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Susan D Raffa

Assistant Consulting Professor in the Department of Psychiatry and Behavioral Sciences
Psychiatry & Behavioral Sciences, Behavioral Medicine & Neurosciences

Selected Publications


Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures.

Journal Article Med Care · April 1, 2024 OBJECTIVE: The association between participation in a behavioral weight intervention and health expenditures has not been well characterized. We compared Veterans Affairs (VA) expenditures of individuals participating in MOVE!, a VA behavioral weight loss ... Full text Link to item Cite

Black Veterans Experiences with and Recommendations for Improving Weight-Related Health Care: A Photovoice Study.

Journal Article J Gen Intern Med · March 4, 2024 BACKGROUND: Non-Hispanic Black or African American (hereafter Black) veterans lose less weight than other users of the Veterans Health Administration's (VHA) weight management program (MOVE!), despite higher enrollment. OBJECTIVE: To understand factors tha ... Full text Link to item Cite

Real World Use of Anti-Obesity Medications and Weight Change in Veterans.

Journal Article J Gen Intern Med · March 2024 BACKGROUND: Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss. OBJECTIVE: To compare weight change between Ve ... Full text Link to item Cite

Development and Psychometric Assessment of the Weight and Eating Quality of Life (WE-QOL) Scale in US Military Veterans.

Journal Article J Gen Intern Med · July 2023 BACKGROUND: The Veterans Health Administration (VHA) is in need of population health approaches to address overweight and obesity-related diseases. BMI serves as a simple, blunt metric to monitor these efforts. However, emerging research has demonstrated t ... Full text Link to item Cite

Facility-level program components leading to population impact: a coincidence analysis of obesity treatment options within the Veterans Health Administration.

Journal Article Transl Behav Med · November 21, 2022 Obesity is a well-established risk factor for increased morbidity and mortality. Comprehensive lifestyle interventions, pharmacotherapy, and bariatric surgery are three effective treatment approaches for obesity. The Veterans Health Administration (VHA) of ... Full text Link to item Cite

Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study.

Journal Article Am J Surg · July 2022 BACKGROUND: Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. METHODS: Adults w ... Full text Link to item Cite

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

Journal Article Prev Chronic Dis · March 10, 2022 INTRODUCTION: In response to COVID-19, the Veterans Health Administration (VHA) converted appropriate outpatient visits to virtual care, including MOVE! Weight Management Program for Veterans (MOVE!) visits. Before the pandemic, most veterans participated ... Full text Link to item Cite

Deriving Weight From Big Data: Comparison of Body Weight Measurement-Cleaning Algorithms.

Journal Article JMIR Med Inform · March 9, 2022 BACKGROUND: Patient body weight is a frequently used measure in biomedical studies, yet there are no standard methods for processing and cleaning weight data. Conflicting documentation on constructing body weight measurements presents challenges for resear ... Full text Link to item Cite

A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration.

Journal Article Ann Surg · January 1, 2022 OBJECTIVE: To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. SUMMARY OF BACKGROUND DATA: Bariatric surgery is the most effective weight loss option for Veterans with ... Full text Link to item Cite

Protocol and short-term results for a feasibility randomized controlled trial of a video intervention for Veterans with obesity: The TOTAL (Teaching Obesity Treatment Options to Adult Learners) pilot study.

Journal Article Contemp Clin Trials Commun · September 2021 INTRODUCTION: All three evidence-based treatment options for adults with severe obesity - behavioral weight management, weight management medications (WMM), and bariatric surgery - are underutilized in the Veterans Health Administration (VHA) system. Our o ... Full text Link to item Cite

Synopsis of the 2020 U.S. VA/DoD Clinical Practice Guideline for the Management of Adult Overweight and Obesity.

Journal Article Mil Med · August 28, 2021 INTRODUCTION: In May of 2020, the U.S. Veterans Health Administration (VHA) and Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients who have overweight and obesity. This guideline is intended to ... Full text Link to item Cite

Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming.

Journal Article BMC Health Serv Res · August 11, 2021 BACKGROUND: While the Veterans Health Administration (VHA) MOVE! weight management program is effective in helping patients lose weight and is available at every VHA medical center across the United States, reaching patients to engage them in treatment rem ... Full text Link to item Cite

Research translation for military and veteran health: research, practice, policy.

Journal Article Transl Behav Med · March 16, 2021 Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembe ... Full text Link to item Cite

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings.

Journal Article J Gen Intern Med · February 2021 BACKGROUND: Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams' quality improvement (QI) capability may increase the implementation readiness and success ... Full text Link to item Cite

Dissemination of cognitive behavioral therapy for substance use disorders in the Department of Veterans Affairs Health Care System: Description and evaluation of Veteran outcomes.

