Teaching Obesity Treatment Options to Adult Learners (TOTAL): A Multi-site RCT

背景：近80%的退伍军人符合超重标准(体重指数[BMI]为25-29.9公斤/平方米)或 肥胖(体重指数≥30)。退伍军人管理局提供了三种基于证据的肥胖治疗方法，对退伍军人来说几乎没有成本：动起来！(至 通过行为改变改善饮食摄入量和体力活动)；肥胖药物；和减肥 手术，但都严重未得到充分利用：10%的肥胖症退伍军人参与Move！；2% 肥胖药物；在符合体重指数减肥手术标准(体重指数≥35)的人中，有0.3%的人接受了肥胖治疗。那里 迫切需要增加所有这三种疗法的使用，以改善退伍军人的健康。 意义/影响：近400万退伍军人符合BMI超重/肥胖标准。至关重要的是 患有超重/肥胖的退伍军人知道这三种治疗方案，并有动力去追求它们。 目前，VA中没有任何干预措施寻求增加所有三种基于证据的肥胖治疗方案的使用 目前没有参与搬家的退伍军人！全面干预(讲授肥胖治疗方案 成人学习者)，如果有效，将增加退伍军人的肥胖症治疗起点，导致更大的体重减轻， 并提高生活质量。鉴于可以通过退伍军人管理局远程医疗交付总金额，该计划可以实施 在整个退伍军人管理局医疗系统中不需要大量资源，并且可以集成到 现有的退伍军人行为体重管理计划，Move！ 创新：这项提案中的研究将是第一个在VA测试和 干预以增加所有三种循证肥胖治疗的使用：Move！、肥胖药物和 减肥手术。它将利用退伍军人管理局电子健康记录的力量，并将改善获得 通过扩大使用最近开发的远程医疗技术-VA Video Connect(VVC)进行护理-这是 由退伍军人管理局的研究人员开发。鉴于这一举措，它可以在退伍军人管理局内有效地实施和传播！ 在每个VAMC上都可用，并受NCP支持。 具体目标：目标1：比较全面护理与常规护理对增加肥胖治疗的有效性 在没有参与搬家的超重/肥胖退伍军人中启动！；目标2：比较 增加持续移动的总体护理与常规护理的有效性！参与、接受肥胖 药物处方或减肥手术转介，以及减肥；目标3：告知未来的传播努力 通过与关键利益相关者的访谈、“REACH”分析和成本分析，对总成本进行评估。 研究方法：研究人群：两家VAMC的退伍军人，年龄18-75岁，体重指数≥30或27-29.9+肥胖- 相关的合并症谁还没动呢！在过去12个月内访问，因此不参与 肥胖治疗将参加随机对照试验；干预：总干预由18分钟组成 肥胖治疗教育视频和三次激励会议(均通过VA Video Connect[VVC]提供)； 对比：平时照看(退伍军人没动过！过去12个月的访问)；结果： 移动!启动，持续移动！参与、减肥药使用、减肥手术转诊、体重 变化；时机：主要和次要结果将在随机化18个月后进行评估。 执行/下一步：目标3将评估全面执行的促进者和障碍 使用以下整合框架与资深人士、提供商和运营利益相关者进行访谈 实施研究(CFIR)。[我们还将执行“REACH”和成本分析。我们将与NCP合作 向所有有行动的VAMC传播TOTAL！程序。举国上下行动！导演将出席 全国行动上的学习成绩！致电并在全国行动中提供演示材料！ SharePoint传播站点。举国上下行动！导演会支持搬家的！直接工作的协调员 与每个VAMC的健康行为协调员一起行动！研究小组将考虑与NCP合作 进行QUERI全国合作评估，评估道达尔如何在退伍军人管理局实施。

Background: Nearly 80% of Veterans meet criteria for overweight (body mass index [BMI] of 25-29.9 kg/m2) or obesity (BMI≥30). VA offers three evidence-based obesity treatments at little to no cost to Veterans: MOVE! (to improve dietary intake and physical activity through behavioral modification); obesity medications; and bariatric surgery, but all are significantly underutilized: <10% of Veterans with obesity participate in MOVE!; 2% receive obesity medications; and 0.3% of those who meet BMI criteria for bariatric surgery (BMI≥35) undergo it. There is an urgent need to increase use of all three treatments to improve Veteran health. Significance/Impact: Nearly 4,000,000 Veterans meet BMI criteria for overweight/obesity. It is essential that Veterans with overweight/obesity are aware of the three treatment options and are motivated to pursue them. Currently, no interventions in VA seek to increase use of all three evidence-based obesity treatment options for Veterans not currently participating in MOVE!. The TOTAL intervention (Teaching Obesity Treatment Options to Adults Learners), if effective, would increase obesity treatment initiation for Veterans, lead to greater weight loss, and improve quality of life. Given that TOTAL is deliverable via VA telemedicine, it could be implemented throughout the VA healthcare system without requiring significant resources and could be integrated into the existing VA behavioral weight management program, MOVE!. Innovation: The research in this proposal would be the first adequately powered RCT in VA testing an intervention to increase use of all three evidence-based obesity treatments: MOVE!, obesity medications, and bariatric surgery. It would leverage the power of the VA electronic health record and would improve access to care by expanding use of a recently developed telemedicine technology – VA Video Connect (VVC) – which was developed by VA researchers. It could be implemented and disseminated efficiently within VA given that MOVE! is available at every VAMC and is supported by NCP. Specific Aims: Aim 1: Compare the effectiveness of TOTAL vs. usual care for increasing obesity treatment initiation among Veterans with overweight/obesity who are not participating in MOVE!; Aim 2: Compare the effectiveness of TOTAL vs. usual care for increasing sustained MOVE! participation, receipt of an obesity medication prescription or bariatric surgery referral, and weight loss; Aim 3: Inform future dissemination efforts of TOTAL via interviews with key stakeholders, a “Reach” analysis, and cost analysis. Methodology: Study population: Veterans at two VAMCs, age 18-75 with a BMI ≥30 or 27-29.9 + an obesity- related comorbidity who have not had a MOVE! visit within the past 12 months and thus are not participating in obesity treatment will participate in the RCT; Intervention: The TOTAL intervention consists of an 18-minute obesity treatment educational video and three motivational sessions (all delivered via VA Video Connect [VVC]); Comparison: Usual care (Veterans who have not had a MOVE! visit in the previous 12 months); Outcomes: MOVE! initiation, sustained MOVE! participation, obesity medication use, bariatric surgery referral, weight change; Timing: Primary and secondary outcomes will be measured 18 months post-randomization. Implementation/Next Steps: Facilitators and barriers to TOTAL implementation will be assessed in Aim 3 interviews with Veteran, provider, and operations stakeholders using the Consolidated Framework for Implementation Research (CFIR). [We will also perform “reach” and cost analyses. We will collaborate with NCP to disseminate TOTAL to all VAMCs that have a MOVE! program. The National MOVE! Director will present study results on a national MOVE! call and make presentation materials available on the national MOVE! SharePoint dissemination site. The National MOVE! Director will support MOVE! coordinators who work directly with health behavior coordinators at every VAMC with MOVE!. The study team will consider partnering with NCP to conduct a QUERI National Partnered Evaluation evaluating how TOTAL can be implemented throughout VA.