Improving weight management at the VA: Enhancing the MOVE!23 for primary care

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DESCRIPTION (provided by applicant): Project Summary In this application for a Mentored Career Development Award (CDA-2), Melanie Jay, MD, MS describes her plan to pursue training and research to achieve her long-term goal of becoming an independent, clinically- oriented, translational investigator dedicated to improving the treatment and prevention of obesity at the Veterans Health Administration (VHA). Her specific and training aims address the hypothesis that a brief, computer-assisted intervention to treat obesity in primary care will be feasible and acceptable to patients and providers and result in improvements in intermediate (i.e. patient self-efficacy, intention, and motivation to change lifestyle behaviors), behavioral (diet and physical activity improvements), and weight-loss outcomes. Under the sponsorship of Scott Sherman, MD, MPH, the training plan capitalizes on the resources of the VA New York Harbor Healthcare System (HCS), New York University, and the NIH-sponsored New York Obesity Nutrition Research Center, combining formal coursework, directed readings, and experiential components. The plan involves mentorship and didactic instruction in key areas including qualitative methodology, behavior change theories, implementation science, clinical trial design and implementation, obesity innovations, digital media design, advanced statistical analysis, grant writing, and research dissemination. Dr. Jay proposes a three-phased project to enhance the VA MOVE!23 software application so that it can be used as part of a goal- setting intervention to treat obesit in primary care. She will then evaluate this intervention so that it can be adopted to serve the broader primary care Veteran population. During the Formative Phase, she will use qualitative methodologies to inform enhancement of the MOVE!23 software and development of the intervention. During the Development Phase, she will enhance the MOVE!23 software application and develop and pilot-test other components of the intervention. She will then apply for a Clinical Translational Science Institution (CTSI) and/or foundation grant to help support the Evaluation Phase of her project. During the Evaluation Phase, she will conduct a pilot study at the VA New York Harbor HCS primary care clinics to test the feasibility, acceptability, and explore preliminary outcomes of this intervention. She will also explore differences in feasibility and outcomes when telephone counseling is added to the intervention. She will recruit 140 subjects. All subjects will receive the enhanced MOVE!23 and Patient Aligned Care Team (PACT) counseling. They will then be randomized into two intervention arms: PACT counseling only or PACT counseling plus additional telephone counseling support. She will explore differences in feasibility, acceptability, and intermediate, behavioral, and weight loss outcomes at 6 and 12 months pre- and post- within each arm and comparing the two intervention arms. This research and training plan will generate pilot data for the development of a Merit Review application to conduct a 3-arm randomized controlled trial of the intervention. PUBLIC HEALTH RELEVANCE: Project Narrative The high prevalence of obesity and its negative impact on Veteran health make treating and preventing obesity a high priority of the Veteran Health Administration since modest weight loss can prevent and ameliorate chronic disease. Unfortunately, innovative VA obesity treatment programs such as MOVE! do not reach the majority of eligible Veterans. Primary care is an important venue to provide obesity-related services and increase access to obesity care, but, few effective interventions exist that can be delivered in this setting. Dr. Jay proposes to use qualitatitve methods to enhance existing MOVE!23 software for use as part of a brief, computer-assisted primary care-based intervention to treat obesity and improve Veteran Health. She will then do a pilot study to evaluate preliminary outcomes.