This is the first submission of an HSR&D CDA-2 proposal to provide five years of salary support to Luke Funk, M.D., M.P.H. The goal of this application is to prepare Dr. Funk for a career conducting health services research focused on severe obesity treatment in VA. Dr. Funk will accomplish this goal by pursuing training activities, obtaining expert mentorship, and completing a program of research focused on identifying and addressing barriers to severe obesity care and bariatric surgery for Veterans. This is a priority for the VA. The National Director of Surgery National Program Director for Weight Management, and the Director of VA HSR&D have recently agreed to convene a State of the Art Conference on this topic. Little is currently known about how severely obese Veterans navigate treatment options. Little is also known about why less than 0.5% of severely obese Veterans pursue the most effective treatment for severe obesity - bariatric surgery. The primary objectives in this CDA application are 1) to better understand how severely obese patients and their primary care providers (PCPs) make obesity treatment decisions; and 2) to pilot-test a communication tool designed to improve shared decision-making and optimize treatment for severely obese patients. These objectives will be achieved through three specific aims.
Aim 1 involves semi-structured interviews with severely obese Veterans and providers who treat them, including PCPs, MOVE! team members and bariatric surgery program members. Facilitators and barriers to bariatric surgery and MOVE! program participation as well as attitudes and experiences of providers and patients who have pursued bariatric surgery in VA will be identified.
Aim 2 involves developing, refining and pilot-testing a communication tool called the Best Case / Worst Case communication tool which is designed to optimize decision-making for Veterans considering bariatric surgery or behavioral weight management within MOVE!. Subsequently, an IIR will be submitted to fund an adequately powered RCT to test intervention effectiveness.
In Aim 3, a national survey of VA PCPs will be administered in an attempt to understand how PCPs manage severely obese patients throughout the VA system. Additionally, their perceptions regarding how severely obese patients engage with the MOVE! program will be explored. To facilitate these research activities and his career development, Dr. Funk will complete a numerous short courses and workshops focusing on health services research, human factors engineering, qualitative research, and intervention design and evaluation. Dr. Funk will be mentored during this award by Dr. Corrine Voils, an expert in qualitative research and health behavior interventions. Co-mentor Dr. Nasia Safdar will provide expertise in human factors engineering and career development. Co-mentor Caprice Greenberg will provide career development mentorship. Co-mentor Margaret Schwarze will provide expertise in pilot-testing the communication tool. Upon completion of the grant, Dr. Funk will be well-prepared to lead an independent research program in health services research in the area of severe obesity treatment and bariatric surgery within VA.
More than 300,000 Veterans are severely obese. These Veterans exert significant costs on the VA system, experience poorer quality of life, and have shortened lifespans. Bariatric surgery is the most effective treatment for severe obesity for weight loss, comorbidity resolution, and quality of life. Bariatric surgery is supported as a treatment option by many national societies, including those representing primary care and endocrinology. However, less than 1% of Veterans who qualify for bariatric surgery undergo it. Reasons for low utilization are unclear, although our preliminary research suggests that there are various patient, provider and system level barriers to severe obesity care. This CDA proposal addresses the VA's urgent need to 1) understand the barriers to severe obesity care within VA; 2) test interventions designed to improve communication between providers and Veterans regarding severe obesity treatment options, including bariatric surgery and behavioral weight loss strategies; and 3) characterize management practices surrounding severe obesity care within VA.