Patient, facility, and environmental factors associated with obesity treatment in US Veterans.
Autor: | Kamalumpundi V; Department of Internal Medicine Mayo Clinic Rochester Minnesota USA.; Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa City Iowa USA.; Department of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USA.; Department of Surgery Division of Gastrointestinal Minimally Invasive and Bariatric Surgery University of Iowa Healthcare Iowa City Iowa USA.; Iowa City Veterans Affairs Health System Iowa City Iowa USA.; The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) Iowa City Veterans Affairs Healthcare System Iowa City Iowa USA.; Veteran Rural Health Resource Center - Iowa City Veterans Affairs Health Care System Iowa City Iowa USA., Smith JK; Department of Surgery Division of Gastrointestinal Minimally Invasive and Bariatric Surgery University of Iowa Healthcare Iowa City Iowa USA.; Iowa City Veterans Affairs Health System Iowa City Iowa USA., Robinson KM; Department of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USA.; Iowa City Veterans Affairs Health System Iowa City Iowa USA.; The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) Iowa City Veterans Affairs Healthcare System Iowa City Iowa USA., Saad Eddin A; Department of Surgery University of Texas Southwestern Medical Center Dallas Texas USA., Alatoum A; Department of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USA., Kasasbeh G; Department of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USA., Correia MLG; Roy J. and Lucille A. Carver College of Medicine University of Iowa Iowa City Iowa USA.; Department of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USA.; Iowa City Veterans Affairs Health System Iowa City Iowa USA., Vaughan Sarrazin M; Department of Internal Medicine Division of Endocrinology and Metabolism University of Iowa Healthcare Iowa City Iowa USA.; The Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) Iowa City Veterans Affairs Healthcare System Iowa City Iowa USA.; Veteran Rural Health Resource Center - Iowa City Veterans Affairs Health Care System Iowa City Iowa USA. |
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Jazyk: | angličtina |
Zdroj: | Obesity science & practice [Obes Sci Pract] 2024 Oct 24; Vol. 10 (5), pp. e70014. Date of Electronic Publication: 2024 Oct 24 (Print Publication: 2024). |
DOI: | 10.1002/osp4.70014 |
Abstrakt: | 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. Competing Interests: The authors declare no conflicts of interest statement. (Published 2024. This article is a U.S. Government work and is in the public domain in the USA. Obesity Science & Practice published by World Obesity and The Obesity Society and John Wiley & Sons Ltd.) |
Databáze: | MEDLINE |
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