Received date: February 25, 2014; Accepted date: March 03, 2014; Published date: March 31, 2014
Citation: Kuzmar I, Rizo MM, Cortes E (2014) Social Classes, Level of Education, Marital Status, Alcohol and Tobacco Consumption as Predictors in a Successful Treatment of Obesity. J Nutr Disorders Ther 4:135. doi:10.4172/2161-0509.1000135
Copyright: ©2014 Kuzmar I, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Objective: To evaluate if there is a relation between social classes, level of education, marital status, alcohol and tobacco consumption with the success of weight loss in obese patients at a nutrition clinic.
Methods: A clinical intervention study was conducted among overweight and obese patients who consulted a nutrition clinic in Barranquilla (Colombia) for the purpose of nutritional assessment. They were subject to a personalized weekly follow-up consultation over the course of 16 weeks in which food consumption patterns, body image and self-perception were registered.
Results: A total of 271 patients were evaluated. 27 (10%) of whom did not complete the study. 244 (90%) patients followed the treatment, 70 (28,7%) didn't lose weight, considering them failures and 174 (71,3%) did lose weight. No considerable differences were observed in relation to social classes, level of education, marital status, alcohol and tobacco consumption in failure-success distribution.
Conclusion: Based on these results, social classes, level of education, marital status, alcohol and tobacco consumption are not regarded as influential factors in the successful outcome of treatment in overweight and obese patients.
Obesity; Social classes; Marital Status; Alcohol; Tobacco; Predictors; Treatment
Overweight and the obesity represent an increasing threat to the general population in many countries , and it is considered to be a worldwide epidemic . Body image and self-perception play an important role in the personal growth and adaptation, as well as children and adolescents .
High rates of overweight in adolescence described in many countries  could suggest a relation with the energy balance factors involved. Obesity is the result of caloric expenditure failing short of caloric intake. Unhealthy eating habits, the lack of fruits and vegetables in the daily intake, consuming soft drinks and fast food combine with a poor physical activity and exercise are major contributors with the problem .
Previous studies have shown the association between the increase of Body Mass Index (BMI) in adolescents coming from poorest regions and the decreased of the BMI in richest regions . Obesity is related to a low level of educational attainment, has been use as a marker of inadequate health  and branded as a social phenomenon for which appropriate actions should target cultural and socioeconomic issues.
In regards of marital status, obese wives who do household activities reflect greater insecurity in contrast with those who have a career. They feel less attractive; suffer from physical discomfort or feel of rejection and poor self-esteem .
More than half of obese post-menopausal women are living in rural areas with conditions below poverty, less alcohol intake and tobacco consumption as a result of this although they have a greater sedentary lifestyle .
In Colombia to measure population’s wealth, the socioeconomic status must be obtained from the amount of monthly services charges as well as tax billing for different areas of the city .
The main objective is to determine if there is a relation between social classes, level of education, marital status, and alcohol and tobacco consumption with the success of weight loss in obese patients.
A clinical intervention study was conducted among overweight and obese patients who consulted a nutrition clinic in Barranquilla (Colombia) for the purpose of nutritional assessment. They were subject to a personalized weekly follow-up consultation over the course of 16 weeks in which food consumption patterns, body image and self-perception were registered. The inclusion criteria were voluntary assistance, patient desire to improve their aesthetic image, excluding those with chronic diseases such as diabetes, kidney failure, etc., 233 women and 38 men were interviewed.
The study used data of patients who consulted a nutrition medical centre in Barranquilla (Colombia) for nutritional assessment and to improve their physical appearance, which underwent a low-calorie personalized diet nutritional health program by food consumption patterns, over the course of 16 consecutive weeks. The sample was formed by patients from 16 to 72 years of age collected over a period of 3 years.
The study included, an initial complete medical record (date accessed, date of birth, personal identification data, socioeconomic status, educational level, marital status and personal medical history, toxic precedents, etc.) and a weekly medical-nutritional assessment (age, height and weight, waist and hip perimeter, and one photography)
The data were treated using IBM SPSS Statistics version 22.0 software, checking the normality and comparative nonparametric statistics on data that not showed a normal distribution. The multivariate linear correlation was performed to the dependent variable percentage of weight loss regarded to social status, educational level, marital status, alcohol and tobacco consumption. The distributions were analysed using the Chi square test with Epidat version 3.1 software. A significance level of p<0,05 is considered.
