BACKGROUND/RATIONALE:
There are more than 700,000 Veterans with severe obesity (body mass index >=35). These Veterans exert significant costs on the VA system, experience poorer quality of life, and have shortened lifespans. Bariatric surgery is the most effective treatment for severe obesity for weight loss, comorbidity resolution, and quality of life. Yet less than 0.5% of Veterans who qualify for bariatric surgery undergo it. Reasons for low utilization are unclear, although our preliminary research suggests that there are various patient, provider and system level barriers to severe obesity care.

OBJECTIVE(S):
This CDA proposal addresses the VA's urgent need to 1) understand the barriers to severe obesity care within VA; 2) test interventions designed to improve communication between providers and Veterans regarding severe obesity treatment options, including bariatric surgery and behavioral weight management strategies; and 3) characterize management practices surrounding severe obesity care within VA.

METHODS:
Aim 1 will include semi-structured interviews with Veterans with severe obesity and providers who treat them, including PCPs, MOVE! team members and bariatric surgery program members. Facilitators and barriers to bariatric surgery and MOVE! program participation as well as attitudes and experiences of providers and patients who have pursued bariatric surgery in VA will be identified. Aim 2 will include the development, refinement and pilot-testing of a communication tool designed to enhance shared decision-making for severe obesity treatment. For Aim 3, a national survey of VA PCPs will be administered in attempt to understand how PCPs manage severely obese patients and how severely obese patients engage with the MOVE! program.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The knowledge generated in this CDA will advance our understanding of the patient, provider and work system elements that contribute to low levels of bariatric surgery utilization. This will provide potential targets for optimizing clinical programs, such as MOVE! and bariatric surgery, that offer severe obesity care within the VA. It will also provide information on whether a communication tool designed to enhance shared decision-making is feasible and acceptable to Veterans and providers. Completion of these aims will provide the foundation for a future, multi-site randomized trial, evaluating the efficacy of the communication tool.

PUBLICATIONS:

