The Burden of Obesity among a National
Probability Sample of Veterans
Karin Nelson, MD MSHS
Assistant Professor
Department of Medicine, University of Washington
VA Puget Sound Health Care System
Seattle, WA
Background


Department of Veterans Affairs (VA) is
the largest integrated health care system
in the US
Few national data on the prevalence of
obesity, lifestyle factors and the resulting
disability and health burden among
veterans
Background




Cross sectional study of 136 VA medical centers in
2000: 68% overweight, with 37% obese 1
Behavioral Risk Factor Surveillance System (BRFSS)
2000 among VA users: 44% overweight and 25%
obese. 59% of obese were inactive 2
Boston area 1,731 veterans: 75% overweight or
obese 3
Morbid obesity associated with poorer quality-of-life
scores among veterans 4
1. Das, Am J Prev Med, 2005
2. Wang, Obesity Research, 2005
3. Norwicki, Mil Med, 2003
4. Arterburn, Am J Med, 2004
Study Objectives

Compare rates of obesity among
veterans who do and do not utilize the VA
compared to non-veterans

To describe the association of obesity
with lifestyle factors, health status,
disability and co-morbid disease
Methods

Data from 2003 Behavioral Risk Factor
Surveillance System (BRFSS)
– cross sectional telephone survey
– civilian, non-institutionalized population
– state specific probability sample of
households

n=242,362 adults with height, weight
and veteran status
Measures
Self-reported weight, height (BMI kg/m2)
 Veteran status and use of VA care






Demographics: age, gender, race/ethnicity,
annual income
Self-reported health status
Co-morbid diseases associated with obesity
Disability: mental and physical health
Physical activity and nutritional intake
Data Analysis
Bivariate analysis to describe the
association of obesity with lifestyle
factors, health status, disability and
co-morbid disease
 Multivariate analysis to assess the
independent association of obesity
with VA care

Population Characteristics
%
Age > 60
Male
White
Hispanic
African American
Income < $15,000
Health limits activities
Nonveteran
Veteran
Veteran
VA care No VA care
n=208,913
n=6,338
n=27,111
19
41
70
15
10
12
18
57
94
76
6
14
15
41
47 *
94 *
83 *
6
7
6*
22 *
* χ2 p<0.001
Obesity and veteran status
Weight category
(BMI kg/m2)
Nonveteran
Veteran
with VA
care
%
Veteran with
no VA Care
2.1
1.1
0.5
Normal (18.5-24.9)
40.5
26.7
27.4
Overweight (25-29.9)
34.6
44.5
48.2
Obese (>30)
22.8
27.7
23.9
Underweight (<18.5)
χ2 p<0.001
Co-morbid disease and disability
among veterans who utilize the VA
%
High blood pressure
Diabetes
Fair or poor health status
Health limits activities
14+ days/past month
restricted activities
Normal Overweight Obese
N=1,823 N=2,818
N=1,697
47
55
66 *
14
33
41
19
18
30
38
15
31 *
39 *
47 †
28 *
χ2 * p<0.001 † p<0.05
Unhealthy lifestyles among veterans
who utilize the VA
%
Normal Overweight Obese
N=1,823 N=2,818 N=1,697
Physical activity
Met recommendation
Insufficient
No physical activity
43
36
21
46
34
20
37 †
35
27
5+ daily fruits/vegetables
24
20
19 †
χ2 † p<0.05
Limitations
Self report
 Suboptimal response rate
 No data on psychiatric illness
 Does not include individuals without
phones, homeless individuals or
those living in institutions

Conclusions


Veterans who utilize the VA have high
rates of obesity, with significant comorbid disease, disability and unhealthy
lifestyles
High rates of obesity have important health
policy and economic implications for the VA
– Economic burden of obesity due to treating comorbid disease
MOVE! Managing overweight and/or
Obesity for Veterans Everywhere


National dissemination in 2006
Evidence-based stepped care program
– Level 1 Assessment, tailored self-help material
– Level 2 Referral for counseling, group
clinics/classes
– Level 3 Weight control pharmacological agents
– Level 4 Inpatient or residential weight control
program
– Level 5 Consideration for bariatric surgery