Senior Research Project

Obesity

By Peter Cheng

Introduction

• Obesity is becoming a major health concern in our nation due to following 3 reasons:

- Prevalence increasing each year

- associated w/ many chronic diseases

- healthcare cost of obesity is rising each year

Prevalence

• National Health and Nutrition Examination Survey (NHANES) conducted 4 studies:– NHANES I: 1971-1974– NHANES II: 1976-1980– NHANES III: 1988-1994– NHANES 1999-2000

NHANES Results

• NHANES II– 47 % of US population overweight/obese

• NHANES III– 56 % of US population overweight/obese

• NHANES 1999-2000– 64 % of US population overweight/obese

Prevalence Comparison

Health Consequences

• Obesity is related to: – Cardiovascular: CAD, stroke, HTN– Endocrine: DM2, Dyslipidemia, Infertility– Resp: sleep apnea– GI: gallstones– MS: OA– cancer (endometrial, breast, prostate, colon)

Health Consequences

• Each year 300,000 people die of obesity related diseases

• Making it the 2nd leading cause of preventable death, just behind smoking

Healthcare Cost

• Imagine the amount of time, effort, and money we put in each day in FCC treating pts w/ DM, HTN, lipid

• Center of Disease & Control released a report stating that in 2003, cost of obesity related healthcare expenditure was: 75 billion dollars

Research Objective

• Prevalence of obesity in our pt population

• Perception of these pts on their obesity

• What pts are doing for their obesity

• Patient’s level of knowledge on obesity

• Ideal way of outreach without offending pts

Method

• A questionaire was randomly given to FCC patient, after our nurses record their medical record numer, age, sex, weight, and height

• Exclude pts under age 20 over over 80

• No abbreviations were used on questionaire

Questionaire: stats

• Age

• Sex

• Weight

• Height

Perception

• Do you think you are overweight?

• What do you think your ideal weight is?

What are pts doing

• On average, how many hrs per wk do you exercise?

• What kind of exercises do you do the most?

- run, walk, swim, bike, rollerskate, basketball, aerobics, weighttrainning, others

What are pts doing: cont

• Have you tried to lose weight before?

• If you tried to lose wt before, what was the most amount of wt that you were able to lose?

• If you were to lose weight, which method are you willing to use consistently? – Diet, exercise, meds, herbal products, surgery

Pt Knowledge

• What is your education background?

• Which of the following conditions do you think is associated with obesity?– DM2, HTN, OA, Strokes, MI, infertility,

dyslipidemia, venous insufficeincy, anemia, bad vision

Pt knowledge: cont

• Do you think Americans in general are becoming more overweight than before?

• Do you think that obesity is an important health issue in our society?

• What do you think causes obesity? Genetic, diet, lack of exercise, others

Info and Outreach

• Where do you get the most information about weight lose from? – Your doctor, books/mags, TV infomercials,

friends, others

• Do you feel offended when your doctor tells you that you have to lose weight?

Info and Outreach: cont

• Would you like to learn more about obesity and weight loss from your doctor?

• What do you think your doctor can do to help you lose weight?

- oral Instructions, handouts/pamphlets, medications, others

Result

• General figures:– Number of Patient: 101– Age: range 23-71, average of 51– Sex: male 28 (28%), female 73 (72%)

Prevalence of Obesity

• Avg height: 63.98• Avg weight: 194.5• Average BMI: 33.32

Prevalence of Obesity

• Prevalence of pt overweight (BMI 25-29.9)– 27%

• Prevalence of pt obese (BMI >30)– 53%

• Prevalence of pt overweight/obese (BMI>25)

– 80%

US vs RCRMC

% Overweight / Obesity Comparison

0.00%10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%

Overweight Obese Overweight &Obese

US

RCRMC

Prevalence

• Prevalence of overweight/obesity in male– 84%

• Prevalence of overweight/obesity in female– 80%

Pt’s own perception

• Do overweight pts know that they are overweight?

• Ideal weight difference:

- Pt’s own ideal weight minus their true ideal weight (using BMI of 25): even if they know they are overweight, do they know by how much?

Pt’s own perception

• of those who are overweight:– 82% of pt think they are overweight

(BMI: 37)– 18% of pt thinks that they are NOT

overweight (BMI: 31)

Pt’s own ideal weight

• Patient’s own ideal weight comes out to BMI of 26

What pts are doing

• Exercises: – avg 2 hrs/wk– Walk (65%), Bike (11%), swim (8 %),

wt training (5%), gardening (4%), aerobics (3%), Run (1%), basketball (1%), play with pets (1%)

What pts are doing

• 78% of pt tried to lose wt, 22% did not

• Those who tried to lose wt, max amount of wt lost was average of 25.7 pounds

• If pt was to lose wt, they prefer:

- 64% prefer exercise, 61% prefer diet, 20% prefer medication, 15% prefer herbal products, and 15% prefer surgery

Pt knowledge on Obesity

• Education

- none (6%), elementary (13%), middle school (14%), high school (47%), College of above (21%)

Patient EducationPercent

None

Elementary

Middle

High

College

Patient Source of Information on Obesity

0

5

10

15

20

25

30

35

40

45

50

Doctors Books/Mag TV Friends

Pt knowledge on Obesity

• More Americans are obese than ever? – 7% says No– 93% says Yes

• Is obesity an important health issue? – 7% says No– 93% says Yes

Pt knowledge on Obesity

• Obesity can cause which? – DM (38%), HTN (40%), OA (18%),

stroke (30%), MI (39%), infertility (8%), dyslipidemia (49%), venous insuff (9%), anemia (4%), vision (7%)

• Number of pt who got all of them right: 1

Patient Knowledge on Effects of Obesity

Patient Knowledge

0102030405060708090

100

Percentage

Pt knowledge on cause of obesity

• What is the cause of obesity: – 43% says genetic, 67% says diet,

82% says lack of exerciseds– Only 26% of pt think it is all three

factors

Outreach Preference

• Are you offended when your doctor tell you to loose weight? – 98%: No– 2%: Yes

• Would you like to learn more about obesity from your doctor? – 17 %: No– 83 % : Yes

Outreach Preferences

• What do you think your doctor can do to help you lose weight? 73– Oral instructions: 58%– Handout/pamphlets: 49%– Medications: 40%

Conclusion

• Prevalence of obesity among RCRMC pt population is significantly higher than national average – 82% vs 64%– Average BMI of our pt population: 33.3

Conclusion

• Majority of overweight pts know that they are overweight; however they underestimate the amount of weight loss they need– The average of patient’s own ideal weight is

BMI of 26

Conclusion

• Our patient population do not have enough exercise hours:– Only 2 hrs per wk

Conclusion

• 68% of pt have education high school or above, yet their knowledge of obesity are still very lacking. More than ½ of them do not realize the important health implications of obesity.

Conclusion

• Vast majority of pts are NOT offended when doctors tell them to lose weight; in fact, they would like to learn more about weight loss from their doctors.

Discussion

• What can be contributing to obesity in pts? – Patients do not know their true ideal weight– They don’t know the long term health

implications of obesity, thus they lack motivation

– They do not know the correct method to lose weight

– They just can’t/won’t start diet & exercise

Discussion

• What can we do to better serve our patients?– Patients are more receptive than we think; they

want to know more about losing weight– Discuss with them their ideal weight– Educate pts on health consequences of obesity – Go into more detail about what to do with diet

and how much exercises they need

Discussion

• What can be improved on this study:– larger patient sample size– Include ethnicity– Questions on diet intake– A more accurate prevalence can be obtained

from random patient chart review