kjhp Korean Journal of Health Promotion Korean J Health Promot 2234-2141 2093-5676 The Korean Society of Health Promotion and Disease Prevention 10.15384/kjhp.2017.17.2.54 kjhp-17-54 Original Article Prospective Study for Evaluating Therapeutic Efficacy of Obese Patients of Low Socioeconomic Status in Korea AnSang Joon 1 ParkEun-Jung 2 CheonJi-Hyeon 3 HwangHee-Jin 4 KimMin-Jeong 5 Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea Department of Family Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea Chungdam i Plastic Surgery, Uijeongbu, Korea Department of Family Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea Mihana Clinic, Yongin, Korea Corresponding author : Min-Jeong Kim, MD Mihana Clinic, 86 Geumnyeong-ro, Cheoin-gu, Yongin 17051, Korea Tel: +82-31-336-1111, Fax: +82-31-336-7077 E-mail: dr2kim@yahoo.co.kr 012017 19012017 17254 63 01062017 25062017 Copyright © 2017 The Korean Society of Health Promotion and Disease Prevention 2017 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background:

Recently, the prevalence of obesity and socioeconomic costs stemming from obesity are increasing steeply. Obesity, in particular, has a highly polarization caused by income levels. Obesity in low-income patients is expected to become a serious social problem in the future. This study aims to observe the effects of consistent consultation and drug therapy during a six months period, and to develop the treatment process of obesity for low-income people.

 Methods:

The body weight, waist circumference, body mass index (BMI), and blood pressure (BP) was measured every 2 weeks, and laboratory blood tests with a survey including Beck Depression Inventory (BDI) and eating behavior index was checked at 0, 3, and 6 months. Paired t-test and linear mixed model was done to evaluate the difference between pre-treatment data and post-treatment data.

 Results:

Twenty-one patients (2 males, median age [interquartile range] of 39 years [29-46]) were analyzed. There were statistically significant reductions of body weight (P<0.01), BMI (P<0.01), waist circumference (P<0.01), low-density lipoprotein (P=0.01), BDI-I (P<0.01), eating behavior index (P<0.01). There was no statistically significant difference of safety outcome of the BP and blood tests.

 Conclusions:

Proper obesity treatment of obese patients of low socioeconomic status was meaningful enough to affect depression and eating patterns as well as reducing body weight and decreased waist circumference.

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Study design.

Study administration process.

Baseline characteristics of 21 patients

Variable Value
Gender  
Male 2 (9.5)
Female 19 (90.5)
Age, y 20-29 5 (23.8)
30-39 7 (33.3)
40-49 7 (33.3)
50-59 2 (9.5)
Body mass index, kg/m2  
27-34 10 (47.6)
35-44 8 (38.1)
45-54 3 (14.3)
Body weight, kg  
60-89 9 (42.9)
90-119 10 (47.6)
120-150 2 (9.5)
Height, cm  
140-159 7 (33.3)
160-179 13 (61.9)
180-199 1 (4.8)
Waist circumference, cm  
80-99 3 (14.3)
100-119 11 (52.4)
120-149 7 (33.3)
Hypertension 6 (28.6)
Diabetes 4 (19.0)
Hyperlipidemia 3 (14.3)
Smoking 8 (38.1)
Systolic BP, mmHg  
90-119 4 (19.0)
120-149 15 (71.4)
150-179 2 (9.5)
Diastolic BP, mmHg  
50-79 5 (23.8)
80-109 16 (76.2)

Abbreviation: BP, blood pressure. Values are presented as number (%).

