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Weight Loss Behavior in Obese Patients Before Seeking Professional Treatment in Taiwan

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Weight Loss Behavior in Obese Patients Before Seeking Professional Treatment in Taiwan Obesity Research & Clinical Practice (2009) 3, 35—43 ORIGINAL ARTICLE Weight loss behavior in obese patients before seeking professional treatment in Taiwan Tsan-Hon Liou a,b, Nicole Huang c, Chih-Hsing Wu d, Yiing-Jenq Chou c, Yiing-Mei Liou e, Pesus Chou c,∗ a Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan b Graduate Institute of Injury Prevention and Control, College of Public Health and Nutrition, Taipei Medical University, Taiwan c Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan d Department of Family Medicine, National Cheng Kung University Hospital, Tainan, Taiwan e Institute of Community Health Nursing, National Yang-Ming University, Taipei, Taiwan Received 13 March 2008; received in revised form 22 September 2008; accepted 14 October 2008 KEYWORDS Summary Obesity; Objective: To assess weight loss strategies and behaviors in obese patients prior to Anti-obesity drug; seeking professional obesity treatment in Taiwan. Weight expectation; Design: A cross-sectional study was conducted between 1 July 2004 and 30 June Weight loss behavior 2005. Setting and subjects: Obese subjects (1060; 791 females; age, ≥18 years; median BMI, 29.5 kg/m2) seeking treatment in 18 Taiwan clinics specializing in obesity treat- ment were enrolled and completed a self-administered questionnaire. Results: Of the 1060 subjects, the prevalence of anti-obesity drug use was 50.8%; more females than males used anti-obesity drugs (53.6% vs. 42.4%). Approximately one-third of normal weight or overweight subjects with no concomitant obesity- related risk factors took anti-obesity drugs. Merely 26.7% of female and 34.7% of male subjects regularly received panel-recommended levels of physical activity. Further, two-thirds (66.1%) of subjects expressed an intention to lose more than 20% of initial body weight. Multiple logistic regression analyses revealed a substan- tially higher odds ratio (OR) for anti-obesity drug use in females than in males (OR, 2.3, 95% CI: 1.7—3.2). Obesity was also associated with younger age and higher body mass index (BMI). Females were more likely than males to have unrealistic ∗ Corresponding author at: Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, 155 Li-Nong St., Sec. 2, Peitou, Taipei, Taiwan. Tel.: +886 2 28267050; fax: +886 2 28201461. E-mail address: [email protected] (P. Chou). 1871-403X/$ — see front matter © 2008 Published by Elsevier Ltd on behalf of Asian Oceanian Association for the Study of Obesity. doi:10.1016/j.orcp.2008.10.004 36 T.-H. Liou et al. weight loss goals. Younger patients and those with high BMI were also more likely to have unrealistic weight goals than their reference groups. Conclusion: Obese patients in Taiwan tend to use anti-obesity drugs, receive inade- quate physical activity and have unrealistic weight loss expectations before seeking professional treatment for obesity. © 2008 Published by Elsevier Ltd on behalf of Asian Oceanian Association for the Study of Obesity. Introduction 1.5—3 times higher than expert recommendations (5—10%). Obese patients tend to have unrealis- According to obesity treatment guidelines, three tic weight loss expectations. A significant disparity major components of weight loss therapy are has been noted between what physicians and what dietary therapy, increased physical activity and patients consider ideal weight loss [12]. Studies of behavior therapy [1—4]. Lifestyle therapy should be goal setting have observed that weight loss goals attempted for at least 6 months before considering which are unrealized or overly difficult to achieve pharmacotherapy. Additionally, pharmacotherapy tend to increase the likelihood of negative emo- should be considered as an adjunct to lifestyle tions, impaired task performance and abandonment therapy in obese or overweight patients with con- of weight loss goals. Dalle Grave et al. suggested comitant obesity-related diseases. Studies have that baseline weight loss expectations are inde- shown that most patients who have been pre- pendent cognitive predictors of attrition in obese scribed anti-obesity drugs, including orlistat and patients entering a weight loss program [12]. Unre- sibutramine, are not treated in accordance with alistic weight loss goals should be tackled at the obesity treatment guidelines [5,6]. Many patients very beginning of treatment. continue to take anti-obesity drugs even after As more and more subjects aware the impor- achieving normal body weight. tance to lose weight, there are lots of weight losing Further, although individuals attempting to lose and slimming methods in Taiwan. It is