scholarly journals Mixed-Methods Evaluation of the Phased Implementation of a National Telehealth Weight Management Program for Veterans (Preprint)

2018 ◽  
Author(s):  
David E Goodrich ◽  
Julie C Lowery ◽  
Jennifer A Burns ◽  
Caroline R Richardson
Keyword(s):  
Weight Loss ◽  
Mixed Methods ◽  
Weight Management ◽  
Contextual Factors ◽  
Clinical Effectiveness ◽  
Average Weight ◽  
Health Administration ◽  
Program Outcomes ◽  
Number Of Patients ◽  
Uptake Sites

BACKGROUND The burden of obesity is high among U.S. veterans yet many face barriers to engaging in in-person, facility-based treatment programs. To improve access to weight-management services, the Veterans Health Administration (VHA) developed TeleMOVE®, a home-based 82-day curriculum that utilizes in-home messaging devices to promote weight loss in VHA patients facing barriers to accessing facility-based services. OBJECTIVE Our primary aims were to establish preliminary evidence for the program to engage the priority population based on the number of patients enrolled per site as well as the program’s clinical effectiveness as demonstrated by average weight lost per patient. A secondary aim was to understand factors influencing implementation variability across demonstration sites to develop recommendations to inform the national TeleMOVE dissemination. METHODS We employed a formative mixed-methods design to evaluate the phased implementation of TeleMOVE programming at nine demonstration sites and to compare patient- and site-level measures of program uptake. Data was collected between October 1, 2009 and September 30, 2012. Twenty-eight stakeholders were recruited to provide contextual details while patient-level program outcomes were extracted from VHA patient care databases. Program stakeholders were recruited to participate in two rounds of semi-structured interviews about aspects of implementation processes, site-level contextual factors, and daily program delivery. Administrative data was used to evaluate program enrollment rates and clinical outcomes. To assess preliminary clinical effectiveness, weight loss outcomes for veterans who enrolled in TeleMOVE were compared to outcomes for participants enrolled in standard MOVE! at each demonstration site as well as to national averages during the first two years of program implementation. RESULTS Program uptake was high at two sites, delayed-high at one site, low at three sites, and three late-adopting sites declined interviews. At six months post-enrollment, mean weight loss was comparable for TeleMOVE (n=417) and MOVE! (n=1543) participants at -5.2 lb (SD=14.4) and -5.1 lb (SD=12.2), respectively (p=.91). All sites reported high program complexity because TeleMOVE required more staff time per participant than MOVE! due to logistical and technical assistance issues related to the devices. High-uptake sites overcame implementation challenges by leveraging strong communication networks with stakeholders, adapting the program to patient needs whenever possible, setting programmatic goals and monitoring feedback of results, and taking time to reflect and evaluate on delivery to foster incremental delivery improvements whereas, low-uptake sites reported less leadership support and effective communication among stakeholders. CONCLUSIONS This evaluation of the phased implementation of a new clinical telehealth program demonstrates the value of partnership-based research in which researchers not only provide operational leaders with rapid and responsive feedback regarding the effectiveness of a new clinical program but also relevant feedback into contextual factors related to implementation to enable adaptations for national rollout of the program.

scholarly journals Antidepressant Effect of the VA Weight Management Program (MOVE) Among Veterans With Severe Obesity

2020 ◽  
Vol 185 (5-6) ◽  
pp. e586-e591
Author(s):  
Paulo R Shiroma ◽  
Tina Velasquez ◽  
Timothy J Usset ◽  
John H Wilhelm ◽  
Paul Thuras ◽  
...  
Keyword(s):  
Weight Loss ◽  
Energy Expenditure ◽  
Weight Management ◽  
Severe Obesity ◽  
Management Program ◽  
Antidepressant Effect ◽  
Weight Management Program ◽  
Health Administration ◽  
History Of ◽  
Severity Of Depression

