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Senior Research Project
Obesity
By Peter Cheng
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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
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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
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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
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Prevalence Comparison
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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)
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Health Consequences
• Each year 300,000 people die of obesity related diseases
• Making it the 2nd leading cause of preventable death, just behind smoking
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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
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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
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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
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Questionaire: stats
• Age
• Sex
• Weight
• Height
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Perception
• Do you think you are overweight?
• What do you think your ideal weight is?
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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
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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
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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
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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
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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?
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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
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Result
• General figures:– Number of Patient: 101– Age: range 23-71, average of 51– Sex: male 28 (28%), female 73 (72%)
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Prevalence of Obesity
• Avg height: 63.98• Avg weight: 194.5• Average BMI: 33.32
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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%
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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
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Prevalence
• Prevalence of overweight/obesity in male– 84%
• Prevalence of overweight/obesity in female– 80%
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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?
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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)
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Pt’s own ideal weight
• Patient’s own ideal weight comes out to BMI of 26
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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%)
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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
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Pt knowledge on Obesity
• Education
- none (6%), elementary (13%), middle school (14%), high school (47%), College of above (21%)
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Patient EducationPercent
None
Elementary
Middle
High
College
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Patient Source of Information on Obesity
0
5
10
15
20
25
30
35
40
45
50
Doctors Books/Mag TV Friends
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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
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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
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Patient Knowledge on Effects of Obesity
Patient Knowledge
0102030405060708090
100
Percentage
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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
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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
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Outreach Preferences
• What do you think your doctor can do to help you lose weight? 73– Oral instructions: 58%– Handout/pamphlets: 49%– Medications: 40%
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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
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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
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Conclusion
• Our patient population do not have enough exercise hours:– Only 2 hrs per wk
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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.
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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.
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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
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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
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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