Journal Article Subst Abus · 2021 As part of the nation's largest dissemination and implementation of evidence-based psychotherapies (EBPs) and the promotion of EBPs for substance use disorders (SUDs), the Veterans Health Administration (VHA) is working to nationally implement Cognitive Be ... Full text Link to item Cite

An Evaluation of Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Application of Tolin's Criteria for Empirically Supported Treatments.

Journal Article Clin Psychol (New York) · December 2020 The American Psychological Association's Society of Clinical Psychology recently adopted the "Tolin Criteria" to evaluate empirically supported treatments. These criteria better account for strength and quality of rapidly accumulating evidence bases for va ... Full text Link to item Cite

Weight Management and Healthy Lifestyles.

Journal Article JAMA Intern Med · October 1, 2020 Full text Link to item Cite

Construction and Use of Body Weight Measures from Administrative Data in a Large National Health System: A Systematic Review.

Journal Article Obesity (Silver Spring) · July 2020 OBJECTIVE: Administrative data are increasingly used in research and evaluation yet lack standardized guidelines for constructing measures using these data. Body weight measures from administrative data serve critical functions of monitoring patient health ... Full text Link to item Cite

Association Between a National Behavioral Weight Management Program and Veterans Affairs Health Expenditures.

Journal Article Med Care · April 1, 2024 OBJECTIVE: The association between participation in a behavioral weight intervention and health expenditures has not been well characterized. We compared Veterans Affairs (VA) expenditures of individuals participating in MOVE!, a VA behavioral weight loss ... Full text Link to item Cite

Black Veterans Experiences with and Recommendations for Improving Weight-Related Health Care: A Photovoice Study.

Journal Article J Gen Intern Med · March 4, 2024 BACKGROUND: Non-Hispanic Black or African American (hereafter Black) veterans lose less weight than other users of the Veterans Health Administration's (VHA) weight management program (MOVE!), despite higher enrollment. OBJECTIVE: To understand factors tha ... Full text Link to item Cite

Real World Use of Anti-Obesity Medications and Weight Change in Veterans.

Journal Article J Gen Intern Med · March 2024 BACKGROUND: Anti-obesity medications (AOMs) can be initiated in conjunction with participation in the VA national behavioral weight management program, MOVE!, to help achieve clinically meaningful weight loss. OBJECTIVE: To compare weight change between Ve ... Full text Link to item Cite

Development and Psychometric Assessment of the Weight and Eating Quality of Life (WE-QOL) Scale in US Military Veterans.

Journal Article J Gen Intern Med · July 2023 BACKGROUND: The Veterans Health Administration (VHA) is in need of population health approaches to address overweight and obesity-related diseases. BMI serves as a simple, blunt metric to monitor these efforts. However, emerging research has demonstrated t ... Full text Link to item Cite

Facility-level program components leading to population impact: a coincidence analysis of obesity treatment options within the Veterans Health Administration.

Journal Article Transl Behav Med · November 21, 2022 Obesity is a well-established risk factor for increased morbidity and mortality. Comprehensive lifestyle interventions, pharmacotherapy, and bariatric surgery are three effective treatment approaches for obesity. The Veterans Health Administration (VHA) of ... Full text Link to item Cite

Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study.

Journal Article Am J Surg · July 2022 BACKGROUND: Less than 1% adults in the United States who meet body mass index criteria undergo bariatric surgery. Our objective was to identify patient and provider perceptions of individual-level barriers to undergoing bariatric surgery. METHODS: Adults w ... Full text Link to item Cite

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

Journal Article Prev Chronic Dis · March 10, 2022 INTRODUCTION: In response to COVID-19, the Veterans Health Administration (VHA) converted appropriate outpatient visits to virtual care, including MOVE! Weight Management Program for Veterans (MOVE!) visits. Before the pandemic, most veterans participated ... Full text Link to item Cite

Deriving Weight From Big Data: Comparison of Body Weight Measurement-Cleaning Algorithms.

Journal Article JMIR Med Inform · March 9, 2022 BACKGROUND: Patient body weight is a frequently used measure in biomedical studies, yet there are no standard methods for processing and cleaning weight data. Conflicting documentation on constructing body weight measurements presents challenges for resear ... Full text Link to item Cite

A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration.

Journal Article Ann Surg · January 1, 2022 OBJECTIVE: To characterize system-level barriers to bariatric surgery from the perspectives of Veterans with severe obesity and obesity care providers. SUMMARY OF BACKGROUND DATA: Bariatric surgery is the most effective weight loss option for Veterans with ... Full text Link to item Cite

Protocol and short-term results for a feasibility randomized controlled trial of a video intervention for Veterans with obesity: The TOTAL (Teaching Obesity Treatment Options to Adult Learners) pilot study.

