Does the built environment influence the effectiveness of behavioral weight management interventions?

Area of Science:

• Public Health
• Behavioral Science
• Environmental Health

Background:

• Weight loss interventions show variable outcomes.
• Environmental context may influence intervention effectiveness.
• The health production model suggests environment and interventions interact.

Purpose of the Study:

• To assess the short- and longer-term effects of the VA MOVE! weight management program.
• To investigate if environmental factors (walkability, park/fitness access) modify program effectiveness.
• To test if the program complements or substitutes environmental supports.

Main Methods:

• Utilized VA electronic health records (2009-2014) for 114,256 participants and 498,494 non-participants.
• Employed a difference-in-differences design with inverse propensity score matching.
• Analyzed body mass index (BMI) changes at 6, 12, 18, and 24 months, stratified by built environment features.

Main Results:

• The MOVE! program reduced BMI by 0.4-0.6 kg/m² in men and 0.3-0.5 kg/m² in women at 6 months.
• Weight loss effects diminished significantly by 12, 18, and 24 months.
• Program effectiveness was consistent across varying levels of walkability, park access, and fitness facility access.

Conclusions:

• The national MOVE! weight management program's effectiveness is not significantly influenced by the built environment.
• Findings do not support hypotheses that the program complements or substitutes for environmental factors in weight management.
• Behavioral lifestyle interventions may have inherent effects independent of neighborhood characteristics.