EVELUATION OF THE EFFECTIVENESS OF EDUCATION GIVEN TO OBESE PATIENTS

Öz

Objective: To examine the effectiveness of health education on metabolic, psychologic status and quality of life. Method: The population included 160 obese case separated into two groups: 80 interventions, 80 controls. We held six education classes during first three months for intervention group. Participants in control group were provided with routine outpatient services and were asked to maintain their usual lifestyle. Data were gathered at baseline and at the end of 6 months. We evaluated obesity measurements body weight, body mass index, and waist circumference , fasting blood glucose, hemoglobin A1C protein, triglycerides, total cholesterol, systolic blood pressure, and diastolic blood pressure as metabolic parameters. Depression, self-esteem, body image, and state anxiety level were evaluated as psychological parameters. Quality of life was evaluated in two main and 8 subdomains. Results: At the end of 6 months body weight, body mass index, waist circumference, triglycerides, hemoglobin A1C protein and systolic blood pressure of intervention group had declined significantly. From baseline to 6 months, mean reductions in body weight, body mass index, waist circumference, triglycerides, hemoglobin A1C protein, and systolic blood pressure were 6.7 kg , 1.87 kg/m2 , 4.45 cm , 8.35 gr/dl , 0.82 % , and 1.68 mmHG respectively. Triglycerides, fasting blood glucose, hemoglobin A1C protein and systolic blood pressure had worsened in control group. Mean depression scores had decreased, self-esteem, and five quality of life domains’ scores in SF-36 had increased significantly in intervention group. Mean state anxiety score of control group had increased significantly, while all quality of life domains scores, except emotional role had decreased.Conclusion: Results demonstrate benefits of health education on metabolic, psychological parameters and quality of life in obese patients

Anahtar Kelimeler

• Anxiety,body image,blood glucose,blood pressure,depression,health education,hemoglobin A1C protein,lipids,obesity,quality of life,self-esteem

OBEZ HASTALARA VERİLEN EĞİTİMİN ETKİNLİĞİNİN DEĞERLENDİRİLMESİ

Öz

Amaç: Sağlık eğitiminin metabolik, psikolojik ve yaşam kalitesi parametreleri üzerine etkisini incelemektir. Yöntem: Araştırma 80 deney, 80 kontrol, 160 obez olguda yapılmıştır. Deney grubuna üç ay süre ile altı eğitim oturumu yapılmış; kontrol grubuna çalışma süresince hiçbir müdahalede bulunulmamış, hastalar rutin yaşamlarını sürdürmüşlerdir. İlk görüşmede ve eğitim bittikten 6 ay sonra iki değerlendirme yapılmıştır. Metabolik parametre olarak, obezite değerleri beden ağırlığı, beden kitle indeksi, bel çevresi , açlık kan şekeri, HbA1c, trigliserid, total kolesterol, sistolik kan basıncı ve diyastolik kan basıncı değerlendirilmiştir. Psikolojik parametre olarak depresyon, benlik saygısı, beden imajı ve sürekli kaygı düzeyi ele alınmıştır. Yaşam kalitesi fiziksel ve mental boyutları içeren 8 alt başlıkta incelenmiştir. Bulgular: Eğitim sonunda deney grubundaki olgular ortalama 6.7 kg kaybetmiş, beden kitle indeksi 1.87 kg/m2, bel çevresi 4.45 cm p

Anahtar Kelimeler

• Anksiyete,beden imajı,depresyon,HbA1C,kan basıncı,kan şekeri,lipidler,obezite,özgüven,sağlık eğitimi,yaşam kalitesi

Kaynakça

1. Appel LJ, Champagne CM, Harsha DW, Cooper LS, Obarzenek E, Elmer PJ, Stevens VJ, Vollmer WM, Lin PH, Svetkey LP, Stedman SW, Young DR (2003) Effects of comprehensive lifestyle modification on blood pressure control: Main results PREMIER clinical trial. The Journal of the American Medical Association 289, 2083-2093.
2. Beck AT, Steer RA, Garbin GM (1988) Psychometric properties of the Beck Depression Inventory
3. Twenty-five years of evaluation. Clinical Psychology Review 8, 77-100. Blissmer B, Riebe D, Dye G, Ruggiero L, Grene G, Caldwell M (2006) Health-related quality of life following a clinical weight loss intervention among overweight and obese adults: Intervention and month follow up effects. Health and Quality of Life Outcomes 4, 1-8.
4. Cuff DJ, Meneilly GS, Martin A, Ignaszewski A (2003) Effective exercise modality to reduce insulin resistance in women with type 2 diabetes. Diabetes Care 26, 2977-82.
5. Cakir H, and Pinar R (2006) Randomized controlled trial of lifestyle modification in hypertensive patients. Western Journal of Nursing Research 28, 190-209.
6. Foster GD, Phelan S, Wadden TA, Gill D, Ermold J, Didie E (2004) Promoting more modest weight losses: A pilot study. Obesity Research 12, 1271-1277.
7. Hatemi H, Yumuk VD, Turan N, Arik N (2003) Prevalence of overweight and obesity in Turkey.
8. Metabolic Syndrome and Related Disorders 1, 285-290. Hession M, Rolland C, Tuya C, Wise A, Murray S, Pirie I, Jarrett K, Broom J (2006) Weight physical activity, and general health changes after 3 and 6 months of dietary interventions. Obesity Reviews 7 (Suppl 2), 307.

