Incidence of obesity in psychiatric patient at patton state hospital an observational study
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Incidence of Obesity in Psychiatric Patient at Patton State Hospital: An Observational Study. Corinna Ruf Patton State Hospital Dietetic Intern January 9, 2014. Introduction. Obesity in U.S. and Canada 10 : Men: 32.6% Women: 36.2% Rise of BMI in incarcerated population

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Incidence of Obesity in Psychiatric Patient at Patton State Hospital: An Observational Study

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Incidence of obesity in psychiatric patient at patton state hospital an observational study

Incidence of Obesity in Psychiatric Patient at Patton State Hospital: An Observational Study

Corinna Ruf

Patton State Hospital Dietetic Intern

January 9, 2014


Introduction

Introduction

  • Obesity in U.S. and Canada10:

    • Men: 32.6%

    • Women: 36.2%

  • Rise of BMI in incarcerated population

  • At Patton State Hospital:

    • Women were more severely obese (BMI>40) than men.


Literature review

Literature Review

  • 2/3 of U.S. adults are now obese or overweight6

  • 1% of the population is now incarcerated6

  • Weight gain may be caused by:

    • Imprisonment3

    • Psychological Harm3

    • Physical Harm3

    • Stressors6


Physical activity

Physical Activity

  • Incarceration leads to decreased physical activity

  • This can lead to:

    • Decreased muscle mass

    • Decreased calorie burned

    • Obesity

  • In addition, these establishments often provide excess calories.


Incidence of obesity in psychiatric patient at patton state hospital an observational study

Diet

  • Hinataet al. 6 placed female prisoners on an 1800 calorie, low-fat, high fiber diet with mandatory activity for inmates

    • Decreased BMI

    • Decreased Blood Pressure

    • Decreased Cholesterol

    • Decreased LDL

    • Increased HDL

  • Shows that physical activity and diet are a large source for health issues and high BMI in inmates.


Antipsychotic medications

Antipsychotic Medications

  • It was found that 77% of patient treated with atypical antipsychotics were obese7

  • Other metabolic side effects:

    • Central obesity

    • High blood pressure

    • High triglycerides

    • Low HDL

    • Insulin resistance


Cost considerations for obesity

Cost Considerations for Obesity

  • Increased risk for diabetes, hypertension and cardiovascular disease2

  • Increased cost for government providing health care to inmates6

  • Infrastructure changes6

    • Beds, restraints, chairs and medical equipment

  • Transportation cost6

    • Each 100 pounds recuses MPG by 2%.


Weight loss counseling men vs women

Weight Loss Counseling: Men vs. Women

  • Whiteman et al. 201311

    • Physicians provided more counseling to women then men in all weight ranges

    • 100% of doctors reports discussing weight loss with overweight patients

    • 56% of overweight patients report having discussed it with their doctors


Genetic and physiological differences men vs women

Genetic and Physiological Differences: Men vs Women

  • Biological regulators of body weight5

    • Gastrointestinal hormones

    • Dietary behaviors

    • Eating related cues

      • Social factors

      • Environmental factors

  • Brain Structure differences5

    • Women are less likely to:

      • Control eating

      • Resist emotional cues


Physiological differences men vs women

Physiological Differences: Men vs. Women

  • Average body fat:8

    • Women: 25%

    • Men:15%

  • Female hormones in relation to fat8

  • Metabolic rate of fat8


Incidence of obesity in psychiatric patient at patton state hospital an observational study

Age

  • Increased age leads to higher rated of fat deposition

  • Fat distribution

    • Men and post-menopausal women: central or abdominal obesity

    • Pre-menopausal women: peripheral obesity

  • Thus older age fat distribution in women leads to higher risk for diabetes mellitus 2 and cardiovascular mortality.9


Women and antipsychotics

Women and Antipsychotics

  • Women have greater risk of side effects

    • Elevated prolactin

    • Weight gain

    • Obesity

    • Diabetes

    • Metabolic syndrome

  • Weight gain higher in women

  • Ziprasidone and Aripirazole were least likely to cause weight gain in women.9


Objectives

Objectives

  • Describe/compare rates of obesity .

  • Investigate factors leading to increased obesity.

