MOVE OUT: A Partnership with Veterans Groups to Enhance Weight Management in VHA

搬出：与退伍军人团体合作，加强 VHA 的体重管理

• 批准号: 8201481
• 负责人: JEFFREY C. WHITTLE
• 金额: --
• 依托单位: CLEMENT J. ZABLOCKI VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-01 至 2015-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8201481
• 关键词: Address; Attitude; Blood Pressure; Body Weight decreased; Cardiac; Cardiovascular system; Cholesterol; Chronic Disease; Clinical Trials Design; Collaborations; Commit; Communities; Consensus; Data; Degenerative polyarthritis; Diabetes Mellitus; Diet; Education; Effectiveness; Elements; Evaluation; Exercise; General Population; Goals; Health Professional; Home environment; Hypertension; Intake; Intervention; Learning; Link; Lipids; Location; Malignant Neoplasms; Measures; Medical; Medical center; Metabolic syndrome; Methods; Modeling; Moderate Exercise; Monitor; Obesity; Outcome; Overweight; Participant; Patients; Physical activity; Physiological; Prevalence; Primary Health Care; Process; Qualitative Methods; Questionnaires; Randomized; Recruitment Activity; Reporting; Research; Risk; Sampling; Schedule; Services; Severities; Support Groups; Testing; Time; United States; United States National Institutes of Health; Veterans; Walking; Weight; Weight maintenance regimen; Work; base; behavior change; cardiovascular risk factor; clinically significant; design; diet and exercise; effective therapy; evidence base; fruits and vegetables; group intervention; health belief; high risk; improved; innovation; mortality; peer; programs; randomized trial; response; success; symposium

DESCRIPTION (provided by applicant): Background: Obesity increases the prevalence and severity of cardiovascular risk factors such as hypertension, diabetes, and metabolic syndrome. It is also a leading contributor to cancer and osteoarthritis. Obesity and overweight are highly prevalent among VA patients: As with the general population, over two-thirds of VA users are either overweight or obese. There is good evidence that intensive weight reduction programs can have a modest-but clinically significant-impact on weight. VHA has developed a comprehensive weight management program known as MOVE! to address obesity among its patients. MOVE! evaluations to date have demonstrated success in helping veterans lose weight, but participation is low. In our preliminary work, we found that the timing (daytime) and location (Zablocki VAMC) of MOVE! activities were viewed by eligible patients as barriers to participation. In addition, previous research has often demonstrated significant rebound in weight at the end of formal program activities, which may be mitigated if there is a convenient place for ongoing weight monitoring and healthy activities with peers. Objectives: The overall goal of the project is to increase participation in the ZVAMC MOVE! program by implementing an innovative community-based program known as MOVE OUT. MOVE OUT will incorporate the key elements of the proven MOVE! program (education, peer support, and planned physical activity), but in settings closer to the homes of eligible Zablocki patients. We have the following objectives: 1) To reduce the mean weight of high-risk overweight or obese veterans who receive primary care at ZVAMC. 2) To improve the physical activity and diet of high-risk overweight or obese veterans who receive primary care at ZVAMC. 3) To demonstrate that an innovative community-based program can increase the proportion of ZVAMC users who participate actively in a moderately intensive weight management program as recommended by the NIH Consensus Conference on Obesity. Methods: We will use a cluster randomized trial design. We will allocate groups of eligible veterans from ZVAMC to either a MOVE OUT invitation or a standard MOVE! invitation. We will use clinically gathered weight data to determine overall rates of weight loss in the randomly assigned veterans. In addition, we will recruit a sample of veterans from each randomized group to participate in a study of the effectiveness of the weight management program to which they are assigned. We will use established methods to assess changes in diet, exercise and attitude, as well as physiologic outcomes including weight, blood pressure, HgbA1c, and lipid values. We will use qualitative methods to learn what aspects of the two programs are most effective. Impact: We will demonstrate that VHA can deliver effective weight management services in a community-based fashion. If this study finds that such a delivery approach leads to an increased number of at-risk veterans participating in weight control programs, it will guide program design throughout VHA. Although weight management is particularly well suited to a disseminated delivery model, lessons learned from this research are likely to help VHA improve its ability to help patients self-manage a variety of chronic diseases.

描述（由申请人提供）： 背景：肥胖增加了心血管危险因素如高血压、糖尿病和代谢综合征的患病率和严重程度。它也是癌症和骨关节炎的主要贡献者。肥胖和超重在VA患者中非常普遍：与一般人群一样，超过三分之二的VA使用者超重或肥胖。有充分的证据表明，强化减肥计划可以对体重产生适度但具有临床意义的影响。VHA开发了一个全面的体重管理计划称为移动！以解决患者的肥胖问题。动起来！迄今为止的评估表明，在帮助退伍军人减肥方面取得了成功，但参与率很低。在我们的初步工作中，我们发现MOVE！符合条件的患者将活动视为参与的障碍。此外，以前的研究经常表明，在正式的计划活动结束时，体重会显著反弹，如果有一个方便的地方进行持续的体重监测和与同龄人一起进行健康活动，体重反弹可能会减轻。目标：该项目的总体目标是增加参与ZVAMC MOVE！通过实施一项名为MOVE OUT的创新社区计划，MOVE OUT将包含经过验证的MOVE的关键要素！计划（教育，同伴支持和有计划的身体活动），但在更接近符合条件的Zablocki患者的家中。我们有以下目标：1）降低在ZVAMC接受初级保健的高危超重或肥胖退伍军人的平均体重。 2)改善在ZVAMC接受初级保健的高危超重或肥胖退伍军人的身体活动和饮食。 3)证明一个创新的基于社区的计划可以增加积极参与NIH肥胖共识会议推荐的中等强度体重管理计划的ZVAMC用户的比例。方法：我们将采用整群随机试验设计。我们将从ZVAMC分配合格的退伍军人团体，要么迁出邀请或标准的移动！邀请.我们将使用临床收集的体重数据来确定随机分配的退伍军人的总体体重减轻率。此外，我们将从每个随机分组中招募一名退伍军人样本，参加他们被分配的体重管理计划的有效性研究。我们将使用已建立的方法来评估饮食，运动和态度的变化，以及生理结果，包括体重，血压，HbA 1c和血脂值。我们将使用定性的方法来了解这两个方案的哪些方面是最有效的。影响：我们将证明VHA可以以社区为基础的方式提供有效的体重管理服务。如果这项研究发现，这种交付方法导致更多的风险退伍军人参与体重控制计划，它将指导整个VHA的计划设计。虽然体重管理特别适合于分散的交付模式，但从这项研究中吸取的经验教训可能有助于VHA提高其帮助患者自我管理各种慢性疾病的能力。