2013

SPC used to track daily calorie content

COURSE PROJECT SPC-721
A case study using SPC tools to monitor the daily calorie intake of an individual

Submitted by: RaghavaKashyap Jyothi Swaroop Reddy Yerasi

Contents
1. 2. Introduction .................................................................................................................................... 3 Process characteristic ...................................................................................................................... 4 2.1 Process Characteristic Measurement ............................................................................................. 4 2.2 Estimated Costs to implement the plan .......................................................................................... 6 2.3 Conditions of the subject for experimentation ............................................................................... 6 3. 4. 5. Data Collection ................................................................................................................................ 7 Characteristics of the data collection point ...................................................................................... 8 Control Charts ................................................................................................................................. 9 5.1 Process Capability analysis ........................................................................................................... 10 6. Conclusions ................................................................................................................................... 11

7. References ........................................................................................................................................ 12

Executive Summary
According to Centers for Disease Control and Prevention (CDC) 33.3% of adults, aged 20 years and over are overweight and 35.9% are obese. Overweight is the most common phenomenon and it occurs when either the body metabolism is slow or when the calorie content is more than needed. There are several other factors such as age, hormonal imbalances, lack of exercise, etc. that make people over weight. Of these factors, the major factor contributing to overweight is the lack of balance between the amount of calories taken in and the amount of calories burned. The scope of this project is limited to track the amount of calories in take by an individual over a period of 30 days and thereby understanding the dietary process. With the level of technological development and competition in the world, there is no much time left for people to think and bother about the calories consumed. While there is no direct cure or shortcut to reduce weight, a calculated approach using statistical tools can help in reducing or maintain weight. Every extra pound gained by a person is a weight on his own legs. There are many side effects of being overweight. Some of them being accelerated ageing, asthma, fatigue, high blood pressure, joint and muscle pain, infertility etc. Statistical process control involves tools to monitor whether the process is under control and reduce the variability. Nowadays SPC is used not only to monitor manufacturing processes but also improving health care practices. It is proven that diseases like diabetics, high blood pressure, hypothyroidism etc., can also be monitored using SPC. Using these approaches doesnt cost a lot of money but a few minutes every day to track down the data. In this case study, we are analyzing a subject who weighs 200 pounds and wants to maintain his weight over a period of 30 days. For this, we averaged the number of calories he burned over a day and then tracked the number of calories he consumed. We used an online calorie calculator to identify the ideal number of calories he needs to take in order to maintain his weight. The minimum and maximum number of calories to be consumed obtained from this tool are used as the upper and lower specification limits to monitor his dietary process. Individual and MR control charts are plotted and analyzed to understand his process performance.

1. Introduction
According to American Diabetes Association, approximately 26 million children and adults in US have diabetes and there are many reasons for this disease like genetic defects, pancreatic defects, hypothyroidism etc. While diabetes can be controlled with proper medication, one has to keep an eye on the calorie consumption on daily basis and maintain proper blood sugar by eating well, exercising and sleeping in proper time. Managing calories intake is very important to control weight and thereby to control all the diseases having a root cause of excessive weight.

Figure 1: Tracking Total calories per day Statistical tools like Statistical process control (SPC) are being used now days in health care and direct patient care applications. There is a great misconception that SPC is used only in manufacturing industries but can be used anywhere is you want to control delay, deviation and defects. The main aim of the SPC is to reduce the variation and it is often used to identify assignable causes of variation. SPC is very important tool for process improvement and guides us in making decisions about where our improvement efforts have to be made. Statistically derived conclusions motivate us to change our behavior and improve our performance especially if it is related to health care. SPC in particular to control charts helps us to identify whether our process is in control, if not build up a case to brainstorm the assignable cause responsible for the process to be out of control.

This project uses SPC tools like control charts, histograms etc. to track the daily calories in diet and to understand the process of dietary intake. Control charts here in this case acts as a visual control in understanding and tracking our daily calorie content which is otherwise difficult to keep an eye onto. They are used to understand whether the process of dietary intake is in control and can be used as an alarm if few values fall out of designed control limits. They also identifies whether the process is drifting to the either side of the control limits. Histograms with reference to the lines on the other hand are used to track daily calories, fats and carbohydrates intake. The goal of this project is to improve the process of dietary intake thereby maintaining proper weight and reduce the chances of getting attacked by various diseases related to excessive weight.