  • Describe/compare characteristics of women with BMI above 40.


Hypothesis

Hypothesis

  • Women will have a higher percent prevalence of obesity compared to men at Patton State Hospital.

  • Women with a BMI above 40 will have a higher BMI at admission, but will not have a higher weight change compared to women with BMIs below 30.


Methods

Methods

  • BMIs from November 6th, 2013

  • 1455 patients

    • 15 women with BMI over 40

    • 15 women with BMI under 30

  • Further data collected through Computrition and patient charts

  • Statistical analysis with StatPlus.


Results

Results


Results obesity rates by unit

Results-Obesity Rates by Unit


Results women comparison

Results-Women Comparison

  • Average age of women

    • BMI above 40: 48.9 years

    • BMI below 30: 47.7 years


Results diet comparison

Results- Diet Comparison


Results medical condition comparison

Results- Medical Condition Comparison


Results bmi comparison

Results- BMI Comparison


Results weight change and length of stay

Results- Weight Change and Length of Stay


Results weight change and antipsychotic medications

Results- Weight Change and Antipsychotic Medications


Discussion

Discussion

  • BMI greater than 30 at Patton:

    • Women:52.7%

    • Men: 37.1%

  • Inherent differences between men and women

  • Varied effects of antipsychotics


Discussion1

Discussion:

  • Type of Unit

    • Unit 32 and 36 most overweight

  • Diet

  • Age

  • Weight Change

  • Medications


Limitations

Limitations

  • Observational Study

  • Small Sample Size

  • Human Error


Conclusion

Conclusion

  • Supporting original hypothesis women had higher BMI then men.

  • Contrary to original hypothesis women with higher BMI gained more weight.

  • Overall, weight gain is expected for most patients entering Patton State Hospital.

  • Recommendation: Make the regular diet for women lower calorie.


Work cited

Work Cited

  • Anderson C., Peterson C., Fletcher L., Mitchell J., Thuras P., Crow S. “Weight Loss and Gender: An Examination of Physician Attitudes” Obesity Research. April 2001, 9;4; 257-263.

  • Clarke J., Waring M. “Overweight, Obesity and Weight Change Among Incarcerated Women” Journal of Correctional Health Care. 2012 18 (4) pp. 285-292.

  • Fogel C. “Hard Time: The Stressful Nature of Incarceration for Women” Issues in Mental Health Nursing. 1993 14:367-377.

  • Fryar C., Carroll M., Ogden C. “Prevalence of Overweight, Obesity and Extreme Obesity Among Adults: United States, Trends 1960-1962 Through 2009-2010” National Center or Health Statistics. September 2012

  • Horstmann A., Busse F., Mathar D., Muller K., Lepsien J., Schlogl H., Kabish S., Kratzsch J., Neumann J., Stumvoll M., Villringer A., Pleger B. “Obesity-related differences between women and men in brain structure and goal-directed behavior” Frontiers in Human Neuroscience; June 2011;5;58;pp.1-8.


Work cited1

Work Cited

  • Leddy M., Schulkin J., Power M. “Consequences of High Incarceration Rate and High Obesity Prevalence on the Prison System” Journal of Correctional Health Care. October 2009. 15;4; 318-327.

  • McIntyre R., Trakas K., Lin D., Balshaw R., Hwang P., Robinson K., Eggleston A. “Risk of Weight Gain Associated with Antipsychotics Treatments: Results From the Canadian National Outcome Measurement Study in Schizophrenia” Canadian Journal of Psychiatry. November 2003 48;10, pp. 689-695.

  • Miller W., Lindeman A., Wallace J., Niederpruem M. “Diet composition, energy intake and exercise in relation to body fat in men and women.” American Journal of Clinical Nutrition; 1990;52; pp.426-430.

  • Seeman M. “Secondary Effects of Antipsychotics: women at Greater Risk than Men” Schizophrenia Bulletin; 2009; 35:5; pp. 9337-948.

  • Shields M., Carroll M., Ogden C. “Adult Obesity Prevalence in Canada and the United States” NCHS Data Brief. March 2011, 56.

  • Whiteman H. “Patient-Doctor Disconnect ‘Impacts Weight Loss Interventions’” Medical News Today. November 2013.


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