title: Obesity-related health status changes and weight-loss treatment utilization.
abstract: BACKGROUND
  Behavioral weight-loss treatment can improve health, yet it is underutilized. Factors leading to initiation of weight-loss treatment are not well characterized. In particular, it is unknown whether changes in obesity-related health status contribute to weight-loss treatment initiation.
  
  
  OBJECTIVE
  To determine if recent weight change or diagnosis of an obesity-related comorbidity was associated with utilization of a behavioral weight-loss program in an integrated healthcare setting.
  
  
  METHODS
  In a retrospective cohort study of 45,272 Veterans Affairs (VA) patients with BMI >30, logistic regression was used to examine whether recent weight change or obesity-related comorbidities newly diagnosed in the past 6 months were associated with initiation of a VA behavioral weight management program (called MOVE!) in 2010 or sustained MOVE! use (eight or more sessions). Weight change in prior year was categorized as >3% weight loss; weight stable (<3% change); or weight gain of 3%-4.9%, 5%-9.9%, or ≥10%. Data were analyzed in 2013.
  
  
  RESULTS
  Patients were 91% male, 68% white, and had a mean age of 58 years. Patients were more likely to initiate treatment if they had ≥3% weight gain (3%-4.9%: OR=1.64, 95% CI=1.52, 1.77; 5%-9.9%: OR=1.99, 95% CI=1.84, 2.16; ≥10%: OR=2.68, 95% CI=2.32, 3.10) or were newly diagnosed with any obesity-related comorbidity (ORs: 2.14-3.59). Weight change and new comorbidity diagnoses were not associated, however, with sustained MOVE! use.
  
  
  CONCLUSIONS
  Adverse obesity-related health events were associated with initiation of behavioral weight-loss treatment offered in an integrated healthcare setting.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina. Electronic address: megan.mcvay@va.gov.
authors.forename: Megan A
authors.initials: MA
authors.lastname: McVay
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: William S
authors.initials: WS
authors.lastname: Yancy
authors.affiliation: Division of General Internal Medicine, University of Michigan, Ann Arbor, Michigan; Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vijan
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina.
authors.forename: Lynn
authors.initials: L
authors.lastname: Van Scoyoc
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina; Department of Biostatistics & Bioinformatics, Duke University, Durham, North Carolina.
authors.forename: Brian
authors.initials: B
authors.lastname: Neelon
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Corrine I
authors.initials: CI
authors.lastname: Voils
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Duke University, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
mesh_terms: D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications* / Q000628:therapy*; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D015431:Weight Loss; D061217:Weight Reduction Programs / Q000379:methods*