Nutrition Program for Obese and Overweight Indigenous Adults in Western Australia - Essay Example

Nutrition Program for Obese and Overweight Indigenous Adults in Western Australia Name: Unit: Course: Supervisor: Date of submission: Health issue: obesity and overweight Public health program: nutrition Community: Adult indigenous population in Western Australia Introduction Obesity and overweight according to (See et al., 2007) is defined as excessive or abnormal accumulation of fats in the body that may hinder good health progression in a person. BMI (body mass index) is a tool often used to assess an adult individual’s fat accumulation in relation to height, weight, age and sex. The WHO defines overweight as BMI ≥25 and obesity as BMI ≥30 (World Health Organization [WHO], 2004). Overweight and obesity are essential in health assessment as they lead to non-communicable diseases (Kelly, Wang, Chen, Reynolds and He, 2008). Such include: some cancers like colon, breast and endometrial, musculoskeletal disorders more so the osteoarthritis, diabetes, cardiovascular disease especially stroke and heart diseases which were rated as leaders in death in 2008 statistics. WHO, (2004) increase in BMI is associated with non-communicable disease risk increase. Kelly et al. (2008) overweight and obesity puts low and middle income nation in a situation of double disease burden. This is because these countries not only face other communicable disease challenges but also the challenges of handling the underweight impact on its population yet the overweight and obesity curve stretches its resources. The encouraging fact is that obesity and overweight are preventable and controllable (Kelly et al., 2008). This is possible through: change of personal lifestyle such as eating habits, exercise and frequent weight assessment. WHO (2004) BMI is one of tools used to assess weight in relation to height. However, other tools are also necessary to help in assessing the fat levels and type of fat within the individual’s body. This is because it is possible for a lean bodied athlete or muscle builder to be in overweight or obese cluster yet his body is healthy in reference to the amount and type of fat within the body system. Additional tools applicable in assessing obesity and overweight include: techniques like magnetic resonance imaging, computed tomography and ultrasound, circumference ratios calculation of waist-to-hip; waist circumference and skin fold thickness measurements to estimate body fat amount and distribution. This essay, put on board a nutrition program in reference to obesity and overweight adult indigenous community in Western Australia (20 years and above). Justification According to AusDiab study carried out in 1999-2000 5% of the population was obese. A health survey conducted among the Torres Strait islanders and aboriginal nationally in 2004-2005 show that compared to other groups and ages the indigenous population was highly likely to be obese (Australian Bureau of Statistics [ABS], 2006). For instance indigenous western Australians were found to have a more possibility of 1.3 times compared to the non-indigenous to either be obese or overweight. The 2004-05 census data did indicate that of the total indigenous Australians 24% were obese. Subsequently, there was an increase of 48% to 56% in 1995 to 2004-05 data of either obese or overweight cases of non-remote indigenous Australians proportion (ABS, 2006). Study design The nutrition program will encompass nutritional education, counseling and provision of high fiber diet and a follow up during the program; a period for 6 months. Millen et al. (1997) six months is a reasonable period to assess impact of the nutritional program. The program will employ random inclusive criteria to reduce bias. A crossectional study will be employed in enrolling persons in this program. This is because according to (Boudreau, 2002) crossectional studies can describe odd ratio as well as relative and absolute risks from prevalence. Such a study is quite applicable in describing the illness or disorder prevalence, cause or effect of a health issue for a given population. A prospective study cohort will be employed as well Boudreau (2002). This is significance for this study as those enrolled in the nutrition program will need to be followed up to evaluate the impact of the program on the target group. More advantages of using prospective study cases include: i. It is possible to study more than a single outcome or diseases. ii. It is efficient for exposures which are rare iii. Rates of incidences can be obtained iv. High chances of data nature and quality Sample size Willet (1998) argues that a reasonable sample size is between 100-200 cases. In this study, to increase precision the cases will be 300 people identified as overweight or obese using BMI index and skin fold to assess excess body fat accumulation. The study will gather the details of the person from the government hospital and community health centers in western Australia. Door to door weight and height assessment survey will be carried to meet the sample size number of the appropriate group. The nutrition program The program will encompass assessment