Models of Health for Obesity Intervention Essay
Models of Health for Obesity Intervention Essay
Public health has been a topic of government debates. It is an increasing issue that is provoking a lot of publicity. Strategies are being implemented as well as policies in order to tackle the ever increasing problem of obesity which is clearly a public health issue. A case study from the Nuffield Council on Bioethics (2007) showed that the United Kingdom has the highest prevalence of obesity in Europe. Due to the NMC confidentiality clause in accordance with The Nursing and Midwifery Council (2008) Code of Conduct, nurses must respect people’s right to confidentiality. Therefore for the purpose of this essay the patient’s name has been changed and any personal or identifiable information has also been altered so as to protect his privacy and dignity.This essay aims to discuss and explore policies, biopsychosocial model and contribution of therapies to health and wellbeing with reference to Troy (see appendix 1)Models of Health for Obesity Intervention Essay
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Public health
Public health refers to the methods of preventing disease, prolonging life and promoting health through organised efforts and informed choices of society, organisations, public and private, communities and individuals (WHO, 2013). It is concerned with threats to health based on population health analysis. The population in question can be as small as a handful of people, or as large as all the inhabitants of the United Kingdom. The dimensions of health can encompass “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 2013). Sim & McKee (2011) suggest that Public health incorporates the interdisciplinary approaches of epidemiology, biostatistics and health services. The focus of public health intervention is to improve health and quality of life through prevention and treatment of disease and other physical and mental health conditions. This is done through surveillance of cases and health indicators, and through promotion of healthy behaviors. The range of public health interventions in order to reduce food related ill health is potentially considerable and this includes; presenting on an individual basis, health education and promotion, composition regulation in food, accurate food information labels and product traceability just to name a few. From 2004, the United Kingdom has put together a number of initiatives that are aimed at tacking obesity with recognition of the need for policy change as well as individual behavior change and personal attitude towards food.Models of Health for Obesity Intervention Essay
Policy
Due to the alarming statistics on obesity in the United Kingdom, the government has a policy to try and tackle the rising problem. According to the Policy, figures show that 61.9% of adults and 28% of children aged between 2 and 15 are overweight or obese. People who are overweight have a higher risk of getting type 2 diabetes, heart disease and certain cancers (Department Of Health, 2013). Excess weight can also make it more difficult for people to find and keep work, and it can affect self-esteem and mental health. This being the case of Troy as he suffers from type 2 diabetes due to his weight, has mental health and has never found work. It is costing the Government 5million pounds to obesity related illnesses.Models of Health for Obesity Intervention Essay
The policy has an action plan to reduce these statistics by 2020. The government want people to eat and drink more healthily while being more active. It is giving people advice on a healthy diet and physical activity through the change4Life programme. The programme promotes healthy life styles. The moto is ‘Eat Well, Move More and Live Longer’. Change4Life is a society-wide movement that aims to prevent people from becoming overweight by encouraging them to eat better and move more. It is the marketing component of the Government’s response to the rise in obesity (Nhs, 2013).Models of Health for Obesity Intervention Essay
Improving labelling on food and drink will help people make healthy choices. The policy states that a system for labelling on the packages that makes it clear what is in food and drink, is important. The consistent system combines red, amber, green colour-coding and nutritional information to show how much fat, saturated fat, salt and sugar, and calories are in food products. Also encouraging businesses on the high street to include calorie information on their menus so that people can make healthy choices. By giving people guidance on how much physical activity they should be doing, the policy seeks to help individuals as well as professional to understand how to reduce the risk of ill health associated with inactivity and sedentary behaviors.