Abstract Introduction Obesity is prevalent among users of Veteran’s Health Administration services, where it is comorbid with depression, post-traumatic stress disorder, type 2 diabetes, cardiovascular disease, colon, and breast cancer. Among obese subjects, severe obesity represents a subpopulation with the highest risk of depression. We investigate the antidepressant effect of a local VA weight management program (Managing Overweight Veterans Everywhere – MOVE) among depressed veterans with severe obesity. Material and Methods In a 10-week prospective pilot study, 14 clinically depressed veterans with severe obesity were recruited from: (1) the 2-week residential based intense MOVE program (IMP) (N = 7) and (2) the 10-week educational module of self-management MOVE program (SMP) (N = 7). Subjects had a Beck Depression Inventory, 2nd edition (BDI-II) score > 12 and BMI > 40 or BMI > 35 with associated to comorbid conditions. Concurrent treatment for depression such as medications or psychotherapy was excluded. The primary efficacy endpoint was the change in BDI-II score form baseline to week 10. Analysis consisted of linear mixed model with baseline BDI-II score as a covariate, and level of MOVE intervention (IMP vs. SMP), time, and time by treatment interaction as fixed effects, and random patient effect. Pearson’s correlation examined the relationships between clinical and demographic variables and change in severity of depression by BDI-II scores. Secondary outcomes include weight loss and energy expenditure. Results The sample was composed by 14 subjects (IMP = 7; SMP = 7) mostly unemployed (N = 9), married (N = 10), mid-aged (mean = 58.2, SD = 8.4), Caucasian (N = 13), male (N = 12), with recurrent depression (N = 11), and a mean overall duration of current depressive episode of 13.5 months (SD = 10.2). Out of 14 participants; seven had a family history of mood disorder, two had previous psychiatric hospitalization, three had a previous suicidal attempt, and eight had a history of substance use disorder. There was a significant decrease in severity of depression among all 14 (F3,36.77 = 5.28; P < 0.01); antidepressant effect favored the IMP compared to SMP at day 12 (F1,15.10 = 9.37, P = 0.01) and week 6 (F2,27.34 = 4.26, P = 0.03), but effect fell short of significance at week 10. The change in severity of depression measured by BDI-II score significantly correlated with total weight loss (r = −0.60; P = 0.04) and daily energy expenditure at 12 days (r = −0.67; P = 0.01), week 6 (r = −0.59; P = 0.03), and week 10 (r = −0.71; P = 0.01). Conclusions Depressed veterans with severe obesity improved their depressive symptoms by participating in the MOVE program. Veterans in the IMP had greater but short-term antidepressant effect as compared to educational intervention for obesity. Future studies with larger sample size may elucidate the underlying mechanisms of weight reduction to improve depression and, more importantly, sustain response among veterans with severe obesity.

Effect Of Weight Loss Quality On Weight Management Program Outcomes In Obese Female Adolescents

2014 ◽  
Vol 46 ◽  
pp. 644
Author(s):  
Matthew Browning ◽  
Cory Lail ◽  
Sarah Malone ◽  
Melanie Bean ◽  
Edmond Wickham ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Management Program ◽  
Female Adolescents ◽  
Weight Management Program ◽  
Program Outcomes ◽  
Obese Female

Clinical outcomes of an inpatient pediatric obesity treatment program in the USA

2017 ◽  
Vol 31 (1) ◽  
Author(s):  
Sharonda J. Alston Taylor ◽  
Kimberly Rennie ◽  
Cindy Jon
Keyword(s):  
Blood Pressure ◽  
Weight Loss ◽  
Weight Management ◽  
Depressive Disorders ◽  
Sleep Apnea Syndrome ◽  
Management Program ◽  
Symptom Improvement ◽  
Average Weight ◽  
Weight Management Program ◽  
Obstructive Sleep

