DVD Lifestyle Intervention
DVD Lifestyle Intervention
Most Veterans who receive VA healthcare have obesity (41%) or are classified as overweight
 (37%), putting them at higher risk for multiple serious chronic health conditions. Providing
 evidence-based behavioral weight management programs to Veterans with obesity is a priority
 for the VA National Center for Health Promotion and Disease Prevention (NCP). While the VA
 NCP's MOVE! program-primarily delivered with in-person group visits-helps Veterans with
 obesity lose weight, its reach has been limited because of various barriers to care. Some
 Veterans may do better with a program they can complete from home at their own pace. In this
 trial, study investigators are examining the effectiveness among Veterans of a previously
 proven self-directed lifestyle intervention (called DVD Lifestyle Intervention (D-ELITE))
 that targets modest, clinically meaningful weight loss over the course of a year using
 recorded video lessons (DVD or online streaming), written self-study aids, and optional
 lifestyle coaching. The study will compare participants randomly assigned to receive D-ELITE
 to those continuing in usual care on weight and self-reported general physical health status,
 one year after enrollment. Secondary outcomes include weight and general physical health
 status two years after enrollment; and obesity-related biometric measures (blood pressure and
 HbA1c) and self-report psychological and behavioral factors such as physical activity and
 sleep quality, at one- and two-years following enrollment.

 Veterans with obesity living in the western US were identified using the VA Corporate Data
 Warehouse (CDW), recruited to participate via mail and telephone, and randomly assigned to
 receive the study intervention or usual care alone. The study uses CDW to assess weight
 change and biometric outcomes. To assess self-report outcomes, participants completed
 questionnaires, by mail or telephone, at baseline and 12 months after randomization, and are
 currently completing 24-month follow-up questionnaires. The D-ELITE intervention focuses on
 gradual lifestyle behavior change aimed at improving eating habits and increasing physical
 activity. It encourages participants to gradually achieve and maintain a 5-10% loss of
 baseline body weight and at least 150 minutes of moderate-intensity physical activity, such
 as brisk walking, each week. The D-ELITE intervention program consists of watching one video,
 completing corresponding written self-guided learning materials, and tracking food intake and
 physical activity each week for the first 12 weeks, then working through 10 additional
 written handouts and continued food and activity tracking for the next nine months.
 Intervention participants have access to a lifestyle coach, as desired, for the full 12-month
 intervention period. In addition to patient outcomes, this study will examine the cost of
 delivering the intervention, information relevant to decision-makers and potential future
 dissemination. Evidence-based programs like this, which can be delivered remotely and with
 likely minimal resources required from the VA healthcare system, are greatly needed,
 especially now as the SARS-CoV-2 pandemic has required VA to rapidly transition to providing
 more remotely-delivered care.

 Impact: The DELITE trial has potential to provide the evidence needed for deciding whether a
 low-cost, low-technology, self-directed program can be used to expand the treatment of
 obesity to a population-based level by improving access to obesity treatment regardless of
 Veteran place of residence.
Inclusion Criteria:

 -  Recent VA primary care measured BMI between 30.0-44.9 kg/m2 (at facility in pacific or
 mountain time zone)

 -  Access to DVD player or internet

 -  Able to participate fully in all study protocol/procedures including informed consent

 Exclusion Criteria:

 -  Inability to speak, read, or understand English

 -  Recent weight loss interventions including use of prescription weight-loss
 medications, participation in group or individual weight loss programs provided by
 trained personnel, bariatric surgery (or plans for during the study period)

 -  Expected weight loss because of alternate explanations such as from illness

 -  High variability in weight due to fluctuations in volume status (ascites - liver
 disease, chronic heart failure)

 -  Safety and/or adherence concerns due to severe physical or mental health issues, or
 life expectancy <24 months

 -  Pregnant, lactating, or planning to become pregnant during the study period;

 -  Participation in other intervention studies