a multivariate analysis, the intense and sustained participants in MOVE! had a 33% reduction in incident diabetes over 3 years, compared with the roughly 1.5 million VA patients who were MOVE! eligible but didn’t participate.

Ms. Jackson noted that a major limitation of the MOVE! program is that less than 10% of participants are actively involved. Those are the ones who reap the greatest benefits in terms of weight loss and reduced risk of diabetes.

"We need to learn how to encourage participation," she observed.

MOVE! to more health plans?

Ms. Jackson and her coinvestigators see MOVE! as well suited for adoption by other large national health care organizations.

MOVE! differs from the DPP in several key ways. It’s shorter, with 8-12 weekly group sessions largely devoted to nutrition and physical activity, compared with 16 sessions in DPP. The MOVE! classes can be taken in any order, while the DPP program requires sessions to be done in a specific sequence. MOVE! sessions can be run by exercise physiologists, nutritionists, diabetes educators, and other professionals; DPP uses a single coach.

Also, MOVE! is less structured than the DPP in that MOVE! emphasizes individualized, patient-determined goal setting developed through motivational interviewing techniques, while the DPP features fixed, generic goals.

For example, whereas the DPP set a target of 150 minutes of moderate exercise per week, MOVE! is more inclusive. It is open to veterans for whom that exercise goal may not be achievable.

Another important difference: Eligibility for MOVE! is based upon body weight, and many participants already have diabetes. In contrast, DPP participants had to be prediabetic, Ms. Jackson noted.

Future MOVE! analyses will explore the program’s impact upon participants’ health and resource utilization.

The originality of the MOVE! program is that it allows people with or without diabetes to participate, explained session chair Dr. Elbert S. Huang of the department of medicine at the University of Chicago. In contrast, most of the classic diabetes prevention studies had very narrow entry criteria. How is it possible, he asked, for such a wide range of patients in a given class to stay on the same page in terms of goal setting?

"As a practical matter," Ms. Jackson explained, "it’s much easier for the VA system to allow all comers who are obese or overweight with a weight-related health condition to participate. The goals are individualized. The program uses the principles of motivational interviewing to ask veterans, ‘How do you want to change your life?’ "

The Department of Veterans Affairs supported the study. Ms. Jackson reported having no conflicts of interest.

bjancin@frontlinemedcom.com

CHICAGO – A low-cost lifestyle intervention program designed for real-world application in obese and overweight patients achieved sustained weight loss and a reduced risk of developing diabetes in a large 3-year observational study.

The MOVE! program (Managing Overweight and/or Obesity in Veterans Everywhere) was launched in 2005 in 130 hospitals and clinics in the Department of Veterans Affairs (VA) system, the nation’s largest integrated health care system. MOVE! is based upon principles proven effective in the National Institutes of Health’s landmark Diabetes Prevention Program (DPP), an intensive diet and exercise program that achieved a sustained 34% reduction in the incidence of diabetes at 10 years.

The problem, according to Sandra L. Jackson, is that the DPP and other successful research projects use patients who volunteer to participate and thus may be particularly highly motivated.

"We know little about the results that can be achieved in real-world health care settings, where participants are patients and their health care providers recommend a change in lifestyle," she noted in presenting the MOVE! results at the annual scientific sessions of the American Diabetes Association.

That was the impetus for her study of 3-year outcomes nationally in MOVE! The results were so impressive that MOVE! was named one of the five studies selected for an encore presentation at the ADA President’s Oral Session out of the more than 2,000 studies presented at the conference.

The MOVE! program consists of 8-12 weekly group sessions focused primarily on physical activity and nutrition. More than 400,000 veterans have participated in MOVE! since 2005. They signed up for one of two reasons: either they were obese, or they were overweight with a weight-related chronic health condition, such as osteoarthritis, coronary artery disease, diabetes, or sleep apnea. At their first MOVE! session, 38% of participants were known to have diabetes.

Ms. Jackson, a PhD candidate at Emory University, Atlanta, reported on the 135,686 MOVE! participants with 3-year follow-up data, comparing their outcomes with roughly 1.5 million VA patients who were MOVE! eligible but chose not to participate.

A total of 8.7% of participants were classified as intense and sustained in their involvement with the program based upon their having attended at least eight sessions within a 6-month period, with at least 129 days between the first and last session. Everyone else was categorized as "less involved."

Among the overall group of nearly 136,000 patients, mean body mass index dropped over the course of 3 years of follow-up from 36.3 kg/m² to 35.8 kg/m², representing a 1.3% loss in body weight. The intense and sustained participants lost an average of 2.5% of their initial body weight, compared with a 1% loss in the less-involved subjects.

The active participants typically experienced virtually all of their weight loss during the first 6 months, then maintained their new body weight for the next 2.5 years.

