Associations Between Social Risks and Obesity in High-risk Veterans

The high prevalence of obesity among US Veterans has profound impacts on morbidity and mortality. Although many individual social risks have been linked to obesity, few studies have comprehensively assessed the independent associations between multiple patient-reported social risks (rarely available in electronic health records) and obesity. We investigate the cross-sectional associations of 11 potentially intervenable patient-reported social risks and, separately, 3 social risk domains with obesity among Veterans Health Administration (VHA) patients at high risk for hospitalization or death.

We analyzed data from a 2018 survey distributed by mail to a nationally representative sample of 10,000 VHA patients at high-risk of hospitalization or death. We conducted logistic regression with 4,504 respondents to assess the associations of 11 patient-reported social risks across 3 domains (social, material, and personal) with prevalent obesity (body mass index [BMI] ≥ 30 kg/m²), adjusting for potentially confounding social, demographic, and clinical factors. Models used composite weights to account for sampling and non-response probabilities.

Nearly half of the Veteran respondents had obesity (unweighted, 46%, n = 2,094). In adjusted analyses, Veterans who were unmarried had a 7-percentage point lower probability of obesity (marginal effect -0.07; 95% confidence interval -0.11, -0.03; p-value < 0.001), and Veterans reporting transportation barriers had a 6-percentage point lower probability of obesity (marginal effect -0.06; 95% CI -0.11, -0.01; p-value = 0.02). No other survey-based social risks or social risk domains were independently associated with obesity in adjusted logistic regression analyses.

This national survey linked to robust electronic health record data revealed that few patient-reported social risks were independently associated with obesity among high-risk Veterans with a high prevalence of obesity and social risks. Future analyses should characterize the impact of Veterans' social risks upon protective health behaviors and engagement with obesity management therapies to better inform future obesity interventions and disease self-management supports.