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Development of a Tailored Behavioral Weight Loss Program for Veterans With PTSD (MOVE!+UP): A Mixed-Methods Uncontrolled Iterative Pilot Study

2020; SAGE Publishing; Volume: 34; Issue: 6 Linguagem: Inglês

10.1177/0890117120908505

2168-6602

Katherine D. Hoerster, Lamont Tanksley, Tracy L. Simpson, Brian E. Saelens, Jürgen Unützer, Marissa Black, Preston A. Greene, Nadiyah Sulayman, Gayle E. Reiber, Karin M. Nelson,

Occupational Health and Performance

Purpose: Veterans with post-traumatic stress disorder (PTSD) lose less weight in the Veterans Affairs (VA) weight management program (MOVE!), so we developed MOVE!+UP. Design: Single-arm pre–post pilot to iteratively develop MOVE!+UP (2015-2018). Setting: Veterans Affairs Medical Center. Participants: Overweight Veterans with PTSD (5 cohorts of n = 5-11 [N = 44]; n = 39 received ≥1 MOVE+UP session, with cohorts 1-4 [n = 31] = “Development” and cohort 5 [n = 8] = “Final” MOVE!+UP). Intervention: MOVE!+UP weight management for Veterans with PTSD modified after each cohort. Final MOVE!+UP was coled by a licensed clinical psychologist and Veteran peer counselor in 16 two-hour in-person group sessions and 2 individual dietician visits. Sessions included general weight loss support (eg, behavioral monitoring with facilitator feedback, weekly weighing), cognitive-behavioral skills to address PTSD-specific barriers, and a 30-minute walk to a nearby park. Measures: To inform post-cohort modifications, we assessed weight, PTSD, and treatment targets (eg, physical activity, diet), and conducted qualitative interviews. Analysis: Baseline to 16-week paired t tests and template analysis. Results: Development cohorts suggested improvements (eg, additional sessions and weight loss information, professional involvement) and did not lose weight (mean [ M] = 1.8 lbs (standard deviation [SD] = 8.2); P = .29. Conversely, the final cohort reported high satisfaction and showed meaningful weight ( M = −14 pounds [SD = 3.7] and 71% lost ≥5% baseline weight) and PTSD ( M = −17.9 [SD = 12.2]) improvements, P < .05. Conclusions: The comprehensive, 16-week, in-person, cofacilitated Final MOVE!+UP was acceptable and may improve the health of people with PTSD. Iterative development likely produced a patient-centered intervention, needing further testing.