16. VA's MOVE! Weight Management Program | Kelley Hagerich, MD

How can we better support our veterans in their journey to better health?

Dr. Kelly Hagerich, National Lead Physician Champion for the Veterans Administration's MOVE! weight management program, dives into a few of the unique challenges veterans face, from managing chronic diseases to addressing the impacts of sexual assault and traumatic brain injuries.

She sheds light on how MOVE! is making a difference through lifestyle medicine and highlights the power of mental health support and community connection in improving lives.

Tune in for an inspiring conversation about holistic health and the path to lasting wellness for our nation's heroes!

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Transcript

Kelley Hagerich, MD (00:00.291)
some military members walk away from an explosion and said, I'm okay. Maybe I blacked out for a few seconds, but otherwise, didn't really affect me. Whereas that might not be the case when they're developing longer term symptoms such as difficulty sleeping, memory loss, tinnitus, ringing in the ears, dizziness. So that traumatic brain injury

when it is more moderate or severe, and even in some more mild cases, has been shown to be associated with pituitary hormonal changes. So it affects the pituitary gland in the brain, and that can then in turn affect hormone levels, which then can contribute to obesity.

Bill Jollie (01:00.631)
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50 meals are donated for every item sold to the nation's largest hunger relief network. So you get to look good while feeling good. Now onto today's episode. Hey everyone, it's Jolly here with Interrupt Hunger's Move, Eat, Give podcast. Thanks for joining us today. We've got Kelly Hagerich, MD with us today, National Lead for the VA's MOVE Weight Management Program and Provider Champion. She is field-based at the Veterans Administration in

Dr. Paolo Alto is in 21. She's also medical director of bariatric surgery there. So Dr. Hagerich, welcome to the show. Thank you so much for having me. I'm very excited to be here. Why don't we start by saying what brings you to be an expert in the topic of weight management for our vets?

Yeah, well, I would say that my interest in working with veterans goes back to my childhood. Both of my grandfathers were veterans in World War II. And my paternal grandfather always encouraged me to go to medical school and funded my medical school journey. So I always wanted to give back to veterans. I did an internal medicine residency.

Kelley Hagerich, MD (03:11.533)
years ago and well, I enjoyed it. I found it disheartening that I saw so much disease that I felt could be prevented through lifestyle changes. after that, immediately after that residency, I pursued a second residency in general preventive medicine and public health, which is what brought me out to California. I wasn't

aware of the newly developed field of lifestyle medicine at that time of my residency. And it really took off in the few years after I finished my residency, which was in 2012. At that time, I chose to join the San Diego Veterans Administration as a primary care physician. And I soon discovered the weight management

clinic there because I was looking to really do more preventive medicine and health promotion. So I worked for nine years at the San Diego VA doing primary care and helping to grow the weight management program there. I really wanted to move more into full-time weight management and lifestyle medicine.

So two years ago, I transferred to the Palo Alto VA to take on a full-time position doing weight management for veterans. And then as part of my role, I also work with the National MOVE Weight Management Program as the MOVE provider champion lead, meaning I help lead the physicians, the nurse practitioners, PAs, pharmacists.

who are the provider champions at their own VA's. Very good. Thanks for that. Okay. So I think generally speaking, I like to think of stressors in a life. So as you file up more more stress, it weighs on you literally and figuratively. And the more stresses in life, are basically the harder life is. And we find over and over and over again, the more stressors you have in life, think like,

Kelley Hagerich, MD (05:30.283)
social determinants of health, obviously, the more chronic disease, the more food insecurity, the more rates, higher rates of obesity and overweight. Vets are no different. So their stress may be different. They may have multiple layers of stress, but just a typical non-vet versus a vet. Why don't you share some of these differences and some of the things that the vets encounter that might lead to higher rates of

of obesity and chronic disease. Yes. And that's a very good question. So I think veterans, one, struggle from physical illnesses and ailments that the general population does not necessarily have to deal with. The majority of my patients who are all veterans have some sort of musculoskeletal injury, whether it's back pain, neck

pain, knee injuries, shoulder injuries, like you name it. I was not in the military myself, so I can't, you know, attest to the rigors of basic training, but I've heard from a lot of them, a lot of veterans, how hard it can be on their bodies and how many of them came out of basic training with significant injuries at a young age that then...

you know, really affects their ability to do physical activities that they enjoy moving forward when they're out of the military. And also mental health is something that is definitely of significance to veterans. They have been in an incredibly stressful environment for years that they're in the military and oftentimes that

stress does not end when they become a veteran because it's just a different type of stress and still trying to deal with, you know, the things that they saw and endured during their time in the service. my, so I was, I served six years in Marine Corps reserves, didn't go overseas, never got shot at. Thankfully came out of it relatively unscathed.