2. Process characteristic
Since daily dietary intake is the process that is going to be studied in this project, checking the calories intake on daily basis seems to be appropriate process characteristic. Calories are the units of energy contained in the food and drink we consume. If the amount of calorie intake is more than calories we spend the excess to requirements is stored as fat and thus we gain weight. On the other hand if the amount of calories we spend is more than the amount of calories we take we lose weight. To track the dietary intake process on a daily scale, the calorie intake has to be measured on a daily scale.

2.1 Process Characteristic Measurement

The ideal calorie intake on daily basis of a person depends on gender, height, body frame, age and many other factors. There are many online resources which gives tells us the ideal calorie intake that we need take on daily basis depending on all these factors. The calorie intake on daily basis in measured through an iphone app called myfitnessspal which is shown in the below figure 2.

Figure 2: myfitnesspal app This app has inbuilt database of all foods and respective calorie contents. The food and drinks we take in all courses of time (breakfast, lunch,supper, dinner) is entered into our daily summary as shown in below figure 3,

Figure 3: Adding food to myfitnesspal app After adding each and every food and drinks including water into the daily summary of the app, it gives us the net calorie intake on a particular day as shown in below figure 4,

Figure 4: Total calorie intake in a day The rational subgroup of one is chosen in this case because daily total calorie content in a day can be checked only once. The time of interval between the collection of two data points is 24 hours. The data is collected for a period of 30 days.

2.2 Estimated Costs to implement the plan

There are no costs involved in the implementation of the plan. The mobile application used in this project was a free app available for download both on the iOs market and Android market. The weighing machine was available at the University Gym. Since there was no major change in diet plans or quantity of food taken by the individual, there was no drastic change in the food cost. All it took wasonly a couple of minutes every day to input the data into the mobile application.

2.3Conditions of the subject for experimentation

For this project, the following conditions of our subject are taken into consideration for determining the ideal number of calories required to maintain weight: Table 1:Conditions of the subject Current Weight Goal Sex Duration of experimentation Height Age Activity Workouts 200 lbs 200 lbs Male 1 month 5 feet. 10 inches 23 Lightly Active 3 times*1hr/week

Here, Daily calorie intake calculator is used to calculate the specification limits of our process and the following figure 5 shows its output. According to the calculator, our subject must take 2627 calories/day in order to maintain his weight. Given his exercise and physical activity, our subject starts losing weight if he consumes less than 2101 calories/day over a period of 30 days. Extreme fat loss may happen if he consumes 1600 cal/day. Therefore we had chosen 2627 cal as our upper specification limit and 2101cal as our lower specification limit for monitoring our process. We are assuming our subject to be free from all medical illness which may result in unnecessary weight gain even if he takes proper diet (for example Hypothyroidism).

Figure 5: Output of the calculator

3. Data Collection
Data is collected over a period of 1 month and calories are counted every breakfast, lunch, dinner and snacks. The following histogram shows his daily consumption for this period,

Figure 6: Graphical representation of calorie consumed From the above figure we could clearly see, our subject met the minimum requirement for maintaining his weight almost every day. We could also see the minimum calories in took for this period is 2000 and the maximum is 2700 cal. This bar chart with reference lines would be very helpful in identifying his diet changes. To verify the normality assumption of our data collected, we plotted normal probability plot as shown in below figure 7. From the plot we can see that most of our data points seem to be falling on the straight line except for 2 points. Therefore the normality assumption of our data seems to be valid and we can use normal Shewart control charts to monitor our process performance.
Probability Plot of Total calories consumed
Normal
99 Mean StDev N AD P-Value 2504 161.9 30 0.384 0.374

95 90 80

Percent

70 60 50 40 30 20 10 5

2000

2100

2200

2300 2400 2500 2600 Total calories consumed

2700

2800

2900

Figure 7: Normal probability plot of Total calories consumed

4. Characteristics of the data collection point

The selection of control limits is very important in designing control charts. The wider the control limits the less is the type 1 error, which the risk of a false alarm when actually the process is in control ,but on other hand it might increase type 2 error which is the risk of not detecting an out of control point when actually there is one. For control charts we have chosen three sigma control limits and since flow width of data is normally distributed, we find our type 1 error to be 0.0027 (From the standard normal table). That is an incorrect out of control signal or a false alarm would be generated 27 times out of 10,000 points. ARL (Average run length) is the average number of points that must be plotted before a point indicates out of control condition. Since our process observations are uncorrelated, we can calculate ARL by the following equation, = 1/

Here p, is the probability that any point exceeds out of control limits. Since the value of p in our case is 0.0027, ARL is calculated to be 370. This means an out of control point is expected after 370 points. =
1 0.0027

= 370

ATS (Average time to signal) on the other hand is the average time in which we can expect a false alarm. It can be estimated by the following equation, = Here, h is the fixed time interval between collection two consecutive data points. In our case, since we are collecting data once in a day, we have our average time to signal to be 370 days.

