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Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting


Low enrollment in behavioral weight loss treatments limits their impact. We aimed to identify factors associated with treatment initiation. The participants were outpatients (n = 198) at Veterans Affairs (VA) healthcare facilities who were referred to a free VA-based behavioral weight loss treatment. Participants were assessed on psychosocial factors potentially relevant to treatment initiation. Subsequent treatment initiation was determined via medical record review. Study participants were 77 % male, 60 % African American, and 54 % initiated treatment. In multivariable analyses, treatment initiation was associated with being single, higher anxiety, and patients’ perceptions that referring provider supported their weight autonomy. Endorsement of treatment barriers was not associated with treatment initiation. Treatments offering in-person sessions and mood management components were rated as more preferred. Initiation of behavioral weight loss treatments may increase if patients believe that providers respect their weight control autonomy and if healthcare organizations offer treatments that match patients’ preferences.

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Author information



Corresponding author

Correspondence to Megan A. McVay PhD.

Ethics declarations

The findings reported have not been previously published and the manuscript is not being simultaneously submitted elsewhere.Portions of this data have previously been presented at the Annual Meeting of the Society for Behavioral Medicine in 2015. The authors have full control of all primary data and agree to allow the journal to review data if requested.

Ethics statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors. Informed consent

Informed consent was obtained from all individual participants included in the study. This study was approved by the Durham VA Institutional Review Board.

Conflicts of interest

The authors declare that they have no conflicts of interest.


This research was made possible by funding from the Veterans Affairs Office of Academic Affiliation Health Services Research and Development postdoctoral fellowship (TPP 21-024) and a Career Development Award from the National Institutes of Health (K23 HL127334) to Dr. Megan McVay. This research was also funded by a Career Research Scientist Award to Dr. Corrine Voils (RCS 14–443)

Additional information


Practice: Healthcare providers should respect patient autonomy when discussing weight management and treatment options.

Policy: Healthcare systems should provide training to providers in communication styles that convey respect for patient autonomy and should consider offering evidence-based behavioral weight loss treatments with varying features to appeal to varying patient treatment preferences.

Research: Researchers should test the effects of offering treatments with differing characteristics on treatment initiation.

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McVay, M.A., Yancy, W.S., Scott, C.N. et al. Patient factors associated with initiation of behavioral weight loss treatment: a prospective observational study in an integrated care setting. Behav. Med. Pract. Policy Res. 7, 75–83 (2017).

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  • Behavioral weight loss treatment
  • Treatment engagement
  • Provider communication