Journal Article Contemp Clin Trials Commun · September 2021 INTRODUCTION: All three evidence-based treatment options for adults with severe obesity - behavioral weight management, weight management medications (WMM), and bariatric surgery - are underutilized in the Veterans Health Administration (VHA) system. Our o ... Full text Link to item Cite

Synopsis of the 2020 U.S. VA/DoD Clinical Practice Guideline for the Management of Adult Overweight and Obesity.

Journal Article Mil Med · August 28, 2021 INTRODUCTION: In May of 2020, the U.S. Veterans Health Administration (VHA) and Department of Defense (DoD) approved a new joint clinical practice guideline for assessing and managing patients who have overweight and obesity. This guideline is intended to ... Full text Link to item Cite

Facility-level conditions leading to higher reach: a configurational analysis of national VA weight management programming.

Journal Article BMC Health Serv Res · August 11, 2021 BACKGROUND: While the Veterans Health Administration (VHA) MOVE! weight management program is effective in helping patients lose weight and is available at every VHA medical center across the United States, reaching patients to engage them in treatment rem ... Full text Link to item Cite

Research translation for military and veteran health: research, practice, policy.

Journal Article Transl Behav Med · March 16, 2021 Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembe ... Full text Link to item Cite

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings.

Journal Article J Gen Intern Med · February 2021 BACKGROUND: Integrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams' quality improvement (QI) capability may increase the implementation readiness and success ... Full text Link to item Cite

Dissemination of cognitive behavioral therapy for substance use disorders in the Department of Veterans Affairs Health Care System: Description and evaluation of Veteran outcomes.

Journal Article Subst Abus · 2021 As part of the nation's largest dissemination and implementation of evidence-based psychotherapies (EBPs) and the promotion of EBPs for substance use disorders (SUDs), the Veterans Health Administration (VHA) is working to nationally implement Cognitive Be ... Full text Link to item Cite

An Evaluation of Cognitive Behavioral Therapy for Insomnia: A Systematic Review and Application of Tolin's Criteria for Empirically Supported Treatments.

Journal Article Clin Psychol (New York) · December 2020 The American Psychological Association's Society of Clinical Psychology recently adopted the "Tolin Criteria" to evaluate empirically supported treatments. These criteria better account for strength and quality of rapidly accumulating evidence bases for va ... Full text Link to item Cite

Weight Management and Healthy Lifestyles.

Journal Article JAMA Intern Med · October 1, 2020 Full text Link to item Cite

Construction and Use of Body Weight Measures from Administrative Data in a Large National Health System: A Systematic Review.

Journal Article Obesity (Silver Spring) · July 2020 OBJECTIVE: Administrative data are increasingly used in research and evaluation yet lack standardized guidelines for constructing measures using these data. Body weight measures from administrative data serve critical functions of monitoring patient health ... Full text Link to item Cite

Early-phase study of a telephone-based intervention to reduce weight regain among bariatric surgery patients.

Journal Article Health Psychol · May 2020 OBJECTIVE: This study describes early-phase development of a behavioral intervention to reduce weight regain following bariatric surgery. We utilized the Obesity-Related Behavioral Intervention Trials model to guide intervention development and evaluation. ... Full text Link to item Cite

Systematic Review of Behavioral Weight Management Program MOVE! for Veterans.

Journal Article Am J Prev Med · May 2018 CONTEXT: Since 2006, the Veterans Health Administration has delivered a population-based behavioral weight management program (MOVE!) to Veterans, which numerous studies have examined. The purpose of this study was to systematically review these studies to ... Full text Link to item Cite

Weight management and physical activity throughout the cancer care continuum.

Journal Article CA Cancer J Clin · January 2018 Mounting evidence suggests that weight management and physical activity (PA) improve overall health and well being, and reduce the risk of morbidity and mortality among cancer survivors. Although many opportunities exist to include weight management and PA ... Full text Link to item Cite

A System-Level Approach to Overweight and Obesity in the Veterans Health Administration.

Journal Article J Gen Intern Med · April 2017 Healthcare systems are challenged by steady increases in the number of patients who are overweight and obese. Large-scale, evidence-based behavioral approaches for addressing overweight and obesity have been successfully implemented in systems such as the ... Full text Link to item Cite

State of the art conference on weight management in VA: Policy and research recommendations for advancing behavioral interventions.

Journal Article J Gen Intern Med · April 2017 This article summarizes outcomes of the behavioral interventions work group for the Veterans Health Administration (VHA) State of the Art Conference (SOTA) for Weight Management. Sixteen VHA and non-VHA subject matter experts, representing clinical care de ... Full text Link to item Cite

Examining the Dose-Response Relationship in the Veterans Health Administration's MOVE!® Weight Management Program: A Nationwide Observational Study.

