The Skinny on Obesity in Texas:

1
The Skinny on Obesity in Texas BMI in Texas
Family Medicine Clinics
Kristin M. Yeung, Ramin Poursani, MD, Sandra K.
Burge, PhD The University of Texas Health Science
Center at San Antonio
Introduction
Methods
In recent years, the media has been filled with
conversations and information about the United
States growing problem with obesity. What seems
to be an unstoppable disease, obesity leads to
several other deadly conditions, including
diabetes mellitus, heart attack and stroke (1,4).
Due to the nations advancing concerns, much
research has been done about the prevalence of
obesity. In the United States, this condition is
greater among women than men for all age groups
(1,2,3), it is seen most often in African
Americans and Hispanics (3), and those within the
age group of 45-59 are most likely to be obese
(1,2). How has obesity affected Texans,
especially patients seen in primary care
settings? Our study examined patient visits in
community family medicine clinics and determined
how obesity was correlated with age, gender,
ethnicity, and key co-morbid conditions.

• Medical students documented 726 outpatient visits
  from 9 family medicine residency programs across
  Texas. Eligible patients included all
  patient-visitors seeing a physician in the study
  clinics during the study period. A Visit Survey
  documented elements of each primary care visit,
  including patient demographics, vital signs,
  reasons for visit, diagnoses, health education,
  medications prescribed, diagnostic tests ordered,
  nonmedical treatments, referrals to specialists
  and admissions to hospitals. Over a one-month
  period, students identified half-days for data
  collection, then randomly selected a physician to
  shadow.  During the physicians clinic session,
  the student invited all the physicians patients
  to participate in the study.  After informed
  consent, students observed the visit and
  completed the Visit Survey.

Results
Of the 726 visits sampled, 65.6 were females and
14.6 were children age 20 and under. The mean
age of our patient sample was 44.3 (min 0, max
97). The main ethnic groups observed were
Hispanics (57), Caucasians (24.5), African
Americans (12.7) and Asians (3.6). Obesity for
children was determined based on the CDC growth
chart for children age 2 to 20. Pregnant females
were excluded from analysis. The results showed
48.4 of child visits were made by overweight
children and 20.3 by obese children.
Alternatively, 26.3 of adult visits were
attended by overweight individuals (25 lt BMI
30) and 50 by obese individuals (BMI gt 30).
Women were more likely to be obese than men
(53.8 and 42.1 respectively), and Hispanic
adults were more likely to be obese than adults
from other ethnic/racial groups (p 0.05,figure
1). Patients from age 40-49 had the highest BMI
(34.0) compared to all other adult age groups (p
0.05, figure 2). Finally, patients with
asthma, COPD, diabetes, hyperlipidemia, and
hypertension were significantly more likely to
be obese (Figure 3).
Figure 1 Obesity and Ethnicity in Adults.
Figure 2 Obesity and Age in Adults.




Expected value
Figure 3 Obesity and Co-Morbidities in Adults.
Persons with this disease are more likely to be
obese, p 0.05.
Discussion
Exactly half of the visits in our data from
adults represented patients who were clinically
obese. Among those, women, Hispanics, and those
aged 40-49 had the highest prevalence of obesity.
While the three latter characteristics coincide
with data from the nation as a whole, the result
of 50 of the visits containing obese individuals
is an outlier. In 2009, the CDC reported that
28.7 of Texas residents were obese, but the
highest prevalence of obesity in any state that
year was only 34.4. One possible explanation for
our finding is that obese individuals are more
likely to see a physician than others. Given the
numerous diseases significantly associated with
obesity in our study, it is likely that obese
individuals have other complications that would
account for their more likely and more frequent
visit to a physician. This data supports the
recommendation that physicians need to screen
often for overweight and obese individuals and
talk to each patient, no matter their BMI, about
the risks and costs of obesity.
References
Acknowledgements
1. Graves BW. The obesity epidemic scope of the
problem and management strategies. J Midwifery
Womens Health. 201055568-578. 2. Haslam D,
Sattar N, Lean M. Obesity time to wake up. Br
Med J. 2006333640-642 3. Hedley AA, Ogden CL,
Johnson CL, et al. Prevalence of overweight and
obesity among US children, adolescents, and
adults, 1999-2002. J Am Med Assoc.
20042912847-2850. 4. Ma J, Xiao L, Stafford RS.
Adult obesity and office-based quality of care in
the United States. Obesity. 2009171077-1085.
This study was conducted in The Residency
Research Network of Texas (RRNeT) with support
from the Office of the Medical Dean at UTHSCSA
and the Health Resources and Services
Administration (Award D54HP16444).