한국인 저소득층 비만 환자의 치료 유효성 평가를 위한 전향적 연구
Prospective Study for Evaluating Therapeutic Efficacy of Obese Patients of Low Socioeconomic Status in Korea
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연구배경: 최근 비만의 유병률과 비만으로 인한 사회경제적 비용은 급격히 늘고 있다. 특히 비만은 소득수준에 따른양극화가 심한 질환으로, 저소득층의 비만 문제는 향후 사회경제적으로 중대한 문제가 될 것으로 보인다. 이에 본 연구는 저소득층 비만 환자를 대상으로 비만치료의 프로세스를 개발하고 실행 가능성을 확인하기 위하여 6개월간 전향적으로 일관된 상담치료와 약물치료를 하였을 때 보이는효과를 관찰하고자 한다. 방법: 본 연구는 최저생계비 200% 이하의 18세 이상부터65세 미만의 저소득층 환자 중, 체질량지수가 27 kg/m 2 이상인 환자를 대상으로 하였다. 6개월 동안 비만 상담과 약물치료를 하며 2주 간격으로 체중, 허리둘레, 체질량지수, 혈압을 추적관찰하였으며 혈액검사와 설문지는 0, 3, 6개월에 시행하였다. 대응표본 t-검정과 선형혼합모형으로 치료전과 후를 비교하여 유효성 및 안전성을 평가하였다. 혈액검사는 일반혈액검사, 공복시 혈당, 간기능검사, 지질검사, 코르티솔(cortisol), DHEA-S 등을 시행하였으며, 설문지는우울감척도(BDI-I), 섭식척도 등이 포함되었다. 결과:21명의 연구 대상자(남자 2명)를 6개월간 추적관찰한결과, 체중(P<0.01), 체질량지수(P<0.01), 허리둘레(P<0.01), 저밀도지단백 콜레스테롤(P=0.01), BDI-I (P<0.01), 절제섭식척도(P<0.01), 감정섭식척도(P<0.01), 외부섭식척도(P=0.01)가 통계적으로 유의하게 감소하였다. 안전성 평가를위하여 시행한 혈압과 혈액검사는 통계적으로 유의한 변화가 없었다. 결론: 저소득층의 비만 환자들에게 적절한 비만치료는체중감량, 허리둘레 감소뿐만 아니라 우울감과 섭식패턴에영향을 줄 만큼 의미가 있었고 결과적으로 향후에 사회 경제적 비용절감의 효과를 보일 수 있을 것이다.
Abstract
Background:Recently, the prevalence of obesity and socioeconomic costs stemming from obesity are increasing steeply. Obesity, in particular, has a highly polarization caused by income levels. Obesity in low-income patients is expected to become a serious social problem in the future. This study aims to observe the effects of consistent consultation and drug therapy during a six months period, and to develop the treatment process of obesity for low-income people. Methods:The body weight, waist circumference, body mass index (BMI), and blood pressure (BP) was measured every 2 weeks, and laboratory blood tests with a survey including Beck Depression Inventory (BDI) and eating behavior index was checked at 0, 3, and 6 months. Paired t-test and linear mixed model was done to evaluate the difference between pre-treatment data and post-treatment data. Results:Twenty-one patients (2 males, median age [interquartile range] of 39 years [29-46]) were analyzed. There were statistically significant reductions of body weight (P<0.01), BMI (P<0.01), waist circumference (P<0.01), low-density lipoprotein (P=0.01), BDI-I (P<0.01), eating behavior index (P<0.01). There was no statistically significant difference of safety outcome of the BP and blood tests. Conclusions:Proper obesity treatment of obese patients of low socioeconomic status was meaningful enough to affect depression and eating patterns as well as reducing body weight and decreased waist circumference.
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