9. Jensen GL, Roy MA, Buchanan AE, Berg MB (2004) Weight loss intervention for obese older women: Improvements in performance and function. Obesity Research 12, 1814-1820.
10. Kaukua J, Pekkarinen T, Sane T, Mustajoki P (2003) Health-related quality of life in obese outpatients losing weight with very-low-energy diet and behaviour modification: A 2-year follow-up study. International Journal of Obesity and Related Metabolic Disorders 27, 1072-1080.
11. Kaukua J, Pekkarinen T, Sane T, Mustajoki P (2002) Health-related quality of life in WHO class
12. II-III obese men losing weight with very-low-energy diet and behaviour modification: A randomised clinical trial. International Journal of Obesity and Related Metabolic Disorders 26, 487-495. Kolotkin RL, Crosby RD, Williams GD, Hartley GG, Nicol S (2001) The relationship between health related quality of life and weight loss. Obesity Research 9, 564-571.
13. Kozan O, Oguz A, Abaci A, Erol C, Ongen Z, Temizhan A, Celik S (2007) Prevalence of the metabolic syndrome among Turkish adults. European Journal of Clinical Nutrition 61, 548-553.
14. Malone M, Alger-Mayer SA, Anderson DA (2005) The lifestyle challenge program: A multidisciplinary approach to weight management. The Annals of Pharmacotherapy 39, 2015-2019.
15. Mathus-Vliegen EM, De Weerd S, De Wit LT (2004) Health-related quality of life in patients with morbid obesity after gastric banding for surgically induced weight loss. Surgery 135, 489-497.
16. Miller ER, Erlinger TP, Young DR, Jehn M, Charleston J, Rhodes D, Wasan SK, Appel LJ (2002) Results of diet, exercises and weight loss intervention trial. Hypertension 40, 612-618.
17. WHO (2006) Obesity and overweight; what are the overweight and obesity. WHO Fact Sheet No: , September 2006.
18. Onat A (2003) Türkiye'de obezitenin kardiyovasküler hastalıklara etkisi. Türk Kardiyoloji Derneği Araştırmaları 31, 279-289.
19. Pınar R (2002) Obezlerde depresyon, benlik saygısı ve beden imajı: Karşılaştırmalı bir çalışma.
20. Cumhuriyet Üniversitesi Hemşirelik Yüksekokulu Dergisi 6, 30-41. Pınar R (1995) Sağlık araştırmalarında yeni bir kavram: Yaşam kalitesi, bir yaşam kalitesi ölçeğinin kronik hastalarda geçerlik ve güvenirliğinin sınanması. Hemşirelik Bülteni 9, 85-95.
21. Redmon JB, Reck KP, Raatz SK, Swanson JE, Kwong CA, Ji H, Bantle JP (2005) Two-year outcome of a combination of weight loss therapies for type 2 diabetes. Diabetes Care 28, 1311-1315
22. Rock CL, Flatt S, Thomson CA, Stefanick ML, Newman VA, Jones L, Natarajan L, Pierce JP, Chang RJ, Witztum JL (2004) Plasma triacylglycerol and HDL cholesterol concentrations confirm self-reported changes in carbohydrate and fat intakes in women in a diet intervention trial. Nutrition Journal 134, 342-347.
23. Sertöz ÖÖ, Mete HE (2005) Obezite tedavisinde bilişsel davranışçı grup terapisinin kilo verme, yaşam kalitesi ve psikopatolojiye etkileri: Sekiz haftalık izlem çalışması. Klinik Psikofarmakoloji Bülteni 15, 119-126.
24. Swetkey LP, Erlinger TP,Vollmer Win, Feldstein A, Cooper LS, Appel LJ, Ard JD, Elmer PJ, Harsha D, Stevens VJ (2005) Effects of life style modification on blood pressure by race, sex, hypertension status and age. Journal of Human Hypertension 19, 21-31.
25. Swetkey LP, Simons-Morton DG, Proschon MA, Sacks FM, Conlin PR, Harsha D, Moore TJ (2004) Effect of dietary approaches to stop hypertension diet and reduced sodium intake on blood pressure control. The Journal of Clinical Hypertension 6, 373-381.
26. Volek JS, Sharman MJ, Gomez AL, Scheett TP, Kraemer VJ (2003) An isoenergetic very low carbohydrate diet improves serum HDL cholesterol and triacylglycerol concentrations, the total cholesterol to HDL cholesterol ratio and postprandial pipemic responses compared with a low fat diet in normal weight, normolipidemic women. Nutrition Journal 133, 2756-2761.
27. Ware JE, Sherbourne DC (1992) The MOS 36 item short form health survey (SF 36). Medical Care , 473-483.
28. Whelton SP, Chen A, Xın X, He J (2002) Effect of aerobic exercise on blood pressure: A meta analysis ad randomized, controlled trials. Annals of Internal Medicine 136, 493-503.
29. Womble LG, Wadden T, McGuckin BG, Sargent SL, Rothman RA, Krauthamer-Ewing ES (2004) A randomized controlled trial of commercial internet weight loss program. Obesity Research , 1011-1018.