Enhanced Weight Management Program for Veterans With Posttraumatic Stress Disorder: A Randomized Clinical Trial

TL;DR

A tailored weight management program for veterans with PTSD did not lead to better weight loss than the standard program, suggesting more research is needed.

Contribution

Examined a PTSD-specific weight management program's effectiveness compared to a standard program in veterans.

Findings

Six-month weight loss was modest and similar between the two groups.

PTSD symptoms and 12-month weight loss also did not differ significantly between groups.

No adverse events were reported, and both programs were well-tolerated.

Abstract

Does an enhanced behavioral weight management intervention tailored to address unique barriers to weight loss for veterans with a body mass index of 25 or higher and posttraumatic stress disorder (PTSD) improve weight loss more than a Veterans Health Administration program?

In this randomized clinical trial of 174 participants, 6-month weight loss was modest and did not differ significantly between the study groups. The 6- and 12-month PTSD symptom improvements and 12-month weight loss also did not differ between the study groups.

This study’s results suggest that further research is needed to improve care for veterans with PTSD and an elevated body mass index.

This randomized clinical trial examines whether a weight management program designed to address barriers to weight loss unique to veterans with posttraumatic stress disorder (PTSD) was more effective than an established Veterans Health Administration weight management program among veterans with PTSD.

Posttraumatic stress disorder (PTSD) increases the risk of obesity and is associated with less weight loss in the Veterans Health Administration’s (VHA’s) weight management program (MOVE!). MOVE!+UP was developed to address unique barriers to weight loss among veterans with PTSD and elevated body mass index.

To examine whether weight change differed between MOVE!+UP and MOVE! participants.

This randomized clinical trial was conducted from October 6, 2020, to February 28, 2024, at 1 VHA site. Six- and 12-month outcomes were collected by masked assessors. Participants were veterans with PTSD and a body mass index of 25 or greater who were engaged in PTSD care.

Participants were randomly assigned to MOVE!+UP or MOVE!. Both groups received 16 weekly sessions of group-based standard behavioral weight management counseling via video. MOVE!+UP included cognitive behavior therapy–based content (eg, coping, relationship support, and community engagement) and a community-based walk to facilitate exercise and exposure to feared experiences (a PTSD treatment target). MOVE!+UP offered 2 individualized dietitian sessions to enhance benefit.

The prespecified primary outcome was weight change at 6 months measured on a scale provided by the study.

Among 174 randomized participants (mean [SD] age, 55 [13] years; 113 men [65%]; 85 participants randomized to MOVE!+UP and 89 randomized to MOVE!), unadjusted mean (SD) weight loss at 6 months among MOVE!+UP participants was 8.9 (13.7) lb (decreased from 224.0 [42.0] to 215.1 [38.1] lb compared with 7.8 [13.8] lb among MOVE! participants (decreased from 232.9 [48.4] to 225.2 [50.2] lb). Adjusted intervention minus control mean weight change was −1.5 lb (95% CI, −5.9 to 2.9; P = .50). Secondary outcomes (change in PTSD symptoms at 6 and 12 months and weight change at 12 months) did not significantly differ between groups. No participants were withdrawn due to adverse events.

In this randomized clinical trial, weight change did not differ between a tailored weight management program for veterans with PTSD (MOVE!+UP) and VHA’s standard weight management program (MOVE!). These results suggest that research must continue to address weight loss among those with PTSD.

ClinicalTrials.gov Identifier: NCT04563741

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