variables (ie, management; whether
VHA or non-VHA as primary provider) were not parameters of this
study. Some factors are traceable,
while others would be data mining
/extended-facility prohibitive. The
aforementioned limiting factors
lend potential bias to current study
biologic measures and findings. The
study is presented acknowledging
the above limitation and potential
bias—including those unknown.
For clinicians and their patients, current study findings indicate there is
clinical relevance for MOVE! and
similar weight management prevention programs as Effective
practice interventions Maintained over
time. Continued MOVE! participation should be encouraged to support long-term outcomes as noted
by the leveling off of improvement in
BMI trends and effects on comorbid
disease measures by 1 year for the
MOVE! intervention group. Future
strategies to increase participation
(Reach) need further development.
Of the 1,574 veterans referred to
MOVE! during the study time frame,
14.6% attended 2 or more sessions,
while 65.3% declined participation.
Additionally, since long-term results
with lifestyle interventions require
compliance, strategies to increase
and consistently track participation
levels need further attention.
Current VA initiatives addressing
these issues include the TeleMed outreach MOVE! 101 sessions, which
were initialized late during the study
but are expected to expand to MOVE!
2 sessions. A future MOVE! initiative
proposal includes 8 patient contacts
in 4 months, with a goal of measuring
intensity of participation.
There is also relevance for fur-
ther weight management prac-
tice translated Effectiveness studies.
While equivalent standard primary
care treatment is assumed for both
groups, a specific effect question for
medical management changes in
disease control (HTN, lipids, and
diabetes), including pharmaceutical
intervention, degree of patient compliance, and level of disease burden,
surfaced during the study with the
unexpected finding of decreased
DBP observed in the control group.
Further study on BMI and obesity
comorbid disease biologic measure
trends compared with trends in medical management, including medication changes (addition/increase or
decrease/discontinuation, etc), patient compliance, and degree of disease burden, are indicated. Trends in
specific weight management intervention participation levels (activity
dietary changes) as well as sociode-mographic effects are also relevant.
Insight into these possible effect
associations is indicated to gain a
clearer understanding of the effect
MOVE!, and similar practice intervention prevention programs contribute.
As outlined in Healthy People 2020,
more modest obesity objectives were
proposed compared with the prior
objectives. 3, 5 Perhaps a trend in the
right direction is the most realistic
and attainable outcome with a pop-
ulation goal that eventually results
in normalization of weight—par-
ticularly given that the current obe-
sity issue did not occur overnight.
Glasgow and colleagues (RE-AIM)
previously noted that although they
have lower Efficacy, interventions
that are lower in cost and intensity
and can be applied to larger popula-
tions for longer periods of time are
more likely to have the most real-
world impact Effectiveness. 16 In prac-
ticality, these type of interventions
are more likely to be implemented
broadly with greater numbers of pa-
tients participating both short- and
long-term. As found in prior evi-
dence-based RCTs, the current study
findings indicate there is clinical rele-
vance for MOVE! and similar weight
management programs for use as
real-world practice interventions. 10-15
This material is based on work sup-
ported in part by the Department of
Veterans Affairs, Veterans Health Ad-
ministration and Office of Research
and Development. This project is the
result of work supported with resources
and the use of facilities at the Robert J.
Dole VAMC in Wichita, Kansas.
The authors report no actual or poten-
tial conflicts of interest with regard to
The opinions expressed herein are those
of the authors and do not necessarily
reflect those of Federal Practitioner,
Quadrant HealthCom Inc., a division
of Frontline Medical Communications,
Inc., the U.S. Government, or any of its
agencies. This article may discuss un-
labeled or investigational use of certain
drugs. Please review complete prescrib-
ing information for specific drugs or
drug combinations—including indica-
tions, contraindications, warnings, and
adverse effects—before administering
pharmacologic therapy to patients.
1. Vital signs: State specific obesity prevalence among
adults—United States, 2009. Centers for Disease
Control and Prevention Website. http://www.cdc
.htm. Updated August 3, 2010. Accessed April 25,
2. Wang Y, Beydoun MA, Liang L, Caballero B,
Kumanyika SK. Will all Americans become overweight or obese? Estimating the progression and
cost of the U.S. obesity epidemic. Obesity (Silver
Spring). 2008; 16( 10):2323-2330.
3. U.S. Department of Health & Human Services.