1. The Burden of Obesity among a National Probability Sample of Veterans Karin Nelson, MD MSHS Assistant Professor Department of Medicine, University of Washington VA Puget Sound Health Care System Seattle, WA

2. Background Department of Veterans Affairs (VA) is the largest integrated health care system in the US Department of Veterans Affairs (VA) is the largest integrated health care system in the US Few national data on the prevalence of obesity, lifestyle factors and the resulting disability and health burden among veterans Few national data on the prevalence of obesity, lifestyle factors and the resulting disability and health burden among veterans

3. Background Cross sectional study of 136 VA medical centers in 2000: 68% overweight, with 37% obese 1 Cross sectional study of 136 VA medical centers in 2000: 68% overweight, with 37% obese 1 Behavioral Risk Factor Surveillance System (BRFSS) 2000 among VA users: 44% overweight and 25% obese. 59% of obese were inactive 2 Behavioral Risk Factor Surveillance System (BRFSS) 2000 among VA users: 44% overweight and 25% obese. 59% of obese were inactive 2 Boston area 1,731 veterans: 75% overweight or obese 3 Boston area 1,731 veterans: 75% overweight or obese 3 Morbid obesity associated with poorer quality-of-life scores among veterans 4 Morbid obesity associated with poorer quality-of-life scores among veterans 4 1. Das, Am J Prev Med, 2005 2. Wang, Obesity Research, 2005 3. Norwicki, Mil Med, 2003 4. Arterburn, Am J Med, 2004

4. Study Objectives Compare rates of obesity among veterans who do and do not utilize the VA compared to non-veterans Compare rates of obesity among veterans who do and do not utilize the VA compared to non-veterans To describe the association of obesity with lifestyle factors, health status, disability and co-morbid disease To describe the association of obesity with lifestyle factors, health status, disability and co-morbid disease

5. Methods Data from 2003 Behavioral Risk Factor Surveillance System (BRFSS) Data from 2003 Behavioral Risk Factor Surveillance System (BRFSS) –cross sectional telephone survey –civilian, non-institutionalized population –state specific probability sample of households n=242,362 adults with height, weight and veteran status n=242,362 adults with height, weight and veteran status

6. Measures Self-reported weight, height (BMI kg/m 2 ) Self-reported weight, height (BMI kg/m 2 ) Veteran status and use of VA care Veteran status and use of VA care Demographics: age, gender, race/ethnicity, annual income Demographics: age, gender, race/ethnicity, annual income Self-reported health status Self-reported health status Co-morbid diseases associated with obesity Co-morbid diseases associated with obesity Disability: mental and physical health Disability: mental and physical health Physical activity and nutritional intake Physical activity and nutritional intake

7. Data Analysis Bivariate analysis to describe the association of obesity with lifestyle factors, health status, disability and co-morbid disease Bivariate analysis to describe the association of obesity with lifestyle factors, health status, disability and co-morbid disease Multivariate analysis to assess the independent association of obesity with VA care Multivariate analysis to assess the independent association of obesity with VA care

8. Population Characteristics % Non- veteran n=208,913 Veteran VA care n=6,338Veteran No VA care n=27,111 Age > 60 Male 19 41 57 94 47 * 94 * White Hispanic African American 70 15 10 76 6 14 83 * 6 7 Income < $15,0001215 6 * Health limits activities184122 * * χ2 p<0.001

9. Obesity and veteran status Weight category (BMI kg/m 2) Non- veteran Veteran with VA care Veteran with no VA Care % Underweight (<18.5) Normal (18.5-24.9) Overweight (25-29.9) Obese (>30) 2.1 40.5 34.6 22.8 1.1 26.7 44.5 27.7 0.5 27.4 48.2 23.9 χ2 p<0.001

10. Co-morbid disease and disability among veterans who utilize the VA %NormalN=1,823OverweightN=2,818ObeseN=1,697 High blood pressure Diabetes Fair or poor health status Health limits activities 14+ days/past month restricted activities 47 14 33 41 19 55 18 30 38 15 66 * 31 * 39 * 47 28 * χ2 * p<0.001 p<0.05

11. Unhealthy lifestyles among veterans who utilize the VA %NormalN=1,823OverweightN=2,818ObeseN=1,697 Physical activity Met recommendation Met recommendation Insufficient Insufficient No physical activity No physical activity 5+ daily fruits/vegetables 43 36 21 24 46 34 20 37 35 27 19 χ2 p<0.05

12. Limitations Self report Self report Suboptimal response rate Suboptimal response rate No data on psychiatric illness No data on psychiatric illness Does not include individuals without phones, homeless individuals or those living in institutions Does not include individuals without phones, homeless individuals or those living in institutions

13. Conclusions Veterans who utilize the VA have high rates of obesity, with significant co- morbid disease, disability and unhealthy lifestyles Veterans who utilize the VA have high rates of obesity, with significant co- morbid disease, disability and unhealthy lifestyles High rates of obesity have important health policy and economic implications for the VA High rates of obesity have important health policy and economic implications for the VA –Economic burden of obesity due to treating co- morbid disease

14. MOVE! Managing overweight and/or Obesity for Veterans Everywhere National dissemination in 2006 National dissemination in 2006 Evidence-based stepped care program Evidence-based stepped care program –Level 1 Assessment, tailored self-help material –Level 2 Referral for counseling, group clinics/classes –Level 3 Weight control pharmacological agents –Level 4 Inpatient or residential weight control program –Level 5 Consideration for bariatric surgery