# Body Mass Index (BMI) Risk Zones and Variations in Obesity Detection in Veterans with Spinal Cord Injury (SCI)

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

Background. Obesity is a chronic disease that is associated with significant morbidity and mortality, and is
a national healthcare and public health concern. The prevalence of obesity is high among U.S. Veterans,
with more than two-thirds being overweight or obese. The World Health Organization (WHO) and the
Centers for Disease Control and Prevention (CDC) classify “overweight” and “obesity” as a body mass
index (BMI) > 25 kg/m2 and > 30 kg/m2, respectively; as such, BMI assessment is an established standard
of care that is supported by the Healthcare Effectiveness Data and Information Set (HEDIS) and is a CMS
Physician Quality Reporting System (PQRS) cross-cutting measure. The Departments of Veterans Affairs
and of Defense mandate annual universal BMI screening of Veterans for overweight and obesity.
Significance. Obesity in individuals with spinal cord injury (SCI) is common due to changes in body
composition, changes in energy balance, and a significant decrease in mobility. However, due to these
changes, it is likely that BMI underestimates obesity and obesity-related risk in patients with SCI, compared
to able-bodied individuals. Because of physical and logistical barriers to conducting height and weight
assessments in Veterans with SCI, we suspect that BMI is not consistently measured in this population.
Innovation. Appropriate detection and management of obesity in Veterans with SCI relies on consistent
measurement of BMI and proper interpretation of BMI when it is assessed. To better understand the
burden of obesity in this vulnerable Veteran population and to identify individuals at risk for obesity-related
morbidity, we propose to describe system-wide variation in BMI assessment. In addition, we plan to
determine the longitudinal associations between BMI and obesity-related risk in Veterans with SCI in order
to determine if SCI-specific adjusted BMI risk zones are needed to properly recognize obesity and risk for
comorbidity in this population.
Specific Aims. Thus, our goals for this project are three-fold:
1) To characterize guideline-concordant BMI assessment in Veterans with SCI in FY16-FY18.
2) To qualitatively understand drivers of facility-level variation in BMI assessment in Veterans with SCI.
3) To evaluate and calibrate SCI-spceific, adjusted BMI-based morbidity risk zones in Veterans with SCI. As
such, we will identify Veterans with SCI at risk for obesity-related morbidity whose obesity status, based on
current conventional BMI risk zones, would be undetected.
Methodology. We will determine facility-level annual proportions of Veterans with SCI that receive
guideline-concordant BMI assessment; then identify elements that could influence implementation of BMI
assessment strategies by interviewing Veterans and providers in pre-selected facilities; and finally calibrate
BMI risk zones in this population by characterizing the functional form of the relationship between BMI and
onset of obesity-related comorbidities.
Next Steps. B...

## Key facts

- **NIH application ID:** 10087798
- **Project number:** 5I01HX002432-02
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Dan Eisenberg
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2020-01-01 → 2022-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10087798

## Citation

> US National Institutes of Health, RePORTER application 10087798, Body Mass Index (BMI) Risk Zones and Variations in Obesity Detection in Veterans with Spinal Cord Injury (SCI) (5I01HX002432-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10087798. Licensed CC0.

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