Acknowledgements and Disclosures Incidence and Trajectory of Obesity in Veterans and Service Members with TBI: A VA TBI Model Systems Study Racine Marcus Brown, Ph.D.,1 Risa Nakase-Richardson, Ph.D.,1-3 Xinyu Tang, Ph.D.,4 Laura Dreer, Ph.D.,5 Simon Driver, Ph.D.,6 Doug Johnson-Greene, Ph.D.,7 Aaron M. Martin, Ph.D.,2 Tamara McKenzie-Hartman, Psy. D.,8 Mary Jo Pugh, Ph.D.,9,10 Steven Scott, D.O.,11 Timothy Shea, Psy.D.,12 Tong Sheng, Ph.D.,13 Marc A. Silva, Ph.D.1,2 1Center of Innovation for Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL; 2Department of Mental Health and Behavioral Science, James A. Haley Veterans Hospital, Tampa, FL; 3University of South Florida, Tampa, FL; 4University of Arkansas for Medical Sciences, Little Rock, AR; 5University of Alabama at Birmingham, Birmingham, AL; 6Baylor Institute for Rehabilitation, Dallas, TX; 7University of Miami, Coral Gables, FL; 8Defense and Veterans Brain Injury Center, Tampa, FL 9University of Texas Health Science Center, San Antonio, TX; 10South Texas Veterans Health Care System, San Antonio, TX; 11Physical Medicine and Rehabilitation Service, James A. Haley Veterans Hospital, Tampa FL; 12Ohio State University, Columbus, OH; 12Stanford University School of Medicine, Palo Alto, CA; 13Palo Alto VAMC, Palo Alto, CA Introduction Results Discussion Purpose: Describe BMI and weight classification 1-year post injury in a Veteran and Service Member cohort enrolled in VA TBI Model Systems. Little literature on the effect of TBI on weight in chronic phase of TBI To date, no study has examined long-term weight change in Veterans and Service Members Traumatic Brain Injury (TBI): Complex injury with various, often co-morbid conditions such as cognitive impairment,1 motor impairment,2 sleep apnea,3-5 and hypopituitarism.6,7 TBI is often a chronic condition needing health management. Obesity: Modifiable risk factor associated with high morbidity and early mortality, with health problems including metabolic syndrome, diabetes,8,9 hypertension,10 heart disease,11,12 and chronic pain.13,14 Traumatic Brain Injury and Obesity Three contradictory studies on impact of pre-TBI obesity on outcomes15-17 One case series with 2 patients having hyperphagia and becoming obese18 Civilian TBIMS study (N=20) found a mean weight gain of 25.8 lb. post-TBI2 Study from acute care to 3 years post-TBI found 42% gained weight19 Indications of TBI and weight change as complex co-morbidity in need of chronic disease management, but data are needed to inform optimal care Results of the current study indicate that there is no simple linear trend of increased obesity in VA TBIMS study participants 1 year post-injury. Obesity in TBI-affected Veterans at 1 year post-injury is a notable, but not pervasive problem that may be part of a complex metabolic response to brain injury with a broad array of possible outcomes. Univariate Models Demographics, military service status at the time of injury, and potentially related conditions such as injury severity show minimal effect on BMI at 1 year post-injury BMI at the time of injury supports other findings that obesity at younger ages is associated with greater odds of these conditions later in life21 Smoking tobacco seems to have a suppressive effect on weight gain at one year post injury22 Multivariate Model That BMI at time of injury would have some influence on BMI at a later point in time is not surprising21 The positive association with FIM motor and the strong positive association with National Guard or Reserve at time of injury require a more careful interpretation FIM Motor: it is possible that a higher degree of functional independence in mobility allows for a greater degree of uncontrolled eating in some cases National Guard or Reserve: there is possible deconditioning from having a more active lifestyle pre-TBI to more limited mobility coupled with higher caloric intake in the chronic phase of TBI Further research with larger sample is needed to confirm these findings References are available upon request. Please contact Racine Brown at Racine.Brown@va.gov Table 1: Summary of study variables Table 2: BMI data at time of injury and 1-year post-injury Table 3: Univariate and multivariate models for continuous BMI