Social Classes, Level of Education, Marital Status, Alcohol and Tobacco Consumption as Predictors in a Successful Treatment of Obesity

High rates of overweight in adolescence described in many countries [5] 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 [6].


Introduction
Overweight and the obesity represent an increasing threat to the general population in many countries [1], and it is considered to be a worldwide epidemic [2]. Body image and self-perception play an important role in the personal growth and adaptation, as well as children and adolescents [3]. It is extremely important to diagnose and tackle obesity at early stages due to the high risk of cardiovascular events, cancer and the mortality associated [4].
High rates of overweight in adolescence described in many countries [5] 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 [6].
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 [7]. Obesity is related to a low level of educational attainment, has been use as a marker of inadequate health [8] 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 [9].
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 [10].
Weight loss and dieting are common concerns for both genders, for most of them a diet is about consuming less fat rather than using a combination of lower caloric intake with aerobic exercise [11].
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 [12].
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.

Subjects
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.

Methodology
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.
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.

Discussion
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 [13], likewise, they indicate that obesity is less common in singles [14]; 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 [15], and, like other studies, obesity no longer depends on the economic income [16].
World population tends to overweight and obesity due to current lifestyle [17], nevertheless, a personalized diet improves the pathological condition of the patients [18], being very important to perform previous surveys that lead to treatment success [19].
It is known that smoking [20] and alcohol consumption [21] 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.

Conclusion
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.