AbstractBackgroundWhen treating recalcitrant and severe childhood obesity, pharmaceutical options are limited and few patients qualify for bariatric surgery. A prolonged inpatient program serves as an alternative treatment. The purpose of this project was to describe the development of a medically supervised inpatient weight management program and evaluate its effectiveness.MethodsThis is a retrospective chart review of 18 patients [4–18 years, mean body mass index (BMI) 50.2 kg/m2] admitted to an inpatient pediatric weight management program from October 2011 through December 31, 2012 to evaluate the biometric, laboratory, sleep and behavioral changes that occurred from admission to discharge from the program.ResultsAverage weight loss was 15% (6.9%–21.5%, p = 0.0001), the decrease in BMI was 15.1% (1.61–21.57, p = 0.0001), systolic blood pressure and diastolic blood pressure decreased by 7.2% (p = 0.003) and 10.3% (p = 0.040), respectively. The reduction in heart rate was 15% (p = 0.013). Upon admission, nine patients had obstructive sleep apnea syndrome (OSAS), of which one was treated with tonsillectomy and six were not compliant with home positive airway pressure (PAP) therapy. At discharge, three patients no longer required PAP and five required decreased PAP settings. Upon admission, seven patients met the criteria for an internalizing disorder. At discharge, symptom reduction was noted.ConclusionAn intensive pediatric inpatient weight management program leads to successful weight loss, improvement in hemodynamic parameters, reduction in OSA treatment requirements and symptom improvement in anxiety and depressive disorders in obese children.

scholarly journals A systematic exploration of differences in contextual factors related to implementing the MOVE! weight management program in VA: A mixed methods study

2011 ◽  
Vol 11 (1) ◽  
Author(s):  
Laura J Damschroder ◽  
David E Goodrich ◽  
Claire H Robinson ◽  
Carol E Fletcher ◽  
Julie C Lowery
Keyword(s):  
Mixed Methods ◽  
Weight Management ◽  
Contextual Factors ◽  
Management Program ◽  
Mixed Methods Study ◽  
Weight Management Program ◽  
Systematic Exploration

scholarly journals The Effectiveness of Adding Pharmacotherapy to Dietary Counseling for Veterans in a Veterans Health Administration Move! Weight Management Program

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A38-A38
Author(s):  
Diego Alcaraz Alvarez ◽  
Mary F Salter ◽  
Namita Gupta ◽  
Thiyagarajan Thangavelu ◽  
Cyrus V Desouza
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Management Program ◽  
Fat Free Mass ◽  
Weight Management Program ◽  
Veterans Health ◽  
Health Administration ◽  
Weight Changes ◽  
Dietary Counseling ◽  
Weight Loss Medication

Abstract Background: Over 78% of veterans are overweight or obese. MOVE! is the VA’s national evidence-based self-management program. This program focuses on health and wellness through healthy eating, physical activity, and behavior change (1). We evaluated the effects of adding pharmacotherapy to dietitian coaching in a real-world MOVE! Program in the VA Nebraska-Western Iowa Health Care System. Methods: A systematic retrospective and prospective chart review were completed of 66 patients who completed a minimum of 6 months of medication at our Weight Loss Medicine clinic from June 2017 to February 2020. Body composition was measured using SECA Bio Electrical Impedance Analyzer. Descriptive statistics were used to analyze weight changes, fat mass (FM), and fat-free mass (FFM) changes at 6 and 12 months after starting weight loss medications. Results: The percentage of patients with a 5% decrease in weight from baseline after at least 6 months with pharmacotherapy was 47% and a 10% decrease was 36% after 12 months. In 6 months, a decrease of a minimum of 5% was seen with GLP-1 (semaglutide or liraglutide) 55 % (29/53), orlistat 11% (1/9), and bupropion-topiramate 25 % (1/4). An average of 3.4% FM decrease and a 3.47% FFM increase was seen from baseline to 6 months and 4.8% FM decrease and 4.7% FFM increase was seen from baseline to 12 months. Conclusion: A clinically significant decrease in weight was seen at 6 and 12 months after starting weight loss medication in addition to monthly MOVE! Dietitian visits. A significant decrease was seen in FM and an increase in FFM. Veteran’s receiving a GLP-1 had a greater amount of weight loss compared with Orlistat and bupropion-topiramate. Weight loss medication is recommended as an adjunct to dietitian counseling for optimizing weight loss. References 1 Kinsinger LS, Jones KR, Kahwati L et al. Design and dissemination of the MOVE! Weight-Management Program for Veterans. Prev Chronic Dis 2009; 6: A98