5. Control Charts
We used control charts to identify any gaps between his current performance and goal performance. Since we are not having any sub groups and data is collected is only once a day, I/MR charts are helpful in our case. The limits chosen to monitor his performance are 2627 cal on higher end and 2100 cal on lower end. These limits are obtained from daily calorie calculator described above. The following charts are I/MR charts obtained from Minitab,

I Chart of Total Calories intake

3200 3000 2800 2600 2400 2200 2100 2000 1 4 7 10 13 16 19 Observation 22 25 28 LCL=1943 2627 _ X=2504 UCL=3066

Individual Value

Figure 8: I chart of Total calorie consumed over 1 month

Moving Range Chart of Total Calories intake

700 600 500 UCL=690.0

Moving Range

400 300 200 100 0 1 4 7 10 13 16 19 Observation 22 25 28 LCL=0 __ MR=211.2

Figure 9: Moving range chart of Total calorie intook over 1 month

From the above charts we can see that process seems to be in statistical control with upper and lower control limits of I chart being 3066 cal and 1943 cal respectively. However with our chosen specification limits (2100 2627 cal), the process appears to be falling out of limits many times. We could clearly see many of the points are falling out of our upper target i.e. 2627 cal and only one point falling below lower target i.e, 2100 cal. The red points in the individual chart indicates the points that lie outside the limits.

5.1 Process Capability analysis

In order to understand more about our process, we performed process capability study. The process capability analysis shows that the even though the process seems to be in statistical control. The process is not capable with our chosen lower specification limit. It shows that 3.33% of the data lies below the lower specification limit and 26.67% of the data lies above the upper specification limit. This is around 30% of the data is outside the specification limits. The C p of the process is 0.47. The value of which takes process centering into account is merely 0.22. Overall, this shows that the dietary process needs to be improved and there is a need for developing new strategies to maintain the desired weight.

Process Capability of Total Calories intake

LSL
P rocess D ata LS L 2100 Target * USL 2627 S ample M ean 2504.38 S ample N 30 S tD ev (Within) 187.232 S tD ev (O v erall) 161.855

USL Within Ov erall

P otential (Within) C apability Cp 0.47 C P L 0.72 C P U 0.22 C pk 0.22 O v erall C apability Pp PPL PPU P pk C pm 0.54 0.83 0.25 0.25 *

2000
O bserv ed P erformance % < LS L 3.33 % > U S L 26.67 % Total 30.00

2200

2400

2600

2800

E xp. Within P erformance % < LS L 1.54 % > U S L 25.63 % Total 27.17

E xp. O v erall P erformance % < LS L 0.62 % > U S L 22.43 % Total 23.06

Figure 10: Process Capability study of Daily Dietary Process

6. Conclusions
From the analysis it is clear that the dietary process is not capable in achieving the desired output which in our case is maintaining weight. To validate our results we checked the weight of an individual at the end of 30 days and we found it to be 201.2 pounds. Although this slight weight gain cant trigger a sense of problem, desired results will not be obtained in a longer run if he continues to have such imbalanced diet approach. One recommendation that can be suggested is to increase the number of calories burnt by exercises. It is very difficult to maintain constant calorie consumption throughout life time but the easy way to maintain weight is by increasing the calories spent. To decrease weight, one misconception that people have is to restrict the calories as low as possible but this can lead to other health problems like malnutrition. A balanced diet approach with proper carbohydrates, vitamins, proteins with regular exercise, sauna, massages, swimming etc can not only contribute in maintaining weight but also improves overall health. The limitations of this study are restricted to accuracy of university weighing machines, myfitnesspal app and daily calorie calculator. We feel that this Statistical process control tools can be used not only to maintain weight but also to control other health problems like diabetes, blood pressure etc. The effects of number of pills consumed to control sugar levels and blood pressure levels can also be monitored.

7. References
1) http://en.wikipedia.org/wiki/Diabetes_mellitus 2) http://blog.minitab.com/blog/real-world-quality-improvement/managing-diabetes-with-sixsigma-and-statistics-part-i 3) Application of statistical process control in healthcare improvement: systematic review by Johan Thor et.al. 4) http://www.qualitydigest.com/june08/articles/03_article.shtml