VA Lifestyle Program Linked to Improved Cardiometabolic Risk

Key Clinical Summary

• In a retrospective analysis of 67 US veterans (mean age 69 years; 97% male) completing a 15-week lifestyle program at a US Department of Veterans Affairs (VA) Behavioral Medicine Clinic, several cardiometabolic risk factors improved from baseline to post-treatment.
• Post-treatment changes included reductions in waist circumference (−2.8 inches), systolic blood pressure (−7.9 mmHg), low-density lipoprotein (LDL) cholesterol (−11.27 mg/dL), fasting glucose (−15.10 mg/dL), and hemoglobin A1c (−0.55%).
• Among veterans with type 2 diabetes (n = 34), hemoglobin A1c decreased by −0.80%, and blood pressure improved; medication use did not significantly change.

In a retrospective analysis conducted in a VA Behavioral Medicine Clinic in Sacramento, California, a 15-week multiple health behavior change (MHBC) program emphasizing a whole foods and plant-based diet, physical activity, and cognitive-behavioral stress management was associated with statistically significant improvements in several cardiometabolic risk factors among US veterans with atherosclerotic heart disease and/or type 2 diabetes.

Study Findings

Investigators retrospectively analyzed outcomes for 67 program completers (mean age 69.2 years; 97% male) who participated in the Heart Disease Reversal Program (HDRP) delivered in-person at the Sacramento VA Medical Center. Participants had atherosclerotic heart disease and/or type 2 diabetes, and were evaluated at baseline, 1 month, and 15 weeks (post-treatment).

From baseline to post-treatment, completers demonstrated statistically significant improvements in waist circumference (−2.8 inches; P = .03), systolic blood pressure (−7.9 mmHg; P = .03), LDL cholesterol (−11.27 mg/dL; P = .04), fasting glucose (−15.10 mg/dL; P = .03), and hemoglobin A1c (−0.55%; P = .017). In the subgroup with type 2 diabetes (n = 34), post-treatment changes included reductions in hemoglobin A1c (−0.80%; P = .007), systolic blood pressure (−10.98 mmHg; P = .01), and diastolic blood pressure (−6.65 mmHg; P = .03).

Program completion was defined as attending at least 70% of group sessions (≥ 8 of 12). In the broader participant pool (N = 109), half attended 10 to 12 sessions, while 20% attended 3 or fewer sessions. The analysis reported no statistically significant change in medication use for cholesterol, hypertension, or diabetes.

Clinical Implications

For clinicians caring for veterans—who may have elevated risk for atherosclerotic cardiovascular disease and complex comorbidity profiles—these data suggest that an interdisciplinary, clinic-based lifestyle intervention can be associated with measurable improvements in cardiometabolic risk factors in routine VA practice. The intervention integrated dietary change (a strict whole foods, plant-based pattern), a tailored moderate-intensity activity plan (often walking), and structured stress-management skills grounded in cognitive-behavioral approaches.

Notably, improvements were observed without significant medication changes, which may be clinically relevant for patients already receiving pharmacotherapy yet remaining above targets for blood pressure, glycemia, or LDL cholesterol. The findings also highlight implementation considerations: noncompletion occurred, and noncompleters had a somewhat higher prevalence of chronic pain and certain cardiopulmonary and mental health conditions, while spouse/partner participation was more common among completers.

Because this was a retrospective analysis without a control group and lacked adherence measures (diet, activity, stress practices), the results should be interpreted as associations rather than causal effects. Still, the program’s structure—21 total hours over 15 weeks—may be a pragmatic model for health systems seeking scalable secondary prevention options beyond traditional cardiac rehabilitation eligibility windows.

“Veterans who completed the HDRP achieved statistically significant improvements in waist circumference, systolic blood pressure, LDL-C, fasting glucose, and hemoglobin A1c from baseline to post-treatment,” said the study authors. 

They also noted that participants with type 2 diabetes experienced larger improvements in glycemic control and blood pressure, while medication usage did not significantly change during the program.

Conclusion

In a Sacramento, California VA clinic setting, a 15-week lifestyle program centering a whole foods and plant-based diet with physical activity and stress management was associated with improvements in multiple cardiometabolic risk factors among participating veterans. The authors call for prospective studies with larger samples, longer follow-up, and adherence measurement to better define effectiveness and durability.

Reference

Yiaslas TA, Rogers-Soeder TS, Ono G, Kitazono RE, Sood A. Effect of a 15-week whole foods, plant-based diet, physical activity, and stress management intervention on cardiometabolic risk factors in a population of US veterans: a retrospective analysis. Am J Lifestyle Med. 2024;20(1):126-143. doi:10.1177/15598276241267932