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Obesity in the Veteran Population A Growing Problem

Obesity in the Veteran Population A Growing Problem. Jimmy Hall, RN, MSN. Objectives. Define Overweight/Obesity Recognize complications Identify who is at risk Identify areas of prevention Distinguish methods of treatment. Defined.

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Obesity in the Veteran Population A Growing Problem

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  1. Obesity in the Veteran PopulationA Growing Problem Jimmy Hall, RN, MSN

  2. Objectives • Define Overweight/Obesity • Recognize complications • Identify who is at risk • Identify areas of prevention • Distinguish methods of treatment

  3. Defined • Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. • The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/defining.html

  4. Overweight vs. Obese • Overweight - Adults with a body mass index (BMI), calculated as weight in kilograms divided by height in meters squared, between 25 and 30 are considered overweight. • Obese - Adults with a BMI greater than or equal to 30 are considered obese. • Morbidly Obese - Anyone who is more than 100 pounds overweight or who has a BMI greater than or equal to 40. Obesity. (2010). National Center for Biotechnology Information.

  5. Obesity • BMI is calculated from a person's weight and height and provides a reasonable indicator of body fatness and weight categories that may lead to health problems. • In 2009, only Colorado and the District of Columbia had a prevalence of obesity less than 20%. • Thirty-three states had a prevalence equal to or greater than 25%. • Nine of these states (Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia) had a prevalence of obesity equal to or greater than 30%!! Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/trends.html

  6. Body Mass Index (BMI) • Body Mass Index (BMI) is a number calculated from a person's weight and height. • Some people question the validity of BMI itself as an indicator of obesity. • BMI is higher in higher in highly physically fit individuals, such as professional athletes

  7. Percent of Obese (BMI > 30) in U.S. Adults Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/trends.html

  8. Percent of Obese (BMI > 30) in U.S. Adults Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/trends.html

  9. Percent of Obese (BMI > 30) in U.S. Adults Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/trends.html

  10. Percent of Obese (BMI > 30) in U.S. Adults Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/trends.html

  11. Percent of Obese (BMI > 30) in U.S. Adults Overweight and Obesity. (2010). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/data/trends.html

  12. What Causes It? • Increased Food Intake • Increased Alcohol Consumption • Sedentary Lifestyle • Genetics • children of obese parents are 10 times more likely to be obese than children with parents of normal weight • Antidepressants/Antipsychotics • Hypothyroidism (5-10 pound gain) Obesity. (2010). National Center for Biotechnology Information.

  13. Complications • High blood pressure (hypertension ) • High blood cholesterol (dyslipidemia ) • Type 2 (non-insulin dependent) diabetes • Coronary heart disease • Angina pectoris • Congestive heart failure • Stroke • Gallstones • Cholescystitis and cholelithiasis • Gout • Osteoarthritis • Obstructive sleep apnea • Some types of cancer (such as endometrial, breast, prostate, and colon) • Complications of pregnancy such as; gestational diabetes, gestational hypertension and preeclampsia as well as complications in operative delivery (i.e., c-sections). • Poor female reproductive health (such as menstrual irregularities, infertility, irregular ovulation) • Bladder control problems (such as stress incontinence) • Uric acid nephrolithiasis • Psychological disorders (such as depression, eating disorders, distorted body image, and low self-esteem) Health Impact. (2006). Department of Veterans Affairs. Retrieved from http://www.move.va.gov/whyMove_health.asp

  14. Who is at Risk? • People who are at higher risk for obesity include: • Lower income groups • Former smokers • People with chronic mental illness • People with disabilities • People with a sedentary lifestyle Obesity. (2010). National Center for Biotechnology Information.

  15. Who Else Is At Risk? Veterans!

  16. How Is This Possible? • New recruits must pass medical evaluation to enter military service, which would screen out those with serious pre-existing obesity or obesity-related chronic conditions. • Physical fitness is mandated throughout a military career, and some evidence suggests that higher exercise levels are maintained after discharge from service. • Tobacco smoking has also been found to be more common among Veterans than among non-Veterans – which might limit weight gain. Koepsell, T., Littman, A., & Forsberg, C. (2011). Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity. Advance online publication.

