MOVE! Weight Management Participation During COVID-19

Abstract and Introduction

Abstract

Introduction: In response to COVID-19, the Veterans Health Administration (VHA) converted appropriate outpatient visits to virtual care, including MOVE! Weight Management Program for Veterans (MOVE!) visits. Before the pandemic, most veterans participated in MOVE! in person, with several telehealth modalities available. We sought to describe national trends in MOVE! participation during the pandemic (March 2020–January 2021) overall and by modality and to compare participation to prepandemic levels.

Methods: We conducted a national retrospective cohort study of veterans who participated in MOVE! from January 2018 through January 2021. We examined MOVE! participation across VHA aggregated at the national level by month, including the number of visits, participants, and new participants in person and via telehealth, including telephone, clinic-to-clinic synchronous video, anywhere-to-anywhere (eg, provider home to patient home) synchronous video, and remote education and monitoring. We also determined the percentage of all MOVE! visits attributable to each modality and the monthly percentage change in participation during the pandemic compared with monthly averages in prior years.

Results: Before March 2020, 20% to 30% of MOVE! was delivered via telehealth, which increased to 90% by April 2020. Early in the pandemic, telephone-delivered MOVE! was the most common modality, but anywhere-to-anywhere synchronous video participation increased over time. Compared with the same months in prior years, total monthly MOVE! participation remained 20% to 40% lower at the end of 2020 and into January 2021.

Conclusion: The VHA MOVE! program rapidly shifted to telehealth delivery of weight management services in response to the pandemic. However, a gap remained in the number of veterans receiving these services compared with prior years, suggesting potential unmet needs for weight management.

Introduction

Since 2006, the Veterans Health Administration (VHA) has offered the MOVE! Weight Management Program for Veterans (MOVE!) to veterans receiving care at all facilities to support the more than 80% who have a body mass index (BMI) of 25 or more.^[1] MOVE! is an evidence-based comprehensive lifestyle intervention combining dietary, physical activity, and behavioral strategies targeting clinically meaningful weight loss (≥5%) delivered in individual or group formats. Patients can participate in person or by using various technologies, including telephone, video conferencing, in-home monitoring with support, and a self-directed mobile app.^[2,3] MOVE! is effective, resulting in weight loss of 5% or more among 20% to 25% of participants at 12 months;^[4] telehealth individual modalities have been as effective as in-person group options.^[5] Before the COVID-19 pandemic, most MOVE! participation was through in-person group sessions at local VHA facilities. In response to the pandemic, on March 15, 2020, VHA leadership directed all facilities to convert in-person care to virtual care where appropriate.^[6] As of April 2, 2020, in-person MOVE! visits were suspended nationwide and transitioned to telehealth modalities.

Given that higher BMI is associated with increased risk of severe COVID-19 among veterans with a BMI of 30 or more,^[7] understanding the effect of the pandemic on weight management is critical for anticipating future behavioral weight management needs. This knowledge will help the VHA and other health care systems better understand how to address future local or national disruptions in care. Despite widespread availability of telehealth weight management options in the VHA, little is known about how the COVID-19 pandemic affected trends in MOVE! participation and the uptake of telehealth modalities. With pandemic-associated unintended weight gains and decreases in physical activity,^[8] there is likely a greater need for weight management services in the postpandemic recovery period, which telehealth may be well-suited to address. This study aims to 1) describe trends in national MOVE! participation overall and by modality and 2) compare participation with prepandemic levels. We hypothesized that in-person program participation would decrease and telehealth participation would increase.