Reducing Obesity - Essay Example

Running Head: Reducing Obesity Reducing Obesity of Reducing Obesity Introduction Obesity is an epidemic in which results in an increase of the natural energy reserve in humans and mammals. Besides being viewed as a clinical condition, it has also been viewed as a public problem. Obesity has been associated with various diseases like cardiovascular disease, diabetes and osteoarthritis. Inside the United States at least 30 percent of adults are suffering from obesity. The adult obesity rate in Europe is at least 20 percent. Low income groups and countries are affected most from obesity. Obese people are vulnerable to multiple health problems. Increased fat mass is associated with osteoarthritis, obstructive sleep apnea and social stigma. Increase in number of fat cells has been associated with diabetes, cancer and cardiovascular disease. Obesity has many costs for a country's health services. The situation is even worse for low income countries. There are personal, health and economic factors due to obesity (Hedley, 21, 2004). Obesity occurs if there are problems in energy balance. Reducing obesity is not only based on medical treatment. Other factors are also essential in the treatment of obesity. Dietary changes and physical activity are vital for weight loss but do not guarantee it. Effective interventions tackle diet and physical activity in an integrated way. Successful intervention must be sustainable and influence energy balance. Changing the environment is one of the best ways to ensure long term permanent change. This paper studies the socio-political context of obesity on health. It discusses the ethical, professional and legal perspectives of reducing obesity (Hofferth, 51, 2005). Legal Perspectives The public health revolution in the United States has been revolutionized by the intervention of legislative strategies. The average life expectancy has increased due to legal regulations. Further infectious diseases no longer pose a threat to the American public. Law is the primary tool for controlling obesity. Physical activity is another strategy that plays a part in reducing obesity. It is also the key to reshaping the medical care system which provides better preventive and curative services to the public. Prohibition model for food does not work simply because obesity is very much complex. Some people who eat fast food are more vulnerable to getting obese, but other people who do not eat fast food are equally at the risk of getting fat. Obesity is a lifelong problem which requires great time and effort to change behavior (Kromeyer, 41, 1999). Laws can produce an environment that makes it easier to eat less and exercise regularly but they cannot complete eradicate the problem of obesity. Obesity as a disease has many social stigmas associated with it (Moyers, 31, 2005). Obesity has become a legislative topic which tremendous pressure to pass laws that can reduce it. Change can only occur if powerful groups care about an issue. Obesity is quickly becoming a public concern. Therefore laws must be passed to deal with it. Many laws will have no impact but they can definitely make a difference. Legislation which focuses on reducing obesity on a long term is viable. It needs to tackle the factors associated with obesity. Obesity impacts on the cost and availability of food. The policy of the US was to make food cheap and abundant. Ways were sought to make food less perishable. Food substitutes were developed to replace expensive products like beet sugar. Industrial production reduced the cost of food. Today in the United States food prices are very much low. Cheaper and widely available food is one of the most important cultural changes behind obesity (Ogden, 81, 2002). Schools have been the major contributors of obesity. School lunches now consist of vending machines that serve snacks and soft drinks. Unlimited amounts of fast food and candy is available at school cafeterias. Organized physical activity has been reduced in schools. Targeting schools by legislation is an effective tactic in reducing obesity. Increasing funding for public schools would allow them to serve healthy food. Placing a ban on vending machines and fast food would be effective if the schools are allowed to have increased funding. This funding would allow them to prepare traditional meals and hire extra staff to prepare those meals. Providing healthy juice would be an alternative to soft drinks. Water is a better choice as it is cheap and widely abundant (Olshansky, 71, 2005). Drugs and steroids are used by teenagers to increase their body shape and for sports enhancement. The increase social pressure to lose weight has seen the rise of increased weight loss drugs. These are unregulated stimulants and prescription drugs which carry many disastrous health consequences. Smart legislation which can target these products would be an effective step in reducing obesity. Daily physical activity is one of the important parts of reducing obesity. A society of suburbs and single use neighborhoods prevent walking. There is no place to walk and there are no sidewalks. This has resulted in little physical activity of people in the United States. Most people do not have the time to perform physical activity regularly. Legislation was introduced to keep housing rates low and to make neighborhoods safer. Changing these existing laws will definitely result in reaction by the public because of fears of crime and high