The increasing prevalence of Veterans who are overweight and obese suggests that high-quality weight management will need to become as ubiquitous as primary care and will likely require effective and strategic coordination across interventions, especially in large health systems. This is a management and service delivery challenge that does not yet appear to have been solved in health systems in the US or abroad. To stimulate discussion about how to address a clinical challenge of this magnitude, Raffa and colleagues summarize the themes from all three workgroups regarding challenges in developing an integrated population-based approach that incorporates behavioral, medication, and surgical treatments. Their paper notes four overlapping tasks: (1) implementing an evidence-based multicomponent approach to weight management; (2) providing access to overweight and obesity care across VHA; (3) promoting care coordination and patient-engagement strategies; (4) stratifying treatment by the level of patient risk.9 An accompanying editorial by Pronk discusses the potential role of systems science, which represents a broad approach that recognizes the importance of the whole—and the interdependence of the component parts that contribute to obesity. These include an individual’s past experiences, behaviors, family dynamics, workplace culture, community design, and environmental exposures.4
Additional articles in this Supplement focus on several other important issues related to weight management. Young and colleagues discuss the benefits of using technology-delivered weight management with peer coaching to overweight Veterans who have serious mental illness.10 Lutes and colleagues examine the effectiveness of a second year of low intensity support for small changes in weight loss compared to the usual care approach used in MOVE! Programs.11 Chan and colleague examine the relationship between Veterans participating in the MOVE! Program and weight outcomes.12 Breland and colleagues examine the prevalence of obesity among key populations of male and female Veterans, including racial/ethnic and comorbidity sub-populations,2 while Estabrooks and colleagues assess the impact of a community-based weight loss program among non-Veterans.13
VA HSR&D believes this Supplement will make a significant contribution to establishing an integrated approach to weight management in the VHA, one that will better help Veterans obtain effective, patient-centered interventions to assist them in reaching a healthier weight. As representatives of the nation’s largest integrated healthcare system, serving more than 6 million patients each year, we are optimistic about creating a more integrated, population-based approach to obesity that will improve the health of Veterans and offer other healthcare systems an effective model for addressing the rising tide of obesity facing our country today.