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Overweight/Obesity in VHA: 

Overweight/Obesity in VHA Linda Kinsinger, MD, MPH Director, VA National Center for Health Promotion and Disease Prevention Office of Patient Care Services

Scope of the Problem: 

Scope of the Problem Over 70% of veterans in VA are overweight/obese 3% men and 6% women class III obesity (BMI ≥40) Over 20% have diabetes 75% of patients with amputations 50% of patients with stroke 40% of patients on dialysis

VA/DoD Clinical Practice Guideline for Management of Overweight and Obesity: 

VA/DoD Clinical Practice Guideline for Management of Overweight and Obesity Key screening recommendations: Screen all adults using BMI Evaluate obese patients for weight loss treatment Assess overweight patients for other risk factors to determine treatment Promote healthy lifestyles in low-risk patients Key treatment recommendations: Assess readiness to lose weight, reach shared decision Initiate interventions based on risk level and patient preference Assess progress toward goals, reinforce or modify as needed

VA Weight Management Program – MOVE!: 

VA Weight Management Program – MOVE! Managing Overweight/obesity for Veterans Everywhere Based on 1998 NIH/NHLBI 'Guidelines for Identification, Evaluation, and Treatment of Overweight and Obesity in Adults' Tailored for VHA primary care Multi-disciplinary, lifestyle approach

MOVE! Treatment Levels: 

MOVE! Treatment Levels Level 1: Self-management Support (via telephone) Level 2: Group Sessions and/or Individual Specialty Consultation Level 3: Weight Loss Medications Level 4: Intensive Medical Treatment Level 5: Bariatric Surgery

MOVE!23 : 

MOVE!23 23-item computerized multifactorial assessment – identifies and addresses barriers Individualized patient report with handouts Staff report incorporated into CPRS

Handouts on Internet: 

Handouts on Internet

Implementation Tools: 

Implementation Tools MOVE! Handbook MOVE! Quick Start Manual and Clinical Reference Guide MOVE! Web-based Training Web site www.move.va.gov Toolkit

Program Evaluation: 

Program Evaluation Based on RE-AIM framework: REACH - How well did the intervention reach those who needed it? EFFECTIVENESS* - Was the intervention effective? ADOPTION - Was there organizational support to deliver the intervention? IMPLEMENTATION -Was the intervention delivered properly? MAINTENANCE -Was the intervention incorporated over the long-term?

HealthierUS Veterans: 

HealthierUS Veterans VA-HHS Joint Initiative on Obesity andamp; Diabetes Prevention

Why Should VA & HHS Partner?: 

Why Should VA andamp; HHS Partner? HHS has excellent strategies, programs, research to address obesity andamp; diabetes VA is 'lab' with large patient population andamp; significant community presence 'HealthierUS Veterans' brings these together

HealthierUS Veterans: 

HealthierUS Veterans Program Components Communication campaign Partnering with community-based programs funded by CDC/HHS Volunteer Corps National promotion of VA’s MOVE! Weight Management Program Prescription for Health

Prescription for Health: 

Prescription for Health

Evaluation: 

Evaluation Outcomes to measure: Changes in patient measurements Changes in eating patterns, physical activity, quality of life Effectiveness of volunteer corps Effectiveness of promoting MOVE! to veterans, families outside VA

www.healthierusveterans.va.gov: 

www.healthierusveterans.va.gov