A total of 271 patients were evaluated 27 (10%) of whom did not complete the study. 244 (90%) patients followed the treatment of whom174 (71,3%) were successful and 70 (28,7%) failed.
In regards of marital status, 102 (68,9%) singles are successful, opposite to 72 (58,5%) who are married or live in couples, but this major success among singles is not significant. 28 (68,3%)success medium class is obtained in opposite to 146 (63,5%) in high class, not presenting a different significantly distribution either. 141 (68.8%) high school graduates presents a success compared to 33 (50,0%) university students, the distribution is significantly different (p=0,020) (Table 1). Finally, between tobacco consuming, a success is obtained in 36 (65,5%) compared to 138 (63,9%) who did not consume, not being statistically significant; and those with alcohol consumption, a success is obtained in 102 (60,4%) compared to 72 (68,6%) without statistical significance.
|dropouts||failure||success||Chi square test|
|educational level||high school graduate||17||47||141||0,020|
Table 1: Distribution of success and failure in regard of marital status, social classes, educational level and consumption of alcohol and tobacco.
In order to avoid interference between the studied variables, the multinomial regression analysis was performed in dropouts against success and failure versus success regarding social classes, level of education, marital status, and alcohol and tobacco consumption. The results are presented in Table 2 and Table 3 respectively.
|Success vs. dropouts||strong>Sig.||strong>OR (CI 95%)|
|singlevs married (couple)||0,105||0,5 (0,2-1,2)|
|social classes medium vs high||0,867||0,9 (0,2-3,3)|
|high schoolvs university||0,113||0,5 (0,2-1,2)|
|tobacco consumption vs no consumption||0,985||1,0(0,3-2,9)|
|alcohol consumption vs no consumption||0,417||0,7(0,3-1,7)|
Table 2: Multinomial regression analysis to dropouts versus successful weight Loss in relation to marital status, social classes, educational level and alcohol and tobacco consumption.
|Successvs. failure||Sig.||OR (CI 95%)|
|Singlevs. married (couple)||0,812||0,9 (0,5-1,7)|
|social class medium vs. high||0,963||1,0 (0,4-2,2)|
|high school graduate vs. university||0,096||0,6 (0,3-1,1)|
|tobacco consumption vs. no consumption||0,593||0,8 (0,4-1,7)|
|alcohol consumption vs. no consumption||0,056||1,9 (1,0-3,6)|
Table 3: Multinomial regression analysis to failure versus successful consumption.
Weight loss percentage was 2,7% (SD=1,2), from an initial BMI of 27,0 kg/m2 (SD=3,5) to a loss of 0,7 BMI kg/m2 (SD=0,3).
The present study has used a non-invasive clinical approach and has searched if five factors can be determinants in the success of a treatment for obesity in a Caribbean population. Patients who completed treatment and therefore have lost weight in the four months are 64,2% of the total that looked at first, and 71, 3% of the total that began the treatment, despite the great difficulties that arise in the treatment of overweight and obesity. The dropout rate is small maybe, because the initial attendance is voluntary and for aesthetic reasons without a clinical condition. Moreover, the treatment must be performed moderately and continuously in order to avoid dropout and recovery of the initial weight.
In this study there is stated a discreet percentage of weight loss with treatment adherence, and patients were satisfied with their new body image comparing previous and post-treatment photographies.
Numerous studies state that low class linked to a low level of education develops obesity , likewise, they indicate that obesity is less common in singles ; but the present results demonstrate that this condition does not affect the treatment success. It is necessary to bear in mind that the studied population was medium and high class , and, like other studies, obesity no longer depends on the economic income .
World population tends to overweight and obesity due to current lifestyle , nevertheless, a personalized diet improves the pathological condition of the patients , being very important to perform previous surveys that lead to treatment success .
It is known that smoking  and alcohol consumption  associated with obesity, increased cardiovascular risk, but as observed in the present study, did not appear to influence the treatment success, not perceiving greater awareness among consumers, although one of the nutritional advice in cases of regular alcohol consumption is precisely to stop it, because the extra intake of calories with no nutritional sense.
From the study we could suggest that in regards to the correct design of a 16 weeks follow up weight loss program directed to obesity in Colombia, the program has to be designed individually and consider factors such a dietary changes based on patients food choices and preferences, without taking into account social classes, level of education, marital status, alcohol and tobacco consumption which are not proven to be influential factors in the successful outcome in overweight and obese patients.