American Diabetes Association's 73rd Scientific Sessions:
MOVE Program Shown to Promote Lifestyle Changes in Prediabetics
When large health systems and clinicians embrace low-cost interventions, patients achieve lifestyle changes that result in weight loss that cuts their risk of developing diabetes, according to the data from the large-scale Veterans Administration’s Managing Overweight and/or Obesity for Veterans Everywhere (MOVE) program.
The MOVE program is offered at 130 VA hospitals and clinics and consists of 8-12 weekly group sessions focused primarily on physical activity and nutrition, noted Sandra L. Jackson, MPH, a PhD candidate in nutrition and health sciences at Emory University in Atlanta, who presented the team’s findings. “In order to achieve wide-scale results in reducing the prevalence of diabetes in this country, we need to get to patients who are at risk,” said Ms. Jackson. “One way of doing this is through their health care providers, and such a strategy, if found to be effective, could be replicated across many health systems.”
Lawrence S. Phillips, MD, professor of medicine at the Emory University School of Medicine and director of the Clinical Studies Center at the Atlanta VA Medical Center, agreed. “Diabetes is a problem of epidemic proportions. We are older, heavier, and more sedentary as a society, and these are cardinal factors in the diabetes epidemic. The key way to reverse this is lifestyle change. The good news is that this research shows participation does not have to be entirely voluntary to work, and the health care system can and should be part of the solution,” he told EndocrineWeb.
The MOVE Model
According to Ms. Jackson, the research team analyzed the records of 402,693 participants (veterans) who were directed to the MOVE program by their health care providers. Veterans in the VA system are encouraged to participate in the program if they are obese or if they are overweight and have a weight-related health condition, such as osteoarthritis, coronary artery disease, diabetes, or sleep apnea. Among the participants whose records were analyzed in the study, 37.5% had diabetes at their first MOVE visit.
The team obtained follow-up data for 135,686 participants and found that over three years their mean body mass index (BMI) decreased from 36.3 to 35.8, representing a mean weight loss of 1.3%. Participants who attended at least eight sessions in a six-month period—those deemed to have “intense and sustained” participation—lost twice as much weight as other, less involved patients—nearly 2.7% of their initial mean body weight. These more active participants achieved most of their weight loss during the first six months and maintained it for the following 2.5 years. Also, 28% of these participants lost at least 5% of their body weight, compared with 16% of less active participants and 11% of 1.5 million veterans who were eligible to participate in MOVE but chose not to (controls).
Ms. Jackson noted that 9.6% of participants who had diabetes at their first MOVE visit became intense and sustained participants, compared to 7.8% of those who did not have diabetes when they first enrolled. Participants with diabetes also shed more pounds, losing 1.7% of their body weight compared to 0.9% of body weight among participants who did not have diabetes.
Over three years, 18.7% of participants who did not have diabetes when they enrolled went on to develop the disease. Upon analyzing the data, Ms. Jackson determined that each additional pound lost by MOVE participants by the six-month mark was associated with a 1% lower likelihood of developing diabetes over three years.
Ms. Jackson disclosed no conflicts of interest.
Dr. Phillips is an employee of the Veterans Administration and disclosed a relationship with the Centers for Medicare and Medicaid Services. He is on the advisory panel of Boehringer Ingelheim Pharmaceuticals and receives research support from Amylin Pharmaceuticals, the Cystic Fibrosis Foundation, Eli Lilly and Company, Merck, Novo Nordisk, PhaseBio, Roche Pharmaceuticals, and Sanofi.