Kinsinger VA
Obesity and Obesity-Associated Disease in VHA: Obesity and Obesity-Associated Disease in VHA Madhu Agarwal, MD, MPH Chief Officer Patient Care Services Veterans Health Administration Prevalence of Overweight/Obesity in VA: Prevalence of Overweight/Obesity in VA Among men in 2000: 73% overweight (BMI ≥25) 33% obese 3% class 3 obese Among women in 2000: 68% overweight (BMI ≥25) 37% obese 6% class 3 obese Source: Das et al. Am J Prev Med, 2005 Prevalence of Diabetes in VA: Prevalence of Diabetes in VA ~ 25% of veterans who use VA healthcare system have diabetes (~1.3 million users) 75% of non-traumatic amputations done in patients with diabetes 50% of patients with stroke have diabetes Obesity-Related Diseases in VA by BMI, FY 2004: Obesity-Related Diseases in VA by BMI, FY 2004 Source: VSSC, 2005 Priority of Obesity and Obesity-Associated Disease in VHA : Priority of Obesity and Obesity-Associated Disease in VHA Given the burden of obesity-associated disease in VHA, priority is very high Focus within Office of Patient Care Services in VHA: Weight management Diabetes and cardiovascular disease care Community outreach/partnerships Weight Management in VHA : Weight Management in VHA VA/DoD Clinical Practice Guideline for Identification and Management of Obesity Key screening recommendations: Screen all adults using BMI Evaluate obese patients for type of weight loss treatment(s) Assess overweight patients for other risk factors and determine treatment Focus on healthy lifestyle change for low-risk patients Weight Management in VHA: Weight Management in VHA Key treatment recommendations: Assess readiness to lose weight Reach shared decision Initiate interventions based on risk level and patient preference Assess progress toward goals, reinforce or modify as needed MOVE! Weight Management Program for Veterans: MOVE! Weight Management Program for Veterans Based on NHLBI Guidelines Set in primary care clinics Appropriate patients complete baseline assessment, receive individualized report (parallel report for staff in EMR) All patients offered supported self-management with follow-up Some choose group classes, specialty referral Meds, intensive medical management, bariatric surgery available on limited basis MOVE! Weight Management Program for Veterans: MOVE! Weight Management Program for Veterans All VA medical centers now have a weight management program Multi-disciplinary staff involved To date, 52,000 patients have had MOVE!-related visits Evaluation of health outcomes planned Diabetes, CVD Care in VHA: Diabetes, CVD Care in VHA VA/DoD Clinical Practice Guidelines for Treatment of Diabetes, Hypertension, Dyslipidemia, Ischemic Heart Disease Performance measures for diabetes, hypertension, lipid control, ASA/beta-blocker use post-MI On-going research initiatives about implementation of evidence-based practice Community Outreach and Partnerships: Community Outreach and Partnerships HealthierUS Veterans Initiative, in collaboration with DHHS Designed to promote healthy eating and increased physical activity message to veterans and families Includes developing partnerships with CDC programs, local agencies and groups Prognosis for Obesity-Associated Disease in VHA: Prognosis for Obesity-Associated Disease in VHA Anticipate continued increase in prevalence of obesity, diabetes, other associated diseases Developing new methods to provide care: My HealtheVet patient web portal Telehealth care and other patient self-management support Decision support enhancements to EMR National database for population evaluation Community partnerships to share resources