Prospective Study for Evaluating Therapeutic Efficacy of Obese Patients of Low Socioeconomic Status in Korea

Sang Joon An; Eun-Jung Park; Ji-Hyeon Cheon; Hee-Jin Hwang; Min-Jeong Kim

doi:10.15384/kjhp.2017.17.2.54

Korean J Health Promot > Volume 17(2); 2017 > Article

Prospective Study for Evaluating Therapeutic Efficacy of Obese Patients of Low Socioeconomic Status in Korea

Original Article

Korean Journal of Health Promotion 2017;17(2):54-63.

Published online: January 19, 2017

DOI: https://doi.org/10.15384/kjhp.2017.17.2.54

Prospective Study for Evaluating Therapeutic Efficacy of Obese Patients of Low Socioeconomic Status in Korea

Sang Joon An¹, Eun-Jung Park², Ji-Hyeon Cheon³, Hee-Jin Hwang⁴, Min-Jeong Kim⁵

¹Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea

²Department of Family Medicine, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea

³Chungdam i Plastic Surgery, Uijeongbu, Korea

⁴Department of Family Medicine, Catholic Kwandong University International St. Mary's Hospital, Incheon, Korea

⁵Mihana 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

Received June 01, 2017 Accepted June 25, 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.

요약

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.

Keywords: Obesity, Socioeconomic Factor, Korea, Depression, Feeding behavior

Figure 1.

Study design.

Figure 2.

Study administration process.

Table 1.

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 (%).

Table 2.

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.

Table 3.

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

^aPaired t-test.

^bWilcoxon signed rank test.

Table 4.

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.

Table 5.

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.

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