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

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.