1. Obesity and Depression Case Study
Group Members:
Taviel Bartley (Leader), Erika Whiters, Brakimia Boynton, and Johnleekia Little
Georgia Southern University
PUBH 3131: Epidemiology of Chronic Disease
Instructor Hardy

2. Introduction
● A 52 year old woman diagnosed with depression, obesity and poorly controlled Type 2 diabetes.
She is overweight and has a 9 year history of type 2 diabetes.
● She complains of difficulty losing weight, fatigue, no motivation, shakiness, diaphoresis (increase
perspiration), and increased in hunger. She also complains that due to the pain in both her
knees and ankles prevent her from exercising.
● Her energy level has decline, particularly in the afternoons. She has gain an enormous weight
ever since she began taking insulin for 6 years.
● She does not follow any specific diet and is fearful of hypoglycemia that she often eats extra
snacks.
● She’s being treated by physician at the Health Maintenance Organization.

3. Description of Main Issues
● 52 year old female
● Obese
● 9 year type 2 diabetic
● Insulin treatment for 6 years
● Symptomatically depressed
● Sedentary lifestyle
● Advised repeatedly by physician to lose weight and exercise to improve health status

4. Prevalence of Diabetes and Obesity
● Across all age groups, the worldwide prevalence
of diabetes doubled more than in the first decade
of the 21st century, rising from 2.8% (2000) to
6.4% (2010); (Harris, pg. 378).
● In 1995, the World Health Organization revealed
that 4.0% of adults age 20 years or older had
diabetes (King, Aubert, and Herman, 1998).
● The prevalence was highest in developed
countries of North America and Western Europe
and the lowest in developing countries of
SouthEast Asia and Central Africa.

5. Prevalence of Diabetes and Obesity Continued….
● In the US, the prevalence of obesity has
doubled since 1960; 13.3% of the adult
population was classified as obese (Harris,
pg. 423).
● Almost 70% of people ages 20 and older
are overweight or obese, with nearly 34%
classified as obese.
● The prevalence of overweight in high
income and upper middle income countries
was more than double that of low middle
income countries (World Health
Organization).

6. Incidence of Diabetes
● According to CDC, numbers of adults between the ages of 18-79 are diagnosed with diabetes.
● In 2012, the incidence for diabetes was 1.7 million new diagnoses per year.
● In November of 2014, approximately 347 million people have diabetes worldwide (WHO)
● 1 in 10 adults have been diagnosed, and fewer people undiagnosed.

7. Analysis Of Health Problem
Morbidity rate for Diabetes via CDC Fast Stats
Since 2010 in the United States
● Percent for noninstitutionalized 20 years and older with
diabetes (physician diagnosed or undiagnosed): 11.9%
(2007-2010)
● Percent for noninstitutionalized 20 years and older with
physician diagnosed diabetes: 8.5% (2007-2010)
● Percent for noninstitutionalized 20 years and older with
undiagnosed diabetes: 3.4% (2007-2010)
Difference Between Type 1 and Type 2 diabetes
● Type 1 diabetes occurs when elevated blood glucose
or hyperglycemia arises when insulin, the key hormone
produced by the beta cell of the Islets of Langerhans of
the pancreas is no longer secreted. In Type 2 diabetes
insulin becomes unable to sufficiently allow glucose to
enter into the cell to produce energy.
Major Risk Factors associated with Type 2 Diabetes
● family history (strongest), age, ethnicity, obesity, and
prediabetes
● Obesity risk factors: genetics, environment, inactivity,
unhealthy eating, age, SES (socioeconomic status)
Figure 32.7 Relative Mortality of Diabetes
in the United States, 1960-2010

8. Relationship Between Diabetes and Heart Disease
● Cardiovascular Disease (Heart disease) is one of the major complication of diabetes and the
leading cause of early death.
● Approximately 65% of people who suffer with diabetes die from some kind of heart related
diseases and stroke.
● If you have diabetes, you are more likely as someone who does not have diabetes to have
stroke or heart disease.
● High blood glucose levels over time can lead to an increased deposits of fatty materials on the
insides of the blood vessel walls. It can lead to clogging and hardening of blood vessels
(atherosclerosis).

9. Additional information needed to be provided
The nurse needed to provide the following
information:
● Physical Exam (vital signs):
-Height
-Weight
-Blood pressure
-Body Temperature [Pulse Rate, Respiration Rate]
● Laboratory testing:
-Blood glucose test results
-Creatinine Blood Test
-Possible Blood Urea Nitrogen Test
-Fasting Plasma Glucose Test
-Chemistry Screening ( a blood test that measures
the level of several substances in the blood).
-Cholesterol test results
-Kidney test (urinalysis testing)
-Hemoglobin Testing (A1C test)

10. Recommendations
● The physician made several recommendations, including weight loss and exercise. However, the
patient explained that joint pain in her knees and ankles can make exercise a difficult task. Due
to time constraints, the patient did not receive adequate health education. With obesity being the
strongest predictor of type 2 diabetes, it is critical that the patient is presented with options that
allow her to exercise safely and without unnecessary pain (Harris, pg. 393).
● I would refer the patient to a registered dietician that can educate the patient on how she can eat
several small meals each day to reduce the likelihood of hypoglycemia. The dietician should
educate the patient on the glycemic index and show her diabetic-friendly options that are
satisfying as well as filling.
● I would also provide the patient with resources that would encourage the patient to be more
active, while reducing and/or eliminating the issue of joint pain. Total-body resistance exercise,
cycling, yoga, and swimming are just a few of many low impact physical activities that are joint
friendly.
● I believe that the patient would also benefit from a gym membership and a personal trainer,
preferably a trainer that is also familiar with nutrition. The trainer could ensure that the patient is
exercising effectively, while making sure that she is not putting herself at risk for injuries or
disappointment.

11. Recommendations
● The patient’s depression diagnosis must also be addressed in order to ensure a successful
intervention. Depression can lower a patient’s self-efficacy and give her a feeling of
hopelessness, which would make her less likely to work toward the goal. The patient admitted
that she felt fatigued and had no motivation.
● The patient should encouraged to attend support group meetings and get to know the members
of the group. She should be encouraged to reach out to other members for support when she’s
having a bad day and to share her struggles and successes with her group members. This peer
support would remind the patient that she is not alone.
● I would also look into why the patient chose not to take the medicine she was prescribed. She
needs to know that depression is highly treatable and the positive effects the treatment would
have on her life. It is obvious that she is unhappy and is tired of being unhappy. Successful
treatment of her depression could possibly be the deciding factor that makes her want to change
her current situation. I would provide readings and other materials that discuss depression, its
physiological effects, and how it can be treated.

12. Ways in which community resources can work together in chronic disease
management
Gyms:
● have personal trainers develop special dietary programs targeted towards the type of chronic
disease highly prevalent within the community
ex: for obese and diabetic patients recommend low carb and low fat diet that also encourages healthy
eating
● develop fitness programs that have weekly goals of weight loss
ex: for obese and diabetic patients target problem areas that implement push up, sit ups, and other
aerobic and anaerobic exercises so reduce medical complications with blood glucose levels, blood
pressure, etc.
Community Centers:
● enroll in the Center for Disease Control and Prevention Diabetes Prevention and Recognition
Program (DRDP)
The DPRP has three key objectives:
● To assure program quality, fidelity to scientific evidence, and broad use of effective type 2
diabetes prevention lifestyle interventions throughout the United States
● To develop and maintain a registry of organizations that are recognized for their ability to deliver
effective type 2 diabetes prevention lifestyle interventions to people at high risk.
● To provide technical assistance to local type 2 diabetes prevention programs to assist staff in
effective program delivery and in problem-solving to achieve and maintain recognition status.

13. Ways in which community resources can work together in chronic disease
management continued...
Community Centers:
According to the CDC, the purpose of the DPRP is to recognize programs that have shown that they
can effectively deliver a proven lifestyle change program (in-person, virtual, or via distance learning) to
prevent type 2 diabetes.
● have trained psychiatrists hold individual and group sessions to evaluate the mental state of
those who exhibit symptoms of depression for their encouragement towards weight loss
According to the article, Reliable change in depression during behavioral weight loss treatment among
women with major depression, participants who experienced reliable improvement in depression lost
significantly more weight than those who did not.
Also according to this article, depression is commonly encountered in clinically obese patients and
behavioral weight loss interventions result in improved depressive symptoms.
Therefore, examination of mental health by psychiatrist encourages changes in depression during
treatment which may also alter the individuals experiences towards weight loss.

14. Logistical problems that can occur when coordinating
resources in rural, lower income areas in the United States
● Staffing Credibility and Shortages
o Gyms and community centers need to be properly and adequately staffed with
trained professionals
 Example: Gyms need to have enough personal trainers to meet the demand of
patients
 Example: Registered Dietitians need to be staffed. According to the National Institute
of Health, exercise along with healthy eating is essential to weight loss and the
management of type 2 diabetes
● Accessibility and Affordability
o Patients that live in rural or lower income areas may have trouble accessing
and affording the treatment for their chronic condition
 Example: A patient may lack the transportation to a gym or community center
● Transportation should be provided free of cost to patients
 Example: A patient may not be able to afford their treatment plans
● Receiving services from a community center should be covered by an
insurance plan or offered at a reduced rate for patient in lower income areas

15. Logistical problems that can occur when coordinating resources
in rural, lower income areas in the United States continued..
● Personalization
o Example: Sometimes programs provided at community centers can
be impersonal
 According to the article provided by the Robert Wood Johnson
Foundation, diabetic patients should have an “individualized” care plan.
The patient should have a physical activity and diet plan specific to
them.

16. References
● Brownlee M, Aiello LP, Cooper ME. Complications of diabetes mellitus. In: Melmed S, Polonsky KS, Larsen PR,
Kronenberg HM, Polonsky KS, Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Elsevier
Saunders; 2011: chap 33
● Busch, A. M., Whited, M. C., Appelhans, B. M., Schneider, K. L., Waring, M. E., DeBiasse, M. A., Oleski, J. L.,
Crawford, S. L. and Pagoto, S. L. (2013), Reliable change in depression during behavioral weight loss treatment
among women with major depression. Obesity, 21: E211–E218. doi: 10.1002/oby.20113
● Centers for Disease Control and Prevention (2015). Diabetes. http://www.cdc.gov/nchs/fastats/diabetes.htm
● Centers for Disease Control and Prevention (2010). Division of Diabetes Translation. National Diabetes
Surveillance System.
● Center for Disease Control and Prevention (2015). Read About the DPRP.
http://www.cdc.gov/diabetes/prevention/recognition/about.htm
● Harris, Randall E. (2013). Epidemiology of Chronic Disease:Global Perspectives. Burlington, MA:Jones & Bartlett
Learning
● National Institutes of Health (2014). Type 2 Diabetes.
http://www.nlm.nih.gov/medlineplus/ency/article/000313.htm
● Robert Wood Johnson Foundation (2013). Low-Income Patients Face Added Challenges in Managing Diabetes.
http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2013/08/low-income-patients-face-added-
challenges-in-managing-diabetes.html