The Relationship between Body Mass Index and Mental Health Among Iraq and Afghanistan Veterans

Abstract

BACKGROUNDObesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period.OBJECTIVETo explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years.DESIGNRetrospective, longitudinal cohort analysis of veterans’ health recordsPARTICIPANTSA total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011).MAIN MEASURESBMI, mental health diagnoses.KEY RESULTSSeventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: “stable overweight” represented the largest class; followed by “stable obese;” “overweight/obese gaining;” and “obese losing.” During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.CONCLUSIONSThe growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-013-2374-8) contains supplementary material, which is available to authorized users.

The Obesity Epidemic in the Veterans Health Administration: Prevalence Among Key Populations of Women and Men Veterans

“…35 Several other intriguing areas for future work emerge from our findings, for example, understanding why Asian veterans using the VHA have such high obesity prevalence compared to other Asian Americans (24% vs. 13% 1 ). In addition, given the correlation between some mental health conditions and excess weight, [36][37][38][39] it is worth investigating whether the high prevalence of mental health conditions among VHA patients 5 contributes to the higher rate of obesity in the VHA compared to the general US population. Considering the high need and associated high costs of patients with multimorbid conditions, 40 the relationship between obesity and multimorbidity also merits further research, particularly because conditions in the present analyses were selected based on their associations with obesity and/or high prevalence among VHA-using veterans.…”

PTSD and depression symptoms are associated with binge eating among US Iraq and Afghanistan veterans

“…Moreover, rates of meeting binge eating screening criteria were substantially higher among those meeting PTSD (14.6%) and depression (26.4%) screening criteria. Addressing this issue is critically important, given the high burden of obesity and related illness among Veterans with psychiatric conditions (Cohen et al, 2009;Maguen et al, 2013), including higher rates of premature mortality for those with PTSD (Kilbourne, Ignacio, Kim, & Blow, 2009). …”

“…Veterans with post-traumatic stress disorder (PTSD) and depression are at particularly high risk for being overweight or obese and for having related conditions, including the relatively younger cohort of returning Veterans who served in the Iraq and Afghanistan Wars (Cohen, Marmar, Ren, Bertenthal, & Seal, 2009;Maguen et al, 2013). Addressing the disproportionate burden of overweight and obesity among Iraq/Afghanistan Veterans with psychiatric conditions is a high public health priority.…”

PTSD and obesity in younger and older veterans: Results from the mind your heart study

“…As such, the identification of potentially modifiable mechanisms linking PTSD and these and other chronic conditions is needed. Obesity represents a significant public health problem that is strongly associated with increased disease burden and mortality (Malnick and Knobler, 2006), and early studies in the area have found evidence that PTSD confers heightened risk for obesity for some groups (Scott et al, 2008; Perkonigg et al, 2009; Pagoto et al, 2012; Maguen et al, 2013; Mitchell et al, 2013; Kubzansky et al, 2014). Examining PTSD–obesity risk associations in groups at increased risk for PTSD could advance understanding of the potential mechanisms by which PTSD undermines health over the long term.…”