title: The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans.
abstract: BACKGROUND
  Most US adults are overweight or obese. Understanding differences in obesity prevalence across subpopulations could facilitate the development and dissemination of weight management services.
  
  
  OBJECTIVE
  To inform Veterans Health Administration (VHA) weight management initiatives, we describe obesity prevalence among subpopulations of VHA patients.
  
  
  METHODS
  Cross-sectional descriptive analyses of fiscal year 2014 (FY2014) national VHA administrative and clinical data, stratified by gender. Differences ≥5% higher than the population mean were considered clinically significant.
  
  
  METHODS
  Veteran VHA primary care patients with a valid weight within ±365 days of their first FY2014 primary care visit, and a valid height (98% of primary care patients).
  
  
  METHODS
  We used VHA vital signs data to ascertain height and weight and calculate body mass index, and VHA outpatient, inpatient, and fee basis data to identify sociodemographic- and comorbidity-based subpopulations.
  
  
  RESULTS
  Among nearly five million primary care patients (347,112 women, 4,567,096 men), obesity prevalence was 41% (women 44%, men 41%), and overweight prevalence was 37% (women 31%, men 38%). Across the VHA's 140 facilities, obesity prevalence ranged from 28% to 49%. Among gender-stratified subpopulations, obesity prevalence was high among veterans under age 65 (age 18-44: women 40%, men 46%; age 45-64: women 49%, men 48%). Obesity prevalence varied across racial/ethnic and comorbidity subpopulations, with high obesity prevalence among black women (51%), women with schizophrenia (56%), and women and men with diabetes (68%, 56%).
  
  
  CONCLUSIONS
  Overweight and obesity are common among veterans served by the VHA. VHA's weight management initiatives have the potential to avert long-term morbidity arising from obesity-related conditions. High-risk groups-such as black women veterans, women veterans with schizophrenia, younger veterans, and Native Hawaiian/Other Pacific Islander and American Indian/Alaska Native veterans-may require particular attention to ensure that systems improvement efforts at the population level do not inadvertently increase health disparities.
authors.affiliation: VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA. jessica.breland@va.gov.|Stanford University School of Medicine, Stanford, CA, USA. jessica.breland@va.gov.
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Breland
authors.affiliation: VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.|Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Ciaran S
authors.initials: CS
authors.lastname: Phibbs
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.|Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Hoggatt
authors.affiliation: VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, CA, USA.|David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.affiliation: VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
authors.forename: Jimmy
authors.initials: J
authors.lastname: Lee
authors.affiliation: United States Department of Veterans Affairs Central Office, Women's Health Services, Washington, DC, USA.|West Haven VA, West Haven, CT, USA.|Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Haskell
authors.affiliation: United States Department of Veterans Affairs Central Office, Office of Health Equity, Washington, DC, USA.
authors.forename: Uchenna S
authors.initials: US
authors.lastname: Uchendu
authors.affiliation: VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
authors.forename: Fay S
authors.initials: FS
authors.lastname: Saechao
authors.affiliation: United States Department of Veterans Affairs Central Office, Women's Health Services, Washington, DC, USA.|New York University School of Medicine, New York, NY, USA.
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Zephyrin
authors.affiliation: VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.|Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Frayne
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017677:Age Distribution; D000368:Aged; D015992:Body Mass Index; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology* / Q000503:physiopathology; D050177:Overweight / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data; D058014:Veterans Health / Q000208:ethnology / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: health disparities; obesity; population health; veterans; women