title: A System-Level Approach to Overweight and Obesity in the Veterans Health Administration.
abstract: Healthcare systems are challenged by steady increases in the number of patients who are overweight and obese. Large-scale, evidence-based behavioral approaches for addressing overweight and obesity have been successfully implemented in systems such as the Veterans Health Administration (VHA). These population-based interventions target reduction in risk for obesity-associated conditions through lifestyle change and weight loss, and are associated with modest weight loss. Despite the fact that VHA has increased the overall reach of these behavioral interventions, the number of high-risk overweight and obese patients continues to rise. Recommendations for weight loss medications and bariatric surgery are included in clinical practice guidelines for the management of overweight and obesity, but these interventions are underutilized. During a recent state of the art conference on weight management held by VHA, subject matter experts identified challenges and gaps, as well as potential solutions and overarching policy recommendations, for implementing an integrated system-wide approach for improving population-based weight management.
authors.affiliation: National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA. susan.raffa@va.gov.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Raffa
authors.affiliation: Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, Durham, NC, USA.|Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Maciejewski
authors.affiliation: National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, CA, USA.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Zimmerman
authors.affiliation: VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Damschroder
authors.affiliation: College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Estabrooks
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Ronald T
authors.initials: RT
authors.lastname: Ackermann
authors.affiliation: Kaiser Permanente Care Management Institute, Oakland, CA, USA.|University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Adam G
authors.initials: AG
authors.lastname: Tsai
authors.affiliation: Kaiser Permanente Care Management Institute, Oakland, CA, USA.
authors.forename: Trina
authors.initials: T
authors.lastname: Histon
authors.affiliation: National Center for Health Promotion and Disease Prevention, Veterans Health Administration, Durham, NC, USA.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Goldstein
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods; D006297:Health Services Accessibility; D006801:Humans; D009765:Obesity / Q000628:therapy*; D000073319:Obesity Management / Q000379:methods*; D050177:Overweight / Q000628:therapy; D010358:Patient Participation / Q000379:methods; D013597:Systems Analysis; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans; D058014:Veterans Health
keywords: obesity; population health; veterans; weight management