property rates (Sturm, 171, 2005).Legislation must properly address the issue of crime and high property rates in order to create more walking spaces for people. The first step would definitely be the restoration of public confidence in safety from crime. Legislation must address the goals and objectives which are necessary for reducing obesity. This can span over a time period of ten years. The first step will definitely be the creation of a surveillance system to track the nature of the problem and monitor changes which will be implemented in the next ten years. Interventions and incentives are necessary for instance to address the issue of obesity at the school level. Community participation is vital for the success of the program. Sound scientific principles must be used in the passing of legislation designed to reduce obesity. Attempts by interest groups to foil the legislation must be resisted. Banning soft drinks and vending machines would be an easy step but it must also address the financial issues which forced public schools to adopt them in the first place (Tremblay, 271, 2003). Health departments are not adequately prepared or funded to deal with the crisis of obesity. New emergency preparedness and bioterrorism planning exercises in the aftermath of the 9/11 have further added strains to the health department. There are limited resources for staff members and equipment. Public health departments can handle problems like enforcing restaurant labeling requirements. They can also collect data on obesity rates in schools. However they cannot fight obesity with clear cut interventions and regulatory actions. Obesity is more an individual health problem which can be dealt by the medical care system. Obesity costs the health care system a lot of money (Wang, 71, 2002). Reducing obesity in the population will help save costs in the health care system. Collecting data about public health is the first step about the nature of obesity. The incidence and severity of obesity can be found by collection of data. American states have the legal power to collect data about obesity. Parents do not report about obesity because of fears of social stigmas associated with obesity. Comprehensive reporting is required to collect reliable data about the disease. Law can be used to encourage individuals to launch personal interventions. They can include laws that report obesity in children as evidence of neglect. Child abuse and neglect laws can be used to allow child services which can help change the parents' behavior to protect the child. Incentives can be helpful in encouraging healthy eating and physical activity. Insurance surcharges and fitness bonuses on tax returns can be incentives in reducing obesity (WHO, 21, 2000). Building standards can also play an effective role in reducing obesity. The use of multi floor office buildings can provide opportunities for people to engage in physical activity using the stairs. Buildings must be designed in order to encourage walking. Conflict between security and health have to be resolved given the conditions of the post 9/11 time period (Belamarich, 51, 2000). Major federal programs like the WIC and Food stamps can be used to provide nutrition support to children. State cooperation with Federal government is vital to ensure that food programs provide healthy food to obese children and adults. Coordinating food programs with private welfare associations can also be effective in reducing obesity. Private nutrition support groups must be regulated in order to ensure that they provide proper diet to the individuals (Brener, 41, 2004). Health insurance system does not properly pay for preventive services. Most physicians are not properly trained and skilled to provide obesity preventive care. The State has to bear the costs of obesity because of the Medicaid program. Special clinic programs should be set up by the states for obesity, diabetes and cardiovascular diseases. These public health systems can play a vital role in reducing obesity (Dietz, 91, 1998). Private health plans can also play a leading role in providing cost effective and consistent care. Reducing obesity has many legal perspectives. Schools, buildings, drug use and lack of physical activity are some of the issues which can be tackled by legislation in the fight to reduce obesity. Ethical Perspectives There are many ethical issues in reducing obesity. For instance while the law is an effective tool for public health, there are issues about whether there is justification to use coercion to reduce obesity. Adults have the right to chose to be overweight if it suits their lifestyle but the question arises about the impacts on the public health system. Obesity has been considered on the basis of its host factors, vectors and the environment. Products like fast foods and cars are heavily promoted. Bicycles, exercise, fruits and vegetables are not promoted by organizations. Food marketing is an important ethical issue in reducing obesity. Public policy has focused on exercise, education and environment. Personal responsibility must be on the basis of the community and collective response to public health issues (Kmietowicz, 61, 2003). Obesity has been categorized as a medical, economic, social and public health problem. They have been questions of individual lifestyle and decisions. Government can play a leading role in supporting legal support and structures to ensure people live a healthy lifestyle. Personal responsibility