Obesity - Promoting Health and Wellbeing - Essay Example

? Public health: Promoting health and wellbeing – Obesity The growing obesity epidemic is becoming a global issue, contributing to numerous health concerns and is associated with a short lifespan. It is estimated that over 50% of the public in developed countries will be obese by the year 2050 (McPherson, Marsh, & Brown, 2007). Despite the growing body of evidence procured by in-depth research on the impacts of obesity, the rates continue to skyrocket, leading to a need for a different approach in order to address the unique issues with a changing population, as the current tactics do not appear to be effective. The nursing community is essential in bridging the gap between clients and their health, thus training and techniques would be the most effective at the nursing level, which the following paper will address, including associated health problems, treatment, and the various factors that contribute to obesity. What is obesity? The definition of obesity has changed over the years, and now includes different categories, ranging from obese to super-super obese, with body mass indexes (BMI) ranging from 40 to 60 (Leykin et al., 2006). As a reference, for an individual to be considered in the “healthy” range, their BMI is under 25. There are many factors that contribute to obtaining the BMI used in determining the level of obesity, including gender, age, height, and weight of the individual. Additionally, obesity can be determined by taking waist measurements, with a circumference over 35 inches (88 cm) for women, and 40 inches (102 cm) for men, as an indication of possible obesity-related issues being present (Alpert, 2009). However, it is important to note that some body types may fall within the “obese” range as defined by the two aforementioned measurements, but are not classified as obese due to lean muscle mass and body fat percentage (Romero-Corral et al., 2008). In general terms, obesity is an overabundance of fatty, or adipose tissue, caused by a positive energy balance, or an intake of energy (in the form of calories from food) that is in excess of what the body needs to sustain life and support activity level (Lake, 2011). Obesity once had a useful purpose, when food was scarce and the energy reserves found in stored body fat could provide sustained nourishment during the times of famine (Haslam, 2007). A robust and full figure was signs of wealth, indicating that there was an abundance of food. However, times have changed and food is more than plentiful, with a wide range of options, including a growing number of poor nutrient choices. We no longer face uncertainty regarding access, thus humans are in essence fighting against evolutionary instincts, further hampering the pursuit of health (Haslam, 2007). Health implications of obesity While the aesthetic aspect of obesity is easy to see, there are many health issues that are associated with obesity, which are not as readily observed, including cardiovascular disease, diabetes, cancer, and stroke (El-Sayed, Scarborough, & Galea, 2012). Serving as a contributing factor in a depression and a decreased life expectancy, the obesity epidemic is one that deserves more attention and research in finding a more appropriate approach. Obesity is not as simple as an excess amount of body fat, as the distribution of said adipose tissue can influence the associated health implications. For instance, an accumulation of abdominal fat (android obesity pattern) is associated with hypertension and glucose dysregulation (National Task Force on the Prevention and Treatment of Obesity, 2000), whereas body fat around the hips and thighs (gynoid obesity pattern) is not associated with a high incidence of neither cardiovascular impairment nor myocardial infarctions (Wiklund et al., 2010). In addition to the differences between locations of excess adipose tissue, researchers have also identified differences between males and females in the development of health problems that are associated with obesity. While obesity itself may not be a direct cause of the differences observed between the genders, it is a contributing factor to quality of life issues, socioeconomic class, and even the ability to earn an income. Researchers have found that overweight females are less likely to obtain employment as compared to overweight males (Cawley, 2004), thus affecting the quality of life. Contributing factors to obesity As the abundance of food has essentially rendered the storage of excess body fat on the human body unnecessary, societal factors have contributed to the accessibility of unhealthy choices, which combined with a more sedentary lifestyle, have led to the growing obesity epidemic. While a small amount of obesity can be attributed to genetic causes (less than 