Bill Jollie (07:50.937)
my, my uncle and one of my cousins, unfortunately, we're, we're not so lucky and have both been in the VA system, for quite some time. We had some, some, some, some, some fairly significant, long-term effects. So I'm, very familiar with, with what the, the VA is, is able to, to do the level of care. I've actually got to meet quite a few docs and, and

different allied health providers within the VA system. And I think one of the neatest things is how much, how much y'all really care about our vets and the honor and service they've given to their country. And it's only right that we take care of them. So I think that I love that. I love that fact, but there are some, some things that I think most Americans don't realize. we've talked a couple of times now and then there's even a couple of other things I took notes about that.

kind of some darker secrets of life in the military. One of them being the rates of sexual assault and how that can affect so much of a person. And there's just a massive bucket of stress. Another one, and I'll let you comment on these. The other one that really stood out to me is higher correlation with TBIs and obesity. So why don't you start there?

you don't mind, explain what a TBI is and then how that might have a relationship with rates of obesity among vets. So TBI stands for traumatic brain injury. you know, military members can experience these, you know, I've seen in various situations, whether falling and hitting their head, having a blast to the head or blow to the head. But then most

More commonly, our veterans are in IED explosions while in combat overseas. sorry, which is what happened to my cousin. His Humvee ran over an IED. It's a miracle he's still alive, but there's a lot that goes along with that. It is. And I think it's an under recognized injury because oftentimes it's due to the force of the explosion and.

Bill Jollie (10:12.417)
the brain moving back and forth inside the skull causing injury rather than an external blow to the head. So I think some military members walk away from an explosion and said, I'm okay. Maybe I blacked out for a few seconds, but otherwise didn't really affect me. Whereas that might not be the case when they're...

developing longer-term symptoms such as difficulty sleeping, memory loss, tinnitus, or ringing in the ears dizziness. So that traumatic brain injury, when it's more moderate or severe, and even in some more mild cases, has been shown to be associated with pituitary hormonal changes. So it affects the pituitary gland in the brain.

And that can then in turn affect hormone levels, which then can contribute to obesity.

It's not, I hope it's an area of more research in the future. Right now it's recognized, but not that I'm aware of a huge area of research. It is something that I definitely look for in my own patients and ask them about if they have had a significant TBI, I will do a hormonal screening. Okay. We'll get to this, the sexual assault topic in a moment, but I was just thinking, I know

I know a handful of folks years later that are still dealing with some significant PTSD. How might that be correlated with weight gain and chronic disease and rates of obesity? Yeah, think anecdotally I do see a correlation between military sexual trauma and weight, particularly in women, but I do want to...

Bill Jollie (12:12.365)
emphasize that sexual trauma is not limited to just women. I certainly had male patients that have experienced it. And I think it's an area that is still being unraveled and researched as to why it's associated with weight gain. Or oftentimes I see more difficulty with losing weight. And patients have told me that maybe they subconsciously gained weight after the trauma.

to feel less attractive to their attacker. And then they feel that kind of physical barrier of their weight will be protective to them. And it can be really upsetting and challenging to their sense of self when they do lose weight. So this is...

an area that we definitely do screen for and ask about, particularly prior to bariatric surgery, because we want patients to be successful long-term and not have this almost feeling emotionally naked after they lose weight. Wow. That's a lot to deal with. Just hearing it. really is. Oh my gosh. That's, you're not the first time, this isn't the first time I've heard that about some of the reasons behind the weight gain, but.

It's just heartbreaking on top of everything else. It really is. And I know it's difficult for patients to come forward with this. And I'm very thankful that they do so we can work together. You know, I work closely with a psychologist in our program. We have a dedicated psychologist to help us help patients with, deal with these issues related to their weight. That was going to be my next question. I'm sure you do quite routinely.

