The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

• Published in: Journal of general internal medicine : JGIM Vol. 32; no. Suppl 1; pp. 11 - 17
• Main Authors: Breland, Jessica Y., Phibbs, Ciaran S., Hoggatt, Katherine J., Washington, Donna L., Lee, Jimmy, Haskell, Sally, Uchendu, Uchenna S., Saechao, Fay S., Zephyrin, Laurie C., Frayne, Susan M.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-04-2017; Springer Nature B.V
• Subjects: Adult; Adults; Age; Age Distribution; Aged; Black or African American - statistics & numerical data; Body mass; Body Mass Index; Body size; Body weight; Comorbidity; Cross-Sectional Studies; Diabetes mellitus; Epidemics; Female; Health care; Humans; Internal Medicine; Male; Management services; Medicine; Medicine & Public Health; Men; Mens health; Mental disorders; Middle Aged; Morbidity; Obesity; Obesity - epidemiology; Obesity - physiopathology; Overweight; Overweight - epidemiology; Overweight - physiopathology; Patients; Prevalence; Primary care; Risk groups; Schizophrenia; Sex Distribution; Subpopulations; United States - epidemiology; Veterans - statistics & numerical data; Veterans Health - ethnology; Veterans Health - statistics & numerical data; Weight control; Women; Young Adult; veterans; health disparities; population health; obesity; women
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-016-3962-1

Background
Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services.
Objectives
To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients.
Design
Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant.
Participants
Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients).
Main Measures
We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic- and comorbidity-based subpopulations.
Key Results
Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA’s 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%).
Conclusions
Overweight and obesity are common among veterans served by the VHA. VHA’s weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. High-risk groups—such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native veterans—may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.