title: Obesity diagnosis and care practices in the Veterans Health Administration.
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.
  
  
  METHODS
  Retrospective cohort study utilizing VHA administrative data from 6 of 21 VA administrative regions.
  
  
  METHODS
  Veterans seen in primary care in FY2002 with a body mass index (BMI) > or =30 kg/m(2) 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).
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: VERDICT/South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229-4404, USA. noelp@uthscsa.edu
authors.forename: Polly Hitchcock
authors.initials: PH
authors.lastname: Noël
authors.forename: Laurel A
authors.initials: LA
authors.lastname: Copeland
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.forename: Leila
authors.initials: L
authors.lastname: Kahwati
authors.forename: Joel
authors.initials: J
authors.lastname: Tsevat
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
authors.forename: Chen-Pin
authors.initials: CP
authors.lastname: Wang
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Bollinger
authors.forename: Helen P
authors.initials: HP
authors.lastname: Hazuda
mesh_terms: D000328:Adult; D000368:Aged; D015992:Body Mass Index; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D014481:United States