1/3 of all reported cases), there are other factors that are within the control of an individual, and addressing such issues will engage obese clients in an active role in their health (Jebb, 2004). Since the 1980s, the rates of the various categories of obesity have steadily risen, and with it, the incidents of obesity-related health problems such as diabetes, cancer, and sleep apnea, have presented more often in hospitals and health care facilities (Finkelstein, Ruhm, & Kosa, 2005). The primary contributing factors involve a surplus of energy (in the form of calories from food), and a lack of physical activity. The food choices that are present in society are quite different from those offered a generation ago, with the sizes, ingredients, and availability increasing on a regular basis. Several studies have suggested that an increase in physical activity, in conjunction with a healthier diet is the best combination in winning the battle over obesity. The sedentary lifestyle, including the amount of time spent watching television, contribute to the accumulation of additional adipose tissue, with a positive correlation existing between the number of hours spent watching television and impaired glucose metabolism, a key indicator in obesity-related diabetes (Hansen et al., 2012). In addition to insulin resistance diabetes, increased sedentary time is also associated with lower high-density lipoprotein cholesterol (the good kind), and a greater waist circumference (Cooper et al., 2012), which has been linked to an increase in cardiovascular disease. A variable that is not associated with physical activity, yet has an influence on the incidence of obesity pertains to the socioeconomic levels of individuals. Lower socioeconomic positions within a population are often associated with a poor health, depression, and obesity, with those in the lower socioeconomic position reporting a higher likelihood of obesity (Sobal & Stunkard, 1989). The disparity between the upper and lower socioeconomic positions influence the resources and food available for a particular group. Those in the lower part of the scale able to afford lower-quality diets, when compared to those found in the upper part of the scale that are able to benefit from being able to afford healthier food choices and a more dynamic marketplace (Hawkes, 2006). However, research that is more recent has lessened the previous association between socioeconomic levels and obesity, and points more towards a social phenomenon rather than an income-based occurrence, focusing on the economic growth, modernization of technology, and the globalization of the food industry (McLaren, 2007). The level of education one obtains is yet another variable that influences the occurrence of obesity, with low education being associated with a higher risk for obesity and obesity-related diseases (Lawlor et al., 2005). On a familial level, a head-of-household member was associated with a higher weight (Rona & Morris, 1982), as was access to a car (Riva, Curtis, Gauvin, & Fagg, 2009), receiving government aid, and living in rental housing (Wardle, Waller, & Jarvis, 2002). Other studies have found a link between adolescent obesity and the likelihood of attending college (Crosnoe, 2007). However, it is important to note that the educational disparity was not even among the genders, as it was more indicative in females when compared to obese males of the same age category. Health promotion strategies The variety of variables contributes to the need of a precise and targeted approach to intervention methods in the health care industry. One recent study used 20-minute interventions with obese clients, conducted over 11 sessions over a period of 2.5 years (Vermunt et al., 2012). However, the results were not favorable, indicating a need to specialize the training involved for the health professionals, in addition to tailoring the message for the intended population. Early intervention, prior to the onset of obesity appears to be an important aspect in the educational process, however, the approach is essential in the reception of information being presented. When it comes to obesity intervention, health care professionals are called upon to monitor the ethical implications that could be associated with intervening, which is rather unique to the topic, as opposed to offering education on the topics of cancer or prenatal smoking. When approaching high-risk groups for obesity education and intervention, it is essential to refrain from further stigmatization of the condition, as the individuals are already aware of the social stigmatization that occurs within society (Holm, 2007). Striking the delicate balance between providing effective information and it reaching the intended audience is essential in addressing obesity. Ultimately, the