Enhanced Weight Management Program for Veterans With Posttraumatic Stress Disorder

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Importance: 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. Objective: To examine whether weight change differed between MOVE!+UP and MOVE! participants. Design, Setting, and 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. Interventions: 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. Main Outcomes and Measures: The prespecified primary outcome was weight change at 6 months measured on a scale provided by the study. Results: 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 No participants were withdrawn due to adverse events. Conclusions and Relevance: 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. Trial Registration: ClinicalTrials.gov Identifier: NCT04563741.

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