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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

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.
slide5
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
slide11
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 women comparison
Results-Women Comparison
  • Average age of women
    • BMI above 40: 48.9 years
    • BMI below 30: 47.7 years
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.