Obesity Policy in the US - Essay Example

OBESITY INTRODUCTION "Imprisoned in every fat man a thin one is wildly signaling to be let out"(Cyril Obesity isdefined as an abnormal growth of the adipose tissue due to an enlargement of fat cell size (hypertrophic obesity) or an increase in fat cell number (hyperplastic obesity) or a combination of both (Hager 1981)2. It is estimated to affect 20 - 40 % of children and adolescents in developed countries (WHO 1995)3. According to National Health and Nutrition Examination Surveys (NHANES) 30% of American population is obese with BMI > 30(during 1999-2000) and 64% of U.S adults > 20 yrs of age are overweight with BMI > 25 and about 5% of population is extremely obese with BMI > 40. Obesity can occur in any age group but it tends to increase with age " infants with excessive weight gain have an increased incidence of obesity in later life (Charney etal 1976)4. It has a female preponderance and certain genetic component in its causation as evidenced by twin studies, which show a close relation between the weights of identical twins even when they are reared in dissimilar environments (Falkner 1980)5. Physical activity and fitness's are important modifiers of mortality and morbidity related to over weight and obesity (WHO 2003)6 but according to Falkner it is the reduced energy output that is the main etiological factor behind obesity. Food habits play important role in weight gain and obesity, the composition of the food, the periodicity at which it is consumed and the amount of energy derived from it are the factors, which modulate body weight. A diet containing more energy than needed may lead to prolonged postprandial hyperlipidemia and to deposition of triglycerides in the adipose tissue resulting in obesity (Oliver 1981)7. Other factors include psychosocial, familial tendency, endocrine, ethnicity and drugs like corticosteroids etc. Its is a positive risk factor for hypertension, diabetes, gall bladder diseases, congestive heart disease and certain cancers (hormonal and large bowel). It also predisposes to other conditions like varicose veins, abdominal hernia, osteoarthritis of knees and hips. Flat feet; sleep apnea and respiratory problems etc. the Framingham Heart Study in United States of America reveals that there is a dramatic increase (20%) in sudden death among overweight adults as compared to those with normal weight. Healthy People 2010 are a comprehensive set of disease prevention and health promotion objectives for the Nation to achieve over the first decade of the new century and one of the objective is to reduce obesity up to 15% in adults by 2010.the objectives are 19-1: - increase the proportion of adults who are at a healthy weight from 42 % to 60% by 2010. 19-2: - Reduce the proportion of adults who are obese from 23% to 15% by 2010. 19-3: - Reduce the proportion of children and adolescents who are overweight or obese from 11% to 5% by 2010. In order to achieve this objective health care planning has to be done and an obesity policy has to be made which has to be implemented at various health care levels, the work done has to be evaluated and depending upon the results relevant modification should be made in the policy to achieve better results. OBESITY POLICY The policy is to educate the American public on the dangers and medical quandaries that obesity causes and to help eradicate this epidemic from our nation. PLAN: Health education is planned in connection with a health service for proper implementation. This health service provides health education about hazards of obesity in the following three methods Individual approach: by personal interviews in hospitals, consultation rooms, and health care centers or peoples houses. Health education is given at every interaction with the patient about the etiology, risk, prevention and control of obesity. It will be the principal duty of the physician and nursing staff to provide health care to the patient at every opportunity they get. It can also be done by home visits by public health nurses or social workers and also by sending letters to individuals regarding obesity. By this we can discuss on the problem, argue about the benefits and risks and convince the person to bring about a change in his behavior so as to reduce the risk of obesity. Group approach: the target group should be school children because obesity is harder to treat in adults than in children. A qualified person can do it with the help of lectures using flipcharts, exhibits, films and charts of fibrous and low fat diet etc. children can be encouraged for group discussion, it helps the children to learn by freely exchanging their knowledge, ideas and opinions. Various demonstrations can be carried out about various exercises that would help people with passive lifestyle to work out at their work places. Another form of group approach is role-playing or socio-drama where the situation is dramatized by the group and enacts their roles as observed or experienced by them and the audience is actively concerned with the drama and make valuable suggestions. Various conferences, seminars, symposiums and panel discussions can be conducted by qualified personnel at schools, colleges, universities, offices etc and bring all the aspects of obesity to the knowledge of the common man so that he can act accordingly. Mass approach: it is a one way of communication and reaches even