Transcript Skinny on Obesity in Texas - The University of Texas Health Science

The Skinny on Obesity in Texas:
®
BMI in Texas Family Medicine Clinics
Kristin M. Yeung, Ramin Poursani, MD, Sandra K. Burge, PhD
The University of Texas Health Science Center at San Antonio
Introduction
In recent years, the media has been filled with
conversations and information about the United
States’ growing problem with obesity. What seems
to be an unstoppable disease, obesity leads to
several other deadly conditions, including diabetes
mellitus, heart attack and stroke (1,4). Due to the
nation’s advancing concerns, much research has
been done about the prevalence of obesity. In the
United States, this condition is greater among
women than men for all age groups (1,2,3), it is
seen most often in African Americans and
Hispanics (3), and those within the age group of
45-59 are most likely to be obese (1,2). How has
obesity affected Texans, especially patients seen in
primary care settings? Our study examined patient
visits in community family medicine clinics and
determined how obesity was correlated with age,
gender, ethnicity, and key co-morbid conditions.
Methods
Medical students documented 726 outpatient visits
from 9 family medicine residency programs across
Texas. Eligible patients included all patient-visitors
seeing a physician in the study clinics during the
study period. A Visit Survey documented elements
of each primary care visit, including patient
demographics, vital signs, reasons for visit,
diagnoses, health education, medications
prescribed, diagnostic tests ordered, nonmedical
treatments, referrals to specialists and admissions
to hospitals. Over a one-month period, students
identified half-days for data collection, then
randomly selected a physician to shadow. During
the physician’s clinic session, the student invited
all the physician’s patients to participate in the
study. After informed consent, students observed
the visit and completed the Visit Survey.
Results
Of the 726 visits sampled, 65.6% were females and 14.6% were children age 20 and under. The mean
age of our patient sample was 44.3 (min = 0, max = 97). The main ethnic groups observed were
Hispanics (57%), Caucasians (24.5%), African Americans (12.7%) and Asians (3.6%). Obesity for
children was determined based on the CDC growth chart for children age 2 to 20. Pregnant females were
excluded from analysis. The results showed 48.4% of child visits were made by overweight children and
20.3% by obese children. Alternatively, 26.3% of adult visits were attended by overweight individuals
(25 < BMI ≤ 30) and 50% by obese individuals (BMI > 30). Women were more likely to be obese than
men (53.8% and 42.1% respectively), and Hispanic adults were more likely to be obese than adults from
other ethnic/racial groups (p ≤ 0.05,figure 1). Patients from age 40-49 had the highest BMI (34.0)
compared to all other adult age groups (p ≤ 0.05, figure 2). Finally, patients with asthma, COPD,
diabetes, hyperlipidemia, and hypertension were significantly more likely to be obese (Figure 3).
Figure 1 Obesity and Ethnicity in Adults.
Figure 2 Obesity and Age in Adults.
*
*
*
*
Expected
value
Figure 3 Obesity and Co-Morbidities in Adults.
*Persons with this disease are more likely to be obese, p ≤ 0.05.
Discussion
Exactly half of the visits in our data from adults represented patients who were clinically obese. Among
those, women, Hispanics, and those aged 40-49 had the highest prevalence of obesity. While the three
latter characteristics coincide with data from the nation as a whole, the result of 50% of the visits
containing obese individuals is an outlier. In 2009, the CDC reported that 28.7% of Texas residents were
obese, but the highest prevalence of obesity in any state that year was only 34.4%. One possible
explanation for our finding is that obese individuals are more likely to see a physician than others. Given
the numerous diseases significantly associated with obesity in our study, it is likely that obese individuals
have other complications that would account for their more likely and more frequent visit to a physician.
This data supports the recommendation that physicians need to screen often for overweight and obese
individuals and talk to each patient, no matter their BMI, about the risks and costs of obesity.
Acknowledgements
This study was conducted in The Residency Research Network
of Texas (RRNeT) with support from the Office of the Medical
Dean at UTHSCSA and the Health Resources and Services
Administration (Award # D54HP16444).
References
1. Graves BW. The obesity epidemic: scope of the problem and
management strategies. J Midwifery Womens Health.
2010;55:568-578.
2. Haslam D, Sattar N, Lean M. Obesity –time to wake up. Br
Med J. 2006;333:640-642
3. Hedley AA, Ogden CL, Johnson CL, et al. Prevalence of
overweight and obesity among US children, adolescents, and
adults, 1999-2002. J Am Med Assoc. 2004;291:2847-2850.
4. Ma J, Xiao L, Stafford RS. Adult obesity and office-based
quality of care in the United States. Obesity. 2009;17:1077-1085.