decision is up to the individual, but through effective and individualized intervention methods, the choice may be easier to make. Instilling the sense of responsibility for their choice can help clients to feel more empowered, increasing their level of self-efficacy, which has been linked to a positive outcome and improved self-esteem (Mitchell & Stuart, 1984). Self-efficacy, a theory attributed to the psychologist Albert Bandura, is in essence the belief that a client has in their ability to be successful. However, it is important to remember that clients may not be ready to make the change, as their lifestyle habits may provide a sense of well-being, serving as a comfort and substitution for other things that may be lacking or insufficient in their lives (Holm, 2007). The addition of a counselor or psychologist in the healthcare treatment team may be useful when asking clients to make drastic life changes. Regardless of intervention technique, a few aspects remain constant as predictors of success. The incidence of childhood obesity, which has more than tripled in the past 30 years (McTernan & Meiri, 2011), benefits greatly from early-life intervention methods, as it provides tools to both the child and their family members. A focus on healthy options, alternatives to previous comfort foods, smaller portions, and reducing the number of sugar-sweetened soft drinks are some key areas for addressing childhood obesity (Osei-Assibey et al., 2012). Another determining factor in the success rate of obesity interventions is the length of program used, with shorter (less than 6 months in duration), being linked to a higher rate of failure, as compared to longer programs (Sharma, 2007). Worksite health interventions provide a potentially long-term exposure to healthy messages, food choices, and physical activity incentives. Some companies incorporate healthy habits into their core values, and offer discounted or even free gym memberships to their employees (Williams et al., 2007). Sites that offer such health-focused opportunities see a reduction in sick days and medical costs, thus providing a win-win situation. For a more healthcare or nursing environment, there are several options to choose from when it comes to obesity interventions, which is important, as individuals vary. One study effectively used the Cycle of Change, first introduced by Prochaska and DiClemente in 1984, which assesses the stage of willingness to change (Perkins, Wall, Jones, & Simnett, 1999). Doctors used the six stages to evaluate their own process of incorporating health promotion and change in behavior. The six stages include unmotivated (stage 1), undecided (stage 2), motivated (stage 3), action (stage 4), relapse and/or maintenance (stage 5), and the final stage, exit, when change is achieved. The approach in each stage is different, thus the Cycle of Change is instrumental in personalizing the intervention method used with clients. Occupational health nurses may play an important role when working with obese professionals to make lifestyle changes. A recent study of overweight train drivers provided insight into the way food choices and a sedentary job have combined, resulting in an increase rate of obesity (MacGregor, 2009). Occupational health nurses can bring education to the workplace, offer suggestions on healthier choices, and have the clients set their own goals, pointing them on their way to health. Conclusion The obesity epidemic is costly, not only in the economic impact on the health care industry, but also a more valuable resource, the health of society. Technology continues to improve, which often brings a sedentary lifestyle and an influx of new, cheap, and unhealthy food choices. The addition of sugary drinks spiked with high fructose corn syrup provides empty calories, contributing to the obesity-related health problems. Early education is imperative to stave off the increasing obesity epidemic. Reference List Alpert, P. T. (2009). Obesity: A worldwide epidemic. Home Health Care Management & Practice, 21, 442-444. doi:10.1177/1084822309334688 Cawley, J. (2004). The impact of obesity on wages. Journal of Human Resources, 39(2), 451-474. Cooper, A. R., Sebire, S., Montgomery, A. A., Peters, T. J., Sharp, D. J., Jackson, N., . . . Andrews, R. C. (2012). Sedentary time, breaks in sedentary time and metabolic variables in people with newly diagnosed type 2 diabetes. Diabetologia, 55, 589-599. Crosnoe, R. (2007). Gender, obesity, and education. Sociology of Education, 80(3), 241-260. El-Sayed, A. M., Scarborough, P., & Galea, S. (2012). Unevenly distributed: A systematic review of the health literature about socioeconomic inequalities in adult obesity in the United Kingdom. BMC Public Health, 12(1), 18-30. Finkelstein, E. A., Ruhm, C. J., & Kosa, K. M. (2005). Economic