Obesity And Possible Strategies Essay

Australian Health Ministers have identified obesity as an area of National Health Priority Area as evidenced and supported by Durand 2007 “reversing the obesity epidemic is an urgent priority”. Through this essay we will discuss the determinants of health, what is obesity and possible strategies for primary, secondary, and tertiary health promotion for obesity. Most of the primary strategies used are targeted towards children as most of the programs used to promote healthy eating and exercise, according to the literature, reside predominantly in schools while secondary and tertiary promotion are targeted at adults and families.

The key feature of the primary strategies of health promotion to deter behaviors and lifestyle choices that leads to obesity is education, which is why the school aged population is targeted. The discussion of the primary strategies in health promotion will generally focus on school run programs and activities. Obesity And Possible Strategies Essay. From here we will explore the options of screening and testing under the secondary health promotion for obesity which will be aimed at children, adults and families before delving into management of obesity, patient education and other tertiary health promotions available although in this instance most will mostly be targeted towards the adult population. Through the discussion of this health promotion, will we analysis and determine possible limitations and implications for nursing practice. We will commence with the definition of the determinants of health which in this case refers to the causes of obesity in our community and briefly explore possible causes and reasons for obesity.

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DETERMINANTS OF HEALTH

Buttriss (2008) theories that the current obesity trend threatens public health and the research (Galani, Al, Schneider, & Rutten, 2007)supports that not only does obesity become a precursor to morbidity and mortality but an economic drain on government funds the healthcare system in turn cause implication for nurses to accommodate a bariatric patient who will become physically difficult to manually handle and becomes a drain on the nurses resources for a condition that could have been prevented or minimized through deterrence’s and patient education. The Body Mass Index (BMI) is the accepted measurement to determine at what state the body is currently in. Chapman, (2004) explains that a BMI of between 18.5 and 24.9 is a normal weight range and is therefore the desired state however, the trends in this research confirms a steady increase of BMI’s over the last 20 years. As a western style nation we have unlimited access to promotion of fast foods and sedientry like activities (internet, video games etc) and in turn have allowed unhealthy food of convience that are econmically and geographically avaliable destroy our health. Television advertisements target young children during children programming hours inluence there decisions and according to Galani (2007) most of the underprivileged suburbs contain the most amount of fast food outlets. So from the research gathered can we establish the obesity impinges on the under privilaged, uneducated and the easily influenced minds of children who in turn influence the main purchasers of groceries. Obesity and other related chronic health condition order to maintain a healthy body weight you must be able to “balance intake with expenditure” (Frable, Dart, & Bradley, 2002) which is were the health promotion strategies take effect by educating about how to conduct this balancing act and why it is important to be within a normal weight range. Obesity And Possible Strategies Essay.

PRIMARY HEALTH PROMOTION STRATEGIES FOR OBESITY

Primary health promotion is encouraging behviours that will improve health and over all well being, when relating primary health promotion to obesity we are identifying programs and strategies avaliable to the public in paticular, school aged children. Durand, Logan, & Carruth (2007) have labeled childhood obesity “as a critical public health threat for the 21st century” and so we will examine how some of the programs being run at school will benfit not only the general health of children but also reduce future implications on the nursing practice as these children become adults.

The Stephanie Alexander Kitchen Garden National Programs (Better Health, 2009) is a government funded program for primary school children that teaches them to grow and harvest their own fruit in vegetables in a school garden, how to cook and appreciate fresh and seasonal foods and has the benefits of teaching them lifelong skills, keeps them moving and activate in the garden and linking good food choices to optimal health. School ride-a-thons, and walk to school day are also school promoted activities to encourage movement and exercise while portraying exercise to be fun and social activity. Physical education has become an integral part of primary school life where children are encouraged and given an incentive to participate in team sports and activities with a little healthy competition to help motivate and in some children serve a purpose to an exercise. Programs that are inclusive to all children and are made fun provide the incentive they need to get moving and exercise.

