Rates, Variability, and Predictors of Screening for Obesity: Are Individuals with Spinal Cord Injury Being Overlooked?

Abstract

Introduction: Individuals with spinal cord injury (SCI) are vulnerable to obesity. Annual obesity screening using body mass index (BMI) is standard of care mandated by U.S. Veterans Health Administration (VHA) guidelines. Our objective is to determine the rates, variability, and predictors of guideline-concordant annual screening for obesity, given potential challenges of height and weight measurements in individuals with SCI. Methods: This is a cross-sectional retrospective study using U.S. national VA databases. We identified all VHA patients with chronic SCI in fiscal year (FY) 2019, their treating facility, and frequency of recorded height and weight. We applied mixed-effects logistic regression models to assess associations between annual obesity screening and patient- and facility-level characteristics. Results: Of 20,978 individuals with chronic SCI in VHA in FY19, guideline-concordant annual BMI-screening was lacking in 37.9%. Accounting for facility level factors (geographic region, SCI facility type, volume of patients with SCI treated at the facility) a mixed-effects logistic regression model demonstrated that lack of annual obesity screening was significantly associated with older patient age (p<0.001) and fewer outpatient encounters (p<0.001), but not other patient-level factors such as sex, race, level of injury, or rurality. Rate of obesity screening among different facilities within VHA varied widely from 11.1% to 75.7%. Conclusion: A large proportion of persons with SCI receiving care in VHA do not receive guideline-concordant annual obesity screening, an especially acute problem in some facilities. Older patients with fewer outpatient encounters are more likely to be missed. To inform the design of interventions to improve identification and documentation of obesity, further study is needed to assess potential barriers to obesity screening in the population with SCI.