Every 2 weeks follow up data of the 21 patients for 26 weeks

  Baseline 2 wks 4 wks 6 wks 8 wks 10 wks 12 wks 14 wks 16 wks 18 wks 20 wks 22 wks 24 wks 26 wks
Body weight, kg                            
Mean 95.9 94.2 92.5 91.1 89.0 87.8 87.0 86.2 86.2 84.9 85.2 85.1 83.2 84.8
Median 91.0 90.0 88.0 88.0 85.0 83.0 82.0 82.0 83.0 81.0 80.0 81.0 78.5 79.5
SD 19.5 18.2 18.3 8.2 18.2 18.1 18.6 18.1 18.4 19.0 19.9 19.4 20.1 22.1
Range 85 80 77 77 77 72 77 73 75 77 76 75 73 75
IQR 15 14 16 13 13 17 17 17 18 17 21 14 20 28
Height, cm                            
Mean 162.0 162.0 162.0 162.0 162.0 162.0 162.0 162.0 161.8 162.0 162.1 162.7 162.1 162.7
Median 162.0 162.0 162.0 162.0 162.0 162.0 162.0 162.0 162.0 162.0 162.0 162.7 162.0 162.0
SD 7.3 7.3 7.3 7.3 7.3 7.3 7.3 7.3 7.5 7.9 8.1 8.4 8.7 8.8
Range 36 36 36 36 36 36 36 36 36 36 36 36 36 36
IQR 5 5 5 5 5 5 5 5 5 5 5 5 6 6
BMI, kg/m2                            
Mean 36.5 35.7 35.2 34.7 33.6 32.8 33.1 32.6 33.0 32.2 32.2 32.1 31.8 31.9
Median SD 36.0 5.9 35.0 5.7 35.0 5.6 34.0 5.6 33.0 5.8 32.0 5.3 32.0 5.7 31.0 5.6 32.0 5.9 31.0 5.7 31.0 5.9 31.0 5.7 30.0 6.1 30.5 6.7
Range 27 25 24 23 22 22 21 21 21 19 19 19 18 20
IQR 5 5 5 4 4 4 5 5 8 7 6 4 6 11
WC, cm                            
Mean 114.3 113.3 112.0 110.9 108.6 107.5 107.7 106.2 105.4 102.8 102.7 102.4 102.8 102.7
Median 112.0 112.0 108.5 110.0 104.0 108.0 109.0 104.0 107.0 105.5 103.0 101.0 100.5 105.0
SD 13.2 14.1 15.7 16.1 16.6 16.1 15.5 16.0 16.3 16.0 18.0 17.7 18.0 20.4
Range 46 49 56 55 57 55 51 57 63 59 66 65 63 64
IQR 18 17 23 24 22 22 17 18 22 21 27 28 30 36
SBP, mmHg                            
Mean 124.8 123.2 122.9 121.6 121.9 124.9 120.4 122.3 126.5 119.8 124.0 123.3 119.2 123.2
Median 120.0 123.0 120.0 121.0 120.0 120.0 120.0 120.5 126.0 120.0 120.0 122.0 118.0 116.0
SD 16.6 14.9 9.7 15.3 17.5 14.1 12.3 14.2 13.3 15.3 17.6 13.5 11.8 17.7
Range 65 75 42 69 75 53 48 59 54 51 61 51 42 56
IQR 19 11 10 16 19 21 11 16 11 14 13 20 20 23
DBP, mmHg                            
Mean 85.2 82.6 84.1 81.1 83.6 85.2 80.9 82.4 82.5 81.8 85.3 85.3 80.9 82.9
Median 86.0 80.0 83.0 80.0 85.0 80.0 80.0 82.5 80.0 80.0 82.0 85.0 80.0 82.5
SD 11.4 9.9 8.6 11.7 13.3 14.3 8.8 10.4 10.5 13.8 12.8 11.6 9.4 7.0
Range 50 39 30 14 50 50 27 35 31 49 40 40 30 24
IQR 10 14 11 18 23 22 14 19 19 22 24 17 13 12

Abbreviations: SD, standard deviation; IQR, interquartile range; BMI: body mass index; WC, waist circumference; SBP, systolic blood pressure; DBP, diastolic blood pressure.

Difference between baseline and 3 months and 6 months

Parameter Body weight Baseline 96.2±19.9 3 months 86.2±18.1 N 24 P <0.001a Difference 10.0±5.0 Baseline 100.4±23.0 6 months 84.7±22.0 N 21 P <0.000 Difference 15.7±7.6
BMI 36.3±6.1 32.6±5.6 24 <0.001a 3.7±1.7 37.7±6.9 31.9±6.7 21 <0.000 5.8±2.9
WC 114.4±13.1 106.3±16.0 24 <0.001a 8.1±5.4 114.8±15.3 102.6±20.5 21 0.001a 12.2±9.1
Total cholesterol 192.6±34.5 178.3±21.8 24 0.030a 14.3±27.3 192.7±38.9 173.8±22.4 21 0.141a 18.9±41.4
HDL-cholesterol 52.3±11.9 48.9±11.7 24 0.053a 3.4±7.4 52.5±13.2 52.3±8.8 21 0.904b 0.3±7.0
LDL-cholesterol 126.6±33.0 115.4±20.4 24 0.049a 11.2±23.7 125.1±39.0 106.2±23.6 21 0.092a 18.9±35.5
Triglyceride 103.1±39.3 104.9±36.9 24 0.829a -1.9±37.8 110.1±41.0 107.6±36.2 21 0.860a 2.5±48.0
Cortisol 12.2±5.7 11.0±4.6 24 0.507a 1.1±7.4 13.7±6.7 12.0±3.6 21 0.332a 1.7±5.9
DHEA-S 187.2±96.2 177.7±93.6 24 0.269b 9.6±37.6 189.0±90.0 185.5±119.8 21 0.863b 3.6±70.5
BDI-I 35.6±23.4 28.4±23.6 24 0.135a 7.2±18.8 28.7±20.6 16.8±11.3 21 0.019a 11.9±14.2
Restrained eating behavior 18.9±4.8 27.7±6.6 24 <0.001a -8.7±7.7 18.9±5.3 27.5±6.1 21 0.003a -8.6±7.9
Emotional eating behavior 23.9±11.2 20.1±5.2 24 0.043a 3.8±10.5 22.5±9.7 17.1±3.5 21 0.041a 5.4±8.1
External eating behavior 22.6±7.1 19.1±5.1 24 0.036a 3.5±6.4 21.8±6.8 17.8±3.2 21 0.028a 4.0±5.5
Glucose (FBS) 97.6±26.6 91.6±20.7 24 0.173b 6.1±19.1 106.6±30.9 115.2±47.8 21 0.371a -8.6±31.9
AST 28.8±17.3 28.8±16.2 24 0.099b 4.6±11.7 36.1±18.7 24.3±11.8 21 0.014a 11.8±14.1
ALT 28.5±18.5 21.9±17.0 24 0.126a 6.6±18.5 35.1±19.3 22.8±13.6 21 0.052a 12.3±19.4
γ-GTP 49.0±35.4 39.8±34.3 24 0.055a 9.2±20.1 63.5±37.6 43.9±36.3 21 0.055b 19.6±19.4
WBC 7.4±2.9 7.2±2.1 24 0.610b 0.2±1.7 7.6±3.4 7.9±2.7 21 0.548b -0.4±2.1
RBC 4.6±0.4 4.6±0.4 24 0.105b 0.1±0.3 4.7±0.4 4.7±0.6 21 0.820b -0.0±0.2
Hemoglobin 13.7±1.6 13.4±1.6 24 0.078b 0.3±0.8 13.7±2.0 13.7±2.4 21 0.735b -0.1±0.8
Platelet 301.1±84.5 307.6±57.7 24 0.719a -6.4±79.0 316.3±57.0 315.6±57.0 21 0.925b 0.8±26.9