By promoting positive healthy eating and exercise will help them the healthy choice the easy choice. Schools are enforcing healthy lunch policy where children are encouraged to bring along healthy foods for lunch and monitored by the teachers.Obesity And Possible Strategies Essay.  Teachers are encouraging experimenting with foods by awarding points or awards for the healthiest food or most interesting food brought during the week and also undertaking a session on the food pyramid and the 2 and 5, 2 fruit and 5 veg a day theory and to enforce these positive attitudes you only have to look to the likes of Sesame Street where the characters explain what a “sometimes type of food is” meaning food and treats in moderation and on occasion. Popular fruit commercials with catchy jingles such “Bananas, make those bodies sing” all equate healthy food choices to being healthy. Commercial campaigns like “Life be in it” displaying fun activities that children can partake in and new adventures to have all while being active and involved in some sort of physical activity.

Opposed to secondary and tertiary health promotion of behaviour modification (Galani, Al, Schneider, & Rutten, 2007), these programs influence children and their food and exercises choices to have a positive relationship with food and link good food and physical exercises choices with optimal health.

Although these programs are designed for children, the influences of their learning’s may well sway their parents and family to also adapt a healthier lifestyle pattern and in turn succeed in promoting health and the healthy choice to their families, friends and well into their communities. These programs run at school are addressing the childhood obesity epidemic by providing education in a fun way about healthy choices and in turn will decrease the amount of children becoming obese adults. Although Kelly & Melnyk (2008) research shows that the combination of nutrition, physical activity and education decreases BMI, this theory, however, is partial to the limited research on the affects of these programs and a study should be conducted on how these principals may change or influenced once leaving primary school and progress through the life span as according to Buttriss (2008) “as yet, no indication of a decline in the rates of obesity in children and adults” although Barlow et al (2002) argues that these health promotion preventions may lead to favourable long term outcomes.
Regardless of the limitations discussed these positive approaches to healthy eating and embracing an active lifestyle will set them ultimately as an adult with good lifestyle choices and therefore reduce the risk of obesity in adulthood. Obesity And Possible Strategies Essay.

SECONDARY HEALTH PROMOTION STRATEGIES FOR OBESITY

Interventions and screening for obesity are necessary in order to battle this increasing epidemic plaguing the general population. As with the education and programs being run at school with the primary strategies of health promotion, schools are now undertaking responsibility of some possible interventions and screening. As Physical Education has become an integral part of the school’s curriculum, the subject measures the BMI students in conjunction with fitness tests and provides information, strategies and resources to those most vulnerable to obesity and how as a family they can combat the prevalence of obesity. As its teachers who are involved with students for most part of the day, they are able to accurately assess using observation of a pupils motivation and participation in activities and according to Larson, Mandleco, Williams, & Tiedman (2006) “a happy child if often a healthy one.”

Australian Goverment Department of Health and Ageing (2009) has introduced a health check program called “Get set 4 life”. It is avaliabe to all Australian residents aged 4 years and serves the purpose to detetrmine if these children are fit, healthy and ready to learn as the enter their first year of primary school. Carried out by a GP or a nurse registered with the program and involves a history collection and assessment and in return provided with interventions and health advice. Using age appropriate tools and resources, this program teachers parents how to teach there children from an early age about better health while making it fun. The benefits of the program is that it is covered by medicare and so can they be bulk-billed and that they can recieve this check with their 4 year old vaccination. These health checks are used as an early detection device to examine those most at risk of childhood obesity and the research conducted by Durand et al (2007) illustartes that only 1 in 5 mothers were able to correctly identify that they child was in fact overweight which was prevalent in low education knowledge and a high risk of obseity themselves on the mother behalf and “may be the barrier to prevention of childhood obesity.”Obesity And Possible Strategies Essay.  This is imperative as Larson et al(2006) research identifeys a link between paternal obesity and the risk of children developing obesity .These health checks provide a professional health care point of view and dilvierd with the best possible intentions and most up-to date resources. Some of the limitations of this program is that it is only avaliable for 3 to 5 year olds and only one health check can be made. With no review or follow up of how effective these interventions and strategies actually are, we are implementing a program that the research in unable to justify.

