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Obesity Diagnosis and Care Practices in the Veterans Health Administration

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Abstract

BACKGROUND

In response to dramatic increases in obesity prevalence, clinical guidelines urge health care providers to prevent and treat obesity more aggressively.

OBJECTIVE

To describe the proportion of obese primary care patients receiving obesity care over a 5-year period and identify factors predicting receipt of care.

DESIGN

Retrospective cohort study utilizing VHA administrative data from 6 of 21 VA administrative regions.

PATIENTS

Veterans seen in primary care in FY2002 with a body mass index (BMI) ≥30 kg/m2 based on heights and weights recorded in the electronic medical record (EMR), survival through FY2006, and active care (1 or more visits in at least 3 follow-up years FY2003–2006).

MAIN MEASURES

Receipt of outpatient visits for individual or group education or instruction in nutrition, exercise, or weight management; receipt of prescriptions for any FDA-approved medications for weight reduction; and receipt of bariatric surgery.

KEY RESULTS

Of 933,084 (88.6%) of 1,053,228 primary care patients who had recorded heights and weights allowing calculation of BMI, 330,802 (35.5%) met criteria for obesity. Among obese patients who survived and received active care (N = 264,667), 53.5% had a recorded obesity diagnosis, 34.1% received at least one outpatient visit for obesity-related education or counseling, 0.4% received weight-loss medications, and 0.2% had bariatric surgery between FY2002–FY2006. In multivariable analysis, patients older than 65 years (OR = 0.62; 95% CI: 0.60–0.64) were less likely to receive obesity-related education, whereas those prescribed 5–7 or 8 or more medication classes (OR = 1.41; 1.38–1.45; OR = 1.94; 1.88–2.00, respectively) or diagnosed with obesity (OR = 4.0; 3.92–4.08) or diabetes (OR = 2.23; 2.18–2.27) were more likely to receive obesity-related education.

CONCLUSIONS

Substantial numbers of VHA primary care patients did not have sufficient height or weight data recorded to calculate BMI or have recorded obesity diagnoses when warranted. Receipt of obesity education varied by sociodemographic and clinical factors; providers may need to be cognizant of these when engaging patients in treatment.

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Acknowledgements

The research reported here was supported by the Department of Veteran Affairs, Veterans Health Administration, Health Services Research and Development Service (project no. IIR 05–121). Dr. Noël is a Research Psychologist at the South Texas Veterans Health Care System. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

Conflict of Interest

The research reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service (project no. IIR 05–121). The funding agency provided support to conduct this study, including collection, management, analysis, and interpretation of the data, and preparation of the manuscript, but has not participated in manuscript development, and has not reviewed or approved this manuscript.

The authors have no conflict of interests to declare. Sources of support for the authors for the past 3 years are listed below:

Dept. of Veterans Affairs: Noël, Copeland, Pugh, Kahwati, Tsevat, Nelson, Wang, Bollinger

UT Health Science Center: Noël, Copeland, Pugh, Hazuda, Wang

University of Cincinnati: Tsevat

University of Washington: Nelson

NIH: Noël, Copeland, Pugh, Wang, Nelson, Tsevat

CDC: Pugh

Epilepsy Foundation: Pugh

Abbott Laboratories: Pugh

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Correspondence to Polly Hitchcock Noël PhD.

Additional information

The research reported here was supported by the Department of Veteran Affairs, Veterans Health Administration, Health Services Research and Development Service (project no. IIR 05–121). Dr. Noël is a Research Psychologist at the South Texas Veterans Health Care System. The views expressed in this article are those of the author(s) and do not necessarily represent the views of the Department of Veterans Affairs.

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Noël, P.H., Copeland, L.A., Pugh, M.J. et al. Obesity Diagnosis and Care Practices in the Veterans Health Administration. J GEN INTERN MED 25, 510–516 (2010). https://doi.org/10.1007/s11606-010-1279-z

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  • DOI: https://doi.org/10.1007/s11606-010-1279-z

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