Correlates of Concurrent Morbid Obesity and Tobacco Use Disorder Nationally in the Veterans Health Administration

Abstract

Objective

The aim of this study was to examine health, demographic, and service utilization characteristics of veterans with multimorbid tobacco use disorder (TUD) and morbid obesity compared to those with either condition alone. Methods: Health record data were extracted from the computerized patient record system of the Veterans Health Administration (VHA; October 1, 2011 to September 30, 2012). Bivariate and multivariate logistic regression models were used to compare veterans with both TUD and morbid obesity (body mass index [BMI] ≥ 40 kg/m²) to veterans with each condition alone on a range of demographic, health, and service utilization outcome variables that also were extracted from the VHA administrative record. Results: Veterans with both morbid obesity and TUD showed higher rates of medical and psychiatric comorbidity than did veterans with either condition alone. However, while veterans with TUD and morbid obesity showed higher rates of comorbid substance use disorders than veterans with morbid obesity alone, veterans with both conditions showed substantially lower rates of substance use disorders than those with TUD alone. Conclusions: Veterans with co-occurring morbid obesity and TUD appear to be at greater risk for medical disease and psychiatric conditions. The unexpected finding that veterans with TUD alone had more concurrent substance use disorders than veterans with both TUD and morbid obesity suggest the possibility that overeating may be a substitute for substance use in the context of TUD. The multimorbidity profile described here may suggest unique treatment needs for individuals with both TUD and morbid obesity.

Highlights

• Medical multimorbidities predict additional health conditions and poorer outcomes.

• Obesity and tobacco use may share common underlying vulnerabilities.

• Veterans with both conditions showed higher rates of certain multimorbidities.

• Obesity may protect against substance use in tobacco users.

Keywords:

• Multimorbidity
• obesity
• tobacco use disorder
• veterans
• Veterans Health Administration

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

WR and RR designed the study and conducted the analyses. WR conducted the literature review and wrote a first draft of the manuscript. RR provided critical feedback. Both authors contributed to and have approved the final manuscript.

Additional information

Funding

This manuscript is based on work supported by the VA New England Mental Illness Research, Education, and Clinical Center. The views expressed in the article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. The sponsor had no role in the design, analysis, interpretation, or publication of this study.