Moving away from just child secondary health promotions we can also explore the Australian Better Health Intiative Campigan, (2009) called “Measure up” targeting 25-60 particularly families and older Australians most likely to already be suffering from one chronic health condition possibly exacibated by high BMI. This campigan however does not differ from other screening and prevention tools as the goals are still to make healthy lifestyle choices and associate good life style choices with optimal health. This campaign sends measureing tapes out to the population to measure their waist and given an indication of what sort of risk they may be in developing chronic health conditions related to expanding waist lines. This campigan offers the population the chance to investigate for themselves options in reducing their risk of chronic health conditions and to seek further advice from health care professionals with any concerns or further testing while encouraging an invested intrest in their own health as well as that of their families.

TERTIARY HEALTH PROMOTION FOR OBESITY

Tertiary health promotion in obesity is often when obesity has been identified and management of the condtion which includes “a wide variety of treatments for obesity are avaliable including diet, physical exercise, behavioural modifications, pharmacological treatmet and surgery” (Galani, Al, Schneider, & Rutten, 2007). In order to undertake these treament , assessing and “identifying at risk families as early as possible” (Buttriss, 2008) is benficial to ensure exstreme measures of treatment are not offered when aquate patient education will suffice. Of course the best way to intervene is to modify behaviours and lifestyle choices to encourage opitmal health.

If these means are in no way effective, then surgical options “should be offered to patients who are morbidly obese, well informed, motivated and willing to accept the operative risks” (May & Buckman, 2009)  Obesity And Possible Strategies Essay

Overweight and obesity have instituted numerous health complications that has risen steadily over the last two decades. For example, recent data shows that adult overweight and obesity in most European countries has risen alarmingly, with 27% and 38% of men and women respectively considered to be obese (Sallis & Glanz 2009, p.128). Obesity And Possible Strategies Essay.

Even children are not spared, with statistics showing that 27% of UK children overweight and that there is increasing number of children with type 2 diabetes signifying obesity (NICE 2006, p.90).

Australian study found out that slightly more than a half Australians adults and a quarter of Australian children are either overweight or obese, resulting to numerous health and economic consequences such as diabetes, morbidity and mortality, and the estimated financial cost of $3.8 billion, with a further $ 17.2 billion in non-financial costs as a result of lost wellbeing (Wilson, Watts, Signal & Thomson 2006, p.2156). The paper outlines and critically analyses the population based strategy as a method of managing and preventing obesity used in United Kingdom.

Introduction

The global health complications associated with overweight and obesity problems has risen steadily over the last two decades, a significant justification that the global obesity has risen exponentially over this period.Obesity And Possible Strategies Essay.  For example, recent data show that adult overweight and obesity in most European countries has risen alarmingly, with 27% and 38% of men and women respectively considered to be obese (Sallis & Glanz, 2009, p.128).

Approximately 46% of men and 32% of women in England have a body mass index between 25 and 30 kg/m2, therefore considered overweight, and further 17% of men and 21% of women have body mass index of more than 30 kg/m2 implying obesity (House of Commons Health Committee, 2004, p.78).

Underestimated as a serious cause of ill-health, obesity’s steady rise in prevalence has caused many problems in England, where the overweight prevalence has risen by over 50% in the past two decades and obesity incidences has even trebled (National Audit Office 2006, p.65).

Even children are not spared, with statistics showing that 27% of UK children overweight and that there is increasing number of children with type 2 diabetes signifying obesity (NICE 2006, p.90). Between 1995 and 2002 alone, there was a double increase in obesity between boys aged 2 and 15, representing a rise from 3% to 6%, and obese girls increased from 5% to 9% (Penny Gibson et al. 2003, p. 88).

A survey conducted in Hong Kong was even more astonishing, indicating that 38% and 57% of boys and girls respectively between the age of 9 and 12 were obese, with body mass index exceeding 95^th percentile (Grundy 2004, p.557).

More research revealing that obesity is highly associated with diabetes is even more worrying to the health professionals and the society as a whole, with the Hong Kong findings revealing that both obese children showed higher systolic blood pressure, triglyceride, and insulin and lower HDL cholesterol more than the average weight (Grundy 2004, p.557).

