National evaluation of obesity screening and treatment among veterans with and without mental health disorders

Abstract

ObjectiveThe objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. MethodsWe used chart-reviewed, clinical and administrative VHA data from fiscal years 2010–2012 to estimate obesity screening and participation in the VHA’s weight management program (MOVE!) across groups. Six- and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. ResultsCompared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%–94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%–10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (−3.5 and −3.3 lb, respectively), but individuals with DD lost less weight (mean=−2.7 lb). ConclusionsDisparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact.