PROFILING OVERWEIGHT PATIENTS IN THE UNITED-STATES-NAVY - HEALTH CONDITIONS AND COSTS

The U.S.A. has the distinction of being the "fattest" nation in the world, with an estimated 34 million obese citizens. Of grave concern is the reported finding that obesity contributes to 20% of the annual mortality rate, primarily for such conditions as diabetes mellitus, digestive diseases, coronary heart disease, and cerebrovascular disease. In 1982, the Navy initiated the "Health and Physical Readiness Program" in order to establish body fat percentages and physical conditioning standards and to provide Navy personnel with weight reduction and other health promotion programs. Participation in such programs is expected to help overweight personnel solve their weight problems and reduce the risks of obesity-related conditions. The purpose of this study was (1) to identify the health conditions recorded in a sample of U.S. Navy enlisted men who had been diagnosed as obese during one or more of their admissions to a Naval hospital from 1974 through 1984, (2) to determine whether these disorders correspond with those reported in the scientific literature, and (3) to examine the obesity-related costs in terms of numbers of days hospitalized and career outcome. The patient population consisted of 518 U.S. Navy enlisted men who were given a primary diagnosis of obesity and 1,092 who received a secondary or additional diagnosis of obesity on at least one of their inpatient medical records between 1974 and 1984. A 10% sample of Navy male patients, all of whom had not been diagnosed as obese, was selected as a comparison group (n = 30,829). All diagnoses (ICD-9) for each hospitalization were included in the data compilations; however, each unique diagnosis was only counted once. Frequency and percentage distributions were compiled for each of the two samples and by age interval (20 to 29 years, 30 to 39 years, and older than 40 years) for the 16 major diagnostic categories and several specific diagnoses as well as numbers of days hospitalized and type of Navy separation. Univariate analyses were conducted to establish whether hospitalized obese men accounted for significantly higher mean numbers of days hospitalized or percentages of disability separations than controls. Almost one-third of the obese sample was hospitalized with a primary diagnosis of obesity, which accounted for more than 10,000 days hospitalized. Other specific disorders that represented a large proportion of all health problems among obese patients at all ages included hypertension, diabetes mellitus, gout, respiratory symptoms, and gallbladder disorders as well as chronic ischemic heart disease beginning at age 30. Also noteworthy was the high percentage among the overweight of hospitalizations for alcoholism, their second-ranked condition, which is the leading health problem in the control sample. In both samples, alcoholism was listed in the top four specific diagnoses for each age interval and accounted for 10.0% of all days hospitalized. Obese patients had a significantly higher overall mean number of days hospitalized than controls. Other findings showed that obese patients had relatively high percentages of physical disabilities, primarily for diabetes mellitus, chronic ischemic heart disease, and hypertension. The conditions reported in the scientific literature as obesity-related were identical to those noted among obese patients in this study. The relatively high percentage (almost 10%) of 20- to 29-year-old obese patients diagnosed with gout, hypertension, gallbladder disorders, and diabetes mellitus suggests that efforts should be made to initiate prevention and weight reduction programs for men in their 20s. Also, the percentage of hospitalizations for chronic heart disease among 30- to 39-year-old obese patients was quite high, which corresponded with other research reporting that obesity predisposes to premature coronary heart disease. Results of this study support the implementation of the weight-reduction programs that were developed as part of the "Health and Physical Readiness Program." The timing of assigning individuals to such programs is of importance-before any adverse health effects are manifest. In assigning overweight individuals to a weight-reduction program at an early phase of the excess weight condition, therefore, it seems likely that the incidence of obesity-related conditions will decrease as will the overall costs of inpatient care and disability separations.