The Rapid Increase in Obesity Cases - Essay Example

The Etiology, Assessment, Prognosis and Treatment of Obesity Over the second half of the last century, soft drinks and other sugar sweetened beverages (SSB) have assumed an increasingly significant proportion of the total energy intake in the United States and most westernized populations. These beverages are heavily marketed to the youth and adults. This being the case, obesity researchers and public health activists and officials has targeted SSB, one of the primary culprits in the escalating rates of obesity. The purpose of this paper is to discuss the etiology, assessment, prognosis and treatment of obesity. Introduction Obesity has been defined as excess fat deposition due to a chronic positive shift of the energy equation resulting from increases in energy input, decrease in energy output or both (Bhattacharya & Bundorf, 2009). The rapid increase in obesity cases in the recent past has been attributed to cultural and social influences in conjunction with other physio- pathological or genetic determinants which affect the adjustment in the energy balance equation. It is estimated that 40- 70% of obesity related cases are inherited while the environment influences the remaining 30% (Bertaki & Azari, 2005). Obesity has emerged as one of the most serious public health concerns in the 21st century and the morbidity and mortality associated with obesity continues to increase (Kaestner, 2009). Endogenous (genetic) factors and exogenous (diet and physical activity) factors plays an important role in the assessment and management of obesity. Complications of obesity include cardiovascular diseases, hypertension, endothelial dysfunction, type II diabetes and impaired glucose tolerance (Bhattacharya & Bundorf, 2009). Although cases of obesity have dropped in a few developed countries such a United Kingdom and Germany, the prevalence of obesity continue to rise in many parts of the world. In view of the obesity epidemic as a global and public health concern, this paper aims at discussing the etiology, assessment, prognosis and treatment of obesity. The etiology of obesity The etiology and treatment of obesity have been a little to the disappointment of researchers because the mechanisms that control homeostasis and adiposity in the body are incompletely understood (Mokdad, Ford & Bowman, 2003). It is thought that regulatory processes match the dietary fuel supply with energy requirements in order to maintain a stable body mass and adiposity. In the light of new evidence, it can be hypothesized that the control of body weight and composition depends on three interrelated and self controlled components which are; food intake, nutrient turn over and thermo genesis and body fat stores (Mokdad, Ford & Bowman, 2003). A complex feedback mechanism underlies all these components. The major factors involved in obesity are mostly dietary and physical activity habits. These factors are in turn affected by susceptibility genes which may conversely affect energy expenditure, fuel metabolism, muscle fiber function and appetite and food preference (Bertaki & Azari, 2005). However, the increasing rates of obesity cannot be explained exclusively by changes in the genetic makeup, although gene variations that were previously silent could now be triggered by high availability of energy and fat foods and the increasing sedentary lifestyle in modern societies (Mokdad, Ford & Bowman, 2003). The study of factors such as genetic and lifestyle implications in weight gain and obesity is crucial for predictions about the future impacts of the global epidemic of obesity. This will also provide a unique opportunity for the implementation of preventive action. The precision of an ideal body weight regulation requires a powerful feedback path way controlling the total fat mass (Bertaki & Azari, 2005). Therefore, a sustained imbalance between the amount of energy consumed and the energy spent in everyday life contributes to obesity. Other factors such as the dietary micro nutrient composition, distribution of energy expenditure and individual substrate metabolism influence the energy balance equation. It is however assumed that body weight is ultimately determined by the interaction of genetic, environmental and psycho social factors acting through several physiological mediators of food intake and energy expenditure (Mokdad, Ford & Bowman, 2003). The Assessment of obesity A careful, detailed assessment forms the basis of a good weight management program (Kielincher, Hill & Green, 2003). All patients with obesity will have different clinical presentations and it would be important to unravel specific difficulties related to weight control so that treatment can be administered accordingly. A weight management assessment tool should be used to ensure continuity of care across the practice (Kielincher, Hill & Green, 2003). The assessment does not have to be completed in one visit. This will give the patient time to contemplate their readiness for the forthcoming change. The primary functions