outcome Subjects with BMI at Enrollment 1-Year Post-Injury Enrollment & N (N=241) (N=148) (N=84) Demographics   Age at Injury 241 25;31;44 148 24;30;50 84 24;30;51 Male 95% (229) 96% (142) 95% (80) Race 236 146 82 White 74% (175) 69% (101) 70% (57) Black or African American 10% ( 24) 10% ( 14) 12% (10) Other 16% ( 37) 21% ( 31) 18% (15) Hispanic 237 17% ( 40) 17% ( 25) 83 22% (18) Marital Status Married 42% (102) 36% (54) 37% (31) 58% (139) 64% (94) 63% (53) Annual Earnings 177 114 60 ≤ $39,999 49% (86) 57% (65) 57% (34) $40,000 - $79,999 39% (69) 38% (43) 38% (23) ≥ $80,000 12% (22) 5% ( 6) 5% ( 3) Years of Education 240 ≤ HS Diploma 44% (105) 55% (81) 61% (51) > HS Diploma 56% (135) 45% (67) 39% (33) Injury-related and Military Characteristics Cause of Injury Vehicular 49% (117) 62% (91) 63% (52) Fall 15% ( 36) 14% (21) 16% (13) Violence: Penetrating 4% ( 9) 5% ( 7) 4% ( 3) Violence: Blast 16% ( 38) 7% (10) 5% ( 4) 12% (17) GCS 175 3; 8;15 131 3; 8;14 74 Active Duty at Time of Injury 59% (143) 55% (82) 48% (40) Guard or Reserve at Time of Injury 239 6% ( 15) 147 7% ( 10) 8% ( 7) Years in Active Duty 3; 5;10 2;4;8 Deployed in Combat Zone 67% (160) 60% (88) 62% (52) Functional and Mental Health Characteristic PCL-C Total Severity Score 173 20;35;59 105 19;24;38 56 19;27;44 FIM Cognitive at Discharge 228 26;30;32 142 26;30;33 79 FIM Motor at Discharge 230 77;86;90 77;84;89 81 77;84;90 Alcohol and Tobacco Problems Smoked Cigarettes Prior to Injury 37% ( 88) 89 44% (39) 47% (39) Methods BMI Information N BMI at Time of Injury 84 24;26;29 BMI Classification at Time of Injury   Underweight to Normal Weight 30 36% Overweight 37  44% Obese 17 20% BMI at 1-year Follow-up 23.3;26.4;29.7 BMI Classification at 1-year Follow-up 29 34% 35 42% 20 24% Participants: Inclusion and Exclusion Criteria20 Diagnosis of TBI according to case definition Admission to a VA Polytrauma Rehabilitation Center for comprehensive TBI inpatient rehabilitation Provision of Informed Consent by Veteran or Proxy Height and weight reported for time of injury and recorded for 1 year post-injury No amputations Measures BMI=weight(lb.)/height(in)*703 Functional Independence Measure (FIM) Cognitive Motor Behavioral Risk Factor Surveillance System (BRFSS) health questions on tobacco smoking Procedures Interview at enrollment and follow-up incorporating measures Medical record abstraction Analysis Linear regression model predicting the continuous outcome Ordered logistic regression model predicting the ordinal outcome Multivariable linear regression model for continuous outcome   Univariate Model Multivariable Model Risk Factor Comparison Estimate (95% CI) p-value Age† 1 year increase 0.06 (-0.001, 0.11) 0.054 Dropped Years of Education -0.35 (-0.78, 0.08) 0.117 -0.17 (-0.66, 0.32) 0.496 BMI at Enrollment 1 unit increase 0.51 (0.33, 0.69) <0.001 0.60 (0.38, 0.82) GCS 0.21 (-0.01, 0.42) 0.061 0.18 (-0.04, 0.41) 0.124 Deployed in Combat Zone Yes vs. No -0.44 (-2.43, 1.56) 0.669 -1.47 (-3.88, 0.94) 0.240 PCL-C Total Severity Score 0.02 (-0.04, 0.09) 0.476 0.01 (-0.06, 0.07) 0.778 FIM Cognitive at Discharge 0.01 (-0.15, 0.17) 0.899 -0.10 (-0.39, 0.19) 0.486 FIM Motor at Discharge 0.05 (-0.003, 0.10) 0.11 (0.02, 0.21) 0.029 Smoked Cigarettes Prior to Injury -2.69 (-4.54, -0.84) 0.005 -2.01 (-4.68, 0.66) 0.148 Active Duty at Time of Injury -0.69 (-2.62, 1.24) 0.482 1.46 (-0.65, 3.57) 0.183 Guard or Reserve at Time of Injury 2.73 (-0.72, 6.19) 0.120 3.72 (0.43, 7.00) 0.033 Acknowledgements and Disclosures Financial Disclosures: None. This research was sponsored by VHA Central Office VA TBI Model Systems Program of Research; Subcontract from General Dynamics Information Technology (W91YTZ-13-C-0015) from the Defense and Veterans Brain Injury Center; US Army Medical Research and Material Command (USAMRMC); Department of Veterans Affairs grants (1 I50 HX001233-01, W81XWH-13-2-0095); and Department of Defense Congressionally Directed Medical Research Programs. This material is the result of work supported with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official position by the Department of Defense, Department of Veterans Affairs, or any other federal agency, policy or decision unless so designated by other official documentation.