Overall, three-quarters of the intense and sustained participants lost any weight or maintained their baseline body weight over 3 years. In contrast, two-thirds of the less-active participants did so.

Diabetes risk moves down

In a multivariate analysis adjusted for baseline BMI, age, sex, and the use of medications that affect body weight, patients who lost any weight or remained weight stable over 3 years were 16% less likely to develop new-onset diabetes than those who gained weight.

The intense and sustained MOVE! participants were significantly more likely to experience a clinically meaningful weight loss of 5%. A total of 28% of them did so, compared with 16% of the less-active participants and 11% of MOVE!-eligible nonparticipants.

MOVE! enrollees with diabetes at baseline were more likely to become intense and sustained participants than those without baseline diabetes, by a margin of 9.6% to 7.8%. Overall, patients with diabetes also lost more weight: a mean of 1.7% body weight at 3 years, compared with a 0.9% drop in nondiabetic participants.

Among the 66,933 MOVE! participants without diabetes at baseline, the 3-year incidence of diabetes was 18.7%. A progressive relationship existed between weight change and diabetes incidence. At the extremes, participants who lost at least 10% of their initial body weight had a 3-year incidence of diabetes of 15%, while those with a 10% or greater weight gain had a 22% incidence of diabetes.

In a multivariate analysis, the intense and sustained participants in MOVE! had a 33% reduction in incident diabetes over 3 years, compared with the roughly 1.5 million VA patients who were MOVE! eligible but didn’t participate.

Ms. Jackson noted that a major limitation of the MOVE! program is that less than 10% of participants are actively involved. Those are the ones who reap the greatest benefits in terms of weight loss and reduced risk of diabetes.

"We need to learn how to encourage participation," she observed.

MOVE! to more health plans?

Ms. Jackson and her coinvestigators see MOVE! as well suited for adoption by other large national health care organizations.

MOVE! differs from the DPP in several key ways. It’s shorter, with 8-12 weekly group sessions largely devoted to nutrition and physical activity, compared with 16 sessions in DPP. The MOVE! classes can be taken in any order, while the DPP program requires sessions to be done in a specific sequence. MOVE! sessions can be run by exercise physiologists, nutritionists, diabetes educators, and other professionals; DPP uses a single coach.

Also, MOVE! is less structured than the DPP in that MOVE! emphasizes individualized, patient-determined goal setting developed through motivational interviewing techniques, while the DPP features fixed, generic goals.

For example, whereas the DPP set a target of 150 minutes of moderate exercise per week, MOVE! is more inclusive. It is open to veterans for whom that exercise goal may not be achievable.

Another important difference: Eligibility for MOVE! is based upon body weight, and many participants already have diabetes. In contrast, DPP participants had to be prediabetic, Ms. Jackson noted.

Future MOVE! analyses will explore the program’s impact upon participants’ health and resource utilization.

The originality of the MOVE! program is that it allows people with or without diabetes to participate, explained session chair Dr. Elbert S. Huang of the department of medicine at the University of Chicago. In contrast, most of the classic diabetes prevention studies had very narrow entry criteria. How is it possible, he asked, for such a wide range of patients in a given class to stay on the same page in terms of goal setting?

"As a practical matter," Ms. Jackson explained, "it’s much easier for the VA system to allow all comers who are obese or overweight with a weight-related health condition to participate. The goals are individualized. The program uses the principles of motivational interviewing to ask veterans, ‘How do you want to change your life?’ "

The Department of Veterans Affairs supported the study. Ms. Jackson reported having no conflicts of interest.

bjancin@frontlinemedcom.com

CHICAGO – A low-cost lifestyle intervention program designed for real-world application in obese and overweight patients achieved sustained weight loss and a reduced risk of developing diabetes in a large 3-year observational study.

The MOVE! program (Managing Overweight and/or Obesity in Veterans Everywhere) was launched in 2005 in 130 hospitals and clinics in the Department of Veterans Affairs (VA) system, the nation’s largest integrated health care system. MOVE! is based upon principles proven effective in the National Institutes of Health’s landmark Diabetes Prevention Program (DPP), an intensive diet and exercise program that achieved a sustained 34% reduction in the incidence of diabetes at 10 years.

The problem, according to Sandra L. Jackson, is that the DPP and other successful research projects use patients who volunteer to participate and thus may be particularly highly motivated.

"We know little about the results that can be achieved in real-world health care settings, where participants are patients and their health care providers recommend a change in lifestyle," she noted in presenting the MOVE! results at the annual scientific sessions of the American Diabetes Association.

That was the impetus for her study of 3-year outcomes nationally in MOVE! The results were so impressive that MOVE! was named one of the five studies selected for an encore presentation at the ADA President’s Oral Session out of the more than 2,000 studies presented at the conference.

