National Veterans Health Administration MOVE! Weight Management Program Participation During the COVID-19 Pandemic

Kristen E. Gray, PhD, MS; Katherine D. Hoerster, PhD, MPH; Stephanie A. Spohr, PhD, MA; Jessica Y. Breland, PhD; Susan D. Raffa, PhD

Disclosures

Prev Chronic Dis. 2022;19(3):E11 

In This Article

Results

Visits

We found 695,050 MOVE! visits in 2018, 727,585 visits in 2019, and 489,939 visits in 2020. The monthly number of MOVE! visits began to decline sharply in March 2020 because of declines in in-person visits to a nadir in May 2020 of 30,436 visits across modalities (Figure 1).

Figure 1.

Trends in national Veterans Health Administration MOVE! Weight Management Program participation by modality, January 2018 through January 2021. A, Number of MOVE! visits. B, Number of MOVE! participants. C, Number of new MOVE! participants. Note that the scale in C differs from the scale in A and B.

We found concomitant increases in telehealth MOVE! modalities, particularly individual telephone visits and group VHA Video Connect visits (Figure 2).

Figure 2.

Trends in national Veterans Health Administration telehealth MOVE! Weight Management Program participation by format (group vs individual) and modality, January 2018 through January 2021. A, Number of MOVE! visits. B, Number of MOVE! participants. C, Number of new MOVE! participants. Note that the scale in C differs from the scale in A and B. Abbreviations: VVC, VHA Video Connect; CVT, Clinical Video Telehealth.

Before March 2020, telehealth modalities made up approximately 30% of MOVE! visits, which then expanded to 90% or more (Figure 3). In the initial months of the pandemic, telephone visits accounted for the largest proportion of visits, but the proportion declined over time, from 54.8% in April 2020 to 34.7% in January 2021, while the proportion of VHA Video Connect visits increased, from 23.0% in April 2020 to 48.3% in January 2021.

Figure 3.

Distribution of national Veterans Health Administration MOVE! Weight Management Program participation by modality, January 2019 through January 2021. A, MOVE! visits. B, MOVE! participants. C, New MOVE! participants. Abbreviations: VVC, VHA Video Connect; CVT, Clinical Video Telehealth.

When compared with the monthly average in the years before the pandemic, the number of visits dropped by more than 50% in April 2020, driven by a 95% decline in in-person visits (Figure 4). In subsequent months, in-person visits remained 92% to 97% lower than averages for corresponding months in previous years. In the same period, telehealth visits increased relative to averages in previous years, with percentage increases ranging from 66% in April to 147% in December 2020. This increase mitigated some of the decline in total MOVE! visits compared with prior years, such that differences in total number of visits generally declined over time from 51% lower in April 2020 compared with averages in April 2019 and 2018 to 35% lower in January 2021 compared with January 2020 and 2019.

Figure 4.

Monthly percentage change in national Veterans Health Administration MOVE! Weight Management Program participation by modality in January 2020 through January 2021 relative to monthly average in prior years. A, MOVE! visits. B, MOVE! participants. C, New MOVE! participants. Note that the scale in C differs from the scale in A and B.

Participants

Trends in the number of participants were similar to trends in the number of visits: declines began in March 2020 for the number of in-person and total participants, with the lowest numbers in May 2020 (Figure 1). The number of telehealth participants increased starting in March 2020 and continued through January 2021, with increases most pronounced in individual telephone participants and group VHA Video Connect participants (Figure 2). Before the pandemic, telehealth accounted for slightly more than 30% of participants in MOVE! but increased to 90% or more after March 2020 (Figure 3). Starting in April 2020, telephone participants accounted for the largest proportion; however, the proportion of VHA Video Connect participants increased over time, from 16% in April 2020 to 38% in January 2021 (Figure 3). Patterns in monthly participants compared with prior years were similar to patterns in visits: total participants declined by nearly 50% for April and May 2020, driven by declines in in-person participants (Figure 4). Compared with averages in prior years, telehealth participants generally increased over time, peaking at 113% in December 2020. In general, deficits compared with previous years became smaller over time, with above-noted 50% fewer total participants in April and May 2020, compared with prior years, down to 28% fewer in January 2021 relative to prior years.

New Participants

The number of new MOVE! participants was 51,280 in 2018, 50,930 in 2019, and 36,829 in 2020. Declines in the number of new participants in telehealth and in-person modalities caused by the pandemic reached lows in May 2020 such that only 1,803 patients began MOVE! in that month compared with 4,813 in May 2019 (Figure 1). Increases in telehealth modalities began in March 2020 and continued through January 2021, with the most notable increases among new participants using individual telephone and group VHA Video Connect (Figure 2). Before the pandemic, telehealth accounted for approximately 20% of new participants and increased to 90% from April 2020 onward (Figure 3). Although telephone was the most common modality for new participants throughout the pandemic (69% in April 2020 and 47% in January 2021 [Figure 3]), the share attributable to VHA Video Connect continued to increase over time, from 11% in April 2020 to 38% in January 2021. When comparing the monthly number of new participants to averages in prior years, the nadir was in May 2020, when the number of new participants was 61% of the average across May 2018 and 2019, attributable to a 97% decline in in-person MOVE! relative to prior years (Figure 4). Starting in March 2020, participants seen via telehealth increased substantially, compared with previous years, and peaked at 302% in December 2020. Declines in monthly new participants compared with prior years decreased over time, such that in December 2020, there was a slight increase in new participants relative to December of prior years (2%). However, in January 2021 this dipped back to 22% lower than previous years.

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