Study Assesses VA Care for Obese Veterans
Obesity is associated with substantial morbidity and is a modifiable risk factor for a variety of chronic illnesses. In response to dramatic increases in obesity rates, clinical practice guidelines have urged healthcare providers to prevent and treat obesity more aggressively. This retrospective cohort study sought to describe the proportion of obese Veterans in VA primary care who received obesity care over a five-year period, and to identify patient-level factors that predict receipt of such care. Using VA data, investigators assessed body mass index (BMI) and obesity-related healthcare for 264,667 Veterans who received most of their primary care in six geographically diverse VISNs between FY02 and FY06. Investigators specifically examined outpatient visits for individual or group education or instruction in nutrition, exercise, or weight management; receipt of prescriptions for FDA-approved medications for weight reduction; and receipt of bariatric surgery. Sociodemographics and comorbidity also were assessed.
Findings show that 88.6% of Veterans had sufficient heights and weights recorded to calculate BMIs, and 35.5% met criteria for obesity. Of those Veterans identified as obese, only 27.7% had an obesity diagnosis in FY02; by 2006, 53.5% had an obesity diagnosis. Although suboptimal, these rates are comparable or better than those recently reported in the public sector. Results also show that an obesity diagnosis, and not BMI per se, was the strongest predictor of receiving obesity-related education. Only about 10-13% of obese Veterans received individual or group outpatient education in nutrition, exercise, or weight management on an annual basis, and only about one-third received any obesity-related education over the five-year study period. Obese Veterans who were older than 65 years, prescribed fewer types of medications, or lacking an EMR diagnosis of obesity or diabetes were less likely to have outpatient obesity-related education. Investigators also found limited utilization of weight loss medications and bariatric surgery, which may be partially due to system barriers such as access to surgery and medications.
Author note: Beginning in 2006, VA issued policies and provided facilities with tools to systematically identify obese patients and offer them treatment through the MOVE! Weight Management Program for Veterans.
Noël P, Copeland L, Pugh M, et al. Obesity Diagnosis and Care Practices in the Veterans Health Administration. Journal of General Internal Medicine February 24, 2010;e-pub ahead of print.
This study was funded by HSR&D (IIR 05-121). Drs. Noël, Copeland, and Pugh are part of HSR&D's Veterans Evidence-Based Research, Dissemination, and Implementation Center in San Antonio, TX.