WASHINGTON – For veterans, one of the riskiest times for weight gain is immediately following discharge. The transition from the active military lifestyle to a relatively sedentary one can be a struggle for former servicemembers who are trying to maintain healthy weight and physical fitness levels.
That’s why, from the day a new veteran enters the VA healthcare system, healthcare providers begin tracking weight and offering tools to help them avoid putting on pounds.
“Like other Americans, the veterans that are younger are having problems with overweight and obesity,” explained Kenneth Jones, PhD, VA’s national program director for weight management. “Their levels of obesity are pretty comparable to older veterans. The magnitude of that obesity is just not as great.”
VA has a fairly intensive surveillance program for all veterans, young and old, with the goal of measuring weight at least once a year.
“Then we typically use computerized tools to notify when a patient is falling into an obesity range,” Jones said. “Our program has done a lot of work to help nurses and physicians to talk to patients in an effective way, to talk about the risks of obesity and then invite them to participate in the MOVE! program.”
MOVE! is a comprehensive program to promote healthy lifestyle changes in veterans, focusing on diet and physical fitness.
VA is particularly concerned about young veterans who enter its care already qualifying as obese or overweight. In a study headed by Patricia Rosenberger, PhD, at the West Haven, CT, VAMC, the VA looked at 16,656 Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) veterans entering VA care. Looking at data that tracked those patients over six years, Rosenberger observed how their body mass index (BMI) changed over time.
She found that those veterans who started out overweight were more likely to gain weight as they age.
“We’re effectively screening everybody who comes in,” Jones said. “And if they’re considered obese, or even if they’re overweight but have an obesity-related condition like diabetes, prematurely worn out knees and ankles or sleep apnea, we’ll offer participation in MOVE!”
MOVE! for Younger Veterans
Younger veterans are more likely to have families and work full-time, so VA is attempting to tailor MOVE! to their busy schedules.
“We’ve been working to maintain the core elements of MOVE! while making participating as readily available as possible,” Jones said. “We try to do that how, when and where these veterans like to participate.”
This includes a significant expansion of the Telemeter program, a program allowing veterans to remotely participate in MOVE! on a daily basis. Home-messaging devices connected to a patients’ scales automatically sends information to their VA physicians. For veterans without a landline telephone – hich is increasingly common – there is also an option to call in or be contacted daily.
VA also is developing a mobile application called MOVE! COACH. Inspired by the successful PTSD COACH app, it is being designed to help users self-monitor their diet and fitness goals. The application includes 11 self-management guides, which include videos and weight loss and fitness tips as well as tricks to help patients succeed in MOVE!
“What’s really cool is that, because we have an integrated system of records, we’re building an interconnectiveness into the application,” Jones said. “Veterans who want to share data with their medical team can do so.”
That physician-to-patient connection is important, Jones said. “The literature pretty clearly shows that connecting clinicians and patients and helping them problem-solve is critically important.”
MOVE! also encourages veterans to include their families in their diet and fitness goals.
“Weight occurs in the context of a family,” Jones said. “It doesn’t make sense for one person [in a family] to change their diet.”
An example of a very simple and effective tool that can be used by whole families are placemats being given away in VA medical center stores and canteen services. Using HHS and USDA guidelines, the placemats illustrate on a to-scale 9-inch plate how food groups should be portioned in a healthy diet — half fruits and vegetables, one-quarter protein and one-quarter starches.
“Our ideal is that every person at the table would see this,” Jones said. “It’s just so simple.”
Meeting Weight-Control Goals
MOVE! recognizes the difficulty of controlling weight gain and focuses on maximizing patient motivation. Patients are encouraged to set physical activity goals in proportion to what they would like to lose. If their weight starts to creep up, VA caregivers will counsel them on what they can do to change their lifestyle habits.
“Patients do get stuck,” Jones said. “That’s where the clinician can be very helpful. Often the patient can figure out what to do, and sometimes they need advisement.”
The program has been especially successful in spurring long-term weight loss. According to VA data, patients who succeed in losing weight and keeping it off for six months are keeping it off two years later.
“We think we’re helping people make permanent lifestyle changes,” Jones said.
For some veterans, however, losing weight can be more difficult than for others. In response, about 40% of VA hospitals have a program called MOVE! Intensive. It involves more one-on-one sessions each week and can include meal replacement therapies. There also are two residential MOVE! Intensive programs in Minneapolis and Saginaw, MI.
The Food and Drug Administration also has recently approved two medications – Qysmia (phentermine and topiramate extended-release) and Belviq (lorcaserin hydrochloride) – both aimed at reducing obesity. According to Jones, at least oneof those is expected to be added to the VA formulary in the near future.
Both drugs are indicated as adjuncts to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of 30kg/m2 or greater (obese), or 27kg/m2 or greater (overweight) in the presence of at least one weight-related co-morbid condition (e.g., hypertension, dyslipidemia, type 2 diabetes).
However veterans succeed in losing weight, Jones suggested that success helps draw others into the program. A relatively recent addition to VA’s MOVE! website are links to testimonials from veterans who have succeeded with the program.
One of those is from a veteran who enrolled in MOVE only after reading one of the testimonials on its site, and is now sharing his success story in hopes of persuading others to join.