# Presentation: 931310

**HealthierUS Veterans**
- Linda S. Kinsinger, MD, MPH
- Director
- VA National Center for Health Promotion and Disease Prevention

**Notes:**

If you need to give this presentation and need assistance, please call Dr. Ken Jones at 919-383-7874 ext 228

## What is HealthierUS Veterans?

- Initiative sponsored by Departments of Veterans Affairs and Health and Human Services
- Focus on improving health of veterans and family members by encouraging healthy eating and physical activity
- Aim to reduce risk of                          obesity and diabetes

**Notes:**
The U.S. Department of Veterans Affairs (VA) and the U.S. Department of Health and Human Services (HHS) have joined forces in an effort to improve the health of the nation. 
The focus of this joint initiative, HealthierUS Veterans, is to educate veterans, their families, and communities about the health risks of obesity and diabetes and ways to reduce risk - eating healthy and being active. 

VA Secretary James Nicholson said, “Obesity and diabetes are major threats to the health and lifestyles of our veterans, deserving a robust campaign to better educate them on healthy habits.”
HHS Secretary Michael Leavitt said, “We are working to encourage Americans to adopt a healthy lifestyle and to take responsibility for making wise choices to improve their fitness and health.”

## Why Focus on Obesity and Diabetes in Veterans?

- National and VA-specific rates of obesity and diabetes are high and increasing
- Over 70% of veterans who                                 receive health care from VA are overweight or obese; over 20% have diabetes
- Veterans and families make up 1⁄4 of US population (approximately 70 million)

**Notes:**
Both national and VA-specific rates are high and are continuing to increase. 
The national prevalence of overweight/obesity is 64% and in the population of those receiving medical care within VA, the prevalence is over 70%.  Over twenty percent of veterans receiving healthcare from VA have diabetes.  
By focusing efforts to address these conditions on the population of veterans and their families, up to a quarter of the entire US population, about 70 million people, can be reached.  

## Why Should VA & HHS Partner?

- HHS has excellent strategies, programs, research to address obesity & diabetes
- VA is “lab” with large patient population & significant community presence
- “HealthierUS Veterans” brings these together

**Notes:**
Thru the agencies within HHS, an enormous amount of work has been done to develop excellent strategies, programs and the research basis to address obesity and diabetes. CDC and NIH have tremendous resources readily available to put into use. VA can be thought of as a laboratory that serves over 5 million active patients and has more than 7 million enrolled patient  VA is the nation’s largest integrated health care system with 157 major medical centers and nearly 900 community-based out-patient clinics, facilities in every state and large city and many small towns in the country. So bringing those 2 large assets together in a partnership provides a rich opportunity to: 1) improve healthy eating and physical activity among veterans, families, communities; 2) slow the increase in obesity and diabetes rates; 3) provide leadership for on-going VA-HHS collaboration in obesity and diabetes prevention.

## HealthierUS Veterans

- Program Components
- VA’s *MOVE!* Weight Management Program
- Prescription for Health
- Fitness Challenges
- Partnerships between VA medical facilities and community-based programs funded by CDC
- Fit for Life Volunteer Corps

**Notes:**
This initiative will provide substantial momentum for obesity and diabetes prevention through its program components, which include national promotion of the VA’s MOVE! Weight Management Program, a “Prescription for Health” to encourage physical activity, Fitness Challenges, partnering of VA medical facilities with “Steps to a HealthierUS” and other Centers for Disease Control and Prevention programs, and a volunteer corps of active veterans and others.  

## www.healthierusveterans.va.gov

**Notes:**
A website has been developed that explains the HealthierUS Veterans initiative, suggests ways to get involved and provides links to nutrition and physical activity resources that have been specially chosen for this initiative. 