Abstract #615: Hispanic People Achieve Clinically Significant Weight loss with Liraglutide 3.0 Mg for Weight Management

2015 ◽  
Vol 21 ◽  
pp. 121
Author(s):  
Patrick O’Neil ◽  
W. Timothy Garvey ◽  
J. Michael Gonzalez-Campoy ◽  
Pablo Mora ◽  
Rafael Violante Ortiz ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Significant Weight Loss ◽  
Hispanic People ◽  
Clinically Significant

OPTIFAST®Medical Weight Loss Program—Outcomes in the Endocrinology Clinics at UPMC

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 57-LB
Author(s):  
KARLA B. DETOYA ◽  
KATRINA HAN ◽  
BRENNAN R. REGISTER ◽  
DAVID A. ROMETO
Keyword(s):  
Weight Loss ◽  
Weight Loss Program ◽  
Program Outcomes ◽  
Medical Weight Loss

Study of the properties larch and larch wood construction materials

2016 ◽  
Author(s):  
М.А. Чубинский ◽  
К.В. Чаузов
Keyword(s):  
Weight Loss ◽  
Urea Formaldehyde ◽  
Construction Materials ◽  
Siberian Larch ◽  
Larix Sibirica ◽  
Average Weight ◽  
Biological Stability ◽  
Laminated Beam ◽  
Coniophora Puteana ◽  
Larch Wood

Несмотря на огромные запасы, древесина лиственницы до сего времени в незначительных объемах используется в строительной индустрии, других отраслях экономики, что связано как с технологическими сложностями ее переработки, так и недостаточной изученностью ее свойств. Одним из уникальных свойств древесины лиственницы сибирской (Larix sibirica) является ее повышенная естественная биостойкость, наряду с максимально высокой среди отечественных хвойных пород прочностью. Стойкость древесины лиственницы (Larix sibirica) к воздействию дереворазрушающих грибов Coniofora puteana значительно превышает стойкость сосны. В среднем потеря массы ядровой древесины лиственницы сибирской под воздействием дереворазрушающего гриба Coniophora puteana составляет 14,84%, снижаясь с увеличением возраста дерева, а контрольные образцы из ядровой древесины сосны в возрасте 90 лет имели потерю массы 57,8%. Возраст дерева является одним из наиболее значимых факторов, влияющих на степень биостойкости древесины. По мере его увеличения значительно повышается устойчивость деструктивному воздействию дереворазрушающих грибов Coniophora puteana. Положение образцов также влияет на степень биостойкости древесины, однако эта зависимость слабо выражена по сравнению с влиянием возраста и плотности древесины. Исследования кинетики разложения древесины лиственницы сибирской и роли экстрактивных веществ в развитии дереворазрушающих грибов позволяют утверждать наличие связи биостойкости и содержания в древесине экстрактивных веществ. Для изготовления клееного бруса из древесины лиственницы предложена клеевая композиция, включающая карбамидомеламиноформальдегидный клей и карбамидоформальдегидную смолу, модифицированную шунгитами. Ее применение позволяет получать клеевые соединения, не уступающие по прочности при скалывании массивной древесине, как по сухому образцу, так и после его вымачивания. Таким образом, клееный брус из древесины лиственницы сибирской характеризуется высокими показателями биостойкости, прочности и водостойкости. Despite vast reserves, larch wood so far in small volumes used in the construction industry and other sectors of the economy, which is connected as the technological difficulties of its treatment, as well as insufficient knowledge of its properties. One of the unique properties of the wood of Siberian larch (Larix sibirica) is its increased natural biological stability (decay resistant), along with the highest among the domestic softwood strength. Resistance Larch (Larix sibirica) to the effects of wood-destroying fungi Coniofora puteana is much higher than pine. The average weight loss of Siberian larch heartwood exposed wood-destroying fungi Coniophora puteana is 14.84%, decreasing with increasing age of the tree, and control samples of heartwood pine at age 90 had a weight loss of 57.8%. Age of a tree is one of the most significant factors affecting the degree of biological stability of wood. With the increase it significantly increases the stability of the destructive effects of wood-destroying fungi and Coniophora puteana. The position of the sample in tree also affects the degree of biological stability of wood, but this dependence is poorly developed in comparison with the influence of age and wood density. Studies of the kinetics of decomposition of Siberian larch wood and the role of extractives in the development of wood-destroying fungi suggest a link, and the decay resistant of the content in the wood extractives. For the manufacture of larch glued laminated beam proposed adhesive composition comprising urea and melamine-formaldehyde glue and urea-formaldehyde resins, modified shungites. Its use allows to obtain the bonds are not inferior in strength at shearing solid wood as dry sample, and after soaking. Thus, glued laminated beam from Siberian larch wood is characterized by high decay resistant, strength and water resistance.

