Improving Weight Management among Veterans

Atkins, David C.

doi:10.1007/s11606-017-4007-0

Cited by 9 publications

(18 citation statements)

References 14 publications

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“…However, our study illustrated that when comparing obesity and other health outcomes to non-Veterans, Veterans are more likely to be overweight or obese (OR = 1.12) and to suffer from a negative health outcome as a result. Like many large health systems trying to address the obesity epidemic, the VHA healthcare system offers a number of weight-management programs in an effort to stem the tide of this obesity epidemic [6]. A number of VA initiatives aimed at providing the tools for the Veteran to better manage their weight include education on proper nutrition, the benefit of regular exercise, the use of technology such as daily apps, and when warranted, bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Obesity and its co-morbidities are a major cause of morbidity and mortality in the United States [3]. It is linked to a variety of other poor health outcomes including cardiovascular disease (CVD), hypertension (HTN), type 2 diabetes mellitus (T2DM), hyperlipidemia, stroke, certain cancers, sleep apnea, liver and gall bladder disease, osteoarthritis, and gynecological problems [6][7][8][9][10]. Each of these problems results in poor health outcomes for the affected individual in the long term: outcomes that are costly to the individual, costly to their families, and ultimately costly to the U.S. healthcare system [10].…”

Section: Introductionmentioning

confidence: 99%

“…Particularly striking is the fact that not only is there a disproportionate number of Veterans who are obese, but there also exists an overall disproportionate poorer health status among elderly Veterans when compared to the health of the older non-Veteran population enrolled in Medicare-managed care programs [15]. The Veterans Health Administration (VHA) has attempted to tackle obesity through a national, population-based approach since early 2000, utilizing a number of different methods, some more effective than others [6,15]. Of the six million patients who receive VHA care yearly, 80% fall into the categories of either being overweight or obese [16].…”

Section: Introductionmentioning

confidence: 99%

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Obesity and Morbidity Risk in the U.S. Veteran

et al. 2020

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The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation’s best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Obesity and Morbidity Risk in the U.S. Veteran

et al. 2020

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“…Insofar as patients with fewer than 3 months of participation were included in our cohort, the proportion of eligible patients who received WMM may be slightly higher than 1.1%. Subsequently, a VHA Health Services Research and Development Service State of the Art Conference on weight management in veterans concluded that WMM are underused and called for system‐level changes to improve population‐based weight management . This was followed by a new Pharmacy Benefits Management Services CFU for WMM in July 2016 that eliminated the requirements for 3 months of MOVE!…”

Section: Discussionmentioning

confidence: 99%

Patient Characteristics Associated with Receipt of Prescription Weight‐Management Medications Among Veterans Participating in MOVE!

Thomas

Waring

Ameli

et al. 2019

Obesity

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Objective: Weight-management medications (WMM) are recommended for the treatment of obesity. This study examined characteristics associated with initial receipt of WMM among eligible veterans in the first year following enrollment in the Veterans Health Administration (VHA) MOVE! behavioral weight-management program. Methods: We conducted a retrospective cohort study of VHA patients with obesity or overweight and obesity-related comorbidities who enrolled in MOVE! from October 2013 to September 2016 (N =153,939). Multivariable logistic regression models estimated predictors of having a filled prescription for WMM and for orlistat. Results: A total of 1.1% of these veterans received WMM. The most common WMM included orlistat (70.4%), phentermine/topiramate (11.2%), and bupropion/naltrexone (9.7%). Female sex, higher BMI, obstructive sleep apnea, osteoarthritis, depression, lower back pain, and alcohol abuse were associated with greater odds of use of WMM, whereas age over 65 years, Hispanic ethnicity, and required co-payments were associated with lower odds. Among patients receiving WMM, older age, black race, female sex, higher BMI, cardiovascular disease, lower back pain, and congestive heart failure were associated with use of orlistat versus any other WMM. Conclusions: Of patients engaged in MOVE! in the VHA, 1.1% received WMM. WMM are underutilized among veterans. Additional research is needed to understand barriers to incorporating WMM into comprehensive obesity treatment plans.

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“…[2] Of these, the MOVE! Weight Management Program, the VHA CLI program, was by far the most commonly available: on average, more than 100,000 Veterans participated annually in MOVE!, compared to about 2500 Veterans receiving weight loss medications and a few hundred Veterans who undergo bariatric surgery [2,6]. For any treatment program to have meaningful population-level impact, programs must successfully reach patients to engage them in treatment.…”

Section: Introductionmentioning

confidence: 99%

Facility-Level Conditions Leading to Higher Reach: A Configurational Analysis of National VA Weight Management Programming

Miech

Freitag

Evans

et al. 2021

Preprint

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Background: While the Veterans Health Administration (VHA) MOVE! weight management program is effective in helping patients lose weight and is available at every VHA medical center across the United States, reaching patients to engage them in treatment remains a challenge. Facility-based MOVE! programs vary in structures, processes of programming and levels of reach, with no single factor explaining variation in reach. Configurational analysis, based on Boolean algebra and set theory, represents a mathematical approach to data analysis well-suited for discerning how conditions interact and identifying multiple pathways leading to the same outcome. We applied configurational analysis to identify facility-level obesity treatment program arrangements that directly link to higher reach.Methods: A national survey was fielded in March 2017 to elicit information about more than 75 different components of obesity treatment programs in all VHA medical centers. This survey data was linked to facility-level reach scores available through administrative data. Reach scores were calculated by dividing the total number of Veterans who are candidates for obesity treatment by the number of “new” MOVE! visits in 2017 for each program and then multiplied by 1000. Programs with the top 40% highest reach scores (n=50) were compared to those in the lowest 40% (n=50). Configurational analysis was applied to identify specific combinations of conditions linked to reach rates. Results: 125 MOVE! program representatives responded to the survey and had complete reach data. The final solution consisted of 5 distinct pathways comprising combinations of program components related to pharmacotherapy, bariatric surgery, and comprehensive lifestyle intervention; 3 of the 5 pathways depended on the size/complexity of medical center. The 5 pathways explained 78% (39/50) of the facilities in the higher-reach group with 87% consistency (39/45). Conclusions: Specific combinations of facility-level conditions identified through configurational analysis uniquely distinguished facilities with higher reach from those with lower reach. Solutions demonstrated the importance of local context plus specific program components link together to account for a key implementation outcome. These findings will guide system recommendations about optimal program structures to maximize reach to patients who would benefit from obesity treatment such as the MOVE! program.

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Improving Weight Management among Veterans

Cited by 9 publications

References 14 publications

Obesity and Morbidity Risk in the U.S. Veteran

Obesity and Morbidity Risk in the U.S. Veteran

Patient Characteristics Associated with Receipt of Prescription Weight‐Management Medications Among Veterans Participating in MOVE!

Facility-Level Conditions Leading to Higher Reach: A Configurational Analysis of National VA Weight Management Programming

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