Geographic Variation in Obesity, Behavioral Treatment, and Bariatric Surgery for Veterans

OBJECTIVE: To describe geographic variation in Veterans’ prevalence of obesity, participation in Veterans Administration’s (VA) behavioral weight management program (MOVE!), and receipt of bariatric surgery in fiscal year (FY) 2016. METHODS: In this retrospective cohort study of Veterans with obesity who received VA care in FY2016, we obtained electronic health record data on weight, height, outpatient visits to the MOVE! program, and bariatric surgeries. For each Veterans Integrated Service Network (VISN) region, we present the prevalence rate of Veterans with obesity (body mass index [BMI]≥30 kg/m(2)), MOVE! participation rates, and bariatric surgery rates. RESULTS: The prevalence of obesity in Veterans ranged from 30.5%-40.5% across VISNs in FY2016. MOVE! participation among Veterans with obesity was low (2.8-6.9%) across all VISNs, but Veterans with class II and III obesity (BMI≥35) had higher MOVE! participation rates (4.3-10.8%) than Veterans with class I obesity. There was 20-fold variation across VISNs in receipt of bariatric surgery among Veterans with BMI ≥35, ranging from 0.01% to 0.2%. Among Veterans with BMI≥35 participating in MOVE!, there was 46-fold variation in bariatric surgery provision, ranging from 0.07% to 3.27%. CONCLUSIONS: Despite Veterans’ high prevalence of obesity, behavioral and surgical weight management participation is low and varies across regions.