Katherine Hoerster - Academia.edu (original) (raw)

Papers by Katherine Hoerster

JAMA Internal Medicine, 2020

Weight Management and Healthy Lifestyles To the Editor In the Original Investigation by Nyberg an... more Weight Management and Healthy Lifestyles To the Editor In the Original Investigation by Nyberg and colleagues 1 regarding healthy lifestyles and years lived without chronic disease, the finding that a body mass index (BMI) less than or equal to 25, in combination with healthy lifestyle factors, predicts more life-years without chronic disease is noteworthy and important. However, the characterization of a BMI lower than 25 as a healthy lifestyle itself is misleading and conveys implicit bias about the nature of BMI and obesity. Obesity is a complex, chronic, multifactorial disease in which lifestyle plays a role, along with an altered food supply, the built physical environment, genetic susceptibility, epigenetics, and a host of other factors. 2 As reported by Kyle et al, 3 the American Medical Association joined numerous other medical organizations in recognizing the nature of obesity as a disease in 2013. Obesity itself is defined by excess adiposity that harms health. Body mass index is a useful measure for estimating the prevalence of obesity in a population. A BMI greater than or equal to 25 defines overweight in the population, and a BMI greater than or equal to 30 suggests a diagnosis of obesity. However, at an individual level, a more complete assessment of body composition and clinical status is necessary for diagnosis. In 2018, Gordon-Larsen and Heymsfield 4 outlined the problems with misclassifying obesity as a lifestyle behavior. Treating BMI as a lifestyle behavior obscures the complex etiologies that contribute to BMI and the metabolic disease of obesity. Perhaps more importantly, it promotes a mistaken notion that is the foundation for weight bias and stigma-that obesity is a condition that patients choose for themselves through behaviors they elect. The resulting weight bias is welldocumented to harm both health and quality of life for people living with obesity. 5 In addition, it can promote the progression of obesity and discourage patients from seeking appropriate medical care. For all these reasons, it is essential to recognize that BMI is a physical characteristic and a marker for metabolic disease. Body mass index itself is neither a behavior nor a lifestyle, even though health behaviors and lifestyle factors can influence BMI. Many other factors are contributors. Medical professionals must recognize this fact to provide adequate care for patients with obesity.

Translational Behavioral Medicine

Land development, pollution, and waste have affected natural environments, contributing to hurric... more Land development, pollution, and waste have affected natural environments, contributing to hurricanes, wildfires, and pandemic infectious diseases like COVID-19. Globalized corporate food systems that produce ultra-refined foods with low nutritional value contribute to both environmental conditions and health conditions like obesity and undernutrition. This has the greatest impact on communities already suffering from elevated health risks driven by economic inequities rooted in racism. These interacting environmental, health, and social conditions represent a syndemic. We outline practical suggestions to address this syndemic of environmental degradation, pandemic infectious disease, chronic disease, undernutrition, and inequity through research and practice at many levels, including individual behavior, local communities, and regional, national and global policy. Collaboration with communities is central to simultaneously tackling interconnected human and environmental health thre...

Journal of General Internal Medicine

O b e s i t y (b o d y m a s s i n d e x [BMI]≥30kg/m 2) among US adults has tripled over the pas... more O b e s i t y (b o d y m a s s i n d e x [BMI]≥30kg/m 2) among US adults has tripled over the past 45 years, but it is unclear how this population-level weight change has occurred. OBJECTIVE: We sought to identify distinct long-term BMI trajectories and examined associations with demographic and clinical characteristics. DESIGN: The design was latent trajectory modeling over 10 years of a retrospective cohort. Subgroups were identified via latent class growth mixture models, separately by sex. Weighted multinomial logistic regressions identified factors associated with subgroup membership. PARTICIPANTS: Participants were a retrospective cohort of 292,331 males and 62,898 females enrolled in VA. MAIN MEASURES: The main outcome measure was 6month average VA-measured BMI over the course of 10 years. Additional electronic health record measures on demographic, clinical, and services utilization characteristics were also used to characterize latent trajectories. KEY RESULTS: Four trajectories were identified for men and for women, corresponding to standard BMI categories "normal weight" (BMI <25), "overweight" (BMI 25-29.99), and "with obesity" (BMI ≥30): "normal weight" and increasing (males: 28.4%; females: 22.8%), "overweight" and increasing (36.4%; 35.6%), "with obesity" and increasing (33.6%; 40.0%), and "with obesity" and stable (males: 1.6%) or decreasing (females: 1.6%). Race, ethnicity, comorbidities, mental health diagnoses, and mental health service utilization discriminated among classes. CONCLUSIONS: BMI in the 10 years following VA enrollment increased modestly. VA should continue prioritizing weight management interventions to the large number of veterans with obesity upon VA enrollment, because the majority remain with obesity.