important to weight are more likely to engage in regular phys- know how people attempt to lose weight. Given the ical activity, most have not permanently adopted limited available data in Taiwan, this study exam- a physically active lifestyle [7]. Jakicic and Otto ined weight loss behavior, including anti-obesity demonstrated that more than 80% of individu- drug use, weight loss expectation and daily level of als engaging in physical activity as a weight loss physical activity in Taiwanese adults prior to seek- strategy expend insufficient energy to significantly ing professional obesity treatment. This study will improve health, let alone weight loss [8]. Cur- provide valuable data for clinical physicians better rent international association for study of obesity understanding of their patients. (IASO) guidelines recommend 60 min of moderately intense physical activity on most days to prevent weight gain and 60—90 min on most days to avoid Methods regaining weight following significant weight loss [9]. Therefore, those at risk for weight gain or seek- Sampling of obesity clinics and subjects were ing to maintain recent weight loss must maintain shown in Fig. 1 and described in detail elsewhere the recommended activity levels. Obese subjects [13]. This study was approved by the Committee are initially encouraged to reach a target level of of Institutional Human Subject Review Board of 30 min per day of moderately intense physical activ- Taipei Medical University-Wan Fang Hospital, Tai- ity according to current guidelines for the general wan. Each subject completed a self-administered population [10]. Further increase in duration, fre- questionnaire with help from a trained assistant. quency, or intensity may be needed to meet the The questionnaire was divided into three sections: current guidelines [9]. (1) a socio-demographic section for recording data In a study of binge eating disorders (BED), ideal, for age, gender, marital status, education level, satisfactory and minimum acceptable BMI were tobacco and alcohol use, monthly income, etc.; (2) considered by subjects to require average weight a medical history section for hypertension, dyslipi- reductions of 36, 29 and 23%, respectively [11]. demia, CHD, type 2 diabetes and sleep apnea data; Even the ‘‘disappointed’’ body mass index (BMI) (3) a weight loss section to examine behavior during was an average 14% reduction in current weight and the previous year, such as weekly level of physical Weight loss behavior in Taiwan 37 2004 and demonstrated reasonable test—retest reliability (ICC = 0.67) and fairly good inter-method validity (Spearman’s rho = 0.86) [18,19]. Diet and weight history, weight loss expecta- tions and primary motivation for seeking treatment were systematically recorded. Weight loss goals were assessed by asking, ‘‘How much weight do you intend to lose and in what duration?’’ Statistics Statistical analyses were performed using SPSS for Windows version 13.0 (SPSS, Inc., Chicago, IL, USA). Prevalence data were presented as percent- ages (%). Chi-squared test and linear trend test were conducted. Multiple logistic regression analy- ses were performed to assess associations between behaviors violating obesity treatment guidelines and demographic variables, including gender, age and current BMI. A p-value less than 0.05 was con- sidered statistically significant. Results Basic characteristics of respondents Figure 1 Sampling method and flow of subjects (TMASO*: Taiwan Medical Association for Study of Table 1 shows the basic demographic data for Obesity). all respondents. Of the 1060 respondents, 53.7% (569/1060) were college educated, and 51.5% activity, diet control and use of anti-obesity drugs. (546/1060) were married. Approximately one-third BMI was calculated as weight in kilograms divided of the patients were 25—35 years old. Most resi- by height in meters squared (kg/m2). The following dents had a monthly income of NT$ 10,000—50,000. BMI categories were utilized: <24, normal weight; 24—26, overweight; ≥27, obese [14].Weuse Appropriateness of use of anti-obesity drug the Short-Form Self-administered International Physical Activity Questionnaire (IPAQ) assess their Of the 1060 respondents, 16% (179/1060) had nor- amount of past 7-day physical activity, a culture mal weight, 15.6% (165/1060) were overweight adoptive tool that could prove useful for both clin- with no co-morbidity, 6.7% (71/1060) were over- icians and researchers in the field and suitable for weight with at least one co-morbidity and 60.2% international comparison [15—17]. This 7-day recall (638/1060) were obese. Of the 1060 respondents, questionnaire consists of seven questions assessing 536 (51%) had used at least one anti-obesity drug, the frequency and duration of participation in including orlistat, sibutramine
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