I mean, we'll get into this, some of the specifics of the actual program, but so being in the VA system, like all of your patients have access to that, that psychological therapy and counselors too, right? do. Yes. And I'm in a little bit different program now. I can tell you about it, but I'm in a clinical resource hub within a VISN, which is a geographic area of the VA.

Bill Jollie (14:33.933)
So I cover multiple different sites through this clinical resource hub and provide virtual care to areas that would not otherwise have access to this type of care due to often being more remote or rural. I'm based out of the VA Palo Alto, but areas I cover include Northern California, inland Central California, Las Vegas, Reno, Hawaii, Guam, and

all of the Pacific islands that we recently added. So it's great to be able to provide weight management services virtually to these areas that have not previously had as good of access as cities would. know I've seen more more promotions, advertisements within the VA and whatnot about this program. So y'all are doing a really good job of getting the message out there. I'm curious when people come to you.

Like some of them are going to be very willing and just ready to go and make changes in their life. But some are probably like somewhat hesitant about it. Can you talk to us about some of those folks and maybe how you have to approach them differently to get them started in the program? Yeah, I think, you know, we meet with patients on a wide spectrum of readiness to make

changes and we use health promotion and motivational interviewing to try to get them to identify what is meaningful and important to them and why they want to lose weight. So that's one of my first questions to a new patient is why? Why do you want to lose weight? I do probe beyond, well, I want to be healthy or I want to look better.

Oftentimes they are very willing to go deeper with me and provide that answer. Like I want to be able to roll around on the ground with my grandchildren and I want to be able to ride roller coasters again is one story that I heard a few months ago. was one of his hobbies and he exceeded the weight limit for many roller coasters. And thankfully he is now back.

Bill Jollie (16:56.845)
riding all of the roller coasters that he wants to after significant weight loss. How does that make you feel? That's so cool to hear. It is. It definitely is. OK. So why don't you tell us about the program a little bit more. You've touched on some of the virtual aspects of it. What could a vet expect when they're coming into and going through the program? So yeah, I think.

There are multiple levels to our program. So I do want to speak first about the National MOVE Weight Management Program for veterans. So the MOVE program was implemented in about 2006, or it was implemented in 2006 nationally. And it's an evidence-based behavioral curriculum.

implemented in each VA facility, often by a dietician and several other staff members. There are different sizes of programs depending on the VA facility and their patient load. But the goal is really to work on helping veterans improve their quality of life, reduce health risks, and prevent or reverse

chronic disease and focuses on helping them become confident in their own skills to lose weight or to become healthier. So that is our national program. That's one that I champion and really support. And then in our program at the VA Palo Alto, we're kind of the next step up in care. You know, we do really want patients to have gone through and

completed the MOVE programs at their own VA. And then after that, we will see them for, if they're interested in weight loss medications and or bariatric surgery. But we do still emphasize the need for ongoing lifestyle changes. That makes sense. Okay, step approach, I got it. So you might say this, but how long is the initial MOVE program? So the initial MOVE program is

Bill Jollie (19:10.145)
know, 16 sessions. So it can depend on the site, how they choose to implement it, if that's weekly, if it's bi-weekly. And then we do also have what's called a tele-move program for veterans who have work schedules that might not permit them attending classes weekly. Tele-move program is they get this kind of like electronic scale at home, they weigh themselves in

daily, the scale provides them with lessons that would be similar to what they would experience in the MOVE program. And then there is a dietitian or nurse usually who will check in with them over the phone about their weights, their goals, how they're doing. And that teleMOVE program, one session is three months or about 90 lessons. so are there some, are there some, any groups?

engagements involved with this or is that just at the, yeah, I'll just ask you that. Yeah, these, the MOVE classes and programs are almost all groups. So it is a group setting with other veterans. Prior to the pandemic, mostly they were in person, but I would say now they are mostly done via video, although many VA's do still have in-person options.

So you mentioned a little bit about the one patient in the roller coaster. Is there like a success story or two that you might be able to share and just that you were able to witness the transformation in front of you? Yeah, without giving too many details away. had a patient who came to us maybe a little over a year ago, really struggling with their weight.

unsure about how to move forward and feeling very socially isolated because of their weight, did not want to really leave their home at all. So through our virtual program, you know, I worked with them, our dietician worked with them, our psychologist, and we have a physical therapist who provides virtual exercise classes every day that veterans can join remotely.

