Does Effectiveness of Weight Management Programs Depend on the Food Environment?

Health Serv Res. 2018 Dec;53(6):4268-4290. doi: 10.1111/1475-6773.13043. Epub 2018 Sep 23.


Objective: To estimate the causal effects of a population-scale behavioral weight management program and to determine whether the program's effectiveness depends on participants' geographic access to places to purchase healthy and less healthy foods.

Data sources: Secondary data from U.S. Department of Veterans Affairs clinical and administrative records (2008-2014), retail food environment measures from commercial databases (2008-2014), and the American Community Survey (2009-2014).

Study design: We estimated the effect of the VA's MOVE! weight management program on body mass index after 6 months using difference-in-difference regressions to compare participants with a propensity score-matched control group. We estimated treatment effects overall and in subgroups with different access to supermarkets, fast-food restaurants, and convenience stores.

Principal findings: MOVE! reduced BMI by about 0.71 units among men and 0.70 units among women. The program was slightly less effective for men living near fast-food restaurants or convenience stores. We found no evidence that treatment effects varied with the food environment among women.

Conclusions: The residential food environment modestly alters MOVE! effectiveness among men. A greater understanding of environmental barriers to and facilitators of intentional weight loss is needed. This study highlights important potential intersections between health care and the community.

Keywords: Obesity; residential environment; retail food outlets; veterans; weight management.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Body Mass Index
  • Commerce / statistics & numerical data*
  • Databases, Factual
  • Female
  • Food Supply / statistics & numerical data*
  • Humans
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Residence Characteristics / statistics & numerical data*
  • Restaurants / statistics & numerical data
  • Retrospective Studies
  • United States
  • United States Department of Veterans Affairs
  • Weight Reduction Programs*