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We examined 5‐year trends in BMI among obese primary care patients to determine whether obesity‐related education such as nutrition counseling or a weight management program was associated with declines in BMI. Veterans with BMI ≥30 kg/m2 and ≥1 primary care visits in fiscal year 2002 were identified from the Veterans Health Administration's (VHA) national databases. Outpatient visits from fiscal year 2002–2006 for nutrition counseling, exercise, or weight management were grouped into five categories varying in intensity and duration: (i) intense‐and‐sustained, (ii) intense‐only, (iii) irregular, (iv) limited, and (v) no counseling. Generalized estimating equation assessed associations between obesity‐related counseling and BMI trend (annual rate of BMI change fiscal year 2002–2006) among cohort members with complete race/ethnic data (N = 179,881). Multinomial logistic regression compared intensity and duration of counseling among patients whose net BMI increased or decreased by ≥10% vs. remained stable. Compared with patients receiving “intense‐and‐sustained” counseling, the BMI trend of those receiving “intense‐only” or “irregular” counseling was not significantly different, but patients receiving “no counseling” or “limited counseling” had significantly higher rates of decreasing BMI (−0.12 and −0.08 BMI per year; P < 0.01, respectively). This was especially true for veterans in their 50–60s, compared with the oldest veterans who were most likely to lose weight. In contrast, younger veterans (18–35 years) were least likely to lose weight; their BMI tended to increase regardless of counseling intensity and duration. Enhanced efforts are needed to detect and combat increasing weight trajectories among veterans who are already obese, especially among those aged 18–35 who are at greatest risk.

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There are 2.1 million current military servicemembers and 21 million living veterans in the United States. Although they were healthier upon entering military service compared to the general U.S. population, in the longer term veterans tend to be of equivalent or worse health than civilians. One primary explanation for the veterans' health disparity is poorer health behaviors during or after military service, especially areas of physical activity, nutrition, tobacco, and alcohol. In response, the Department of Defense and Department of Veterans Affairs continue to develop, evaluate, and improve health promotion programs and healthcare services for military and veteran health behavior in an integrated approach. Future research and practice is needed to better understand and promote positive health behavior during key transition periods in the military and veteran life course. Also paramount is implementation and evaluation of existing interventions, programs, and policies across the population using an integrated and person centered approach.