of assessment are; Listening to the patient’s experience of their weight as well as establishing rapport: Having raised the issue of body weight, it is important to work closely with the patient so that they can feel supported and understood (Kaestner, 2009). The practitioner is supposed to listen carefully to the patient description of what obesity means to them, what they feel has contributed to, obesity and if they are ready to begin treatment program. Establish what the patient understands about obesity: At this stage, the patient is given an opportunity to describe what has led to their obesity. It is also important to discuss previous weight loss attempts. This will enable the practitioner establish the patients understanding and beliefs about obesity. Practitioners can also offer insight on what is known about genetic influences on obesity (Kielincher, Hill & Green, 2003). It is also important to establish the patients understanding of the health risks associated with obesity. Characterizing health risks: This is an important step which usually involves measuring the degree of obesity (Kaestner, 2009). In clinical practice, the most common measurement is the body mass index (BMI) and waist circumference. Individuals with a BMI of 30- 34.9 are termed as obese class 1, those with a BMI of between 35- 39.9 are termed as obese class 2 while those with a BMI of more than or equal to 40 are characterized as obese class 3 (Kielincher, Hill & Green, 2003). It is also important to measure the waist circumference as it provides information about the distribution of body fat and is a measure of risk for conditions such as coronary heart disease (CHD). In men, a waist circumference of 94 to 102 cm will indicate obesity while in women; a waist circumference of between 80 and 88cm is an indication of obesity (Kielincher, Hill & Green, 2003). Building a picture of risk factors: The practitioner is supposed to build a picture of factors that may influence the risk of obesity. These factors include; advancing age, the duration of obesity, family history of conditions such as CHD and diabetes, existing medical complications, smoking and the level of physical activity (Kielincher, Hill & Green, 2003). A questionnaire can be useful at this stage for gathering information and issues arising here could be discussed during the consultation process. Screening for other diseases: (Kielincher, Hill & Green, 2003) observed that obesity increases the risk of other conditions such as hypertension, diabetes, skeletal disorder s and respiratory diseases. A thorough assessment should be carried out which includes; a random or fasting glucose level, a plasma lipid profile, serum TSL levels, blood pressure, documentation of any physical effects (joint pains, breathing difficulties, sleep disturbance) and documentation of any psychological effects (low self esteem, depression) (Kaestner, 2009). Patient expectations: Patient’s expectations about weight loss are influenced by what they read and see in the media and others around them including healthcare professionals (Kielincher, Hill & Green, 2003). Practitioners are supposed to ensure that they do not place unreasonable demands on their patients. The practitioner is supposed to discuss the long-term and short term goals for weight loss. The Prognosis of obesity The most common causes of obesity are over eating and physical inactivity. The eventual body weight results from genetics, metabolism, environment, behavior and culture. Genetics: A person will more likely develop obesity if one or both parents are obese. Genetics is also known to affect the hormones involved in fat regulation (Kaesrner, 2009). Example; leptin is a hormone produced in the fat cells and it controls weight by signaling the brain to eat less when body fat is too high. If the body is not able to produce enough leptin, this control is lost and obesity occurs. Overeating: This leads to weight gain especially if the diet is high on fat. Foods high in fat and sugar have high energy density and this leads to weight gain (David, Edward & Jesse, 2003). Diet high in simple carbohydrates: Carbohydrates increase the blood glucose levels which in turn stimulate insulin release by the pancreas. Insulin in turn promotes the growth of fat tissues causing weight gain. Simple carbohydrates (sugars, fructose, soft drinks and beer) contribute to weight gain as they are more rapidly absorbed into the blood stream (David, Edward & Jesse, 2003). Slow metabolism: Women have less muscle than men and as a result, they have a slow metabolism rate than men because muscle burns more calories than other tissues. Women therefore tend to put on more weight than men and weight loss is also difficult as compared to men (Lisa & Marion, 2004). Weight gain can also be caused due to increasing age because as people age, they tend to lose muscle and metabolism slows. Physical inactivity: Sedentary lifestyle leads to physical inactivity which in turn leads to weight gain and obesity. People in more urbanized areas suffered more from obesity