Change in body mass index within the first-year post-injury: a VA Traumatic Brain Injury (TBI) model systems study

ABSTRACT

Objective: To describe change in body mass index (BMI) and weight classification 1-year post- traumatic brain injury (TBI) among Veterans and service members.

Design: Prospective observational cohort study.

Setting: VA Polytrauma Rehabilitation Centers.

Participants: Veterans and service members (N = 84) enrolled in VA Traumatic Brain Injury Model Systems (VA TBIMS) study with BMI scores at enrollment and 1-year post-injury.

Interventions: N/A.

Main outcome measures: BMI scores from height and weight and weight classifications (underweight, normal weight, overweight, obese classes 1–3) defined by WHO.

Results: Twenty per cent were obese at time of injury and 24% were obese at 1-year post-injury. Cross-tab analyses revealed 7% of normal weight and 24% overweight participants at time of injury as obese Class 1 one-year post-injury. Univariate models found BMI and tobacco smoking at time of injury were significant predictors of higher BMI scores 1-year post-TBI. Multivariable models found BMI at time of injury and motor functioning, were significant predictors. Preinjury BMI, tobacco smoking and PTSD symptom severity predicted change in weight category.

Conclusion: While obesity among service members and Veterans post-TBI is below national averages, trends in weight gain between time of injury and 1-year follow-up were observed. Implications for health promotion and chronic disease management efforts with regards to rehabilitation for injured military are discussed.

List of Abbreviations: BMI, Body mass index; BRFSS, Behavioural Risk Factor Surveillance; GCS, Glasgow Coma Scale; FIM, Functional Independence Measure; NIDILRR, National Institute on Independent Living and Rehabilitation Research; PCL-C, PTSD checklist-civilian; PSTD, Post-traumatic stress disorder; VA, Veterans Affairs; VA PRC, Veterans Affairs Polytrauma Rehabilitation; VA TBIMS, Veterans Affairs TBI Model Systems;

KEYWORDS:

• Obesity
• weight gain
• traumatic brain injury
• service members
• military
• Veterans

Acknowledgments

The authors would like to acknowledge the invaluable assistance of Kayla LaRosa and Marie Saylors in the preparation of this manuscript. The authors would also like to acknowledge the support of U.S. Department of Veterans Affairs Health Services Research and Development COIN grant (1 I50 HX001233-01; CINDRR) for assistance in manuscript preparation.The views, opinions and/or findings contained in this article are those of the authors and should not be construed as an official position, policy or decision of the Department of Veterans Affairs or any other federal agency unless so designated by other official documentation.

Declaration of interest

The authors report no declarations of interest. The authors have no financial, consultant, institutional or other conflicts of interest to declare. The views, opinions and/or findings contained in this article are those of the authors and should not be construed as an official Departments of Defense or Veterans Affairs position or any other federal agency, policy or decision unless so designated by other official documentation. The participating agencies’ institutional review boards approved this study, and informed consent was obtained after the details of the study were thoroughly explained to participants.

Additional information

Funding

This work was supported by VHA Central Office VA TBI Model System Program of Research, and Subcontract from General Dynamics Health Solutions from the Defense and Veterans Brain Injury Center within the Defense Health Agency [grant number W91YTZ-13-C-0015]; the National Institute on Disability, Independent Living, and Rehabilitation Research [grant number 90DP0044 to PI: Novack], [grant number 90DP0045-01-0 to PI: Shafi & Womack], [grant number H133A120086 to Corrigan]; NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). Department of Veterans Affairs Health Services Research, Center of Innovation on Disability and Rehabilitation Research [grant number 1 I50 HX001233-0]. The contents of this publication do not necessarily represent the policy of NIDILRR, ACL, HHS, Veterans Affairs, and you should not assume endorsement by the Federal Government,National Institute on Disability, Independent Living, and Rehabilitation Research. The VA TBI Model System conducted at the Polytrauma Rehabilitation Centers is a funded collaboration between the Department of Veterans Affairs and the Department of Health and Human Services (National Institute on Disability, Independent Living, and Rehabilitation Research).