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VA Study Identifies Factors In Veterans' Weight Changes
- Categorized in: Department of Veterans Affairs (VA), June 2012
Obesity Treatment More Likely for VA’s Psychiatric Patients
Psychiatric patients at the VA were more likely than others to receive interventions related to weight loss, according to a surprising new study from the Central Texas VA Health Care System in Waco.1
“The results of this study represent an unusual example in which psychiatric patients were relatively more likely to receive care addressing cardiometabolic risk factors,” the authors write.
Researchers looked at a sample of 254,051 obese primary care patients surviving through fiscal year 2006 and included administrative data for VA patients who also had been obese in FY 2002 and received primary care in one of six VHA regions. Specific outcomes measured were receipt of obesity care and weight loss from 2002 to 2006.
Covariates included baseline mental illness (e.g. major depression, post-traumatic stress disorder and substance-use disorders and use of psychotropic medications associated with weight gain as well as comorbidity and demographic characteristics.
The study group was overwhelmingly male, non-Hispanic white, older than 50 years old with comorbid hypertension and dyslipidemia. One-fifth diagnosed with mental illness, most commonly depression (8%) or PTSD (6%).
Significant weight loss, ≥10% from baseline weight, during the period occurred in 10% of the sample, with weight gain in 7%.
One-third (34%) of the patients received obesity care during the study period, but interventions were more likely for those with a psychiatric diagnosis — 46% vs. 31%. The most likely to receive obesity care were those prescribed obesogenic psychotropic medications.
1: Copeland LA, Pugh MJ, Hicks PB, Noel PH. Use of obesity-related care bypsychiatric patients.
Psychiatr Serv. 2012 Mar 1;63(3):230-6. PubMed PMID:22307880.
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Does VA have an appropriate number of specialty physicians to meet patient-care needs?
I recall during my deployment to Bosnia, the dining facilities were open 24/7, the food was high in calorie content, cans of soft drinks were always available, there was no portion control, and no evidence of a guiding hand by a dietician. I literally watched already overweight soldiers eat their way to a new (larger) uniforme size during a 6 month period.
The following risk factors for weight gain were apparent to me:
1. Uniform design that hides weight. The loose top that is not tucked into the belt hides a lot of fat. Out of sight, out of mind.
2. Generalized ignorance regarding calorie need, calorie content, and calorie consumption during sedentary activity, modest exercise, and strenuous work, in the face of high calorie rations provided to sustain the strenous work of carrying 100+ pounds of body armor and weapons systems during long mountain foot patrols (which not all service members perform).
3. Being in a "stop loss" status (involuntary retention on active duty), where in the rules that discharge overweight servicemembers from active duty are set aside.
4. Lack of portion control / ration adjustment depending on activity level. Active intervention by dieticians could do much to prevent undesired weight gain.