The MOVE! program consists of 8-12 weekly group sessions focused primarily on physical activity and nutrition. More than 400,000 veterans have participated in MOVE! since 2005. They signed up for one of two reasons: either they were obese, or they were overweight with a weight-related chronic health condition, such as osteoarthritis, coronary artery disease, diabetes, or sleep apnea. At their first MOVE! session, 38% of participants were known to have diabetes.

Ms. Jackson, a PhD candidate at Emory University, Atlanta, reported on the 135,686 MOVE! participants with 3-year follow-up data, comparing their outcomes with roughly 1.5 million VA patients who were MOVE! eligible but chose not to participate.

A total of 8.7% of participants were classified as intense and sustained in their involvement with the program based upon their having attended at least eight sessions within a 6-month period, with at least 129 days between the first and last session. Everyone else was categorized as "less involved."

Among the overall group of nearly 136,000 patients, mean body mass index dropped over the course of 3 years of follow-up from 36.3 kg/m² to 35.8 kg/m², representing a 1.3% loss in body weight. The intense and sustained participants lost an average of 2.5% of their initial body weight, compared with a 1% loss in the less-involved subjects.

The active participants typically experienced virtually all of their weight loss during the first 6 months, then maintained their new body weight for the next 2.5 years.

Overall, three-quarters of the intense and sustained participants lost any weight or maintained their baseline body weight over 3 years. In contrast, two-thirds of the less-active participants did so.

Diabetes risk moves down

In a multivariate analysis adjusted for baseline BMI, age, sex, and the use of medications that affect body weight, patients who lost any weight or remained weight stable over 3 years were 16% less likely to develop new-onset diabetes than those who gained weight.

The intense and sustained MOVE! participants were significantly more likely to experience a clinically meaningful weight loss of 5%. A total of 28% of them did so, compared with 16% of the less-active participants and 11% of MOVE!-eligible nonparticipants.

MOVE! enrollees with diabetes at baseline were more likely to become intense and sustained participants than those without baseline diabetes, by a margin of 9.6% to 7.8%. Overall, patients with diabetes also lost more weight: a mean of 1.7% body weight at 3 years, compared with a 0.9% drop in nondiabetic participants.

Among the 66,933 MOVE! participants without diabetes at baseline, the 3-year incidence of diabetes was 18.7%. A progressive relationship existed between weight change and diabetes incidence. At the extremes, participants who lost at least 10% of their initial body weight had a 3-year incidence of diabetes of 15%, while those with a 10% or greater weight gain had a 22% incidence of diabetes.

In a multivariate analysis, the intense and sustained participants in MOVE! had a 33% reduction in incident diabetes over 3 years, compared with the roughly 1.5 million VA patients who were MOVE! eligible but didn’t participate.

Ms. Jackson noted that a major limitation of the MOVE! program is that less than 10% of participants are actively involved. Those are the ones who reap the greatest benefits in terms of weight loss and reduced risk of diabetes.

"We need to learn how to encourage participation," she observed.

MOVE! to more health plans?

Ms. Jackson and her coinvestigators see MOVE! as well suited for adoption by other large national health care organizations.

MOVE! differs from the DPP in several key ways. It’s shorter, with 8-12 weekly group sessions largely devoted to nutrition and physical activity, compared with 16 sessions in DPP. The MOVE! classes can be taken in any order, while the DPP program requires sessions to be done in a specific sequence. MOVE! sessions can be run by exercise physiologists, nutritionists, diabetes educators, and other professionals; DPP uses a single coach.

Also, MOVE! is less structured than the DPP in that MOVE! emphasizes individualized, patient-determined goal setting developed through motivational interviewing techniques, while the DPP features fixed, generic goals.

For example, whereas the DPP set a target of 150 minutes of moderate exercise per week, MOVE! is more inclusive. It is open to veterans for whom that exercise goal may not be achievable.

Another important difference: Eligibility for MOVE! is based upon body weight, and many participants already have diabetes. In contrast, DPP participants had to be prediabetic, Ms. Jackson noted.

Future MOVE! analyses will explore the program’s impact upon participants’ health and resource utilization.

The originality of the MOVE! program is that it allows people with or without diabetes to participate, explained session chair Dr. Elbert S. Huang of the department of medicine at the University of Chicago. In contrast, most of the classic diabetes prevention studies had very narrow entry criteria. How is it possible, he asked, for such a wide range of patients in a given class to stay on the same page in terms of goal setting?

"As a practical matter," Ms. Jackson explained, "it’s much easier for the VA system to allow all comers who are obese or overweight with a weight-related health condition to participate. The goals are individualized. The program uses the principles of motivational interviewing to ask veterans, ‘How do you want to change your life?’ "

The Department of Veterans Affairs supported the study. Ms. Jackson reported having no conflicts of interest.

bjancin@frontlinemedcom.com