Do the Natural Chemical Compounds Interact with the Same Targets of Current Pharmacotherapy for Weight Management?-A Review

2019 ◽  
Vol 20 (4) ◽  
pp. 399-411 ◽  
Author(s):  
Shiqi Luo ◽  
George Binh Lenon ◽  
Harsharn Gill ◽  
Heidi Yuen ◽  
Angela Wei Hong Yang ◽  
...  
Keyword(s):  
Weight Loss ◽  
Weight Management ◽  
Pancreatic Lipase ◽  
Weight Reduction ◽  
Chemical Compounds ◽  
Alpha Amylase ◽  
Melanocortin Receptor ◽  
Health Concern ◽  
European Medicines Agency ◽  
Ppar Γ

Background: Obesity has become a worldwide health concern. Pharmacotherapies are now being introduced because lifestyle modifications alone are insufficient for weight management. The treatment outcomes of current approved anti-obesity agents are not satisfying due to drug-related intolerances. And so natural therapies including herbal medicines are popular alternatives for weight reduction; however, there are limited studies about their mechanism of actions. Methods: Five databases (PubMed, Scopus, Google Scholar, Science Direct, Proquest) were searched to investigate the targets and safety profiles of the current and past anti-obesity drugs that have been approved by the Food and Drug Administration (FDA) or the European Medicines Agency (EMA) as well as the commonly used off-label agents. The targets for weight-loss natural products and their principle bioactive components have also been searched. Only articles in English were included. Results: The targets for current anti-obesity single agents include pancreatic lipase, Glucagon Like Peptide-1(GLP-1) receptor, and serotonin 2C (5-HT2C) receptor. Potential targets such as amylin, pancreatic alpha amylase, leptin receptor, melanocortin receptor 4 receptor (MC4R), Peroxisome Proliferator- Activated Receptors gamma (PPAR γ), endocannabinoid 1 (CB1) receptor and Adenosine Monophosphate (AMP)-Activated Protein Kinase (AMPK) were discussed in various studies. Natural compounds have been found to interact with targets like pancreatic lipase, pancreatic alpha amylase, AMPK and PPAR γ to achieve weight reduction. Conclusion: Current pharmacotherapies and natural chemical compounds do act on same targets. Further investigations on the interactions between herbal compounds and the above targets are essential for the development of novel weight-loss therapies.

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