Another recent data in Australia showed that slightly more than a half Australians adults and a quarter of Australian children are either overweight or obese, resulting to numerous health and economic consequences such as diabetes, morbidity and mortality, and the estimated financial cost of $3.8 billion, with a further $ 17.2 billion in non-financial costs as a result of lost wellbeing (Wilson, Watts, Signal & Thomson 2006, p.2156). Obesity And Possible Strategies Essay. These global statistics indicate that obesity is ha no physical boundary and what happens in one country can happen in another country.

What causes obesity?

Although experts agree that there is the connection between genetics as well as biological factors in the obesity prevalence, it is universally acknowledged that there are some behavioral risk factors such as diet and physical activity, which nonetheless are the major causes for obesity (Sigal et al. 2006, p. 43).

The environmental factors such as lack of access to grocery stores, increasing cost of healthy foods, and inadequate play grounds limit the possibility of healthy lifestyle among the people in modern society (Hill & Peters 1998, p.280; Minkler 1989, p.59).

Furthermore, the more sedentary lifestyles prompted by the modern working conditions have pushed the possibility of good exercise at the periphery of the work programs, thereby aggravating the obesity epidemic in the UK major cities(Story et al. 2005, p.231). Obesity And Possible Strategies Essay.

Strategies for controlling obesity

Considering the consequences of obesity, efforts to understand the best ways to prevent it are still the priority number one for health experts and government of UK. There have been numerous separate strategies designed to control obesity based on parameters associated with medical, scientific, social, and economical criteria (Tones & Tilford 2001, p.159).

The strategies have been separate because of the cultural and linguistic diversity that exist among the communities of the world.

There is published evidence showing that the intensity of the chronic disease as well as exposure to attendant risk factors is unevenly distributed among the ethic groups in the United States (Trayhurn & Beattie 2001, p.657). This paper critically analyses the population based strategy for obesity control and management in the UK, considering the past and present studies related to the epidemic.

Population-based promotional strategies

The population- based promotion control is a common strategy to control obesity (Leddy 2006, p.676). In this section of the paper, I will critically look at the population-approach strategy in relation to childhood obesity. As early stated, children and adolescent obesity has dramatically increased exponentially over the last years.

However, the definition for childhood obesity has posed a great challenge to medical fraternity, with some experts simply referring to it just as “an excess of body fats” (Wilson et al. 2006, p.137). But all the frequently used definitions use body mass index as a point of reference to make the variations.

Pi-Sunyer (1993, p.31) states that although BMI is a useful and feasible parameter outside the realm of scientific research for identifying overweight children and adolescent, it is not an accurate measurement for excess depository, normally referred to as the excess accumulation of lipids in a body site or organ. Obesity And Possible Strategies Essay.

Another method of identifying and monitoring obesity in children and adolescent is through the measurement of skin-fold thickness (Grundy, Brewer, Cleeman, Smith & Lenfant 2004, p.436)

5^th– 85^th percentile BMI is taken normal, 85^th to 95^th percentile BMI is at risk of obesity, and more than 95^th BMI percentile is considered obese (Trayhurn & Beattie 2001, p.12). What actually causes obesity in children? Even its causes are said to be complex, obesity is associated with imbalance in the intake of energy and body expenditure (WHO 2002, p.51).

One study found out that children’s BMI is related to adiposity in adulthood and that “overweight children had a greatly increased risk of becoming obese adults” (Freedman, Khan, Serdula, Dietz, Srinivasan, Berenson, 2005, p.412).

Childhood school interventions

To respond to the alarming rise in obesity, the UK government proposed several intervention strategies, setting the public service agreement targets in the year 2004. According to National Audit Office (2006, p.3), with the main objective being to halt the obesity cases in children under the age of 11, several government departments comprising of health, culture, Media and sport, and education departments were outlined as the key stakeholders.

This was after identifying key problem in obesity management among the children population in the UK that is diverse socially, ethnically and economically, and thus the need for a “multi-agency coordination” together with partnership for success.