Preventing Chronic Disease, 2022

What is already known on this topic? The COVID-19 pandemic has affected physical activity and eat... more What is already known on this topic? The COVID-19 pandemic has affected physical activity and eating behaviors, resulting in weight gain. Health systems may be able to address this problem through behavioral weight management. Little is known about the pandemic's effects on participation in weight management programs. What is added by this report? In the Veterans Health Administration, in-person weight management participation declined sharply because of COVID-19, whereas telehealth participation increased, accounting for 90% of participation during the pandemic versus 20% to 30% before. Total participation remained substantially lower into 2021 compared with prior years. What are the implications for public health practice? The demand for weight management services may increase in the postpandemic recovery period, which could be met by health care systems offering telehealth or hybrid options.

Journal of General Internal Medicine, 2021

Background The COVID-19 pandemic has greatly affected front-line health care workers (HCW) and fi... more Background The COVID-19 pandemic has greatly affected front-line health care workers (HCW) and first responders (FR). The specific components of COVID-19 related occupational stressors (CROS) associated with psychiatric symptoms and reduced occupational functioning or retention remain poorly understood. Objectives Examine the relationships between total and factored CROS, psychiatric symptoms, and occupational outcomes. Design Observational, self-report, single time-point online assessment. Participants A total of 510 US HCW (N = 301) and FR (N = 200) with occupational duties affected by the COVID-19 pandemic. Main Outcomes and Measures CROS were assessed using a custom 17-item questionnaire. Post-traumatic stress disorder (PTSD), depression, insomnia, and generalized anxiety symptoms were assessed using the PTSD Checklist-5 (PCL5), Patient Health Questionnaire-9 (PHQ9), Insomnia Severity Index (ISI), and General Anxiety Disorder-7 (GAD7). Respondents’ likelihood of leaving current ...

Translational Behavioral Medicine, 2021

People with low incomes have a disproportionate prevalence of diabetes and its complications and ... more People with low incomes have a disproportionate prevalence of diabetes and its complications and experience many barriers to self-management, which community health workers (CHWs) may help address. We sought to examine the effects of an in-home CHW-led intervention for adults with diabetes and incomes <250% of the federal poverty line on self-management behaviors and test mediators and moderators. From 2010 to 2013, we randomized participants from three Washington State health systems with type 2 diabetes and hemoglobin A1c (HbA1c) ≥ 8% to the CHW intervention (N = 145) or usual care control (N = 142) arms. We examined effects on 12-month self-management: physical activity, dietary behaviors, medication taking, blood glucose monitoring, foot care, and tobacco use. For behaviors with significant intervention-control group differences, we tested mediation by self-efficacy and social support. We also investigated whether intervention-associated changes in behaviors varied by race/et...

Contemporary Clinical Trials, 2020

Nearly half of Veterans have obesity, fueling chronic diseases. The Department of Veterans Affair... more Nearly half of Veterans have obesity, fueling chronic diseases. The Department of Veterans Affairs (VA) offers an evidence-based behavioral weight management intervention called MOVE!, mostly delivered through in-person group sessions. Few eligible Veterans participate due to factors like distance and preferences, mirroring barriers in the general population. Practical alternatives to standard in-person programs are needed to improve access and engagement. A self-directed lifestyle intervention called D-ELITE-delivered through pre-recorded videos by DVD or online streaming-previously efficacious in a general primary care population, may provide such an alternative. This pragmatic clinical trial will evaluate whether D-ELITE improves weight and general health status among Veterans with obesity, relative to VA usual care. The yearlong intervention includes one orientation by phone, supplemental lifestyle coaching primarily via technology-based messages, 12 DVD or online streaming sessions over 3 months, and continued self-directed weight management for months 4-12. Participants use MyFitnessPal.com or paper booklets for self-monitoring weight, diet, and physical activity. Follow-up assessments at 12 and 24 months are administered by mail or phone. The study hypothesis is that compared with usual care, D-ELITE will lead to greater improvements in 12-month weight loss, per VA electronic health records, and general physical health status, assessed using the self-reported SF-12 physical composite score. We will also explore D-ELITE's effects on secondary biometric (e.g., HbA1c) and intermediate (e.g., diet) outcomes, reach, and budget impact. If effective, D-ELITE will offer a potentially scalable, low-cost alternative to VA's existing weight loss interventions by mitigating barriers presented by distance and technology.

