A Pilot Study to Assess the Impact of Structured Diet and Exercise Counseling on Obesity and Quality of Life Measures in South Carolina

Abstract

Purpose: Obesity is a pervasive problem in the U.S., especially in South Carolina, with 33.9% of the population overweight and 32.6% obese. Obesity is associated with a poor quality of life (QOL), as shown by the Medical Outcomes Study Short Form (SF questionnaires). Medicare and Medicaid proposed intensive counseling for all its patients with a body mass index (BMI) over 30kg/m2 in September 2011. Obesity counseling has been used as a Physician Quality Reporting System measure. This study aimed to assess whether structured counseling on healthy diet and exercise choices in patients with a body mass index (BMI) over 25kg/m2 had an impact on their QOL, understanding the benefits of healthy diet and exercise choices (DAEC) and BMI. Methods: In this prospective pilot study, 104 patients were recruited at a gastroenterology center in South Carolina. At the initial consultation, their QOL and knowledge of DAEC were assessed using the SF-12, and a structured ‘diet and exercise' questionnaire (DAEQ). Their BMI was recorded, and categorized according to the World Health Organisation International Classification of Weight According to BMI (Overweight, Obese class I, II or III). They were counseled for 40 minutes on portion sizes, healthy meal choices and the importance of regular exercise. They were shown how to measure serving sizes. Their comprehension was verified by information recall. Written guidelines were supplied, reinforcing this information. These directives were based on guidance from the American Heart Association and Centre for Nutrition Policy and Promotion. The follow-up period was two months, in which patients received two phone calls to monitor their progress, SF-12 and DAEQ scores, and BMI. Results: Obesity class I patients underwent a significant improvement in mean mental health and DAEQ scores. Obesity class II patients experienced significant improvements in mean BMI and mean physical health scores. There were significant improvements in obesity class III patients' mean BMI and mental health scores. Overweight patients demonstrated improvement in all aspects of the SF-12, DAEQ scores, and reduction in BMI. The results before and after structured counseling are summarized in the ‘Summary of Results' table.Table: Table. Summary of resultsConclusion: This study highlights the benefits of regular counseling, even within a short period, as an intervention for obesity management. With further follow-up, there is potential for greater improvement in results. While these results do not evaluate quality of care due to the outcome measures used, there is an opportunity for physicians to motivate patients in clinics to take responsibility for their own physical and mental health, and to prevent future comorbidities through regular counseling and information reinforcement.