Abbreviations: BMI, body mass index; WC, waist circumference; HDL, high-density lipoprotein; LDL, low-density lipoprotein; DHEA-S, Dehydroepiandrosterone sulfate; BDI-I, Beck Depression Inventory-I; FBS, fasting blood sugar; AST, aspartate aminotransferas; ALT, alanine aminotransferase; γ-GTP, gamma-glutamyl transferase; WBC, white blood cell; RBC, red blood cell.

Paired t-test.

Wilcoxon signed rank test.

Linear mixed model summary of effective outcome for time variation

Body weight, kg Coefficient -1.07 SE 0.05 df 257.48 t -23.99 P <0.001
BMI, kg/m2 -0.15 0.05 18.95 -3.03 0.007
Waist circumference, cm -0.94 0.06 101.49 -16.99 <0.001
Total cholesterol, mg/dL -0.14 0.07 20.95 -2.08 0.050
HDL-cholesterol, mg/dL -0.13 0.15 29.29 -0.90 0.377
LDL-cholesterol, mg/dL -1.53 0.57 20.72 -2.71 0.013
Triglyceride, mg/dL 0.38 0.90 16.37 0.43 0.676
Cortisol, ng/mL -0.07 0.10 17.05 -0.69 0.050
DHEA-S, ug/dL -0.56 1.09 32.65 -0.51 0.616
BDI-I -0.98 0.25 12.20 -3.92 0.002
Restrained eating behavior 0.61 0.16 17.05 3.91 0.001
Emotional eating behavior -0.53 0.15 12.89 -3.45 0.004
External eating behavior -0.34 0.12 13.69 -2.88 0.012

Abbreviations: SE, standard error; df, degrees of freedom; BMI, body mass index; HDL, high-density lipoprotein; LDL, low-density lipoprotein; DHEA-S, Dehydroepiandrosterone sulfate; BDI-I, Beck Depression Inventory-I.

Linear mixed model summary of safety outcome for time variation

SBP, mmHg Coefficient -0.18 SE 0.22 df 36.39 t -0.82 P 0.416
DBP, mmHg -0.19 0.15 57.35 -1.23 0.225
Glucose, mg/dL 0.20 0.79 85.37 0.25 0.801
AST, IU/L -0.55 0.24 28.18 -2.31 0.029
ALT, IU/L -0.54 0.34 19.34 -1.56 0.135
γ-GTP, IU/L -0.77 0.38 16.61 -2.05 0.057
WBC, ×1003/uL 0.03 0.04 33.50 0.68 0.051
RBC, ×1003/uL 0.00 0.01 13.74 0.37 0.721
Hemoglobin, g/dL -0.01 0.02 11.87 -0.69 0.505
Platelet, /uL 0.47 1.14 11.95 0.41 0.690

Abbreviations: SE, standard error; df, degrees of freedom; SBP, systolic blood pressure; DBP, diastolic blood pressure; AST, aspartate aminotransferas; ALT, alanine aminotransferase; γ-GTP, gamma-glutamyl transferase; WBC, white blood cell; RBC, red blood cell.