and community response to reducing obesity are the controversial ethical issues which confront the government. However the community can create an environment which allows people to make healthy choices. Legislation which can allow people freedom of choice is the best solution to this controversy. Ethical reflection with regards to reducing obesity must consider all things. They must look at all the aspects of a proposed course of action and on good factual evidence (Strauss, 71, 1999). Two basic ethical problems when reducing obesity are whether it is justified to intervene in order to promote a person's health. The second ethical issue is whether and when it is justified to affect the health of a person for the common good. There are three forms of paternalism. Hard Paternalism consists of coercion which is direct. Soft paternalism involves the spread of unwanted information. Maternalism focuses by spreading guilty conscience (Nader, 11, 2006).There is a gradual transition from soft to hard paternalism. For instance a doctor who provides unwanted advice on diet and weight loss to a patient who has come for another purpose is a type of soft paternalism. Hard paternalism is when the doctor refuses to give treatment unless the patient listens to the doctor's advice. There is a distinction between informed and rational choices. The need for consumers to have information that allows them to make informed choices about food is one of the strongest reasons for requiring organizations to provide information. There are many items such as weight and country of origin. Giving nutritional information improves the customer's ability to make a healthy choice (Robinson, 61, 2006). Targeting high risk groups vulnerable to obesity is one of the most important ethical dimensions. There are potential problems of social stigmas if any individual is identified with a high risk group. There are potential problems of justice as targeting high risk individuals usually results in better cost effectiveness for the health care system. It is however problematic to only focus on high risk groups (Schwimmer, 41, 2003). Targeting the whole population in order to reduce obesity means considering other factors which are responsible for causing it. It might be vital to shift the physical activity curve. There will be a need to changing the lifestyle for majority of people. This might result in some individuals being affected negatively in order to benefit others. This can be justified if it really prevents obesity. It is the general perception that people are responsible for their consequences due to their actions. Therefore obese people would be to blame for being overweight. However this does not take into account the various consequences of lifestyles. Socialization and social construction play an important role in acquiring a certain lifestyle. People may simply like to live the specific lifestyle and accept negative effects (Sinha, 21, 2002). Finally even if it is demonstrated that the obese chose to be obese, it would not settle the question of whether they should be treated differently. There is a conflict between personal responsibility and justification for interventions that affect non obese individuals negatively. An attractive strategy to reduce obesity is to target it at childhood. This would include providing proper nutrition to the child. It would include dietary advice to parents and monitoring of weight. The ethical arguments advanced in favor of such interventions would that it would have good benefits for the child and society. However the problem would occur if parents must be allowed to act against the best interests of the child. It is vague whether parents actually should have an obligation to reduce obesity in children or not (Slyper, 91, 1998). Professional Perspective Health care professionals believe in the treatment of obesity by a combination of exercise and energy limited diet. Diet and exercise programs have found substantial weight loss of the total body mass. Weight loss maintenance has been an important factor in reducing obesity. People with a BMI of over 30 are recommended to have a proper diet, exercise and realistic weight loss goal. Medicine can be effective if these goals are not properly met. Drug therapy is used consisting of orlistat, fluoxetine and bupropion. People with higher BMI rates are recommended for bariatric surgery. This surgery should be performed by skilled surgeons. Dietary counseling interventions produce modest weight losses in individuals. Special diets are also recommended by health care professionals in controlling weight. Atkins diet, Zone Diet, Weight Watchers and Ornish diets are some of the famous diets recommend by doctors. Some diets have focused on reducing calories by using a low carbohydrate diet. Low carbohydrate diets are essential in fighting coronary heart disease (Strauss, 91, 2000). Low carbohydrate and non energy restricted diets have been found to effective in inducing weight loss. Premenopausal women have been the greatest beneficiaries of Atkins Diet. An individual's insulin secretion is the best criteria for the selection of a person's diet. The glycaemic index factor ranks foods based on their effect on blood sugar levels. Low glycaemic foods like lentils provide consistent source of glucose to the bloodstream. They have been found to be effective in treating and reducing obesity. Exercise has been recommended by many health care professionals along with diet as