Translational Behavioral Medicine, 2020

Military service presents unique challenges and opportunities for health care and public health. ... more Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National ...

Psychiatric Services, 2019

This study sought to compare quality of care following medical home implementation among Veterans... more This study sought to compare quality of care following medical home implementation among Veterans Health Administration (VHA) primary care patients with and without mental illness. Methods: VHA primary care patients seen between April 2010 and March 2013 whose medical records were reviewed by the VHA External Peer Review Program were identified. The proportion of patients meeting quality indicators in each mental illness group (depression, posttraumatic stress disorder, anxiety disorder, substance use disorder, serious mental illness, and any mental illness) was compared with the proportion of patients without mental illness. Sample sizes ranged from 210,864 to 236,421. Differences of 5.0% or greater were deemed clinically important, and higher proportions indicated higher quality of care across 33 clinical indicators. Results: The proportion of veterans meeting clinical quality indicators ranged from 64.7% to 99.6%. Differences of 816 ps.psychiatryonline.org Psychiatric Services 70:9

Translational Behavioral Medicine, 2018

Military service assimilates individuals into a socially cohesive force to address dangerous and ... more Military service assimilates individuals into a socially cohesive force to address dangerous and traumatic situations that have no counterpart in civilian life. Upon leaving active duty, many veterans experience a "reverse culture shock" when trying to reintegrate into civilian institutions and cultivate supportive social networks. Poor social reintegration is associated with greater morbidity and premature mortality in part due to adoption of risky health behaviors, social isolation, and inadequate engagement in health care services. Although institutions like the Veterans Health Administration (VA) do much to address the complex psychosocial and health care needs of veterans and their families with evidence-based care, only 61% of Operations Enduring and Iraqi Freedom (OEF/OIF) Veterans are enrolled in VA care and there are numerous perceived barriers to care for enrollees. To address this gap, a community-based nonprofit organization, Team Red, White & Blue (RWB), was created to help veterans establish health-enriching social connections with communities through the consistent provision of inclusive and locally tailored physical, social, and service activities. This article provides an overview of the development and refinement of a theory-based framework for veteran health called the Enrichment Equation, comprised of three core constructs: health, people, and purpose. By operationalizing programming activities and roles, we describe how theoretical components were translated into a social networking implementation package that enabled rapid national spread of Team RWB. We conclude with future opportunities to partner with researchers and other organizations to understand program impact, and to identify effective intervention components that could be adapted for similar vulnerable groups.

Mental Health and Physical Activity, 2016

Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sed... more Individuals with posttraumatic stress disorder (PTSD) have elevated rates of morbidity, and a sedentary lifestyle can cause and aggravate the physical health needs of adults with PTSD. The primary aim of this paper was to explore the impact of physical activity (PA) counseling (vs. usual care) on physical and psychological outcomes among individuals with PTSD. A secondary aim was to compare these arm effects between those with and without PTSD. Methods-Older (>60 years) overweight veterans with impaired glucose tolerance were randomly assigned to an intervention or a usual care control arm. Of the 302 participants who underwent randomization, 67 (22%) had PTSD. Participants in the intervention arm received one in-person activity counseling session followed by regular PA telephone counseling over 12 months. Physical and psychological outcomes were assessed at baseline, 3, and 12 months.

