MOVE! multidisciplinary programs: Challenges and resources for weight management treatment in VHA

Abstract

The MOVE! program has been a successful weight management and physical activity initiative from the Veteran's Health Administration. While it embraces a multicomponent approach to weight management, local facilities have primarily focused on the implementation of delivery of MOVE! educational materials to groups or individuals. We discuss additional MOVE!-related weight management efforts within VHA that reflect treatment strategies beyond delivery of these educational materials. First, we present a case study that highlights the special challenges associated with the Veteran overweight/ obese population. Second, we describe the implementation of our local, multidisciplinary, individualized weight management clinic as an example of on-the-ground provision of a higher treatment intensity program as part of MOVE!'s multicomponent model. Third, we present program outcomes and consider challenges to program sustainability. KEYWORDSObesity, Overweight, Weight loss, Weight management, Primary care, Veterans CASE PRESENTATIONA 60-year-old white male Veteran with diabetes, hypertension, long-standing depression, and knee osteoarthritis presents to a VA multidisciplinary weight loss clinic upon referral by his primary care physician. He has already attended MOVE! educational group visits presenting information on nutrition, physical activity, and behavioral changes necessary for weight management and has made some changes but is frustrated that he has lost only 2 pounds. He has struggled with his weight for over 20 years with a few pounds gained per year, until it accelerated to 30 pounds gained over the past several years with the initiation of insulin therapy and starting an antidepressant. His current weight is 240 pounds with a body mass index (BMI) of 42 and waist circumference of 52 in. He has pain in both knees and reports that his pain score is a six out of ten. The Veteran is retired and has a limited budget for food. He has hypoglycemia several times a week and believes that it is necessary to drink juice and snack on peanut butter crackers frequently in order to prevent low blood sugars. He also endorses daytime fatigue, snoring, and mentions that his wife has noted that at times he stops breathing while he is sleeping. He limits his walking due to knee pain but reports more walking in the past month accompanied by exertional shortness of breath. He has a past diagnosis of major depression. The Veteran's medications include 70/30 insulin 55u twice a day, hydrochlorothiazide/lisinopril, amlodipine, sertraline, simvastatin, and aspirin. His recent labs include normal thyroid testing and diabetes that is only moderately well-controlled. BACKGROUNDObesity is recognized as an independent predictor of mortality [1,2] as well as a risk factor for countless other medical conditions including congestive heart failure, cancer, osteoarthritis, sleep apnea, metabolic syndrome, and diabetes [3][4][5]. Estimates show that obesity accounts for nearly 400,000 deaths annually [4]. The epidemiologic data and medical bur...