title: Iraq and Afghanistan veterans with PTSD participate less in VA's weight loss program than those without PTSD.
abstract: BACKGROUND
  Three-quarters of Iraq and Afghanistan veterans enrolled in Veterans Health Administration (VHA) care are overweight or obese. The VHA MOVE!® weight management program can mitigate the risks of obesity-related morbidity. However, many Iraq and Afghanistan veterans experience barriers to VHA services, which may affect participation, especially among those with posttraumatic stress disorder (PTSD) and/or depression. Little is known about MOVE! engagement among recent veterans. We describe a retrospective evaluation of MOVE! participation among Iraq and Afghanistan veterans with and without mental health problems.
  
  
  METHODS
  As part of a national VHA mental health evaluation study, we accessed VHA patient care databases to identify Iraq and Afghanistan veterans receiving care from 2008-2013 who had ≥1 MOVE! visit(s) and ≥1 weight measurements (N=24,899). We used logistic regression to determine whether mental health conditions were associated with having 12 visits/year (desirable dose of care), adjusting for demographic, health, and utilization factors.
  
  
  RESULTS
  Among Iraq and Afghanistan veterans enrolled in MOVE!, 4% had a desirable dose of participation. In adjusted models, desirable MOVE! participation was more likely among those without PTSD; those who were older, female, and unmarried; and those who had higher baseline weight, more medical comorbidities, no pain, psychotropic medication use, higher disability ratings, and more mental health visits.
  
  
  CONCLUSIONS
  We used administrative ICD-9 codes. Sample only included veterans in VHA care.
  
  
  CONCLUSIONS
  Iraq and Afghanistan veterans, particularly those with PTSD, had low participation in VHA weight management programming. Correlates of MOVE! participation were identified, highlighting opportunities to tailor MOVE! to improve participation for these veterans.
authors.affiliation: San Francisco VA Medical Center, San Francisco, CA, United States; University of California, San Francisco, CA, United States. Electronic address: Shira.Maguen@va.gov.
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.affiliation: VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, United States; University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA, United States.
authors.forename: Katherine D
authors.initials: KD
authors.lastname: Hoerster
authors.affiliation: VA Puget Sound Healthcare System, Seattle Division, Seattle, WA, United States; Department of Epidemiology, University of Washington, United States.
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: Littman
authors.affiliation: VA Maryland Healthcare System, Baltimore, MD, United States; Department of Psychiatry, University of Maryland School of Medicine, United States.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Klingaman
authors.affiliation: Houston VA Medical Center, Houston, TX, United States.
authors.forename: Gina
authors.initials: G
authors.lastname: Evans-Hudnall
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
authors.forename: Rob
authors.initials: R
authors.lastname: Holleman
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
authors.forename: H Myra
authors.initials: HM
authors.lastname: Kim
authors.affiliation: Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, United States.
authors.forename: David E
authors.initials: DE
authors.lastname: Goodrich
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000517:prevention & control; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D061217:Weight Reduction Programs / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Care engagement; Comorbidity; Mental health; Obesity; Sex; Veterans; Weight loss