The Gerontologist, 2016

Purpose of the Study: Trajectories of physical activity (PA) and sedentary time (ST) after milita... more Purpose of the Study: Trajectories of physical activity (PA) and sedentary time (ST) after military separation are likely important determinants of women's health outcomes later in life, because low PA and high ST are known contributors to premature mortality risk. Our objective was to compare longitudinal trajectories of recreational PA and ST between Veteran and non-Veteran postmenopausal women from the Women's Health Initiative (WHI). Design and Methods: Women Veteran (n = 3,719) and non-Veteran (n = 141,800) WHI participants were included. Selfreported participation in recreational PA, converted to metabolic equivalent (MET)-hours/week, was prospectively assessed over 8 years. Self-reported ST, defined as hours/day sitting or lying down, was collected at baseline and at Years 3 and 6. Generalized estimating equations were used to compare trajectories of PA and ST between Veterans and non-Veterans, adjusted for demographics and lifestyle behaviors. Results: Veterans had higher baseline PA than non-Veterans (13.2 vs 12.5 MET-hours/week, p = .03). PA declined for both groups, with a steeper decline among Veterans (change/visit year −0.19 vs −0.02 MET-hours/week; interaction p < .001). At baseline, Veterans and non-Veterans had similar levels of ST (107.2 vs 105.9 hours/week, p = 0.42). Over time, ST remained stable among Veterans but declined slightly among non-Veterans (change/visit year −0.19 vs −0.49 hours/week; interaction p = .01).

Journal of Affective Disorders, 2016

Sleep, Jan 31, 2015

To investigate the influence of SDB on weight loss in overweight/obese veterans. Observational st... more To investigate the influence of SDB on weight loss in overweight/obese veterans. Observational study. National Veterans Health Administration health system. Overweight/obese veterans enrolled in MOVE! from May 2008-February 2012 who had at least two MOVE! visits, baseline weight, and at least one follow-up weight (n = 84,770). Nationally implemented behavioral weight management program (MOVE!). SDB was defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Primary outcome was weight change (lb) from MOVE! enrollment to 6- and 12-mo assessments. Weight change over time was modeled with repeated-measures analyses. SDB was diagnosed in one-third of the cohort (n = 28,269). At baseline, veterans with SDB weighed 29[48] lb more than those without SDB (P < 0.001). On average, veterans attended eight MOVE! visits. Weight loss patterns over time were statistically different between veterans with and without SDB (P < 0.001); veterans with SDB ...

Social Science & Medicine, 2015

Rationale: Veterans, especially those using U.S. Department of Veterans Affairs (VA) healthcare, ... more Rationale: Veterans, especially those using U.S. Department of Veterans Affairs (VA) healthcare, have poorer health than the general population. In addition, Veterans using VA services are more likely than non-VA users to be physically inactive. Little is known about physical activity correlates among Veterans. To identify targets for health promotion interventions, understanding barriers to and facilitators of physical activity in this population is critical. Methods: This study examined individual-, social-, and perceived neighborhood-level associations of meeting weekly physical activity recommendations (150 min/week of combined leisure and transportation activity) based on the International Physical Activity Questionnaire (IPAQ) among N = 717 patients from VA Puget Sound, Seattle Division using a mailed survey sent *

Preventing chronic disease, 2008

Twenty-eight US states have passed legislation for indoor tanning facilities. To our knowledge, w... more Twenty-eight US states have passed legislation for indoor tanning facilities. To our knowledge, whether these state laws are actually enforced has not been evaluated previously in all 28 states. Therefore, we interviewed key informants in these states to assess enforcement practices. Two trained interviewers used a structured survey instrument to interview 28 key informants who were knowledgeable about enforcement practices for laws regarding indoor tanning. Respondents provided information specific to the most populous city in their states. Licensure for indoor tanning businesses was required in 22 of the 28 cities. Slightly less than half of the cities gave citations to tanning facilities that violated state law. Approximately 32% of the cities did not inspect indoor tanning facilities for compliance with state law, and another 32% conducted inspections less than annually. Of those cities that inspected at all, most conducted unannounced inspections. The relatively low rates of an...

Eating behaviors, Jan 4, 2015

US Iraq and Afghanistan Veterans with post-traumatic stress disorder (PTSD) and depression are at... more US Iraq and Afghanistan Veterans with post-traumatic stress disorder (PTSD) and depression are at increased risk for obesity. Understanding the contribution of health behaviors to this relationship will enhance efforts to prevent and reduce obesity. Therefore, we examined the association of PTSD and depression symptoms with binge eating, a risk factor for obesity, among Iraq/Afghanistan Veterans. Iraq/Afghanistan Veterans were assessed at intake to the VA Puget Sound Healthcare System-Seattle post-deployment clinic (May 2004-January 2007). The Patient Health Questionnaire was used to measure depression and binge eating symptoms, and the PTSD Checklist-Military Version assessed PTSD symptoms. The majority of the sample (N=332) was male (91.5%) and Caucasian (72.6%), with an average age of 31.1 (SD=8.5) years; 16.3% met depression screening criteria, 37.8% met PTSD screening criteria, and 8.4% met binge eating screening criteria. In adjusted models, those meeting depression (odds rati...

