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 NHANES III NHANES 1999-2000 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 80% 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

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 Education

Patient Source of Information on Obesity

Pt knowledge on Obesity More Americans are obese than ever? 7% says No 93% says Yes Is obesity an important health issue?

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

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