BOSTON � September 2002 - As significant a problem as obesity is among the general population, it's an even greater problem for adults with disabling conditions, according to a study in the Sept. 11 issue of the Journal of the American Medical Association (JAMA), which also found that, in general, patients with disabilities were as likely to try to lose weight as were overweight adults without disabilities.
"Our research showed that adults with sensory, physical and mental health conditions are at increased risk for obesity," says the study's senior author Christina Wee, M.D., M.P.H. of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center (BIDMC). "We in the field of public health need to develop strategies to help these patients in their weight-control efforts."
Using data pooled from U.S. government surveys including the 1994-1995 National Health Interview Survey, the 1994-1995 Disability Supplement and the 1995 Healthy People 2002 Supplement, Wee and her coauthors examined the cases of more than 145,000 individuals. Of this group, nearly 26,000 had one or more potentially disabling conditions, which were classified into six categories: blind/low vision; deaf/hard of hearing; lower extremity mobility difficulty; upper extremity mobility difficulty; hand dexterity difficulty; and serious mental illness.
After adjusting for sociodemographic factors, the survey analysis found that nearly 25 percent of the group of individuals with disabilities were obese � defined as having body mass index greater than 30 � compared with about 15 percent of the adults without disabling conditions.
According to Wee, who is also an Assistant Professor of Medicine at Harvard Medical School, the highest risk for obesity was found among adults with lower limb mobility difficulties, defined as difficulty walking, standing, climbing stairs or requiring the use of a mobility aid such as a cane or a walker. Further analysis found this same group was also not likely to have received exercise counseling from their physicians.
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"This aspect of our findings was particularly troubling," says Wee. "Exercise is very important for weight maintenance among patients with lower mobility disabilities. Without exercise, you're often left with a 'vicious cycle,' in that inactivity contributes to obesity, obesity exacerbates disability and disability impedes a person's ability to exercise."
Obesity is a serious problem, putting patients at risk for developing type II diabetes, as well as coronary artery disease, hypertension and related cardiac problems. With the exception of patients with lower mobility disabilities, Wee's analysis found that adults with disabilities were as likely to attempt to lose weight as adults without disabilities, a finding that she says should be noted by the medical community. "Physicians need to recognize that these groups of patients face increased risks for obesity and actively encourage their efforts to control their weight," she says.
The authors recommend that further study and more detailed clinical guidelines are needed to help physicians promote weight control and exercise among their patients with disabilities.
Study coauthors include Beth Israel Deaconess researchers Evette Weil, B.A., Melissa Wachterman, B.A., Ellen McCarthy, Ph.D., M.P.H., Roger Davis, Sc.D., and Lisa Iezzoni, M.D., M.Sc.; and Bonnie O'Day, Ph.D., of Cherry Engineering Support Services, Inc. in Virginia. This research was funded by grants from the Agency for Healthcare Research and Quality and the National Institute of Diabetes and Digestive and Kidney Disease.
Source: Beth Israel Deaconess Medical Center