causes and consequences of obesity. Annual Review of Public Health, 26, 239-257. doi:10.1146/annurev.publhealth.26.021304 Hansen, A. L., Wijndaele, K., Owen, N., Magliano, D. J., Thorp, A. A., Shaw, J. E., & Dunstan, D. W. (2012). Adverse associations of increases in television viewing time with 5-year changes in glucose homeostasis markers: The AusDiab study. Diabetic Medicine,29(7), 918-925. doi:10.1111/j.1464-5491.2012.03656.x Haslam, D. (2007). Obesity: A medical history. Obesity reviews, 8(1), 31-36. Hawkes, C. (2006). Uneven dietary development: Linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Global Health, 2(4). Holm, S. (2007). Obesity interventions and ethics. Obesity Reviews, 8(1), 207-210. Jebb, S. (2004). Obesity: causes and consequences. Women's Health, 1(1), 38-41. Retrieved from http://www.womenshealthjournal.co.uk/article/S1744-1870(06)00010-2/abstract Lake, A. A. (2011). Guest editorial. Perspectives in Public Health, 131(4), 154. Lawlor, D. A., Batty, G. D., Morton, S. M., Clark, H., Macintyre, S., & Leon, D. A. (2005). Childhood socioeconomic position, educational attainment, and adult cardiovascular risk factors: the Aberdeen children of the 1950s cohort study. American Journal of Public Health, 95(7), 1245-1251. Leykin, Y., Pellis, T., Del Mestro, E., Marzano, B., Fanti, G., & Brodsky, J. B. (2006). Anesthetic management of morbidly obese and super-morbidly obese patients undergoing bariatric operations: Hospital course and outcomes. Obesity Surgery, 16, 1563-1569. MacGregor, A. (2009). Managing obesity. Occupational Health, 61(7), 44-46. McLaren, L. (2007). Socioeconomic status and obesity. Epidemiologic Reviews, 29, 29-48. doi:10.1093/epirev/mxm001 McPherson, K., Marsh, T., & Brown, M. (2007). Tackling obesities: Future choices-modelling future trends in obesity and the impact on health. Foresight: The Journal of Future Studies, Strategic Thinking and Policy. McTernan, S. E., & Meiri, H. (2011). Research on childhood obesity prevention and intervention. Home Healthcare Nurse, 29(2), 118-123. Mitchell, C., & Stuart, R. B. (1984). Effect of self-efficacy on dropout from obesity treatment.Journal of Consulting and Clinical Psychology, 52(6), 1100-1101. National Task Force on the Prevention and Treatment of Obesity (2000). Overweight, obesity, and health risk. Archives of Internal Medicine, 160(7), 898-904. doi:10.1001/archinte.160.7.898 Osei-Assibey, G., Dick, S., Macdiarmid, J., Semple, S., Reilly, J. J., Ellaway, A., . . . McNeill, G. (2012). The influence of the food environment on overweight and obesity in young children: A systematic review. BMJ Open, 2. doi:10.1136/bmjopen-2012-001538 Perkins, E. R., Wall, D., Jones, L., & Simnett, I. (1999). Hospital doctors and health promotion: support for teaching behaviour change. Medical Teacher, 21(2), 180-184. Riva, M., Curtis, S., Gauvin, L., & Fagg, J. (2009). Unravelling the extent of inequalities in health across urban and rural areas: evidence from a national sample in England. Social Science Medicine, 68(4), 654-663. Romero-Corral, A., Somers, V. K., Sierra-Johnson, J., Thomas, R. J., Collazo-Clavell, M. L., Korinek, J., . . . Lopez-Jimenez, F. (2008). Accuracy of body mass index in diagnosing obesity in the adult general population. International Journal of Obesity, 32, 959-966. doi:10.1038/ijo.2008.11 Rona, R. J., & Morris, R. W. (1982). National study of health and growth: social and family factors and overweight in English and Scottish parents. Annals of Human Biology, 9(2), 147-156. Sharma, M. (2007). Behavioural interventions for preventing and treating obesity in adults.Obesity Reviews, 8, 441-449. doi:10.1111/j.1467-789X.2007.00351.x Sobal, J., & Stunkard, A. J. (1989). Socioeconomic status and obesity: A review of the literature. Psychology Bulletin, 105, 260-275. Vermunt, P. W., Milder, I. E., Wielaard, F., DeVries, J. H., Baan, C. A., VanOers, J. A., & Westert, G. P. (2012). A lifestyle intervention to reduce Type 2 diabetes risk in Dutch primary care: 2.5-year results of a randomized controlled trial. Diabetic Medicine, 29(8), 223-231. doi:10.1111/j.1464-5491.2012.03648.x Wardle, J., Waller, J., & Jarvis, M. J. (2002). Sex differences in the association of socioeconomic status with obesity. American Journal of Public Health, 92(8), 1299-1304. Wiklund, P., Toss, F., Jansson, J. H., Eliasson, M., Hallmans, G., Nordstrom, A., . . . Nordstrom, P. (2010). Abdominal and gynoid adipose distribution and incident myocardial infarction in women and men. International Journal of Obesity, 34, 1752-1758. doi:10.1038/ijo.2010.102 Williams, A. E., Vogt, T. M., Stevens, V. J., Albright, C. A., Nigg, C. R., Meenan, R. T., & Finucane, M. L. (2007). Work, weight, and wellness: The 3W program: A worksite obesity prevention and intervention trial. Obesity, 15, 16-26. Read More