• Dan V Blalock, John A Pura, Karen M Stechuchak, Paul A Dennis, Matthew L Maciejewski, Valerie A Smith, Anna Hung, Katherine D Hoerster, and Edwin S Wong.
• Center of Innovation to Accelerate Discovery and Practice Transformation, Durham Veterans Affairs Medical Center, Durham, NC, USA.
• J Gen Intern Med. 2023 May 1; 38 (6): 142314301423-1430.

BackgroundObesity (body mass index [BMI]≥30kg/m2) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred.ObjectiveWe sought to identify distinct long-term BMI trajectories and examined associations with demographic and clinical characteristics.DesignThe design was latent trajectory modeling over 10 years of a retrospective cohort. Subgroups were identified via latent class growth mixture models, separately by sex. Weighted multinomial logistic regressions identified factors associated with subgroup membership.ParticipantsParticipants were a retrospective cohort of 292,331 males and 62,898 females enrolled in VA.Main MeasuresThe main outcome measure was 6-month average VA-measured BMI over the course of 10 years. Additional electronic health record measures on demographic, clinical, and services utilization characteristics were also used to characterize latent trajectories.Key ResultsFour trajectories were identified for men and for women, corresponding to standard BMI categories "normal weight" (BMI <25), "overweight" (BMI 25-29.99), and "with obesity" (BMI ≥30): "normal weight" and increasing (males: 28.4%; females: 22.8%), "overweight" and increasing (36.4%; 35.6%), "with obesity" and increasing (33.6%; 40.0%), and "with obesity" and stable (males: 1.6%) or decreasing (females: 1.6%). Race, ethnicity, comorbidities, mental health diagnoses, and mental health service utilization discriminated among classes.ConclusionsBMI in the 10 years following VA enrollment increased modestly. VA should continue prioritizing weight management interventions to the large number of veterans with obesity upon VA enrollment, because the majority remain with obesity.© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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