Analysis of a Veterans Affairs Lifestyle Change Program

Chicago—An analysis of a large lifestyle change program in patients with type 2 diabetes found that diet and exercise modification can help patients, although <10% of participants were actively involved in the program.

Sandra L. Jackson, MPH, the study’s lead author, presented the results at the ADA meeting in an oral abstract session. The US Department of Veterans Affairs (VA) and Amylin Pharmaceuticals, LLC supported the trial.

Ms. Jackson noted that previous lifestyle change programs such as the National Institutes of Health’s Diabetes Prevention Program (DPP) have shown they can decrease the incidence of type 2 diabetes. In the DPP trial consisting of intensive diet and exercise, there was a 58% reduction in diabetes incidence by the study’s end, and 34% of participants had their decrease sustained for 10 years. However, individuals in the DPP and other research studies volunteered to take part, which Ms. Jackson said may have led to better results and more motivated participants.

In this study, the authors were interested in evaluating a healthcare setting in which providers recommended a change in lifestyle to patients. In 2005, the VA began the MOVE (Managing Overweight and/or Obesity for Veterans Everywhere) program and modeled it after the DPP, according to Ms. Jackson, who added that the VA is the largest integrated health system in the United States. Since 2005, >400,000 people have participated in MOVE.

The MOVE program includes people who are obese or overweight with a weight-related condition, but patients do not have to have diabetes to enroll. It consists of 8 to 12 sessions, uses continuous, rolling admission, involves multiple nutritionists and social workers, and features individualized, patient-determined goals.

In this analysis, the authors examined data from 402,693 MOVE participants and compared them with 2.5 eligible nonparticipants who were between 18 and 75 years of age and had a body mass index (BMI) of at least 30 kg/m² or a BMI of at least 25 kg/m² with a weight-related condition such as diabetes, coronary artery disease, hypertension, osteoarthritis, or sleep apnea. At the first visit, participants in the MOVE program had a mean age of 57 years, 88% were male, and 67% were white.

After 3 years of follow-up, the authors were able to gather data from 135,686 participants in the MOVE program. During that time period, mean BMI decreased from 36.3 kg/m² to 35.8 kg/m², a reduction of 1.3%.

Overall, approximately three quarters of active participants lost or maintained their weight after 3 years compared with two thirds of less active participants. Of the participants, 8.7% participated actively, which the VA defined as attending at least 8 sessions in 6 months with at least 129 days between the first and last sessions. The mean weight loss among active participants was 2.7% compared with 1.1% for participants who were not active (P<.001). In the DPP program, which was more intense, participants had a mean weight loss of 4% at 3 years, according to Ms. Jackson.

Of the participants, 38% had diabetes at their first visit. People with diabetes were more likely to participate actively in the program compared with those without diabetes (9.6% vs 7.8%; P<.01). Participants with diabetes also lost more weight compared with those without diabetes (1.7% vs 0.9%; P<.01).

Of the patients who did not have diabetes at baseline and who had available 3-year data, 18.7% developed diabetes. The risk ratio for 3-year incident diabetes was 0.84 when comparing participants who lost or maintained weight with those who gained weight (P<.001). The risk ratio was adjusted for baseline BMI, age, and gender, according to Ms. Jackson.