The Burden of Obesity among a National Probability Sample of Veterans Background 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 Study Objectives 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 qualityquality-ofof-life scores among veterans 4 1. Das, Das, Am J Prev Med, 2005 Compare rates of obesity among veterans who do and do not utilize the VA compared to nonnon-veterans To describe the association of obesity with lifestyle factors, health status, disability and coco-morbid disease 2. Wang, Obesity Research, 2005 3. Norwicki, Norwicki, Mil Med, 2003 4. Arterburn, Arterburn, Am J Med, 2004 Methods Data from 2003 Behavioral Risk Factor Surveillance System (BRFSS) – cross sectional telephone survey – civilian, nonnon-institutionalized population – state specific probability sample of households n=242,362 adults with height, weight and veteran status Measures weight, height (BMI kg/m2) Veteran status and use of VA care SelfSelf-reported Demographics: age, gender, race/ethnicity, annual income SelfSelf-reported health status CoCo-morbid diseases associated with obesity Disability: mental and physical health Physical activity and nutritional intake 1 Data Analysis Population Characteristics Bivariate analysis to describe the association of obesity with lifestyle factors, health status, disability and coco-morbid disease Multivariate analysis to assess the independent association of obesity with VA care NonNonveteran % 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 * Age > 60 Male White Hispanic African American Income < $15,000 Health limits activities * χ2 p<0.001 CoCo-morbid disease and disability among veterans who utilize the VA Obesity and veteran status Weight category (BMI kg/m2) NonNonveteran Veteran with VA care % Veteran with no VA Care % High blood pressure Underweight (<18.5) 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 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 Physical activity 43 36 21 46 34 20 5+ daily fruits/vegetables 24 20 55 66 * 14 33 41 19 18 30 38 15 31 * 39 * 47 † 28 * Limitations Unhealthy lifestyles among veterans who utilize the VA Met recommendation Insufficient No physical activity 47 χ2 * p<0.001 † p<0.05 χ2 p<0.001 % Normal Overweight Obese N=1,823 N=2,818 N=1,697 37 † 35 27 19 † Self report Suboptimal response rate No data on psychiatric illness Does not include individuals without phones, homeless individuals or those living in institutions χ2 † p<0.05 2 Conclusions Veterans who utilize the VA have high rates of obesity, with significant cocomorbid 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 cocomorbid disease MOVE! Managing overweight and/or Obesity for Veterans Everywhere National dissemination in 2006 EvidenceEvidence-based stepped care program – Level 1 Assessment, tailored selfself-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 3