National Center for Health Promotion and Disease Prevention
HealthPOWER! Prevention News Fall 2015: MOVE! Celebrates 10 Years
Success, Challenge, Change: MOVE! Weight Management Program Celebrates 10 Years of Helping Veterans Get Healthier
In 2015, NCP’s MOVE! Weight Management Program for Veterans (MOVE!) approached its 10-year anniversary. Members of the MOVE! team recently reflected on the past and future of the program, which has continued to evolve in helping Veterans improve their health and well-being by eating wisely, moving more, and weighing less.
What has MOVE! accomplished in the past decade?
Dr. Susan Raffa, National Program Director for Weight Management: “MOVE! has really helped make obesity and overweight part of the conversation clinicians have with Veterans. We’ve been using performance measures for years to assess the program’s reach and impact, and the results are impressive. The program has a wide reach—we currently screen over 90 percent of Veterans for obesity/ overweight. And it’s had a measurably positive impact on Veteran health—a recent analysis, for example, showed that of the approximately 1 in 5 patients who have sustained, intense participation in MOVE!, most achieve stable weight loss.”
Dr. Ken Jones, former (2004-2014) National Program Director for Weight Management: “The program has been pioneering—no other U.S. health care system has really done what VA’s done with MOVE!. We’ve always been at the leading edge of weight care and prevention—many of the things that are being talked about now, we’ve been doing for years in the MOVE! Program.”
Megan Skidmore, MOVE! Physical Activity Program Coordinator: “MOVE! has touched so many Veterans’ lives over the years. In late 2013, a half-million Veterans had participated in the program, and by the late summer of 2015, that number was over 650,000 patients.”
What were some of the program’s most significant events over the years?
Suzanne Harp, MOVE! Special Projects Coordinator - Clinical Resources: “I remember our MOVE! toolkit as one of our first big accomplishments, and something that had a huge impact in the field. In 2006, just after MOVE! went national, we sent a 42-item toolkit to every facility MOVE! Coordinator and each Community- Based Outpatient Clinic (CBOC). They loved the toolkits, which had everything needed to help Veterans get started with MOVE! and make the program a success. Looking back, I think those toolkits really helped kickstart the program.”
Lynn Novorska, MOVE! Dietitian Program Coordinator: “In 2009, the U.S. Army adopted MOVE!, and that was a big deal because it required a lot of hard work and really confirmed the effectiveness and value of the program. That same year, we registered MOVE! as a service mark with the U.S. Office of Patents and Trademarks, which identified it as a unique service and was a major validation for the program.”
Sophia Hurley, former (2008-2012) MOVE! Physical Activity Program Coordinator, current Prevention Programs Coordinator: “I also remember things like the first VA Symposium on Obesity, Nutrition and Fitness, and our collaboration with the U.S. Department of Health and Human services (HHS) on the HealthierUS Veterans project, both in 2007. They were great examples of the many productive partnerships MOVE! has had over the years. In 2009, for example, we partnered with the Veterans Canteen Service and others to sponsor a national health promotion event, The Champions Challenge, which raised awareness of the HHS’ 2008 Physical Activity Guidelines for Americans. It was another one of those successful, multi-partner collaborations that helped thousands of Veterans get healthy and more physically active.”
Harp: “I feel like each new tool we developed for the program has been a significant event—each new resource has improved and enhanced the MOVE! experience for clinicians and their patients. But getting dedicated staff in permanent FTE positions (FTEs) here at NCP has been really important because it’s allowed us to consistently develop these new resources and programs for the field.”
Hurley: “Yes, and so are programs like TeleMOVE! in 2008 and Telephone Lifestyle Coaching (TLC)—first MOVE! TLC in 2009-2010, and National TLC, which we successfully piloted from 2011-2013 and hope to develop into a national program soon. These are examples of great new programs that have really extended the reach and impact of MOVE!. I also think that things like the MOVE! Handbook and the VA/DoD Clinical Practice Guideline for Screening and Management of Overweight and Obesity, which we contributed to in 2008 and 2014, were important in defining and supporting clinical practice in VA.”
Raffa: “A significant recent milestone for the program this year was the launch of MOVE! Coach, a mobile app that offers Veterans a comprehensive, weight management program, right at their fingertips. I think it shows how MOVE! has always been at or ahead of the cutting edge in clinical trends and technology.”
Karen Eisner, Project Manager: “Yes, to develop MOVE! Coach, we partnered with 11 VHA facilities to complete a full field test for the app in 2014. We learned so much from the field champions and participants during that test, and really appreciate the staff and Veterans who helped shape the design and implementation being used today. And we’ve been fortunate to partner with such a great Office of Information and Technology (OI&T) mobile development team—who provided the talent and skill to make the app a reality—and to collaborate with the VA Mobile Communications team on promoting and marketing.”
Skidmore: “And we’ve had over 6,400 downloads of MOVE! Coach through this month—so Veterans are successfully using it to get healthy and active, and better manage their weight.”
