Obesity diagnosis and care practices in the Veterans Health Administration.
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.
Noël
Polly Hitchcock
PH
VERDICT/South Texas Veterans Health Care System, 7400 Merton Minter Blvd (11C6), San Antonio, TX 78229-4404, USA. noelp@uthscsa.edu
Copeland
Laurel A
LA
Pugh
Mary Jo
MJ
Kahwati
Leila
L
Tsevat
Joel
J
Nelson
Karin
K
Wang
Chen-Pin
CP
Bollinger
Mary J
MJ
Hazuda
Helen P
HP
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