than their counterparts in more rural area (Lisa & Marion, 2004). Medications: Some medications are associated with weight gain such as antidepressants, anticonvulsants, diabetes medications and certain oral contraceptives. Weight gain may also be caused by certain blood sugar medications and antihistamines (David, Edward & Jesse, 2003). Psychological factors: To some people, emotions may influence their eating habits in that many people may eat excessively when they are bored, sad, stressed or in anger. While most overweight people have no other psychological disturbance than people with normal weight, about 30% of these people are struggling with binge eating (Kaesterner, 2009). Treatment of obesity Behavior and cognitive therapy: This type of treatment involves coupling behavioral methods as well as changes in lifestyle so as to make the most out of it. Behavioral treatment is primarily based on the premise of classical conditioning (Lisa & Marion, 2004). This helps patients identify cues that trigger inappropriate eating habits and learn new responses to them. Treatment is also aimed at reinforcing or rewarding the adoption of positive behaviors. Cognitive therapy is also incorporated in behavior therapy with the assumption that cognitions directly affect feelings and behavior (McKinney, 2004). With cognitive therapy, patients learn to set realistic goals for weight and behavior change, to realistically evaluate their progress in modifying eating and activity habits and to correct negative thoughts that occur when they are unable to meet their goals. Lifestyle modification: Treatment also involves adopting a healthy lifestyle, which requires planning, proficiency in making healthy choices and estimating portion sizes and diligence in monitoring caloric intake and activity (McKinney, 2013). This includes strategies such as food provision, meal replacement and commercial weight loss programs. Dietary interventions: They are designed to create a negative energy balance by reducing daily energy intake below energy requirements. Energy requirements vary by sex, weight and level of physical activity. Great energy deficit results in greater weight loss (McKinney, 2013). Physical activity: The benefits of physical activity include inducing negative energy balance, sparing fat free weight mass during weight loss and improving cardiovascular fitness (McKinney, 2013). However, physical activities may produce minimal weight loss if it is not accompanied by caloric restrictions. Pharmacological interventions: Pharmacotherapy usually involves coupling behavioral and pharmacotherapy strategies in weight loss programs. The major benefit of pharmacotherapy is that it facilitates the maintenance rather than the induction of weight loss (Lisa & Marion, 2004). Weight loss medication should be used in long term basis in the same manner as medication used for hypertension and diabetes. Surgical interventions: People who seek bariatric surgery will have exhausted all the conservative weight loss options without satisfactory results (Kaestner, 2009). Bariatric surgery is only appropriate for people with a BMI of more than 40kg/m squared. Bariatric surgery produces average reduction of about 25 to 30% of the initial weight and significant improvement in hypertension, asthma, sleep apnea and diabetes. Conclusion Obesity is a major nutritional problem in the United States and other affluent societies. The amount of money, energy and time invested in the prevention and treatment of obesity is overwhelming (Bertakis & Azari, 2005). It is a serious and highly prevalent disease associated with high morbidity and mortality. Healthcare provider should take an active role in the identification, evaluation and treatment of high risk individuals. (Kaestner, 2009) suggested that all patients should be provided with lifestyle therapy with the consideration of pharmacotherapy and bariatric surgery when need be. References Bertakis, K., & Azari, R. (2005). Obesity and the Use of Health Care Services. Obesity Research. 13(2): 372- 377. Bhattacharya, J., & Bundorf, M. (2009). The Incidence of Healthcare Costs on Obesity. Journal of Health Economics. 28(3): 649- 658. David, M., Edward, L. & Jesse, M. (2003). Why Have Americans Become More Obese. Journal of Economic Perspectives. 17(10): 93- 118. Kaestner, R. (2009). Obesity: Causes, Consequences and Public Policy Solutions. Institute of Government and public affairs. 15 (10): 94- 102. Kielinchev, K., Hill, K., & Green, J. (2003). The Cause and Effects of Growing Waistline of Obesity in the American Society. Allied academic international conference. 7(2):75- 79. Lisa, R. & Marion, N. (2004). The Contribution of Expanding Portion Sizes to the U.S Obesity Epidemic. American Journal of Public Health. 92(30): 246- 249). McKinney, L. (2013). Diagnosis and Management of Obesity. Lea wood: Tomahawk Creek Parkway. Mokdad, A., Ford, E. & Bowman, B. (2003). Prevalence of Obesity, Diabetes and Obesity Related Health Risk Factors. Journal of the American medical association. 289(20): 76- 79. Read More