Obesity Case Study

Obesity and Depression Case Study

Obesity and Depression Case Study Group Members: Taviel Bartley (Leader), Erika Whiters, Brakimia Boynton, and Johnleekia Little

Georgia Southern University

PUBH 3131: Epidemiology of Chronic Disease

Instructor Hardy

IntroductionA 52 year old woman diagnosed with depression, obesity and poorly controlled Type 2 diabetes. She is overweight and has a 9 year history of type 2 diabetes. She complains of difficulty losing weight, fatigue, no motivation, shakiness, diaphoresis (increase perspiration), and increased in hunger. She also complains that due to the pain in both her knees and ankles prevent her from exercising. Her energy level has decline, particularly in the afternoons. She has gain an enormous weight ever since she began taking insulin for 6 years.She does not follow any specific diet and is fearful of hypoglycemia that she often eats extra snacks. Shes being treated by physician at the Health Maintenance Organization.

Description of Main Issues52 year old female Obese9 year type 2 diabetic Insulin treatment for 6 yearsSymptomatically depressedSedentary lifestyleAdvised repeatedly by physician to lose weight and exercise to improve health status

Prevalence of Diabetes and ObesityAcross all age groups, the worldwide prevalence of diabetes doubled more than in the first decade of the 21st century, rising from 2.8% (2000) to 6.4% (2010); (Harris, pg. 378). In 1995, the World Health Organization revealed that 4.0% of adults age 20 years or older had diabetes (King, Aubert, and Herman, 1998). The prevalence was highest in developed countries of North America and Western Europe and the lowest in developing countries of SouthEast Asia and Central Africa.

Prevalence of Diabetes and Obesity Continued.In the US, the prevalence of obesity has doubled since 1960; 13.3% of the adult population was classified as obese (Harris, pg. 423). Almost 70% of people ages 20 and older are overweight or obese, with nearly 34% classified as obese.The prevalence of overweight in high income and upper middle income countries was more than double that of low middle income countries (World Health Organization).

Incidence of DiabetesAccording to CDC, numbers of adults between the ages of 18-79 are diagnosed with diabetes. In 2012, the incidence for diabetes was 1.7 million new diagnoses per year.In November of 2014, approximately 347 million people have diabetes worldwide (WHO)1 in 10 adults have been diagnosed, and fewer people undiagnosed.

Analysis Of Health ProblemMorbidity rate for Diabetes via CDC Fast StatsSince 2010 in the United States Percent for noninstitutionalized 20 years and older with diabetes (physician diagnosed or undiagnosed): 11.9% (2007-2010)Percent for noninstitutionalized 20 years and older with physician diagnosed diabetes: 8.5% (2007-2010)Percent for noninstitutionalized 20 years and older with undiagnosed diabetes: 3.4% (2007-2010) Difference Between Type 1 and Type 2 diabetesType 1 diabetes occurs when elevated blood glucose or hyperglycemia arises when insulin, the key hormone produced by the beta cell of the Islets of Langerhans of the pancreas is no longer secreted. In Type 2 diabetes insulin becomes unable to sufficiently allow glucose to enter into the cell to produce energy. Major Risk Factors associated with Type 2 Diabetes family history (strongest), age, ethnicity, obesity, and prediabetesObesity risk factors: genetics, environment, inactivity, unhealthy eating, age, SES (socioeconomic status)

Figure 32.7 Relative Mortality of Diabetes in the United States, 1960-2010

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Relationship Between Diabetes and Heart DiseaseCardiovascular Disease (Heart disease) is one of the major complication of diabetes and the leading cause of early death. Approximately 65% of people who suffer with diabetes die from some kind of heart related diseases and stroke. If you have diabetes, you are more likely as someone who does not have diabetes to have stroke or heart disease. High blood glucose levels over time can lead to an increased deposits of fatty materials on the insides of the blood vessel walls. It can lead to clogging and hardening of blood vessels (atherosclerosis). According to the Centers for Disease and Prevention, in 2014 there was a total of 29.1 million (9.3.%) of the population in the US diagnosed with diabetes.

Additional information needed to be providedThe nurse needed to provide the following information:Physical Exam (vital signs):-Height-Weight-Blood pressure-Body Temperature [Pulse Rate, Respiration Rate]Laboratory testing:-Blood glucose test results-Creatinine Blood Test-Possible Blood Urea Nitrogen Test-Fasting Plasma Glucose Test-Chemistry Screening ( a blood test that measures

the level of several substances in the blood).-Cholesterol test results-Kidney test (urinalysis testing)-Hemoglobin Testing (A1C test)

RecommendationsThe physician made several recommendations, including weight loss and exercise. However, the patient explained that joint pain in her knees and ankles can make exercise a difficult task. Due to time constraints, the patient did not receive adequate health education. With obesity being the strongest predictor of type 2 diabetes, it is critical that the patient is presented with options that allow her to exercise safely and without unnecessary pain (Harris, pg. 393). I would refer the patient to a registered dietician that can educate the patient on how she can eat several small meals each day to reduce the likelihood of hypoglycemia. The dietician should educate the patient on the glycemic index and show her diabetic-friendly options that are satisfying as well as filling.I would also provide the patient with resources that would encourage the patient to be more active, while reducing and/or eliminating the issue of joint pain. Total-body resistance exercise, cycling, yoga, and swimming are just a few of many low impact physical activities that are joint friendly. I believe that the patient would also benefit from a gym membership and a personal trainer, preferably a trainer that is also familiar with nutrition. The trainer could ensure that the patient is exercising effectively, while making sure that she is not putting herself at risk for injuries or disappointment.

