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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. 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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  1. Incidence of Obesity in Psychiatric Patient at Patton State Hospital: An Observational Study Corinna Ruf Patton State Hospital Dietetic Intern January 9, 2014

  2. 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.

  3. 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

  4. 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.

  5. 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.

  6. 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

  7. 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%.

  8. 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

  9. 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

  10. Physiological Differences: Men vs. Women • Average body fat:8 • Women: 25% • Men:15% • Female hormones in relation to fat8 • Metabolic rate of fat8

  11. 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

  12. 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

  13. Objectives • Describe/compare rates of obesity . • Investigate factors leading to increased obesity. • Describe/compare characteristics of women with BMI above 40.

  14. 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.

  15. 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.

  16. Results

  17. Results-Obesity Rates by Unit

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

  19. Results- Diet Comparison

  20. Results- Medical Condition Comparison

  21. Results- BMI Comparison

  22. Results- Weight Change and Length of Stay

  23. Results- Weight Change and Antipsychotic Medications

  24. Discussion • BMI greater than 30 at Patton: • Women:52.7% • Men: 37.1% • Inherent differences between men and women • Varied effects of antipsychotics

  25. Discussion: • Type of Unit • Unit 32 and 36 most overweight • Diet • Age • Weight Change • Medications

  26. Limitations • Observational Study • Small Sample Size • Human Error

  27. 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.

  28. 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.

  29. 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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