Bill Jollie (21:35.27)
And this veteran really took advantage of these resources and worked really hard. Came to Palo Alto for bariatric surgery, was successful. It was very difficult for this veteran because of to travel. They did not travel frequently. They were fearful about traveling outside of their home. Very anxious about it, but did well.

went home and continued working with us at this point has lost over a hundred pounds, is feeling much more confident, has a significant other, now has traveled to another state for their first vacation ever in their life. you know, is their whole life has been changed and they express gratitude. And we are just so happy at how well this veteran has

done not just with his or her weight, but also with the entire life change. different. Yeah. I like saying if you want to, if you want to change your life, you actually have to change your life. Yes. It's, well, that is so cool. That's, that must've made you feel pretty amazing and keep driving you to help others. So I'm sure, you know, stories like these filter through your own.

hospital, own station, vision, and across the country. Are you finding more more physicians outside your specialty are becoming more open to this and talking to their patients or sending their patients to you? Definitely. When I started out in 2012, everyone was like, you want to work in the weight management program? Why? I'm like, well, this is what I really want to do.

I remember when I graduated from my internal medicine residency, I was telling a cardiologist before I left about my plans to do preventive medicine. He's like, that's great, but just don't prevent too much disease. Because we still want to have a job. And now I feel that the tide is shifting and there is just a growing interest in health and wellness.

Bill Jollie (23:54.448)
changing lifestyle just got back last week from the American college of lifestyle medicine conference. And there were over 4,000 attendees this year. Yeah. My first conference with the American college of lifestyle medicine was 10 years ago in 2014. And there was just a couple hundred attendees at that time. That's, that's, that's amazing. It's kind of funny how many of my episodes have got folks that are, are board certified.

in lifestyle medicine, there's probably a reason for that. So, y'all are actually pretty cool people. do it, do an amazing work. That's actually a good segue. Why don't you, why don't you introduce folks if they're not aware of the American College of Lifestyle Medicine and kind of generally what, what, about the six pillars and, and then we'll get into how lifestyle medicine fits into the VA. but, but what is the American College of Lifestyle Medicine?

Yeah, so the American College of Lifestyle Medicine is, you know, a medical organization that promotes lifestyle medicine, education, research, clinical care, and just advancing the specialty. Lifestyle medicine was recently inducted as a medical specialty with the American Medical Association. was just a few months ago. Lifestyle medicine is

A field in which lifestyle changes are used as the primary treatment to treat and prevent chronic disease like obesity, diabetes, heart disease. And lifestyle medicine has six pillars of health and wellness, including a focus on whole food, plant forward eating, healthy physical activity, restorative sleep, stress management.

avoidance of risky substances and positive social connection and community. neat. Yeah. Just kind of basics of how we should be living ourselves and with each other. It's pretty neat. What about lifestyle medicine? let me ask first. So can any type of doctor that's or any type of specialty be a lifestyle medicine certified as well? Yes.

Bill Jollie (26:19.352)
So any type of specialty and I have met physicians from, you know, anywhere from an orthopedic surgeon, to pediatrician, to internal medicine, like running the gamut. But it's not just physicians, it is, you know, clinicians with many different backgrounds. So physical therapists, psychologists, dietitians, know, social workers.

So that is what I really like about it is that, you know, all of us can contribute our slightly different expertise to move this field forward. it pretty much sounds like anybody in healthcare should have a lifestyle medicine certification. Yes. And I will say I had developed a neck injury myself last year. I've seen my physical therapist frequently.

And I talked about lifestyle medicine so much that she attended the conference this year. that's great. Good for you. You should get a finder's fee for that. Very good. let's see here. Okay. So, so even though we've been talking about weight a lot, that is not the, is not the only measure. What other kind of.

outcomes or measurements, maybe they're biomarkers or something, but what are the measurements besides actual weight loss is important to you that you're talking to your patients about? Yeah. And I think that's a really important point because we do talk a lot about weight and right now we still use BMI, which is body mass index, which is weight over height. And it's an imperfect measure. And I think that's becoming well aware.

You know, it doesn't account for like body distribution, ethnicity, gender. So it's an okay screening measure, but yes, we should be looking at other outcomes and other, other measures. I mean, I do always ask the patient their weight goals when they come into our program, just to kind of have an idea, but also what are their other health goals? So I do like to know.

