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PPO 09-297 – HSR&D Study

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PPO 09-297
Identifying Patterns of BMI Change in OEF/OIF Veterans
Patricia Hirt Rosenberger PhD
VA Connecticut Healthcare System West Haven Campus, West Haven, CT
West Haven, CT
Funding Period: April 2010 - March 2011

BACKGROUND/RATIONALE:
OEF/OIF veterans represent the newest and youngest veteran cohort to utilize VA healthcare services. Weight management is already a concern in active duty military personnel, with 62% males and 32% females overweight. Differences in the prevalence of overweight/obesity and rates of post-deployment body mass index (BMI) gain or loss have been reported between female and male veterans and among different ethnic groups, indicating that different factors may be associated with BMI trajectories across these groups. Identifying BMI trajectory subgroups within the OEF/OIF veteran population as they begin to utilize VA services promotes the VA mission of healthcare promotion and disease prevention. We examined patterns of BMI change to provide a deeper understanding of the 'weight change timeline' beginning at entry into VHA post-deployment.

OBJECTIVE(S):
The objective of this pilot study was to identify patterns of BMI in Veterans returning from OEF/OIF. The first aim was to determine BMI trajectories in returning OEF/OIF veterans beginning at first year post-deployment. We hypothesized that a minimum of four trajectories would be identified, and that the trajectories would vary by post-deployment BMI. The second aim was to examine whether sociodemographic factors were associated with BMI trajectory membership. We hypothesized that trajectories would vary by gender and race, and that fluctuating trajectories would be more associated with female Veterans.

METHODS:
The study sample included 16,656 OEF/OIF Veterans post-deployment and entering the Veteran Healthcare Administration (VHA) healthcare system. The Veterans had 1) a VHA encounter within one year post-deployment with height and weight data, and 2) a minimum of six additional encounters with weight data within a designated six year time frame (2001 - 2007). Data was extracted from national electronic VA sources and included height, weight, and additional demographic data. We used latent class trajectory modeling, both within the full sample and by sex, to identify clinically distinct trajectories of BMI change, and to determine whether sociodemographic characteristics were associated with trajectory membership

FINDINGS/RESULTS:
At first visit, 69.9% of male and 49.8% of female Veterans were overweight/obese. Five trajectories determined in the full sample were primarily differentiated by their post-deployment initial BMI, ranging from 21.9 to 38.0. Fluctuating trajectories were not more likely to be associated with female Veterans. However, greater BMI fluctuation and increase, older age, and male sex were associated with trajectory groups with higher initial BMI. Separate models for male and female Veterans found that male Veterans with higher education and white female Veterans were associated with lower initial BMI.

IMPACT:
The study identifies sociodemographic characteristics associated with BMI change in OEF/OIF Veterans post-deployment. Study results target risk factors associated with Veteran BMI increase beginning at entry into the VHA healthcare system, and promotes the development of weight interventions in VHA appropriate for OEF/OIF Veterans at earliest VHA healthcare involvement. The model may have broad and important implications for future VA research and clinical care.

PUBLICATIONS:

Conference Presentations

  1. Rosenberger PH, Mattocks KM, Brandt CA, Haskell S. Obesity and Health Comorbidities in OEF/OIF Veterans: Early Associations. Poster session presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  2. Rosenberger PH, Ning Y, Brandt CA, Allore H, Haskell S. OEF/OIF Veterans following deployment: BMI change trajectory groups. Poster session presented at: Society of Behavioral Medicine Annual Meeting and Scientific Sessions; 2011 Apr 27; Washington, DC.
  3. Rosenberger PH, Brandt CA, Ning Y, Allore H. Gender differences in trajectories of body mass index in OEF/OIF veterans. Poster session presented at: VA Women's Health Research Conference; 2010 Jul 14; Washington, DC.
  4. Rosenberger PH, Brandt CA, Nong Y, Allore H. Gender Differences in Post Deployment Body Mass Index (BMI) Change in OEF/OIF Veterans. Paper presented at: VA Women's Health Research Conference; 2010 Jul 2; Arlington, VA.


DRA: Other Conditions
DRE: Epidemiology
Keywords: Predictive Modeling, Risk Factors, Statistical Methods
MeSH Terms: none