San Francisco VA Medical Center, 4150 Clement Street (116-P), San Francisco, CA 94121, USA.
J Gen Intern Med. 2013 Jul;28 Suppl 2(Suppl 2):S563-70. doi: 10.1007/s11606-013-2374-8.
Obesity is a growing public health concern and is becoming an epidemic among veterans in the post-deployment period.
To explore the relationship between body mass index (BMI) and posttraumatic stress disorder (PTSD) in a large cohort of Iraq and Afghanistan veterans, and to evaluate trajectories of change in BMI over 3 years.
Retrospective, longitudinal cohort analysis of veterans' health records
A total of 496,722 veterans (59,790 female and 436,932 male veterans) whose height and weight were recorded at the Department of Veterans Affairs (VA) healthcare system at least once after the end of their last deployment and whose first post-deployment outpatient encounter at the VA was at least 1 year prior to the end of the study period (December 31, 2011).
BMI, mental health diagnoses.
Seventy-five percent of Iraq and Afghanistan veterans were either overweight or obese at baseline. Four trajectories were observed: "stable overweight" represented the largest class; followed by "stable obese;" "overweight/obese gaining;" and "obese losing." During the 3-year ascertainment period, those with PTSD and depression in particular were at the greatest risk of being either obese without weight loss or overweight or obese and continuing to gain weight. Adjustment for demographics and antipsychotic medication attenuated the relationship between BMI and certain mental health diagnoses. Although BMI trajectories were similar in men and women, some gender differences were observed. For example, the risk of being in the persistently obese class in men was highest for those with PTSD, whereas for women, the risk was highest among those with depression.
The growing number of overweight or obese returning veterans is a concerning problem for clinicians who work with these patients. Successful intervention to reduce the prevalence of obesity will require integrated efforts from primary care and mental health to treat underlying mental health causes and assist with engagement in weight loss programs.
肥胖是一个日益严重的公共卫生问题，在部署后的退伍军人中也成为一种流行趋势。
在一个大型的伊拉克和阿富汗退伍军人队列中，探索体重指数（BMI）与创伤后应激障碍（PTSD）之间的关系，并评估 BMI 在 3 年内的变化轨迹。
退伍军人健康记录的回顾性、纵向队列分析。
共有 496722 名退伍军人（59790 名女性和 436932 名男性），他们的身高和体重至少在最后一次部署结束后在退伍军人事务部（VA）医疗系统中记录过一次，并且他们在 VA 的第一次部署后门诊就诊至少在研究期间结束前 1 年（2011 年 12 月 31 日）。
BMI，心理健康诊断。
75%的伊拉克和阿富汗退伍军人在基线时超重或肥胖。观察到四个轨迹：“稳定超重”是最大的类别；其次是“稳定肥胖”；“超重/肥胖增重”和“肥胖减轻”。在 3 年的确定期间，特别是患有 PTSD 和抑郁症的退伍军人，他们最有可能体重不减或超重或肥胖且体重继续增加。调整人口统计学和抗精神病药物后，BMI 与某些心理健康诊断之间的关系减弱。尽管 BMI 轨迹在男性和女性中相似，但也观察到一些性别差异。例如，在男性中，患有 PTSD 的退伍军人处于持续肥胖类别的风险最高，而对于女性，患有抑郁症的退伍军人的风险最高。
越来越多的超重或肥胖退伍军人是与这些患者合作的临床医生关注的问题。要成功减少肥胖症的患病率，需要从初级保健和心理健康两方面共同努力，以治疗潜在的心理健康病因，并帮助患者参与减肥计划。
