Coaching Veterans to Healthy Weights and Wellness (ASPIRE)

• Change in weight [ Time Frame: 12 months after enrollment ] [ Designated as safety issue: No ]
  

• Behavioral antecedents of functional exercise capacity and diet [ Time Frame: 12 months after enrollment ] [ Designated as safety issue: No ]
  
• Endpoint outcomes of health related quality of life and cardiovascular risk factors [ Time Frame: 12 months after enrollment ] [ Designated as safety issue: No ]
  
• Cost analysis [ Time Frame: 12 months after enrollment ] [ Designated as safety issue: No ]
  
• Describe and test changes for the Outcomes 1-3 [ Time Frame: 18 and 24 months after enrollment ] [ Designated as safety issue: No ]
  

Background and Rationale:

Over 70% of veterans are overweight or obese, imposing a tremendous burden on the VHA healthcare system due to increased need for treatment of obesity-related chronic disease and disability. The MOVE! 5-level Weight Management Program for Veterans has been promoted in VHA to address this problem. Data suggest that engagement in ongoing treatment is low, clinically significant weight loss is not being achieved by many patients, and weight regain is likely. Although the MOVE! program description includes phone-based self-management support, most facilities have focused resources on developing facility-based group programs.

Project Objective:

To fill the gap in phone-based self-management support and to increase the number of patients who achieve a clinically significant amount of weight loss, we will examine the impact of an innovative approach to weight loss ("Aspiring to Lifelong Health in VA", aka "ASPIRE-VA"). ASPIRE-VA has 3 key features: 1) lifestyle coaches who encourage behavior change through a "small steps" approach; 2) a simplified "Stoplight" diet; and 3) user-friendly "enhanced" pedometers to help participants monitor their physical activity. ASPIRE-VA is not an alternative program to MOVE!; rather, it is a more structured approach within the existing MOVE! framework that is potentially more convenient and satisfying for patients, particularly those unable to participate in facility-based programs.

Project Methods:

468 VA patients eligible for the MOVE! program at two VAMCs will be invited to participate in this 12-month randomized control trial. Willing participants will be randomized to one of 3 study arms: 1) ASPIRE-VA delivered only by phone; 2) ASPIRE-VA delivered through center-based group visits; or 3) the "usual care" MOVE! program in place at each VAMC. Our primary outcome is change in weight between baseline and 12 months. Secondary outcomes are changes in functional exercise capacity, nutrition, glucose levels, serum lipid levels, blood pressure, and health-related quality of life. We will also conduct exploratory analyses of cost and differences in response and experience by different races and genders, and formative evaluation.

Progress:

Recruitment ended in October 2011 and 481 patients were enrolled, 103% of our goal. In the spring of 2011, a decision was made to add a second year of treatment for interested participants. Thus, describing and testing outcomes at 18 and 24 months was added as another secondary aim. Three-month and twelve-month assessments are complete and analysis is on-going. Eighteen-month and twenty-four month assessments are ongoing.