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

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 No participants were withdrawn due to adverse events.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.