Smoking, obesity, and their co-occurrence in the US military veterans: results from the national health and resilience in veterans study

Background: Smoking and obesity are major public health concerns, though little is known about the mental and physical health burden of co-occurring obesity and smoking. Methods: Using a nationally representative sample of U.S. military veterans, we examined the prevalence of mental and physical co-morbidities, physical and mental functioning, and quality of life between obese only; smoking only; and obese smokers. Results: Among current smokers, 31.7% were obese; among obese veterans, 16.4% were current smokers; and in the total sample, 5.4% were obese and current smokers. Relative to the obese-only group, obese smokers were more likely to be younger, male, non-while, non-married, unemployed and VA-served, and have lower household incomes. These also reported higher levels of perceived stress and trauma and were more likely to endorsed current suicidal ideation and lifetime suicide attempts (odds ratio [OR] = 2.0), medical (2.3 < = OR < = 3.9) and psychiatric (1.5 < = OR < = 2.9) comorbidities, and lower overall health status and quality of life. Compared to the smoking-only group, obese smokers were more likely to endorse current suicidal ideation (OR= 2.0) and nicotine dependence (OR =1.5), and reported poorer physical health and overall quality of life. Analyses were adjusted for sociodemographic and military characteristics. Limitations: The cross-sectional study design precludes causal inference. Conclusions: These findings suggest that co-occurring obesity and smoking is associated with substantial mental and physical health burden in U.S. veterans. Collectively, they underscore the importance of multi-component interventions targeting, obesity, smoking, and co-occurring issues, such as trauma and internalizing disorders, in this population.