DVD Lifestyle Intervention (D-ELITE)

通过VHA接受护理的美国退伍军人中有三分之一以上肥胖，这使他们面临更高的风险。 多种严重的慢性健康状况，包括糖尿病、心血管疾病、高血压和 中风即使是少量的减肥也可以降低与这些疾病相关的风险。生活方式 修改是减肥治疗的基石。虽然有效的生活方式干预肥胖 存在，找到可扩展的，具有成本效益的循证计划，并为多样化的VA人群提供服务， 国家健康促进和疾病预防中心（NCP）的优先事项。作为回应，VA 传播MOVE！退伍军人体重管理计划（MOVE！）2006年， 将饮食和体育活动咨询与行为改变相结合的循证干预 战略布局动起来！对于那些积极参与该计划的人来说， 超过5%的退伍军人有资格参加该计划，其中，很少有人参加的水平， 导致有意义的体重减轻。为了解决肥胖对退伍军人和老年人造成的日益沉重的负担， 卫生保健系统，弗吉尼亚州现在面临的挑战，以改善获得全面的生活方式干预 使用以患者为中心和基于人群的方法。我们的目标是通过提供证据来填补这一空白， 一项为期12个月的基于实用DVD的自我导向生活方式干预的有效性， 临床上有意义的体重减轻和增加的体力活动在肥胖的退伍军人。课程， 旨在通过饮食质量和身体活动的渐进健康变化来逐渐减轻体重， 行为技能培训，是基于糖尿病预防计划（DPP）的群体生活方式平衡 (GLB)12集DVD该计划鼓励通过补充目标设定和自我监控， Heart 360网站和可选的远程生活方式指导。我们建议利用退伍军人事务部的企业数据 仓库，以确定和登记500肥胖退伍军人。我们将随机分配参与者接受常规护理或 生活方式干预。作为主要结果，我们将测试与常规护理对照相比， 干预参与者在12个月的减肥随访中有更好的结果， 物理功能。24个月的次要结局包括持续体重减轻、身体功能， 身体活动、久坐行为、饮食质量、血压、睡眠质量、自我效能和计划范围。 与国家联络点的传播工作包括开发工具包和预算影响分析。我们假设 干预参与者将有更多的体重减轻和改善身体功能，以及 改善体力活动、久坐行为、饮食质量、血压、睡眠质量和自我 功效

More than a third of US Veterans who receive care through the VHA are obese, putting them at higher risk for multiple serious chronic health conditions including diabetes, cardiovascular disease, hypertension, and stroke. Losing even small amounts of weight can reduce the risks associated with those conditions. Lifestyle modification is the cornerstone of weight loss treatment. While efficacious lifestyle interventions for obesity exist, finding evidence-based programs that are scalable, cost-efficient, and serves a diverse VA population is a priority for the National Center for Health Promotion and Disease Prevention (NCP). In response, VA disseminated MOVE! Weight Management Program for Veterans (MOVE!) in 2006, a comprehensive, evidenced-based intervention that combines diet and physical activity counseling with behavior change strategies. MOVE! results in meaningful weight loss for those who actively engage in the program, but less than 5% of Veterans eligible for the program participate, and among those, few participate at a level that would result in meaningful weight loss. To address the growing burden that obesity places on Veterans and the health care system, VA now faces the challenge to improve access to comprehensive lifestyle interventions using a patient-centered and population-based approach. We aim to fill this gap by producing evidence on the effectiveness of a proven 12-month pragmatic DVD-based self-directed lifestyle intervention targeting modest, clinically meaningful weight loss and increased physical activity among obese Veterans. The curriculum, aimed at gradual weight loss through progressive healthful changes in diet quality and physical activity and behavioral skills training, is grounded in the Diabetes Prevention Program's (DPP) Group Lifestyle Balance (GLB) 12-session DVD. The program encourages supplementary goal setting and self-monitoring via the Heart360 website, and optional remote lifestyle coaching. We propose to leverage the VA's Corporate Data Warehouse to identify and enroll 500 obese Veterans. We will randomize participants to receive usual care or the lifestyle intervention. As primary outcomes, we will test whether, compared with usual care controls, intervention participants have better outcomes through 12 months of follow-up on weight loss and self-reported physical function. Secondary outcomes through 24 months include sustained weight loss, physical function, physical activity, sedentary behavior, diet quality, blood pressure, sleep quality, self-efficacy, and program reach. Dissemination work with NCP includes development of toolkits and budget impact analyses. We hypothesize that intervention participants will have more weight loss and improved physical function, as well as improvements in physical activity, sedentary behavior, diet quality, blood pressure, sleep quality, and self- efficacy.