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Impact of a Small Changes Treatment Approach with Veterans: 3-month results from the ASPIRE-VA RCT

Lutes LL, Goodrich DE, Ronis DL, Kirsh S, Dinatale E, Damschroder LJ. Impact of a Small Changes Treatment Approach with Veterans: 3-month results from the ASPIRE-VA RCT. Paper presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2012 Apr 12; New Orleans, LA.

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Abstract:

OBJECTIVES: Traditional behavioral therapy is an effective treatment for helping individuals lose 5-10% of their total body weight within 6 months. However, weight regain is common even with long-term follow-up. In contrast, a small changes approach focuses on individuals making small but manageable changes in daily nutrition and physical activity. While clinical trials suggest that this is a promising strategy to prevent weight regain, less is known about its effectiveness in promoting weight loss and maintenance over the long-term. ASPIRE-VA is a multi-site, randomized control trial to test effectiveness of a theoretical small changes treatment approach focused on patient-driven changes, relative to baseline behaviors, to encourage slower initial but continuous weight loss over time. METHODS 481 Veterans were recruited from two VA healthcare systems and randomized to one of three 12-month programs: 1) ASPIRE-VA via phone; 2) ASPIRE-VA via face-to-face group; or 3) usual care VA weight management via MOVE!. We report results for the first 3 months of treatment which consisted of weekly sessions with a lifestyle coach (in the ASPIRE arms) or a multidisciplinary treatment team headed by a registered dietician (in the MOVE! arm). RESULTS Results are based on 356 participants (full data will be available in February 2012). Participants included a relatively high proportion of women (13%) and non-white (44%) Veterans; were obese (BMI = 36.44 kg/m2) and reported an average of 4.6 health conditions including 31% who reported diabetes. At 3 months, all three arms experienced significant weight loss (-1.49kg or -1.39% of baseline weight for ASPIRE-VA Phone; -2.0kg or -1.69% for ASPIRE-VA Group; and -1.45kg or -1.25% for MOVE!; p's < .001) with no significant differences between groups (p's > .62). However, participants in the two ASPIRE-VA treatment arms completed significantly more sessions compared to MOVE! (7.8, 6.8, and 3.5 sessions, respectively; p < .001). CONCLUSIONS 3-month results suggest that ASPIRE-VA promotes significant but modest weight loss. Veterans in ASPIRE-VA completed significantly more sessions compared to MOVE! showing a high degree of engagement. IMPACTS High engagement in ASPIRE-VA may indicate the potential for clinically significant and sustained weight loss and maintenance over the long term.





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