  17. Veterans Receiving Care at VA “Veterans who received health care from the VA hadhigher rates of obesity than the general population, with significant levels of associated comorbid disease and disability, and low rates of preventive health behaviors.” “The results of the current study show a substantial health burden from obesity among Veterans cared for by the VA.” Nelson, K. (2006). The burden of obesity among a national probability sample of veterans. Journal of General Internal Medicine. 21(9):915-9.

  18. Recent Study • National Health and Nutrition Examination Survey (NHANES) • Examined data from 1999 – 2008 • Looked at individuals aged 30 years or older • 21,974 non-Veterans • 3,768 Veterans • Height, weight, and waist circumference were assessed by direct measurement in all years, and self-reported height and weight were also obtained in all years • Age of leaving military not known • Rate of increase in BMI since age 25 years was significantly higher for Veterans aged 30 – 44 years compared to same age non-Veterans. Koepsell, T., Littman, A., & Forsberg, C. (2011). Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity. Advance online publication.

  19. Waist Circumference • Fat stored around the middle of the body (the waist or abdomen) can put you at risk for: • High Blood Pressure • High Blood Cholesterol • Type-2 Diabetes • Heart Disease • Stroke • This risk increases with a waist size • 35 inches or greater for women • 40 inches or greater for men. MOVE! Q&A. (2010). US Department of Veterans Affairs. Retrieved from http://www.move.va.gov/QandA.asp#MOVE!

  20. Did You Know? Studies have shown that extra weight around the waistline is more dangerous to the heart than extra weight that is on the hips and thighs. MOVE! Q&A. (2010). US Department of Veterans Affairs. Retrieved from http://www.move.va.gov/QandA.asp#MOVE!

  21. Veteran Weight(%) 75.4% Koepsell, T., Littman, A., & Forsberg, C. (2011). Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity. Advance online publication.

  22. Non-Veteran Weight (%) 34.6% 65.4% Koepsell, T., Littman, A., & Forsberg, C. (2011). Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity. Advance online publication.

  23. Veteran Weight (%) Koepsell, T., Littman, A., & Forsberg, C. (2011). Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity. Advance online publication.

  24. Veteran and Non-Veteran ComparisonAbove Average Weight (%) Koepsell, T., Littman, A., & Forsberg, C. (2011). Obesity, overweight, and their life course trajectories in veterans and non-veterans. Obesity. Advance online publication.

  25. Study #2 • VA Statistical Information • Cross-sectional analysis of 1,803, 323 veterans receiving outpatient care at 136 VA medical facilities in 2000 • BMI calculated with data broken into groups based on gender and examined by age and race/ethnicity • Of 93,290 women American Veterans receiving care, 68.4% were at least overweight, with 37.4% classified as obese. • Of 1,710,032 men, 73.0% were at least overweight, with 32.9% being obese. Das, S., Kinsinger, L., Yancy, W., Wang, A., Ciesco, E., Burdick, M., & Yevich, S. (2005). Obesity prevalence among veterans at veterans affairs medical facilities. American Journal of Preventive Medicine: 28(3), 291 – 294.

  26. Male vs. Female Veteran Weight Das, S., Kinsinger, L., Yancy, W., Wang, A., Ciesco, E., Burdick, M., & Yevich, S. (2005). Obesity prevalence among veterans at veterans affairs medical facilities. American Journal of Preventive Medicine: 28(3), 291 – 294.

  27. Male vs. Female Veteran Weight Das, S., Kinsinger, L., Yancy, W., Wang, A., Ciesco, E., Burdick, M., & Yevich, S. (2005). Obesity prevalence among veterans at veterans affairs medical facilities. American Journal of Preventive Medicine: 28(3), 291 – 294.

  28. Female Veteran BMI (%) by Race Das, S., Kinsinger, L., Yancy, W., Wang, A., Ciesco, E., Burdick, M., & Yevich, S. (2005). Obesity prevalence among veterans at veterans affairs medical facilities. American Journal of Preventive Medicine: 28(3), 291 – 294.

  29. Male Veteran BMI (%) by Race Das, S., Kinsinger, L., Yancy, W., Wang, A., Ciesco, E., Burdick, M., & Yevich, S. (2005). Obesity prevalence among veterans at veterans affairs medical facilities. American Journal of Preventive Medicine: 28(3), 291 – 294.