## National Promotion of MOVE!                       Weight Management Program

- Patient-centered, comprehensive focus on behavior, nutrition, and physical activity
- Helps veterans lose weight, keep it off, and improve health
- Basic *MOVE!* Program components can be used by veterans, family members, and non-VA providers

**Notes:**
VA has developed a patient-centered weight management program called MOVE!, which is being implemented in VA medical facilities across the country. MOVE! has a comprehensive focus on behavior, nutrition and physical activity and is designed to help veterans interested in managing their weight to lose weight, keep it off and improve their health.  
Veterans first complete an online questionnaire, the MOVE!23, that asks questions about health status and eating and physical activity habits.  Their answers guide the generation of a tailored patient report with recommended handouts and instructions for follow-up with their VA healthcare team.  The VA healthcare team members help veterans to set goals and provide follow-up either in person or by telephone.  If a veteran needs more support for weight management, they can have one-on-one counseling with a dietitian, behavioral health expert or physical activity specialist.  They may also participate in group sessions on behavior, nutrition and physical activity.

Because of the multidisciplinary, tiered structure of MOVE!, many private physicians will not be able to implement the entire program in their offices, but interested persons and providers can use some of the basic components available on the MOVE! website, such as the MOVE!23 questionnaire, the over 100 patient handouts and the resource materials for health professionals.  There are also links to additional nutrition, physical activity and community resources.

## www.move.va.gov

**Notes:**
Visit the MOVE! website at www.move.va.gov.

## Prescription for Health

- States BMI and notes health                          risks if high
- Prescribes daily physical activity                   to reduce risk
- Encourages use of a pedometer                     or an odometer
- Includes a recommended number                 of steps to walk or distance to roll                   if in a wheelchair

**Notes:**
VA primary care providers give each veteran enrolled in MOVE! a pedometer, a handout that explains how to use the pedometer, and an exercise prescription for recommended physical activity, such as a number of daily steps to walk.  For those in wheelchairs, odometers can also be obtained.
For HealthierUS Veterans, activity prescription pads have been developed to tell patients their Body Mass Index (BMI); explain that an elevated BMI puts them at risk for health problems such as diabetes, high blood pressure and heart disease; and give them a recommendation to increase physical activity. Providers have the option to use a prescription for pedometer use with a goal of number of steps to walk each day or a prescription for odometer use with a wheelchair and a goal for distance rolled. 

## Prescription for Health

**Notes:**
Veterans with a doctor’s order can pick up a pedometer or odometer in Prosthetics.  Providers outside VA can use a copy of the prescription from the HealthierUS Veterans website.  Pedometers and odometers can be easily purchased at a reasonable cost.
The brochure and handout on how to use a pedometer or odometer as well as activity logs are downloadable from the MOVE! website.

## Fitness Challenges

- Can be done in a group or individually
- Group challenges can be set up                   within or between facilities or VISNs
- Register for the President’s Challenge            and track fitness activities on-line
- Encourage co-workers, veterans,                    and families to take the challenge
** **

**Notes:**
Competition and sport are ways to inspire activity.  Fitness Challenges amongst VA medical centers, “Steps to a HealthierUS” communities, and others will encourage activity and involvement.  A Fitness Challenge can be a “Walk & Roll”, mini-marathon, or other creative event. 
Take the Challenge! Be a physically active role model for your co-workers, veterans, family, and friends. You can have activity challenges by setting up your own groups on the website for local competitions. 
HealthierUS Veterans promotes the President's Challenge, a program that encourages all Americans to make being active part of their everyday lives. No matter what your activity and fitness level, the President's Challenge can help motivate you to improve. To participate, you can register and log your fitness activities online. 

## www.healthierusveterans.va.gov/FitnessChallenges

**www.healthierusveterans.va.gov/FitnessChallenges**

**Notes:**
Please use the HealthierUS Veterans website portal to access the President’s Challenge.  This allows for tracking participation of veterans, family members, VA employees, and others.