What challenges has MOVE! overcome?
Jones: “In the early years of the program, many VA clinicians were hesitant to promote physical activity for patients—mostly out of safety concerns—and wanted more training on providing weight management care to patients. We were able to overcome these issues, and MOVE! has become a model for other national programs.”
Novorska: “We’ve faced—and overcome—some other significant challenges over the past 10 years. From day one, the program has been an unfunded mandate, so at the local level, MOVE! staff, clinicians, and leadership just worked with what they had to make the program successful. There were times, like in 2013, when we weren’t sure if the program would continue, mainly because some questioned its impact on Veteran health and validity as a weight management program. Fortunately, the data have always shown that the program has clear clinical value to Veterans.”
Hurley: “Local MOVE! programs often face the challenge of limited resources. But in 2010, the local HPDP Program Managers and Health Behavior Coordinators (HBCs) got involved in supporting MOVE!. They were really able to strengthen and complement the efforts of the local VISN and Facility MOVE! Coordinators and MOVE! Physician Champions, who deserve so much praise because they are the ‘heart and soul’ of the program. In the early years, the challenges MOVE! faced were in implementation, but lately, the challenge has been to keep improving and enhancing it.”
Harp: “With less money available for travel, we don’t get out into the field as much to train staff and that’s been a challenge. We’ve relied on face-to-face training a lot over the years, and that was an important part of the program’s success.”
Raffa: “To address this issue, we’ve been doing more online training for MOVE! staff. We started doing it back in 2006, with an update in 2012 and additional updates planned for 2016. Plans are also underway to utilize other virtual training methods.”
Harp: “Stop codes were a big issue, and even though guidelines went into place in 2006, we’ve had to clarify their use with MOVE! over the years. The copay issue also was a big problem early on—Veterans were being charged for MOVE! care. Ken Jones led a 2-year process, from 2008-2009, to get the copay exemption, and we finally got it waived through a change in Federal regulations.”
Novorska: “Integrating MOVE! with CPRS was something that Ken Jones really championed from 2003-2005, and early on, he got support from VISN 8 to make it happen. The integration eventually worked, but there are still technology challenges.”
What does the future hold for the program?
Rosemary Strickland, MOVE! Special Projects Coordinator: “I’ll be interested in seeing how MOVE! looks in 5 and 10 years. VA health care continues to evolve and change, as does technology and clinical care. With the programs and products we’ve developed over the years, I think MOVE! is well-positioned for the future.”
Novorska: “One focus has been to increase physical activity programming as a healthy prevention goal, as well as for programming within MOVE!. This is an area that we can enhance by providing resources like Be Active and MOVE! (BAM) to local MOVE! programs. We’re also working on version 2 of MOVE! Coach, and hope to continue to add many more helpful features and benefits for Veterans and their families as they proceed on their journey to better health.”
Skidmore: “Recently, we’ve also seen an increase in the use of CVT with MOVE!, as well as in the use of BAM at local facilities. So we’ll continue to develop resources to support clinicians and Veterans who use these technologies.”
Raffa: “One thing we’re now planning is a State of the Art Conference in 2016 that will focus on the role of bariatric surgery in treating obese/overweight Veterans and weight management in VHA more generally, both of which are particularly relevant to our patients.”
What about MOVE! makes you most proud?
Tony Rogers, MOVE! Communications and Data Program Coordinator: “It’s really inspiring for all of us on the MOVE! team to see the program working. It’s also great to see that it’s made a difference in so many Veterans’ lives.”
Harp: “I’m most proud of all the success stories from Veterans, and the program outcomes that say ‘MOVE! works’.”
Strickland: “From the time MOVE! started, we’ve been impressed by the field staff who embraced this program and have continually worked with us to make it better. I feel like Veterans have really benefited from MOVE!.”
Eisner: “We’re very proud to be part of expanding technology offerings, with the release of MOVE! Coach as the very first mobile app to be created inhouse by the OI&T developers.”
Novorska: “MOVE! has continued to grow over time, with new programs, resources, tools, and staff, and we’ve enjoyed being part of it and seeing it happen.”
Skidmore: “It’s great that we’re able to offer MOVE! in so many ways. TeleMOVE!, group and individual MOVE! classes, MOVE! Buddy, BAM CVT, TLC, and even NCP’s Diabetes Prevention Program pilot all make weight management really accessible and user-friendly for Veterans.“
Jones: “I’m particularly proud of the multi-disciplinary nature of MOVE! and the amazing success achieved by individual Veterans. It’s been a pleasure to work with a great team at NCP and in the field, and it shows in the outcomes of MOVE! on the population- and individual-level.”
Raffa: “It’s been a privilege for me to join the team of dedicated health professionals who make MOVE! a success here at NCP and in the facilities. They all work tirelessly to champion the program and I’m inspired by their commitment to their work and Veterans. I think we all look forward to working together to make MOVE! the best program that it can be.”