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Obesity and Health Care Experiences among Women and Men Veterans

  • Jessica Y. Breland
    Correspondence
    Correspondence to: Jessica Y. Breland, PhD, VA Palo Alto Health Care System, Center for Innovation to Implementation, 795 Willow Road (MPD-152), Menlo Park, CA 94025. Phone: 650-493-5000 x22015; fax: 650-617-2736.
    Affiliations
    VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
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  • Michelle S. Wong
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California
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  • Susan M. Frayne
    Affiliations
    VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California

    Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
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  • Katherine J. Hoggatt
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California

    Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California
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  • W. Neil Steers
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California

    Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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  • Fay Saechao
    Affiliations
    VA HSR&D Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, California
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  • Donna L. Washington
    Affiliations
    VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, California

    Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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      Abstract

      Background

      Obesity is highly stigmatized, especially for women, and therefore may negatively affect health care experiences. Past findings on the relationship between obesity and health care experiences are mixed, perhaps because few studies examine relationships by gender and obesity class. Our objective was to evaluate whether women and men with more severe obesity report worse health care experiences related to Veterans Health Administration (VA) care.

      Methods

      Health care experiences (self-management support, mental health assessments, office staff courtesy, communication with providers) and overall provider ratings were assessed with the 2014 VA Survey of Health Care Experiences of Patients. Using multiple regression analyses (n = 13,462 women, n = 268,180 men), we assessed associations among obesity classes, health care experiences, and overall provider ratings, adjusting for sociodemographic, health, and primary care use characteristics.

      Results

      The greatest differences in health care experiences between patients with and without obesity were in self-management support experiences, which were more favorable among women and men of all obesity classes. There were gender differences in associations between obesity and mental health assessments: for men, but not women, those in any obesity class gave higher ratings than those without obesity. For most other health care experiences and provider ratings, men with obesity reported slightly less favorable experiences than those without. There was no consistent pattern for women.

      Conclusions

      It is promising that VA patients with obesity report more self-management support, given the behavior change required for weight management. Lower health care experience and provider ratings among men with obesity suggest a need to further investigate possible obesity-related stigma in VA primary care.
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      Biography

      Jessica Y. Breland, PhD, is an investigator at the Center for Innovation to Implementation at the VA Palo Alto. She is a clinical psychologist and health services researcher interested in the implementation of behavioral health treatments and reducing health disparities.

      Biography

      Michelle S. Wong, PhD, is a health services research postdoctoral fellow at the Center for the Study of Healthcare Innovation, Implementation & Policy at the VA Greater Los Angeles. Her research examines health disparities and social determinants of health.

      Biography

      Susan M. Frayne, MD, MPH, is an investigator at the Center for Innovation to Implementation at the VA Palo Alto and a Professor of Medicine at Stanford University. She is an internist and health services researcher interested in reducing gender-related care disparities.

      Biography

      Katherine J. Hoggatt, PhD, MPH, is a Research Health Science Specialist at VA San Francisco and Adjunct Assistant Professor of Epidemiology at UCLA Fielding School of Public Health. Her research focuses on improving substance use disorder care and addressing healthcare disparities.

      Biography

      W. Neil Steers, PhD, is a biostatistician at the Center for the Study of Healthcare Innovation, Implementation & Policy at the VA Greater Los Angeles and Adjunct Professor of Medicine at UCLA with study design and data-analytic phases expertise.

      Biography

      Fay Saechao, MPH, is the Program Manager of the Women's Health Evaluation Initiative at the Center for Innovation to Implementation at VA Palo Alto. Her interests include health care quality and equity, and promotion of health care access for underserved populations.

      Biography

      Donna L. Washington, MD, MPH, is a core investigator at the Center for the Study of Healthcare Innovation, Implementation & Policy at the VA Greater Los Angeles and Professor of Medicine at UCLA. Her research addresses vulnerable populations' healthcare needs.