## Partnering with Steps to a HealthierUS

*Steps to a HealthierUS* programs in 40 communities address physical inactivity and  poor nutrition to reduce obesity and diabetes
- VAMCs will partner with *Steps to a HealthierUS *communities

**Notes:**
The HHS Steps to a HealthierUS program has provided funding to states, cities, and tribal entities for innovative community-based programs that seek to adopt proven measures to reduce the burden of obesity, diabetes, and asthma-related complications. The CDC’s Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases is designed to help states prevent obesity and other chronic diseases by addressing two closely-related factors: poor nutrition and inadequate physical activity. The program supports states with developing and implementing science-based nutrition and physical activity interventions.  
Part of HealthierUS Veterans includes the connection of the 40 Steps to a HealthierUS communities and 28 CDC Nutrition and Physical Activity Program states with local VA medical facilities in order to reduce health disparities and promote quality health care and prevention services.  These resulting coalitions will be charged with implementing chronic disease prevention efforts focused on reducing the burden of diabetes as well as overweight and obesity and addressing related risk behaviors - physical inactivity and poor nutrition.  
As a partner in these programs, VA can contribute to the healthcare, media, and community components of their planned activities. VA will bring to the table resources that have been developed for use in VA medical facilities which can be exported to local healthcare providers. Through media and community activities, healthy eating and physical activity can be promoted by providing a range of recipes, menus, grocery shopping suggestions, and fitness tips using materials developed by CDC, the National Institutes of Health, and VA. 

## Events Across the Country

- Washington, DC

- Boston

- Seattle

**Notes:**
National Kick-off Events to Date:
A press conference was held February 27th at the National Press Club in Washington, DC with VA Secretary James Nicholson; HHS Secretary Michael Leavitt; Surgeon General Richard Carmona, MD,MPH,FACS; and Under Secretary for Health Jonathan Perlin, MD,PhD,MSHA,FACP
A press conference occurred March 2nd with VA Secretary Nicholson and New York Mayor Bloomberg.
On May 6th, the HealthierUS Fitness Challenge at RFK Stadium in Washington, DC included HealthierUS Veterans and MOVE! exhibits as well as nutrition and fitness demos.  A presentation on the main stage included the Harlem Globetrotters; Marine Drill Instructors; VA Under Secretary for Health Jonathan Perlin, MD, PhD, MSHA, FACP; HHS Assistant Secretary for Health John Agwunobi, MD, MBA, MPH; Denise Austin; Dot Richardson, MD, PCPFS Vice Chair; and other members of the President’s Council on Physical Fitness and Sports (PCPFS).
A press conference was held May 12th at National Veterans Golden Age Games at Fort Monroe, VA by VA Secretary James Nicholson to announce MOVE!, a component of the HealthierUS Veterans initiative.
VA Secretary James Nicholson and Under Secretary for Health Jonathan Perlin, MD,PhD,MSHA,FACP visited the 26th National Veterans Wheelchair Games in Anchorage, Alaska July 3-8, 2006.
Regional Kick-off Events to Date:
The “Step Up to Health” VA Puget Sound/Steps King County partnership kick-off event at the VA Puget Sound – Seattle Division held May 13th included health screenings, nutrition counseling, hand cycling demonstrations, healthy snacks and a 1 mile walk to Columbia City.
The HealthierUS Veterans event at the West Roxbury Campus of the Boston VA Healthcare System May 19th included exhibits, a fitness walk with the Boston College Women’s Basketball Team, and healthy snacks.
Local Events:
All VA medical facilities are encouraged to host their own HealthierUS Veterans event.  
A toolkit and guide are being developed to assist VAMCs in planning events and promoting the HealthierUS Veterans initiative.