Journal Article J Gen Intern Med · April 2017 BACKGROUND: For more than a decade, the Veterans Health Administration (VHA) has offered MOVE!, a comprehensive lifestyle intervention for weight management. However, there is limited knowledge to inform resource allocation decisions at the health system l ... Full text Link to item Cite

National Dissemination of Motivation Enhancement Therapy in the Veterans Health Administration: Training Program Design and Initial Outcomes.

Journal Article J Subst Abuse Treat · June 2016 Motivational enhancement therapy (MET) can be defined most simply as the "….combination of Motivational Interviewing (MI) with assessment feedback…." (Miller & Rollnick, 2013, p. 250). MET has a clear evidence-base promoting its use especially for treatmen ... Full text Link to item Cite

National dissemination of cognitive-behavioral therapy for chronic pain in veterans: therapist and patient-level outcomes.

Journal Article Clin J Pain · August 2015 OBJECTIVE: This paper assesses the effects of training in and implementation of Cognitive-Behavioral Therapy for Chronic Pain (CBT-CP) in the US Department of Veterans Affairs (VA) health care system on therapists' CBT-CP competencies and patients' pain-re ... Full text Link to item Cite

National dissemination of interpersonal psychotherapy for depression in veterans: therapist and patient-level outcomes.

Journal Article J Consult Clin Psychol · December 2014 OBJECTIVE: To evaluate the effects of training in and delivery of interpersonal psychotherapy (IPT) for depression throughout the U.S. Department of Veterans Affairs health care system on therapists' competency and patients' clinical outcomes. METHOD: Part ... Full text Link to item Cite

Cognitive behavioral analysis system of psychotherapy and brief supportive psychotherapy for augmentation of antidepressant nonresponse in chronic depression: the REVAMP Trial.

Journal Article Arch Gen Psychiatry · November 2009 CONTEXT: Previous studies have found that few chronically depressed patients remit with antidepressant medications alone. OBJECTIVE: To determine the role of adjunctive psychotherapy in the treatment of chronically depressed patients with less than complet ... Full text Link to item Cite

Anxiety in middle adulthood: effects of age and time on the 14-year course of panic disorder, social phobia and generalized anxiety disorder.

Journal Article Psychol Med · April 2009 BACKGROUND: Much about the long-term course of anxiety disorders is unknown. The present study utilizes a naturalistic, longitudinal, short-interval follow-up design to elucidate the course of anxiety disorders over 14 years in a largely middle-aged adult ... Full text Link to item Cite

Anxiety sensitivity as a predictor of the clinical course of panic disorder: a 1-year follow-up study.

Journal Article Depress Anxiety · 2009 BACKGROUND: There is evidence that negative affect (NA) and anxiety sensitivity (AS) predict the development of anxiety disorders, particularly panic disorder (PD). The main purpose of this study was to examine whether NA and AS will also predict the clini ... Full text Link to item Cite

Risk factors for isolated sleep paralysis in an African American sample: a preliminary study.

Journal Article Behav Ther · December 2008 Isolated sleep paralysis (ISP) is a temporary period of involuntary immobility that can occur at sleep onset or offset. It has previously been reported in association with both panic disorder (PD) and posttraumatic stress disorder (PTSD). The current study ... Full text Link to item Cite

Relapse following combined treatment discontinuation in a placebo-controlled trial for panic disorder.

Journal Article J Nerv Ment Dis · July 2008 A recent double-blind, placebo-controlled trial (Barlow et al., 2000 JAMA. 283:2529-2536) examined separate and synergistic effects of psychological and pharmacological treatments for panic disorder. One finding warranting further investigation involved re ... Full text Link to item Cite

Morbidity of DSM-IV Axis I disorders in patients with noncardiac chest pain: Psychiatric morbidity linked with increased pain and health care utilization.

Journal Article J Consult Clin Psychol · June 2008 The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on th ... Full text Link to item Cite

Prevalence of anxiety disorders in men and women with established coronary heart disease.

Journal Article J Cardiopulm Rehabil Prev · 2007 PURPOSE: Anxiety has been associated with the development and recurrence of coronary heart disease (CHD). The objective of this study was to estimate the prevalence of anxiety disorders in men and women with established CHD. METHODS: One hundred fifty CHD ... Full text Link to item Cite

Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model

Journal Article Cognitive Therapy and Research · February 1, 2005 The tendency to fear and avoid internal experiences may be an important characteristic of individuals with generalized anxiety disorder (GAD). We review here theory and research suggesting that individuals with GAD may be experientially avoidant, and prese ... Full text Cite

Feared consequences of panic attacks in panic disorder: a qualitative and quantitative analysis.

Journal Article Cogn Behav Ther · 2004 Cognitions are hypothesized to play a central role in panic disorder (PD). Previous studies have used questionnaires to assess cognitive content, focusing on prototypical cognitions associated with PD; however, few studies have qualitatively examined cogni ... Full text Link to item Cite