of the feeding habits of the enrolled group using the 7day dietary frequency. The nutrition assessment criteria of 7day-dietary frequency is vital. Millen et al. (1997) this is because it will give a clear picture of the different food classes consumed by the cases. This will help in framing a new diet plan during the 6 month study period. The information is vital in evaluating how well the nutrition program education and food consumption will impact on the cases in the six month period. Goal The main goal of the program is to bring about a renewed food intake in a healthy way to reduce obesity and overweight among the cases and improve their self-esteem in making informed choices in healthy eating. Objectives The program sets out two objectives: i. To find out how nutritional knowledge impacts healthy eating among the overweight and obesity within the six month study. ii. To investigate how reduction in weight reduces cost of other related diseases and disorders using hospital visit frequency of illness and disorders for those in the program within the six months period. Target group The program targets solely the indigenous persons aged 20 years in Western Australia and above with a BMI of 25 and above both men and women. The age will be verified using national ID or passport. The group will be classified in terms of age and sex as shown in the table below to assess how a certain age group and sex responds to the program objectives (Willet, 1998). Persons with nutritional related illnesses and disorders will be identified as this will help in evaluating how reduction in weight impacts on their diseases progression. Age in years 20-30 31-40 41-50 51-60 61 and above Male Female Study instrument A food frequency questionnaire (FFQs) is the key instrument that will be employed in this study see questionnaire appedix1. According to (willet, 1998) FFQs are reliable tools that are used in large survey to measure the usual patterns of food consumption. FFQs are also preferred due to their ability to gather semi-quantitative data, relative low cost and ease to use. However, they require more accurate and detailed assessment methods for validation. FFQs ought to be culture sensitive because food preparation, consumption and nutritional habits vary from one population to another. Altman (1995) in this case diet records will be used to assess validity of the FFQs assessment tool. This is because diet records are easy to remember and quantify the amount consumed by a person per day. Biochemical analysis will be carried during the start of the program and after every month to assess the type amount and of fats an individual has in the body and progress. Statistical application will also be employed to find out measures of differences such as standard deviation and mean for different nutrient intake as (Bland and Altman, 1986) advices. The questionnaire will be taken through a pilot test for 30 similar cases a month prior to actual program kick off to assess its practicability and reliability Lindroos, Lissner. and Sjostrom (1993) supports. Data collection Data collection will be done through personal survey using questionnaire appendix 1(Millen et al., 1997). This will help in gathering any other information the client may provide or give a room for gathering more related information. Biochemical analysis will be done in Western Australia government hospital laboratories and results provided to the surveyors. 7 days-diet records will be filled by the cases at the start of the program, mid and at the end. This will provide more actual type, amount and frequency of feeding pattern .for the subjects before forgetting Estimation methods for food consumed is the key methods that will be used in quantifying amount consumed. Limitation The main challenge is that the client may fail to offer some personal information that would be of substance to the study at the beginning of the study. The cases may dropout as this is a prospective study making the study unable to achieve the anticipated precision. Amount consumed per nutrition classes might be poorly estimated giving a big margin error during analysis. Lack of sufficient funds and data collectors may hinder sufficient data gathering from the 300 cases during program initiation, implantation and evaluation. Conclusion Obesity and overweight is a health issues raising global concern. The BMI is the key tool used to assess either an individual is overweight or obese. Nutrition program is the main focus in this case to help in managing obesity and overweight. The study will incorporate 300 obese and overweight cases of men and women aged 20 years and above. The focus will be on indigenous population in Western Australia. A FFQs will be used to gather data. Personal interviews will be employed. A 7day food frequency record and biochemical will be used to validate the questionnaire. Reference Altman D.G. (1995). Practical Statistics for Medical Research. Chapman &Hall. London. Australian Bureau of Statistics (2006). National Aboriginal and Torres Strait Islander health survey 2004-2005, Canberra. Report No. Cat 4715.0 Bland J. M. and Altman D.G. (1986). Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 8:307-310. Boudreau D. (2002). Observational study designs. Ann Pharmacother 36: 751-757 Kelly T., Wang W., Chen C. S., Reynolds K and He J. (2008). Global burden of obesity in projections 2005 to 2030. Int J Obes. 32: 1431-1437 Lindroos A. K., Lissner L. and Sjostrom L. (1993). Validity and reproducibility of a slf-adminstered dietary questionnaire in obese and non-obese subjects. Eur J Clin Nutr 47(7):461-481 Millen B.E., Quatromoni P.A., Franz M.M., Epstein B.E., Cupples L.A., Copenhafer D. L. (1997). Population nutrient intake approaches dietary recommendations: 1991-1995 framing nutrition studies. J Am Diet Assoc 97:742-749 World Health Organization (2004). Obesity: preventing and managing the global epidemic. Report of WHO Consultation; Geneva. See R., Abdullah S., McGuire D., Khera A., Patel M., Lindsey J., Grundy S. & Lemos J. (2007). The association of differing measures of overweight and obesity with prevalent atherosclerosis. Journal of the American College of Cardiology 50(8):752-759 Willet W. C. (1998). Nutritional Epidemiology. OUP: New York Appendix 1: Questionnaire Overweight and obesity Questionnaire for adult indigenous persons in Western Australia Part A: Consent Dear participant, This questionnaire aims at recruiting individual who are obese or overweight in to a 3-month nutrition program for academic purposes. The information will be vital for health and nutrition review in the country as well. The information provided will only be used for this purpose unless otherwise your consent is consulted. You are free to accept or decline the participation as well as drop the acceptance of continuing with program upon approval for your participation any time. Do you accept............ Do you decline........................Sign.......................Date............ Part B: Demographic characteristic Name: Sex: Date of birth :.........( age in years).....................ID.......................(Indigenous) Weight.......................(kgs) Ht......................(m) BMI...................... (overweight or obese) Contacts: Residence: Part C:Nutrition food frequency questionnaires Qn1a). Do you feed on animal meat and animal product (yes or no)? If yes which one, how much (estimate) and many times in the last 7 days if possible ..................................... .................................... ...................................... ..................................... Qn1b). Do you feed on fish, chicken meat and their product (yes or no)? If yes which one, how much (estimate) and many times in the last 7 days if possible ...................................... ..................................... ..................................... .................................... Qn2). What type of carbohydrates do you feed on (refined or whole grain) Give a list of which types, how much and how many times in the last 7days if possible ....................................... ..................................... ..................................... .................................... Qn3). What kind of fats do you consume mostly oils or fat? Give a list of which types, how much and how many times in the last 7days if possible ............................... ................................ ............................... ............................. Qn4) what kind of vegetables and fruits do you frequently feed on? Give a list of which types, how much and how many times in the last 7days if possible ...................................... ...................................... ..................................... ...................................... Qn5) what type of beverages do you frequently consume (hot or cold drinks or both) Give a list of which types, how much and how many times in the last 7days if possible ................................. ................................. ................................. ................................... Qn6) How much water on average do you consume daily in litres? ................................... ..................................... ................................... ................................... Qn7) How frequent do you eat? a) After an hour b) 2hours c) Three hours d) Others specify................ Part C: other lifestyles Qn8) Do you do exercise (yes or no) If yes which kind of exercise: a) running, b) walking, c) gym d) normal routine activities e) others specify................... Qn9). What do you do when you’re bored, frustrated, sad or angry? a) Eat more b) Sleep c) Drink alcohol (how many litres or bottles) d) Smoke (how many cigars or cigarettes per session) c).No specific action d).others specify........................... Part D: health issues Qn10a) Do you have any illness or disorder (yes or no) If yes which one for example: Diabetes, hypertension, heart stroke, arthritis etc ....................... .......................................... ....................................... ..................................... ......................................... Qn10b). Are you on any medication or do you visit clinic for any illness (yes or no) If yes how frequent? a) Daily b) Weekly c) Bi-weekly d) Monthly e) Others specify.............. Read More