The VHA's MOVE! Weight-Management Program has potential for providing evidence-based, comprehensive weight management to the more than 4 million veterans enrolled in VHA health care who are at risk for obesity-related conditions. Created on the basis of a systematic NIH evidence review and designed to be an intensive model of care, as recommended by the US Preventive Services Task Force, MOVE! provides an extensive set of program materials for staff and patients to assist with long-term weight management. VHA medical facilities can incorporate this treatment model into local settings in ways that best facilitate their adoption.
Through their collaborative work (12
), VA and DoD practitioners have shared their weight-management tools and resources. A recently released toolkit for providers in both systems will incorporate most of the MOVE!
tools that have been developed, which will extend the reach of MOVE!
to active duty members and their families. In 2007, the DoD Weight Management and Education Workgroup was charged with developing an evidence-based program of care that could be implemented in DoD medical treatment facilities and has adopted MOVE!
as the standard weight-management program if weight-management programs are not in place.
The program has also been extended to VA employees. Soon after implementing MOVE! for patients, some facilities began to use MOVE! materials and procedures for the benefit of VA employees. A MOVEmployee! manual, describing alternative ways to implement these services, was added to the program materials in 2006. As of late 2007, 63 employee programs existed.
Another opportunity to extend the reach of MOVE!
has been through the HealthierUS Veterans initiative, a collaboration between the VA and Department of Health and Human Services (14
). HealthierUS Veterans is a health promotion campaign aimed at reaching the larger community of veterans (including those not seen at VA facilities) and their family members with messages about eating healthfully, being physically active, and staying "fit for life." One component of the HealthierUS Veterans campaign is to promote the use of the online MOVE!
resources, including the MOVE!23
and patient handouts, outside of the VHA. Veterans and family members may complete the assessment, print out both the individual and staff reports and associated handouts, and take them to their non-VHA medical providers.
MOVE! implementation has helped to raise the profile of obesity research within the VHA community. A number of VA- and NIH-funded studies have been completed or are in progress and include an investigation of changes in obesity care practices within VHA; a study comparing enhanced physical activity interventions with MOVE!; studies adapting MOVE! materials for special populations, including veterans with serious mental illness and veterans with spinal cord injuries or disease; a study of the long-term outcomes of bariatric surgery within the VHA; and a study evaluating 2 enhancements to usual MOVE!-tailored patient newsletters and peer-led self-management support.
The NCP continues to develop and refine MOVE!. Many veterans live at considerable distances from VHA medical centers or community clinics, so plans include enhancing Web-based tools to be more interactive. VHA has an extensive program for home telehealth management of chronic diseases, such as diabetes and heart failure. Development of a MOVE! telehealth program for overweight and obese patients with metabolic syndrome or prediabetes is under way. This program will encourage patients to weigh themselves frequently and use a simple electronic device to report eating and physical activity patterns. Using the device will provide encouragement and support for patients who meet their goals and will alert staff when monitored parameters become out of range. To facilitate ongoing telephone contact between patients and staff for self-management support, plans for regional call centers with health coaches are being developed.
The VA's MOVE!
Weight-Management Program for Veterans is an innovative and comprehensive strategy to provide sophisticated treatment for overweight and obesity to veterans. The program also provides an opportunity to study the best strategies for delivering this care and for measuring the health outcomes of patients who receive it. Similar to VHA's implementation of quality improvement and system change for tobacco control (15
is an example of translation of research and evidence-based medicine into broad medical practice in a large health care organization.