Bill Jollie (28:36.804)
You know, do they want to improve their diabetes or try to get off insulin? Do they want to prevent their risk for heart disease because they had multiple family members that died of heart attacks in their face? You know, or do they want to get back to playing tennis, different health and other goals? But then we do look at some other objective measures.

waist circumference can be helpful in many situations to look at because elevated waist circumference can be fairly closely correlated with cardiovascular disease. You know, I look at blood sugar, blood pressure, cholesterol. These are all more objective measures that we will look at as well. So it's got to be incredible feeling for you and obviously for the patient.

When someone after going through your program and making some significant life changes is actually able to stop taking insulin or, know, they get their blood pressure under control, they're able to stop another medicine, that's gotta be a great feeling. It's great. I do like, that is one of my favorite parts is, can I discontinue all of your medications from your chart because you don't need them anymore. Yeah. It's great. And they of course love it.

as well, because if you wouldn't love stopping a bunch of medications. What are you most excited about like in the future? The near term, because anybody that's in healthcare or managed care or just trying to get folks healthy, it feels like the momentum's shifting in society at large. I someone say that folks are just hungry to be healthy.

So yeah, what are you most excited about in the near term? Well, I think just I'm most excited about continuing to work with patients, continuing to educate, you know, my colleagues and my work with the American College of Lifestyle Medicine. I'm the co-chair of the VA DOD member interest group for the American College of Lifestyle Medicine. We are really working to bring lifestyle medicine.

Bill Jollie (30:53.52)
to the VA and to the DOD. It's there already, but we want to spread it. And then also to spread veterans' stories of their health and lifestyle changes and find ways to allow them to tell what a difference it's made. So that is what I think we're going to be working on over this upcoming year. good. Well, I know that just from Perk- from-

Previous conversations, your working group there within the VA is growing by leaps and bounds. So I know y'all are, I know it's taken a lot of work to get there, but y'all got to be so proud of how far you've come and just this new level of excitement within the VA, as you know, all aspects of medicine and healthcare as I'm talking to folks. And I will say that I wrote a book chapter last year along with

32 other female physicians boarded in lifestyle medicine about how lifestyle medicine either changed our personal or professional lives. And we self-published this book. It's available most places such as Amazon, Target, it's called How Healers Heal. How Healers Heal. How Healers Heal and lifestyle medicine physicians transforming healthcare in their own health.

And I thank Mary Ann, my co-chair with this member interest group. And I would like to start compiling veteran stories about how they healed using lifestyle medicine. like a wonderful project. Can't wait to hear more. Well, the, so this has been wonderful. Thank you so much for your time and, taking us down your journey and what it's like within, you know, for our vets within,

our VA healthcare system, y'all are doing amazing work, taking care of some of our American neighbors that need the most help. So thank you for everything you're doing. What might you like to leave us with today? Is there any parting words of wisdom? My parting words of wisdom is that I think that the VA healthcare system has come such a long way over

Bill Jollie (33:15.834)
the past several decades, even just over the past decade. And I really want to encourage veterans who've not been involved with the VA to please consider it. There are so many programs available to help you, whether it's with nutrition, physical activity, social connection, there's programs for you. you know, I think VA employees really do care and want

to help you live your best life. That's health-proof. It's wonderful. Thank you so much for that. Somebody's listening here, anyone working in the healthcare field or out of VA, how can they learn more about this or reach out to you? Yeah, so I'm pretty active on LinkedIn. You can find me under my name, Kelly Hagerig. Also, I'm open to emails at kehagerig at gmail. All right, wonderful. And it's K-E-L-L-E-Y.

from anyone listening. Well, Dr. Hagerich, thank you so much. You've been great. And this has been a very worthwhile conversation today. So thank you very much. Well, thank you so much for having me. You bet. All right. Take care. Thanks.

Bill Jollie (34:35.654)
Thanks so much for listening. Please rate and review the podcast on the platform of your choice so we can reach more people and more people are recommended this podcast. And if you really liked it, the single best way you can help us grow is by telling your friends. Now for all the legal stuff. The views and opinion expressed in this program are those of the speakers and do not necessarily reflect the views or positions of any entities they represent. For my day job, I'm an employee of ABB and appear on this podcast on my own accord and not in the professional capacity as an ABB employee.

All viewpoints provided are my personal opinions and not intended to reflect those of my employer. If you have any questions or comments, please shoot me an email at jolly at interrupt hunger.org. Let's go spread some joy people.