Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

IIR 17-047 – HSR Study

IIR 17-047
Body Mass Index (BMI) Risk Zones and Variations in Obesity Detection in Veterans with Spinal Cord Injury (SCI)
Dan Eisenberg, MD MS
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: January 2020 - December 2022


Background. Obesity is a chronic disease that is associated with significant morbidity and mortality, and is a national healthcare and public health concern. The prevalence of obesity is high among U.S. Veterans, with more than two-thirds being overweight or obese. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) classify “overweight” and “obesity” as a body mass index (BMI) > 25 kg/m2 and > 30 kg/m2, respectively; as such, BMI assessment is an established standard of care that is supported by the Healthcare Effectiveness Data and Information Set (HEDIS) and is a CMS Physician Quality Reporting System (PQRS) cross-cutting measure. The Departments of Veterans Affairs and of Defense mandate annual universal BMI screening of Veterans for overweight and obesity. Significance. Obesity in individuals with spinal cord injury (SCI) is common due to changes in body composition, changes in energy balance, and a significant decrease in mobility. However, due to these changes, it is likely that BMI underestimates obesity and obesity-related risk in patients with SCI, compared to able-bodied individuals. Because of physical and logistical barriers to conducting height and weight assessments in Veterans with SCI, we suspect that BMI is not consistently measured in this population. Innovation. Appropriate detection and management of obesity in Veterans with SCI relies on consistent measurement of BMI and proper interpretation of BMI when it is assessed. To better understand the burden of obesity in this vulnerable Veteran population and to identify individuals at risk for obesity-related morbidity, we propose to describe system-wide variation in BMI assessment. In addition, we plan to determine the longitudinal associations between BMI and obesity-related risk in Veterans with SCI in order to determine if SCI-specific adjusted BMI risk zones are needed to properly recognize obesity and risk for comorbidity in this population. Specific Aims. Thus, our goals for this project are three-fold: 1) To characterize guideline-concordant BMI assessment in Veterans with SCI in FY16-FY18. 2) To qualitatively understand drivers of facility-level variation in BMI assessment in Veterans with SCI. 3) To evaluate and calibrate SCI-spceific, adjusted BMI-based morbidity risk zones in Veterans with SCI. As such, we will identify Veterans with SCI at risk for obesity-related morbidity whose obesity status, based on current conventional BMI risk zones, would be undetected. Methodology. We will determine facility-level annual proportions of Veterans with SCI that receive guideline-concordant BMI assessment; then identify elements that could influence implementation of BMI assessment strategies by interviewing Veterans and providers in pre-selected facilities; and finally calibrate BMI risk zones in this population by characterizing the functional form of the relationship between BMI and onset of obesity-related comorbidities. Next Steps. By identifying promising practices and key barriers to providing high quality guideline- concordant care to Veterans with SCI, this work hopes to inform practice and system organization for improved care and decreased undersirable variation. In future study, the information collected here will be used to design implementation and improvement strategies to facilitate guideline-concordant practices for Veterans with SCI throughout VHA, and especially in locations with currently low performance. Evaluating the need for adjusted BMI risk-zones specific to Veterans with SCI will allow providers to identify SCI patients who are at risk for obesity and the development of obesity-related disease, who may otherwise be undetected. Dissemination of these results throughout VHA will improve understanding of the risk of obesity and obesity-comorbidity in this vulnerable population.

External Links for this Project

NIH Reporter

Grant Number: I01HX002432-01A2

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


Journal Articles

  1. Eisenberg D, Arnow KD, Barreto NB, Davis K, LaVela SL, Frayne SM, Nevedal AL, Wu J, Harris AHS. Interaction between increasing body mass index and spinal cord injury to the probability of developing a diagnosis of nonalcoholic fatty liver disease. Obesity science & practice. 2023 Jun 1; 9(3):253-260. [view]
  2. LaVela SL, Wu J, Harris AHS, Frayne SM, Nevedal AL, Arnow KD, Barreto NB, Davis K, Eisenberg D. Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries. The journal of spinal cord medicine. 2022 Nov 30; 1-11. [view]
  3. Eisenberg D, LaVela SL, Frayne SM, Chen R, Barreto NB, Wu J, Nevedal AL, Davis K, Arnow KD, Harris AHS. Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked? Obesity facts. 2022 Mar 9; 15(3):451-457. [view]
  4. LaVela SL, Wu J, Nevedal AL, Harris AHS, Frayne SM, Arnow KD, Barreto NB, Davis K, Eisenberg D. The impact of the COVID-19 pandemic on individuals living with spinal cord injury: A qualitative study. Rehabilitation Psychology. 2023 Feb 1; 68(1):12-24. [view]
  5. Nevedal AL, Wu J, LaVela SL, Harris AHS, Frayne SM, Arnow KD, Barreto NB, Davis K, Eisenberg D. Why may patients with spinal cord injury be overlooked for obesity screening in the Veterans Health Administration? Qualitative research of the perspectives of patients and healthcare providers. Disability and rehabilitation. 2024 Jan 1; 46(2):270-281. [view]

DRA: Brain and Spinal Cord Injuries and Disorders
DRE: TRL - Applied/Translational
Keywords: Healthcare Algorithms, Patient Preferences, Quality of Care
MeSH Terms: None at this time.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.