Patient, facility, and environmental factors associated with obesity treatment in US Veterans
Abstract Background Identifying patient‐, facility‐, and environment‐level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities. Aims T...
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| Format: | Article |
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Wiley
2024-10-01
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| Series: | Obesity Science & Practice |
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| Online Access: | https://doi.org/10.1002/osp4.70014 |
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| author | Vijayvardhan Kamalumpundi Jessica K. Smith Kathleen M. Robinson Assim Saad Eddin Aiah Alatoum Ghena Kasasbeh Marcelo L. G. Correia Mary Vaughan Sarrazin |
| author_facet | Vijayvardhan Kamalumpundi Jessica K. Smith Kathleen M. Robinson Assim Saad Eddin Aiah Alatoum Ghena Kasasbeh Marcelo L. G. Correia Mary Vaughan Sarrazin |
| author_sort | Vijayvardhan Kamalumpundi |
| collection | DOAJ |
| description | Abstract Background Identifying patient‐, facility‐, and environment‐level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities. Aims This study identified factors at these various levels that predicted treatment engagement, retention, and weight management among urban and rural Veterans. Methods A retrospective cohort study of 631,325 Veterans was designed using VA databases to identify Veterans with class II and III obesity during 2015–2017. Primary outcomes were initiation of CLMI, bariatric surgery, or obesity pharmacotherapy within 1 year of index date. Secondary outcomes included treatment retention and successful weight loss. Generalized linear mixed models were used to evaluate the relationships between factors and obesity‐related outcomes, with rurality differences assessed through interaction terms. Results Patient characteristics associated with increased odds of initiating CLMI included female sex (p < 0.001), black race (p < 0.001), sleep apnea (p < 0.001), mood disorder (p < 0.001), and use of medications associated with weight loss (p < 0.001) or weight gain (p < 0.001). Facility use of telehealth was associated with greater odds of CLMI initiation in urban Veterans (p < 0.001) but lower retention in both populations (p = 0.003). Routine consideration of pharmacotherapy was associated with higher CLMI initiation. Environmental characteristics associated with increased odds of CLMI initiation included percent of population foreign born (OR = 1.03 per 10% increase; p < 0.001), percent black (p < 0.001), and high walkability index (p < 0.001). The relationship between total population and CLMI initiation differed by rurality, as greater population was associated with lower odds of CLMI initiation in urban areas (OR: 0.99 per 1000 population; p < 0.001), but higher odds in rural areas (OR:1.01, p = 0.01). Veterans in the south were less likely to initiate CLMI and had lower retention (p < 0.001). Conclusion Treatment and retention of CLMI among Veterans remain low, highlighting areas for improvement to expand its reach both urban and rural Veterans. |
| format | Article |
| id | doaj-art-5b23cb1b0b724310b3dd242f02cf0aff |
| institution | OA Journals |
| issn | 2055-2238 |
| language | English |
| publishDate | 2024-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | Obesity Science & Practice |
| spelling | doaj-art-5b23cb1b0b724310b3dd242f02cf0aff2025-08-20T02:12:11ZengWileyObesity Science & Practice2055-22382024-10-01105n/an/a10.1002/osp4.70014Patient, facility, and environmental factors associated with obesity treatment in US VeteransVijayvardhan Kamalumpundi0Jessica K. Smith1Kathleen M. Robinson2Assim Saad Eddin3Aiah Alatoum4Ghena Kasasbeh5Marcelo L. G. Correia6Mary Vaughan Sarrazin7Department of Internal Medicine Mayo Clinic Rochester Minnesota USADepartment of Surgery Division of Gastrointestinal Minimally Invasive and Bariatric Surgery University of Iowa Healthcare Iowa City Iowa USADepartment of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USADepartment of Surgery University of Texas Southwestern Medical Center Dallas Texas USADepartment of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USADepartment of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USARoy J. and Lucille A. Carver College of Medicine University of Iowa Iowa City Iowa USADepartment of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USAAbstract Background Identifying patient‐, facility‐, and environment‐level factors that influence the initiation and retention of comprehensive lifestyle management interventions (CLMI) for urban and rural Veterans could improve obesity treatment and reach at Veterans Affairs (VA) facilities. Aims This study identified factors at these various levels that predicted treatment engagement, retention, and weight management among urban and rural Veterans. Methods A retrospective cohort study of 631,325 Veterans was designed using VA databases to identify Veterans with class II and III obesity during 2015–2017. Primary outcomes were initiation of CLMI, bariatric surgery, or obesity pharmacotherapy within 1 year of index date. Secondary outcomes included treatment retention and successful weight loss. Generalized linear mixed models were used to evaluate the relationships between factors and obesity‐related outcomes, with rurality differences assessed through interaction terms. Results Patient characteristics associated with increased odds of initiating CLMI included female sex (p < 0.001), black race (p < 0.001), sleep apnea (p < 0.001), mood disorder (p < 0.001), and use of medications associated with weight loss (p < 0.001) or weight gain (p < 0.001). Facility use of telehealth was associated with greater odds of CLMI initiation in urban Veterans (p < 0.001) but lower retention in both populations (p = 0.003). Routine consideration of pharmacotherapy was associated with higher CLMI initiation. Environmental characteristics associated with increased odds of CLMI initiation included percent of population foreign born (OR = 1.03 per 10% increase; p < 0.001), percent black (p < 0.001), and high walkability index (p < 0.001). The relationship between total population and CLMI initiation differed by rurality, as greater population was associated with lower odds of CLMI initiation in urban areas (OR: 0.99 per 1000 population; p < 0.001), but higher odds in rural areas (OR:1.01, p = 0.01). Veterans in the south were less likely to initiate CLMI and had lower retention (p < 0.001). Conclusion Treatment and retention of CLMI among Veterans remain low, highlighting areas for improvement to expand its reach both urban and rural Veterans.https://doi.org/10.1002/osp4.70014obesity treatmentrural populationveterans Affairs |
| spellingShingle | Vijayvardhan Kamalumpundi Jessica K. Smith Kathleen M. Robinson Assim Saad Eddin Aiah Alatoum Ghena Kasasbeh Marcelo L. G. Correia Mary Vaughan Sarrazin Patient, facility, and environmental factors associated with obesity treatment in US Veterans Obesity Science & Practice obesity treatment rural population veterans Affairs |
| title | Patient, facility, and environmental factors associated with obesity treatment in US Veterans |
| title_full | Patient, facility, and environmental factors associated with obesity treatment in US Veterans |
| title_fullStr | Patient, facility, and environmental factors associated with obesity treatment in US Veterans |
| title_full_unstemmed | Patient, facility, and environmental factors associated with obesity treatment in US Veterans |
| title_short | Patient, facility, and environmental factors associated with obesity treatment in US Veterans |
| title_sort | patient facility and environmental factors associated with obesity treatment in us veterans |
| topic | obesity treatment rural population veterans Affairs |
| url | https://doi.org/10.1002/osp4.70014 |
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