the farthest corner and provides information to large number of people at a time and valuable in case of time and money. This used along with other methods completes the mode of conveying health education to the common man. Television, which is the most popular mode of mass media, creates awareness, brings about changes in life style and has the power to modify opinions. Various programmes on health education and various advertisements bringing a change in life style can use it to convey health education. Before the television was had kept its foot, radio was the only medium for mass communication and is still present widely especially in the remote areas and is useful in the form of straight talks, plays, question and answers and quiz programs regarding obesity can be aired to create awareness. Internet is the current fastest growing medium. Various health information regarding obesity can be gathered from various health related websites, motivation for this can be given through various ads and different other media. Newspapers can be used for generous communication and liberal amount of health education can be provided. Artistic posters and billboards catch the eye and create awareness. The message conveyed should be short simple and direct in places where the exposure time is less where as billboards and posters with large messages can be kept at places where people have ample time waiting like bus stops hospitals, subways, railway stations, airports, stadiums etc. IMPLEMENTATION: the health service to which this policy has been assigned should clearly mention the definitions of roles to be played by individuals and the tasks they have to achieve in a limited period of time. This further needs selection of candidates like doctors, nurses, social workers etc and training them in various methods of communicating with the people and providing them with knowledge about obesity. Qualified people should be appointed for the motivation and supervision of the trainees and other manpower involved. A certain network should be formed between group and proper channels of communication should be established between groups, workers, officers and the public. The day-to-day activities should be monitored to keep a track of the course of activities and correct any defects or delays promptly. EVALUATION OF RESULTS: according to WHO Expert Committee on National Health Planning, evaluation "measures the degree to which objectives and targets are fulfilled and the quality of results obtained. It measures the productivity of available resources in achieving clearly defined objectives. It measures how much out put or cost-effectiveness is achieved. It makes possible the reallocation of priorities and of resources on the basis of changing health needs"(WHO1967)8. It gives an idea of how well the plan has worked, were the results sufficient to bring about public awareness about obesity if not where was the defect what went wrong has to be assessed. MODIFICATIONS: depending upon the evaluation of the results, modifications have to be made in the policy. Modifications in the plan are required when the method of communication is not working for the desired population then the mode of communication has to be changed or there is limited time to convey the message which may be a restrain like school and office timings etc. Changes in the implementation are more and may involve manpower, which is either very less or inefficient or not trained properly. Insufficient resources, mismanagement of resources can be major drawbacks. Changes may have to be made in the supervision and governing body. Defects may be in communication between workers, which also may need a check. Defects in evaluation may be due to improper data collection or negligent monitoring. A revised policy should soon be introduced so that the zeal of the policy does not die. CONCLUSION Though health education can cause awareness in people about obesity and the problems related to it and thus decrease the incidence, it has failed to do so. The problem probably lies in the plan and implementation. The limitation in individual health approach is that limited number of people get health education only hose who get n contact get the education. In group approach lectures my not be effective because students are involved in less numbers and the learning is passive and it doesn't stimulate problem solving capacity or thinking of a student and the understanding and learning capacity of different people is different and more over it does not guarantee a change in the behavior of person. Shy persons may not take part in-group discussions or there may be unequal number of participants or if improper guidance is there then some members may deviate from the subject. As mass communication is mostly one-way channel learning is passive. Newspapers convey messages only to the literates. To make the plan more effective different methods of communication should be used in combination. Adequate funds and manpower should be ensured before implementation of policy and adequate training should be provided. Better ideas should be evolved to decrease the sedentary life style and increase physical activity, change attitude towards food and to change behavior of people. We the citizens of America should work hard to create a disease free environment and struggle hard to build a healthy and prosperous country. BIBLIOGRAPHY Read More