## Fit for Life Volunteer Corps

- Open to veterans, family members, and VSO groups
- Corps members may promote HealthierUS Veterans special events, Fitness Challenges and the President’s Challenge

**Notes:**
The Fit for Life Corps consists of volunteers made up of veterans, their families, friends, and anyone interested in supporting the effort. Volunteers will encourage veterans and their family members to establish and maintain behaviors that promote good nutrition, physical activity, and health and minimize risk of illness related to obesity and diabetes. 
Corps members can promote HealthierUS Veterans events, Fitness Challenges, activities of the President’s Council on Physical Fitness and Sports, and special events such as the VA Winter Sports Clinic, National Veterans Wheelchair Games, and Golden Age Games.  They can also serve as liaisons with VA medical facilities and community groups or as health and wellness event coordinators, health information coordinators, etc.

Speaker Reference:
The goals of the Fit for Life Veteran Volunteer Corps are to: 

•	Support the overall mission of the HealthierUS Veterans by encouraging veterans and their family members to 	prevent obesity and diabetes 
•	Provide volunteer resources to help realize the mission of the HealthierUS Veterans 
•	Develop partnerships with local non-profit agencies to promote health and wellness in the veteran community 
•	Generate a significant positive impact within the veteran population and the local community through health 	and wellness programs 
•	Develop positive outreach and networking opportunities with veterans service organizations and local 	community groups 
•	Celebrate, encourage and promote diversity throughout the program 

## My HealtheVet

- My Health_***e***_Vet offers tools for tracking food intake and physical activity
- Website: www.myhealth.va.gov

**Notes:**
My HealtheVet also offers tools for eating healthy, being active, and getting fit for life.  For example, veterans and family members can access online logs to keep track of what they eat and how active they are.  My HealtheVet has links to the MOVE! and HealthierUS Veterans websites.

## Ideas for Activities at VAMCs

- Establish walking trails on facility grounds
- Post reminders about taking the stairs near elevators; brighten/enhance stairwells
- Sponsor “lunch & learns” with healthy
- 	food and information about good nutrition and physical activity
- Organize farmers’ markets

**Notes:**
Here are some ideas for activities that can be done at VA medical facilities to promote healthy eating and physical activity by veterans and staff.

Speaker suggestion:
This slide should be customized or another slide added to explain what is being done locally to promote HealthierUS Veterans, MOVE!, healthy eating, and physical activity.

## Partnering with Community Organizations

- Possible activities
- Community and VAMC “Walk and Roll” events
- Share partnerships with groups such as YMCAs/ YWCAs, etc.
- Join walks sponsored by Volksport clubs
- Promote healthy eating ideas and teach shopping tips (reading nutrition labels, etc.)

**Notes:**
We will develop partnerships between VA facilities and interested “Steps to a HealthierUS” programs. We also want to link VA facilities with the CDC-funded state-level programs on physical activity and nutrition, so the coalitions leading those programs include VA representatives on their groups. As a partner in these programs, VA can contribute to the healthcare, media, and community components of their planned activities. VA will bring to the table resources that have been developed for use in VA facilities which can be exported to local healthcare providers.  VA has had success in organizing “Walk and Roll” events at VA facilities – that could be done in the community as well. We’d like to join in the partnerships with local non-profit organizations, such as YMCAs and YWCAs, so that veterans and families could enroll at a discount, to encourage them to use these facilities. Through media and community activities, we can promote healthy eating by providing a range of recipes, menus, and shopping tips, using materials that NIH and CDC have developed. We’d like to make it easy for veterans to get exercise by having fitness equipment available in places they go, such as VSO posts.

## Evaluation

- Track events and participants to measure outreach for the HealthierUS Veterans initiative.
- VA National Center for Prevention will evaluate various initiative components to understand best approaches.

## ?

**?**

- Web Site and Web-based Materials:
- _[www.HealthierUSVeterans.va.gov](http://www.healthierusveterans.va.gov/)_
- _[www.move.va.gov](http://www.move.va.gov/)__ _
- _[Linda.Kinsinger@va.gov](mailto:Linda.Kinsinger@va.gov)_

**Notes:**
Contact information for questions.