  30. We Know There’s a Problem… Now What?

  31. Prevention “Many diseases can be prevented, yet health care systems do not make the best use of their available resources to support this process. All too often, health care workers fail to seize patient interactions as opportunities to inform patients about health promotion and disease prevention strategies.” Integrating prevention into healthcare. (2011). World Health Organization. Retrieved from http://www.who.int/mediacentre/factsheets/fs172/en/

  32. Primary Prevention • Primary prevention is the prevention of a disease before it occurs. • Given that many conditions are preventable, every health care interaction should include prevention support. • When patients are provided with information and skills to reduce health risks, they are more likely to eat healthy foods and to engage in physical activity. Integrating prevention into healthcare. (2011). World Health Organization. Retrieved from http://www.who.int/mediacentre/factsheets/fs172/en/

  33. Primary Prevention • A collaborative management approach at the primary health care level with patients, their families and other health care actors is a must to effectively prevent many major contributors to the burden of disease. Make prevention an element of every health care interaction!! Integrating prevention into healthcare. (2011). World Health Organization. Retrieved from http://www.who.int/mediacentre/factsheets/fs172/en/

  34. What If Prevention Is Not An Option?

  35. Treatment • Types of Treatment: • Exercise • Diet • Weight Loss Medications • Surgery • Gastric Bypass • Laparoscopic Gastric Banding Obesity. (2010). National Center for Biotechnology Information.

  36. Exercise • Adults need at least: • 2 Hours and 30 Minutes (150 minutes) of moderate-intensity aerobic activity (i.e. brisk walking) every week AND • Muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms). How much physical activity do adults need? (2011). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html

  37. Barriers for Exercising • Lack of Interest • Shortness of Breath • Joint Pain • Perceived Lack of Fitness • Lack of Energy • Doubt that Exercise Can Lengthen Life Crombie, I., Irvine, L., Williams, B., McGinnins, A., Slane, P., Alder, E., & McMurdo, M. Why older people do not participate in leisure time physical activity: a survey of activity levels, beliefs and deterrents. Age and Ageing 2004; 33: 287–292

  38. Diet Recommendations • The Dietary Guidelines for Americans, 2010, released on January 31, 2011, emphasize three major goals for Americans: • Balance calories with physical activity to manage weight • Consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free and low-fat dairy products, and seafood • Consume fewer foods with sodium (salt), saturated fats, trans fats, cholesterol, added sugars, and refined grains Dietary Guidelines for Americans, 2010. (2011). U.S. Department of Health and Human Services. http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf

  39. Weight Loss Medications • If lifestyle changes do not promote weight loss after 6 months, drugs should be considered. • Many side effects related to many medications • Many drugs are constanly being pulled from market NHLBI Obesity Education Intiative: The Practical Guide. Retrieved from http://www.move.va.gov/download/Resources/NIH_Obesity_Guidelines_Practical_Guide.pdf

  40. Weight Loss Medications Prescription Medications for the Treatment of Obesity. (2010). National Institutes of Health. Retrieved from http://win.niddk.nih.gov/Publications/prescription.htm#fdameds

  41. Surgical Treatment Laparoscopic Gastric Banding - the surgeon places a band around the upper part of your stomach, creating a small pouch to hold food. The band helps you limit how much food you eat by making you feel full after eating small amounts Gastric Bypass - helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you will not be able to eat as much as before, and your body will not absorb all the calories and other nutrients from the food you eat. Obesity. (2010). National Center for Biotechnology Information.

  42. Laparoscopic Gastric Banding

  43. Gastric Bypass

  44. What is the VA Doing?

  45. What is the VA Doing? • MOVE! Program • MOVE! is VA's national weight management program for veterans. • All VA facilities have been mandated to initiate MOVE! or an alternative weight management program. • The MOVE! Program has been designed for both men and women. • The MOVE! Program is designed for veterans of all ability levels. MOVE! Q&A. (2010). US Department of Veterans Affairs. Retrieved from http://www.move.va.gov/QandA.asp#MOVE!

  46. MOVE! Success Story! • Ernie Lohmann • Bay Pines VA Healthcare System • After 4 years in program, Ernie lost 225 pounds! • Discontinued all three of his diabetes medications! • Sleep apnea has all but disappeared! • "It’s like a whole new life."

  47. What is the VA Doing? • Weight Loss Medications

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