Journal Articles

1. Funk LM, Alagoz E, Murtha JA, Breuer CR, Pati B, Eierman L, Jawara D, Farrar-Edwards D, Voils CI. Socioeconomic disparities and bariatric surgery outcomes: A qualitative analysis. American journal of surgery. 2023 Apr 1; 225(4):609-614.
2. Murtha JA, Venkatesh M, Liu N, Jawara D, Hanlon BM, Hanrahan LP, Funk LM. Association between neighborhood food environments and bariatric surgery outcomes. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2022 Dec 1; 18(12):1357-1364.
3. Murtha JA, Liu N, Birstler J, Hanlon BM, Venkatesh M, Hanrahan LP, Borza T, Kushner DM, Funk LM. Obesity and "obesity-related" cancers: are there body mass index cut-points? International journal of obesity (2005). 2022 Oct 1; 46(10):1770-1777.
4. Murtha JA, Alagoz E, Breuer CR, Eierman L, Jawara D, Farrar-Edwards D, Voils CI, Funk LM. Impact of COVID-19 on the Postoperative Bariatric Surgery Patient Experience. Annals of surgery. 2023 Apr 1; 277(4):e745-e751.
5. Gonzalez L, Pawlik TM, Kibbe MR, Williams B, Vicente D, O'Leary MP, Velopulos CG, Funk LM. The 2020 Pandemics: Lessons Learned in Academic Surgery and Beyond. The Journal of surgical research. 2022 Aug 1; 276:A1-A6.
6. Funk LM, Alagoz E, Jolles SA, Shea GE, Gunter RL, Raffa SD, Voils CI. A Qualitative Study of the System-level Barriers to Bariatric Surgery Within the Veterans Health Administration. Annals of surgery. 2022 Jan 1; 275(1):e181-e188.
7. Murtha JA, Alagoz E, Breuer CR, Finn A, Raffa SD, Voils CI, Funk LM. Individual-level barriers to bariatric surgery from patient and provider perspectives: A qualitative study. American journal of surgery. 2022 Jul 1; 224(1 Pt B):429-436.
8. Funk LM, Breuer CR, Venkatesh M, Muraveva A, Alagoz E, Hanlon BM, Raffa SD, Voils CI. Protocol and short-term results for a feasibility randomized controlled trial of a video intervention for Veterans with obesity: The TOTAL (Teaching Obesity Treatment Options to Adult Learners) pilot study. Contemporary clinical trials communications. 2021 Sep 1; 23:100816.
9. Liu N, Venkatesh M, Hanlon BM, Muraveva A, Johnson MK, Hanrahan LP, Funk LM. Association Between Medicaid Status, Social Determinants of Health, and Bariatric Surgery Outcomes. Annals of surgery open : perspectives of surgical history, education, and clinical approaches. 2021 Mar 1; 2(1):e028.
10. Maciejewski ML, Smith VA, Berkowitz TSZ, Arterburn DE, Mitchell JE, Olsen MK, Liu CF, Livingston EH, Funk LM, Adeyemo A, Bradley KA. Association of Bariatric Surgical Procedures With Changes in Unhealthy Alcohol Use Among US Veterans. JAMA Network Open. 2020 Dec 1; 3(12):e2028117.
11. Johnson MK, Venkatesh M, Liu N, Breuer CR, Shada AL, Greenberg JA, Lidor AO, Funk LM. pH Impedance Parameters Associated with Improvement in GERD Health-Related Quality of Life Following Anti-reflux Surgery. Journal of Gastrointestinal Surgery : Official Journal of The Society For Surgery of The Alimentary Tract. 2021 Jan 1; 25(1):28-35.
12. Liu N, Greenberg JA, Xu Y, Shada AL, Funk LM, Lidor AO. Phone follow-up after inguinal hernia repair. Surgical endoscopy. 2021 Sep 1; 35(9):5159-5166.
13. Maciejewski ML, Smith VA, Berkowitz TSZ, Arterburn DE, Bradley KA, Olsen MK, Liu CF, Livingston EH, Funk LM, Mitchell JE. Long-term opioid use after bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2020 Aug 1; 16(8):1100-1110.
14. Mamidipalli A, Fowler KJ, Hamilton G, Wolfson T, Covarrubias Y, Tran C, Fazeli S, Wiens CN, McMillan A, Artz NS, Funk LM, Campos GM, Greenberg JA, Gamst A, Middleton MS, Schwimmer JB, Reeder SB, Sirlin CB. Prospective comparison of longitudinal change in hepatic proton density fat fraction (PDFF) estimated by magnitude-based MRI (MRI-M) and complex-based MRI (MRI-C). European Radiology. 2020 Sep 1; 30(9):5120-5129.
15. Koebe S, Greenberg J, Huang LC, Phillips S, Lidor A, Funk L, Shada A. Current practice patterns for initial umbilical hernia repair in the United States. Hernia : The Journal of Hernias and Abdominal Wall Surgery. 2021 Jun 1; 25(3):563-570.
16. Liu N, Birstler J, Venkatesh M, Hanrahan LP, Chen G, Funk LM. Weight Loss for Patients With Obesity: An Analysis of Long-Term Electronic Health Record Data. Medical care. 2020 Mar 1; 58(3):265-272.
17. Liu N, Funk LM. Bariatric Surgery Trends in the U.S.: 1% is the Loneliest Number. Annals of surgery. 2020 Feb 1; 271(2):210-211.
18. Shea GE, Johnson MK, Venkatesh M, Jolles SA, Prout TM, Shada AL, Greenberg JA, Lidor AO, Funk LM. Long-term dysphagia resolution following POEM versus Heller myotomy for achalasia patients. Surgical endoscopy. 2020 Apr 1; 34(4):1704-1711.
19. Liu N, Cusack MC, Venkatesh M, Pontes AL, Shea G, Svoboda DC, Greenberg JA, Lidor AO, Funk LM. 30-Day Outcomes After Intraoperative Leak Testing for Bariatric Surgery Patients. The Journal of surgical research. 2019 Oct 1; 242:136-144.
20. Jolles SA, Alagoz E, Liu N, Voils CI, Shea G, Funk LM. Motivations of Males with Severe Obesity, Who Pursue Medical Weight Management or Bariatric Surgery. Journal of laparoendoscopic & advanced surgical techniques. Part A. 2019 Jun 1; 29(6):730-740.
21. Kleppe KL, Xu Y, Funk LM, Wang X, Havlena JA, Greenberg JA, Lidor AO. Healthcare spending and utilization following antireflux surgery: examining costs and reasons for readmission. Surgical endoscopy. 2020 Jan 1; 34(1):240-248.
22. Pooler BD, Wiens CN, McMillan A, Artz NS, Schlein A, Covarrubias Y, Hooker J, Schwimmer JB, Funk LM, Campos GM, Greenberg JA, Jacobsen G, Horgan S, Wolfson T, Gamst AC, Sirlin CB, Reeder SB. Monitoring Fatty Liver Disease with MRI Following Bariatric Surgery: A Prospective, Dual-Center Study. Radiology. 2019 Mar 1; 290(3):682-690.
23. Taylor LJ, Xu K, Maloney JD, Voils CI, Weber SM, Funk LM, Abbott DE. Deficiencies in postoperative surveillance for veterans with gastrointestinal cancer. Journal of Surgical Oncology. 2019 Mar 1; 119(3):273-277.
24. Walle KV, Funk LM, Xu Y, Davies KD, Greenberg J, Shada A, Lidor A. Persistent Dysphagia Rate After Antireflux Surgery is Similar for Nissen Fundoplication and Partial Fundoplication. The Journal of surgical research. 2019 Mar 1; 235:52-57.

Journal Other

1. Liu N, Funk LM. Comment on: Predictors of postoperative emergency department visits without readmission after laparoscopic bariatric surgery. Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery. 2020 Oct 1; 16(10):1489-1490.

DRA: Diabetes and Other Endocrine Disorders, Other Conditions
DRE: Technology Development and Assessment
Keywords: Outcomes - Patient
MeSH Terms: none