RecommendationsThe patients depression diagnosis must also be addressed in order to ensure a successful intervention. Depression can lower a patients self-efficacy and give her a feeling of hopelessness, which would make her less likely to work toward the goal. The patient admitted that she felt fatigued and had no motivation.The patient should encouraged to attend support group meetings and get to know the members of the group. She should be encouraged to reach out to other members for support when shes having a bad day and to share her struggles and successes with her group members. This peer support would remind the patient that she is not alone.I would also look into why the patient chose not to take the medicine she was prescribed. She needs to know that depression is highly treatable and the positive effects the treatment would have on her life. It is obvious that she is unhappy and is tired of being unhappy. Successful treatment of her depression could possibly be the deciding factor that makes her want to change her current situation. I would provide readings and other materials that discuss depression, its physiological effects, and how it can be treated.

Ways in which community resources can work together in chronic disease managementGyms: have personal trainers develop special dietary programs targeted towards the type of chronic disease highly prevalent within the communityex: for obese and diabetic patients recommend low carb and low fat diet that also encourages healthy eatingdevelop fitness programs that have weekly goals of weight loss ex: for obese and diabetic patients target problem areas that implement push up, sit ups, and other aerobic and anaerobic exercises so reduce medical complications with blood glucose levels, blood pressure, etc.

Community Centers:enroll in the Center for Disease Control and Prevention Diabetes Prevention and Recognition Program (DRDP) The DPRP has three key objectives:To assure program quality, fidelity to scientific evidence, and broad use of effective type 2 diabetes prevention lifestyle interventions throughout the United StatesTo develop and maintain a registry of organizations that are recognized for their ability to deliver effective type 2 diabetes prevention lifestyle interventions to people at high risk.To provide technical assistance to local type 2 diabetes prevention programs to assist staff in effective program delivery and in problem-solving to achieve and maintain recognition status.

Ways in which community resources can work together in chronic disease management continued...Community Centers:According to the CDC, the purpose of the DPRP is to recognize programs that have shown that they can effectively deliver a proven lifestyle change program (in-person, virtual, or via distance learning) to prevent type 2 diabetes.

have trained psychiatrists hold individual and group sessions to evaluate the mental state of those who exhibit symptoms of depression for their encouragement towards weight loss

According to the article, Reliable change in depression during behavioral weight loss treatment among women with major depression, participants who experienced reliable improvement in depression lost significantly more weight than those who did not.

Also according to this article, depression is commonly encountered in clinically obese patients and behavioral weight loss interventions result in improved depressive symptoms.

Therefore, examination of mental health by psychiatrist encourages changes in depression during treatment which may also alter the individuals experiences towards weight loss.

Logistical problems that can occur when coordinating resources in rural, lower income areas in the United StatesStaffing Credibility and ShortagesGyms and community centers need to be properly and adequately staffed with trained professionals Example: Gyms need to have enough personal trainers to meet the demand of patientsExample: Registered Dietitians need to be staffed. According to the National Institute of Health, exercise along with healthy eating is essential to weight loss and the management of type 2 diabetes

Accessibility and Affordability Patients that live in rural or lower income areas may have trouble accessing and affording the treatment for their chronic conditionExample: A patient may lack the transportation to a gym or community centerTransportation should be provided free of cost to patientsExample: A patient may not be able to afford their treatment plansReceiving services from a community center should be covered by an insurance plan or offered at a reduced rate for patient in lower income areas

Logistical problems that can occur when coordinating resources in rural, lower income areas in the United States continued..Personalization Example: Sometimes programs provided at community centers can be impersonal According to the article provided by the Robert Wood Johnson Foundation, diabetic patients should have an individualized care plan. The patient should have a physical activity and diet plan specific to them.

References

Brownlee M, Aiello LP, Cooper ME. Complications of diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, Polonsky KS, Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier Saunders; 2011: chap 33Busch, A. M., Whited, M. C., Appelhans, B. M., Schneider, K. L., Waring, M. E., DeBiasse, M. A., Oleski, J. L., Crawford, S. L. and Pagoto, S. L. (2013), Reliable change in depression during behavioral weight loss treatment among women with major depression. Obesity, 21: E211E218. doi: 10.1002/oby.20113Centers for Disease Control and Prevention (2015). Diabetes. http://www.cdc.gov/nchs/fastats/diabetes.htmCenters for Disease Control and Prevention (2010). Division of Diabetes Translation. National Diabetes Surveillance System.Center for Disease Control and Prevention (2015). Read About the DPRP. http://www.cdc.gov/diabetes/prevention/recognition/about.htm Harris, Randall E. (2013). Epidemiology of Chronic Disease:Global Perspectives. Burlington, MA:Jones & Bartlett LearningNational Institutes of Health (2014). Type 2 Diabetes. http://www.nlm.nih.gov/medlineplus/ency/article/000313.htmRobert Wood Johnson Foundation (2013). Low-Income Patients Face Added Challenges in Managing Diabetes. http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/08/low-income-patients-face-added-challenges-in-managing-diabetes.html