resulting in a greater weight reduction. Special physical activities like walking, swimming, aerobics and cycling are some of the most beneficial exercises in reducing obesity. Orlistat is the most common medicine prescribed to reduce obesity. Orlistat and rimonabant lead to reduced incidence of diabetes. However drugs have potential side effects and contraindications. These side effects can cause serious reactions for individuals. Weight loss drugs are tried by many people and discontinued after no benefit has been achieved. The long term health benefits of medicine are still unclear. Bariatric surgery is a surgical intervention used to combat obesity. It is a last resort due to its complications and side effects. This involves reducing the volume of the stomach and producing an earlier sense of satiation. Adjustable gastric banding and vertical banded gastroplasty are some of the surgical procedures used. Bang surgery can be reversed. Bowel shortening operations cannot be reversed. There are many complications from weight loss surgery. Some of the benefits of bariatric surgery are a lower incidence of diabetes, cardiovascular disease and cancer. Weight loss has been sustained in the long term after bariatric surgery. Gastric dumping syndrome, incisional hernia, infections and pneumonia are some of the complications of this surgical intervention. Mortality is low for patients who undergo bariatric surgery. The rate of complications is reduced if a skilled surgeon performs the surgery. Guidelines have been recommended which ensure that the surgery is performed in dedicated or experienced units (Wisemandle, 141, 2000). The statistics surrounding obesity are dangerous. The risk of obesity carries many health consequences for individuals and for the society. Research has found that nearly one in five Americans is obese. Most of them have one illness because of it. Professionals belonging to the health care system face the dilemma of the most effective treatment of obesity. Prescription medicines are supported by some doctors if diet and exercise do not bring about the desired change. Valvular heart disease has been associated with the use of medications used to control obesity. The safety and effectiveness of these drugs remains an important issue for health care professionals (Wisemandle, 141, 2000). Doctors are divided as to what constitutes the best way to combat obesity. Diet, exercise, medicine, surgery and environment are the areas where they have to make decisions that can help in reducing obesity. Providing information about the potential side effects of medicine is also very important. The setting of realistic goals for reducing obesity is also a professional issue faced by health care professionals. Counseling is usually the first step towards making a person change his behavior. Diet and exercise plan is usually the next step. However if diet and exercise do not bring out the desired effect, than medication is tried to reduce obesity. Surgery is usually the last resort for cases where medication and diet have failed to bring out the desired outcome. Some of the benefits of bariatric surgery are a lower incidence of diabetes, cardiovascular disease and cancer. Weight loss has been sustained in the long term after bariatric surgery. Conclusion Obesity has been associated with various diseases like cardiovascular disease, diabetes and osteoarthritis. Inside the United States at least 30 percent of adults are suffering from obesity. Dietary changes and physical activity are vital for weight loss but do not guarantee it. Effective interventions tackle diet and physical activity in an integrated way. Successful intervention must be sustainable and influence energy balance. Prohibition model for food does not work simply because obesity is very much complex. Some people who eat fast food are more vulnerable to getting obese, but other people who do not eat fast food are equally at the risk of getting fat. Obesity is a lifelong problem which requires great time and effort to change behavior. Legislation must address the goals and objectives which are necessary for reducing obesity. This can span over a time period of ten years. The first step will definitely be the creation of a surveillance system to track the nature of the problem and monitor changes which will be implemented in the next ten years (Wisemandle, 141, 2000). Obesity has been categorized as a medical, economic, social and public health problem. They have been questions of individual lifestyle and decisions. Government can play a leading role in supporting legal support and structures to ensure people live a healthy lifestyle. Personal responsibility and community response to reducing obesity are the controversial ethical issues which confront the government. Obesity will remain a major health problem in the United States of America. The ethical, legal and professional perspectives of the problem all will help in ensuring coordinated strategies and interventions to reduce this health problem. References Hedley AA, Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA. 2004 Hofferth SL, Poverty, food programs, and childhood obesity. J Policy Anal Manage. 2005 Kromeyer-Hauschild K, Prevalence of overweight and obesity among school children in Jena (Germany). Int J Obesity. 1999. Moyers P, Perceptions of school nurses regarding obesity in school-age children. J Sch Nurs. 2005 Apr. 21(2). Ogden CL. 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