Abstract

Background: More than 80% of VA users have body mass index (BMI)>25kg/m2, which contributes to morbidity and mortality. Yet only 9% of eligible Veterans participate in VA’s national MOVE! Weight Management Program, of whom only 20% achieve clinically meaningful weight loss (5%), underscoring MOVE!’s limited reach and effectiveness. Limited effectiveness may be due to the focus on individual behavior change without addressing the social and physical environments in which those changes occur. We developed HealthyTogether – a brief, virtual weight management intervention integrating partners (e.g., spouses, family, friends) into MOVE! programming combined with evidence-based dyadic communication and relationship skills training. In a pilot study, HealthyTogether was feasible and acceptable to Veterans and partners and led to improvements in weight and health behaviors. We propose to test HealthyTogether’s effectiveness and identify barriers and facilitators to implementation in a two-site hybrid type 1 effectiveness-implementation study. Significance: Maintaining a healthy weight, being physically active, and eating a balanced diet substantially reduce premature mortality. However, few Veterans meet these recommendations, and VA’s MOVE! Weight Management Program only produces clinically meaningful weight loss in 2% of eligible Veterans. Therefore, additional effective, feasible, and scalable approaches that improve health behaviors and weight are needed. HealthyTogether leverages Veterans’ social relationships and uses an existing VA workforce with the skills to deliver the intervention. If effective, HealthyTogether could expand existing MOVE! offerings, reach more Veterans, and grow the VA workforce addressing health behaviors and obesity. The proposed project aligns with HSR portfolio topic areas of Primary Care Practice and Management of Complex Chronic Disease and Access/Virtual Care, and contributes to the Quintuple Aim framework of improving outcomes and access. Innovation & Impact: Our study is one of the first to systematically incorporate partners, defined broadly to include a variety of relationships, to improve weight management outcomes and draws upon current, highly relevant interpersonal theories to enhance effectiveness. It is also one of the first fully virtual dyadic weight management interventions, reducing barriers to participation. If effective, HealthyTogether has the potential to be integrated into MOVE! programming to improve weight management outcomes. Specific Aims: 1) Test whether HealthyTogether results in greater weight loss than usual care at 6 months among Veterans (primary); 2) Examine differences between HealthyTogether and usual care groups in secondary Veteran and partner outcomes, including health behaviors (diet and physical activity) and relationship quality; 3) Examine Veteran and partner contributions to changes in their own and each other’s outcomes using dyadic analyses; 4) Assess determinants of implementation, including cost, fidelity, feasibility, acceptability, and appropriateness, to inform future implementation. Methodology: Using a hybrid type 1 effectiveness-implementation design, we will randomly assign N=152 dyads, consisting of a VA Puget Sound or Eastern Colorado patient with BMI>25kg/m2 and an adult partner, to HealthyTogether or usual care 1:1. Over 8 weeks, intervention group participants will receive 6 weekly, hour- long sessions and two brief check-ins, delivered through VA Video Connect by a clinical psychologist, social worker, or trainee. The primary outcome is Veteran weight change at 6-months, assessed remotely, with secondary outcomes of Veteran and partner health behaviors and relationship quality self-reported on web- based surveys. Guided by the Consolidated Framework for Implementation Research, we will assess implementation determinants, including via semi-structured interviews with VA staff and leadership. Next Steps/Implementation: If effective, we will work closely with operational partners, including VA National Center for Health Promotion and Disease Prevention, to identify appropriate implementation strategies.

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.     Search Dimensions for this project

DRA: None at this time.

DRE: None at this time.

Keywords: None at this time.

MeSH Terms: None at this time.