title: Intensity and duration of obesity-related counseling: association with 5-Year BMI trends among obese primary care patients.
abstract: We examined 5-year trends in BMI among obese primary care patients to determine whether obesity-related education such as nutrition counseling or a weight management program was associated with declines in BMI. Veterans with BMI ≥30 kg/m(2) and ≥1 primary care visits in fiscal year 2002 were identified from the Veterans Health Administration's (VHA) national databases. Outpatient visits from fiscal year 2002-2006 for nutrition counseling, exercise, or weight management were grouped into five categories varying in intensity and duration: (i) intense-and-sustained, (ii) intense-only, (iii) irregular, (iv) limited, and (v) no counseling. Generalized estimating equation assessed associations between obesity-related counseling and BMI trend (annual rate of BMI change fiscal year 2002-2006) among cohort members with complete race/ethnic data (N = 179,881). Multinomial logistic regression compared intensity and duration of counseling among patients whose net BMI increased or decreased by ≥10% vs. remained stable. Compared with patients receiving "intense-and-sustained" counseling, the BMI trend of those receiving "intense-only" or "irregular" counseling was not significantly different, but patients receiving "no counseling" or "limited counseling" had significantly higher rates of decreasing BMI (-0.12 and -0.08 BMI per year; P < 0.01, respectively). This was especially true for veterans in their 50-60s, compared with the oldest veterans who were most likely to lose weight. In contrast, younger veterans (18-35 years) were least likely to lose weight; their BMI tended to increase regardless of counseling intensity and duration. Enhanced efforts are needed to detect and combat increasing weight trajectories among veterans who are already obese, especially among those aged 18-35 who are at greatest risk.
authors: VERDICT/South Texas Veterans Health Care System, San Antonio, Texas, USA. noelp@uthscsa.edu
authors: Polly H
authors: PH
authors: Noël
authors: Chen-Pin
authors: CP
authors: Wang
authors: Mary J
authors: MJ
authors: Bollinger
authors: Mary J
authors: MJ
authors: Pugh
authors: Laurel A
authors: LA
authors: Copeland
authors: Joel
authors: J
authors: Tsevat
authors: Karin M
authors: KM
authors: Nelson
authors: Margaret M
authors: MM
authors: Dundon
authors: Helen P
authors: HP
authors: Hazuda
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D003376:Counseling / Q000706:statistics & numerical data* / Q000639:trends; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000517:prevention & control*; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D015431:Weight Loss