Racial and Ethnic Differences in Obesity Treatment in the Veterans Affairs Healthcare System

BackgroundThe burden of obesity in the United States and in the Veterans Affairs (VA) population disproportionately affects minoritized individuals. Major advances in the treatment of obesity have emerged in the last decade, including incretin-based injectables like semaglutide, but it is not clear that they are being distributed equitably. We examined the role that race and ethnicity play in the receipt of a lifestyle change program, medications, and surgical treatment for obesity. MethodsWe analyzed data from patients with BMI [&ge;]27 in the national VA Healthcare System from 2018-2022. We used multivariate logistic regression to evaluate the association between race/ethnicity (American Indian/Alaska Native [AI/AN], Asian/Native Hawaiian/Pacific Islander [NHOPI], Non- Hispanic Black, Hispanic/Latino, Non-Hispanic White) and use of weight loss interventions (VA lifestyle change program, medication prescriptions, bariatric surgery), adjusting for age, gender, comorbidities, and diagnosis year. ResultsAmong Veterans with BMI [&ge;]27 (n=2,423,070), 38.8% had Class 1 obesity (BMI 30-34.9), 18.1% had Class 2 obesity (BMI 35-39.9), and 9.8% had Class 3 obesity (BMI>40), with significant differences by race/ethnicity (p<0.01). Across the cohort, 7.7% participated in the lifestyle change program, 7.9% received weight loss medications, and 0.1% underwent bariatric surgery. Compared to Non-Hispanic White patients, Veterans belonging to many racial/ethnic minority groups were more likely to participate in the lifestyle change program (Asian/NHOPI Veterans, 1.12 [95% CI 1.06-1.19]; Non-Hispanic Black Veterans, adj OR 1.24 [95% confidence interval [CI] 1.22-1.26]; Hispanic/Latino Veterans, adj OR 1.17 [95% CI 1.14-1.20]) and less likely to receive weight loss medications (AI/AN Veterans, adj OR 0.84 [95% CI 0.77-0.92]; Asian/NHOPI Veterans: adj OR 0.94 [95% CI 0.89-0.999]; Non-Hispanic Black Veterans, adj OR 0.75 [95% CI 0.74-0.76]; Hispanic/Latino Veterans, adj OR 0.94 [95% CI 0.91-0.97]). Black Veterans were also less likely to undergo bariatric surgery (adj OR 0.79 [95% CI 0.69-0.89]). ConclusionsAmong Veterans with obesity, rates of treatment across all modalities are low. Inequities in treatment approach by race/ethnicity suggest areas for focused intervention to close gaps in care.