This intervention focused on the diet improvement and addition of more physical activities among the population’s schedule, thus the inclusion of parental participation that was considered to be very important (NICE 2006, p. 7)

According to Seidell, Kahn, Williamson, Lissner & Valdez (2001, p.675) schools in England and any other country provide opportunity to offer a proactive approach to obesity management in a positively proactive, broader, and more cost effective. Obesity And Possible Strategies Essay. They highlight that schools provide critical intervention base since the disadvantaged group can be reached at ease (p. 676).

Furthermore, schools have a great influence on the children in terms of promoting a healthy diet, physical activity and other healthy behaviors (WHO 2002, p.12). However, there is little evidence that supports such multifaceted approaches like the school- based intervention strategy according to the meta-analysis of the applied strategies (Campbell et al. 2002, p. 2).

The analysis revealed that the approach that targeted both parents and their children had “mixed reviews in terms of success and evidence” that was rather inconclusive in relation to the strategy effectiveness (p. 8).

Furthermore, Bracht (1999, p.2786) and Teague (1987, p.123) had earlier refuted the claim of success of such strategies by stating that even a Cochrane review produced no supporting evidence to the child obesity management strategies, citing limited data on BMI reporting, lack of process indicators, and lack of sustainability and ability to generalize results as the main barrier to the success of the strategy.

For the success of this process, the design should be made with some specific information about the target audience, children and adolescents in this case (Sim & Mackie 2009, p.49). They state that this process should identify some specific issues considered to be critically important for children and adolescents, considering their “social and cultural values, incentives and disincentives” (p.58).

It’s therefore advisable to identify and emphasize on factors that will increase their attention, motivation and participation, and most importantly, when making decisions.Obesity And Possible Strategies Essay.  “Obesity intervention education in schools should discuss the environmental and socio-cultural factors that contribute to obesity, such as levels of physical activity, the selection of healthy food options at home and school, the impact of television fast-food advertisements, attitudes, perceptions, beliefs around food, intake of energy-dense nutrition and sedentary child entertainment activities” (Cheung 2007, p.453).

Another controlled evaluation study on the impact of nutritional education to reduce the consumption of carbonated drinks among school children between the ages of 7 and 11 in England (James, Thomas, Cavan & Kerr 2004, p.459). The component of the intervention entailed one-hour lesson, conducted three times a week by a trained personnel assisted by teachers, who would reiterate the same message in their later lessons in class.

The sessions dwelled on promoting drinking water or diluted fruit juice and tasting fruit to establish natural sweetness, music competition, and quiz (James et al., 2004, p. 1237). The students were encouraged to compose songs with positive message and were exposed to all information from the project website (Lucas & Lloyd 2005, p.876).

The evaluation team assessed the situation after twelve months and there were no significant difference in the interventions and the control classes. However, the intervention group reported the reduction in soft drink consumption after just three days, in contrast to the controlled group who never participated in the program (Lucas & Lloyd 2005, p.877).

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In addition to the insignificant nature of the population based approach to obesity management, the epidemiological studies are said to posses several bias i.e. the way the study subjects are designed, selected or classified are always “loaded “ with bias (Stanhope & Lancaster 2006, p.621). Stanhope & Lancaster classifies some of the factors that lead to bias into three categories as follows:

• Selection or the way subjects enter study, thus the selection of the population bias that may involve self-selection factors. For example, are the teenage populations who accept to complete questionnaires related to alcohol, tobacco and other drugs are a representative data of the total teenage population?
• classification or misclassification bias; there is likely to be misclassification of subjects already in the study leading to insufficient information,
• Confounding or bias resulting from the relationship between the outcome and study factor with some third factor not accounted for. For example, studies reveal that there is a real association between maternal smoking during pregnancy and low-birth weight babies. Another is the association between alcohol and cigarettes, i.e. smoking neither make neither one drink alcohol nor does drinking alcohol make someone smoke. If a researcher was to investigate the relationship between alcohol consumption and low birth weight, smoking would be a confounder because it is related to both alcohol consumption as well as low birth-weight. The existing failure to account for smoking in the subsequent analysis would bring bias (Stanhope & Lancaster 2006, p.622). Obesity And Possible Strategies Essay.