General Hospital Psychiatry, 2015

The objective was to determine whether obesity screening and weight management program participat... more The objective was to determine whether obesity screening and weight management program participation and outcomes are equitable for individuals with serious mental illness (SMI) and depressive disorder (DD) compared to those without SMI/DD in Veterans Health Administration (VHA), the largest integrated US health system, which requires obesity screening and offers weight management to all in need. Methods: We used chart-reviewed, clinical and administrative VHA data from fiscal years 2010-2012 to estimate obesity screening and participation in the VHA's weight management program (MOVE!) across groups. Six-and 12-month weight changes in MOVE! participants were estimated using linear mixed models adjusted for confounders. Results: Compared to individuals without SMI/DD, individuals with SMI or DD were less frequently screened for obesity (94%-94.7% vs. 95.7%) but had greater participation in MOVE! (10.1%-10.4% vs. 7.4%). MOVE! participants with SMI or DD lost approximately 1 lb less at 6 months. At 12 months, average weight loss for individuals with SMI or neither SMI/DD was comparable (−3.5 and −3.3 lb, respectively), but individuals with DD lost less weight (mean=−2.7 lb). Conclusions: Disparities in obesity screening and treatment outcomes across mental health diagnosis groups were modest. However, participation in MOVE! was low for every group, which limits population impact. Published by Elsevier Inc.

Telemedicine and e-Health, 2015

Background: Collaborative care and care management are cornerstones of Primary Care-Mental Health... more Background: Collaborative care and care management are cornerstones of Primary Care-Mental Health Integration (PC-MHI) and have been shown to reduce depressive symptoms. Historically, the standard of Veterans Affairs (VA) collaborative care was referring patients with posttraumatic stress disorder (PTSD) to specialty care. Although referral to evidence-based specialty care is ideal, many veterans with PTSD do not receive such care. To address this issue and reduce barriers to care, VA currently recommends veterans with PTSD be offered treatment within PC-MHI as an alternative. The current project outlines a pilot implementation of an established telephone-based collaborative care model-Translating Initiatives for Depression into Effective Solutions (TIDES)-adapted for Iraq/Afghanistan War veterans with PTSD symptoms (TIDES/PTSD) seen in a postdeployment primary care clinic. Materials and Methods: Structured medical record extraction and qualitative data collection procedures were used to evaluate acceptability, feasibility, and outcomes. Results: Most participants (n = 17) were male (94.1%) and white (70.6%). Average age was 31.2 (standard deviation = 6.4) years. TIDES/PTSD was successfully implemented within PC-MHI and was acceptable to patients and staff. Additionally, the total number of care manager calls was positively correlated with number of psychiatry visits (r = 0.63, p < 0.05) and amount of reduction in PTSD symptoms (r = 0.66, p < 0.05). Overall, participants in the pilot reported a significant reduction in PTSD symptoms over the course of the treatment (t = 2.87, p = 0.01). Conclusions: TIDES can be successfully adapted and implemented for use among Iraq/Afghanistan veterans with PTSD. Further work is needed to test the effectiveness and implementation of this model in other sites and among veterans of other eras.

Epidemiologic reviews, Jan 16, 2015

Post-traumatic stress disorder (PTSD), a prevalent and costly psychiatric disorder, is associated... more Post-traumatic stress disorder (PTSD), a prevalent and costly psychiatric disorder, is associated with high rates of obesity and cardiometabolic diseases. Many studies have examined PTSD and risky behaviors (e.g., smoking, alcohol/substance abuse); far fewer have examined the relationship between PTSD and health-promoting behaviors. Physical activity and eating behaviors are 2 lifestyle factors that impact cardiometabolic risk and long-term health. This comprehensive review of the literature (1980-2014) examined studies that reported physical activity and eating behaviors in adults with PTSD or PTSD symptoms. A systematic search of electronic databases identified 15 articles on PTSD-physical activity and 10 articles on PTSD-eating behaviors in adults. These studies suggest that there may be a negative association among PTSD, physical activity, and eating behaviors. Preliminary evidence from 3 pilot intervention studies suggests that changes in physical activity or diet may have bene...