As much as it is an individual’s choice on when and what they eat, the government want businesses to take responsibilities of the products that they are selling by making it easier for everyone make healthier choices for both staff and customers. The ‘Responsibility Deal has 4 networks’ include; alcohol, food, health at work and physical activity which all have collective pledges that businesses are encouraged to sign up to. The actions to help people eat more healthily include; reducing ingredients like salt, sugar and fat that can be harmful if people eat too much of them. Also encourage people to eat more fruit and vegetable to help reach their ‘5 A DAY’. Lastly putting calorie information on menus and helping people to eat fewer calories by changing the portion size or the recipe of a product (Department Of Health, 2013). The policy asks the local councils to get involved in combating obesity and encourage healthier lives by making sure that the right services are in place. An example of this is recreational areas in the neighborhoods have outdoor gym facilities.Models of Health for Obesity Intervention Essay
Biopsychosocial model
Biopsychosocial model, traditionally considered appropriate with regards to obesity, as all elements of the model are relevant. This model shows disease arising from the overlap of components. In applying this model to obesity research, biologic systems are viewed in isolation, not taking into account their interaction with the environment and behaviours until one is obese. There are several factors that could lead one to be overweight or obese and the biopsychosocial model can be used to understand these factors. One of them is biological factors which include genetic susceptibility, increased number of adipose cells formed during childhood, hormonal imbalance such thyroxine produced be the thyroid gland, and several more (Marieb & Hoehn, 2010).Although strides have been made exploring the pathophysiology of obesity, treatment and prevention have focused mainly on two components, the psychological and the social. The psychological aspects include eating behaviours, activity habits and health awareness or knowledge. Troy suffers from depression this could be a factor to consider as a reason why he is obese.Models of Health for Obesity Intervention Essay
Taylor (2012) recognises that people that eat while depressed or stressed are more likely to consume sweet and high-fat foods. Troy has accustomed himself to bad eating behaviour. Most take away food have high volumes of sugar, fat and salt, which are triggers of weight gain. He may not be aware of the implications of his weight increase. As a student nurse, I feel talking to Troy and making him aware of his weight problems may be ideal. Giving him healthier options when he asks me order him a take away and advising him to eat more of the reduced sugar, fat and salt food. Troy has a high craving for sweet fizzy drinks, telling him of the alternative drinks such as sugar free or sweeteners would be ideal thus empowering him to make a choice.Models of Health for Obesity Intervention Essay
The social aspect of the model include socioeconomic, neighbourhood, schools and food policy. When it comes to obesity there are a great variety of social variables that contribute to one being overweight and obese. For instant today we are bombarded with advertisements for fast food restaurants and high calorie pre-packaged foods or microwave food. The media plays a big role in changing our attitude and behaviour toward food by using persuasive messages and images. A study by Taylor (2012) shows that socioeconomic factors contribute to one’s attitude towards food. The study revealed that that people of low socioeconomic status tend to be more overweight than people with high socioeconomic status. An explanation for this could be the fact that food that contain high-fat and processed foods are cheaper than nutritious and fresh foods such as vegetables and fish. Troy lives in poor estate and relies on the benefit system for his income. This in not much so he tend to buy the cheaper and faster foods. Also social and family interaction could affect one to become obese as eating habits can be influence by others around the house. Other social factors could be educational level, employment and cultural influences. Advising Troy tocook his own meals when his at home and educating him on the difference between fresh cooked meals that contain low fat, sugar and salt versus Fast food would be in his best interest. He lives alone so giving himself more time outdoors and engaging in activities, like going out for walks or even light exercise as a starting point. Understanding the reasons for obesity is important but more important is to find ways to stop and prevent it. Health promotion is any effort that encourages people to engage in healthy behaviour’s such having a healthy diet and maintaining a healthy weight (Schneider, Gruman & Coutts, 2005).Models of Health for Obesity Intervention Essay
Behavioral treatment
Behavioral treatment is an approach used to help individuals develop a set of skills to achieve a healthier weight. This treatment is used in people who suffer from eating disorders and those who are overweight or obese. It does more than helping people to decide what to change but also helps them identify how to change. The behavior change process is facilitated through the use of self-monitoring, goal setting, and problem solving. Studies suggest that behavioral treatment produces weight loss of 8–10% during the first 6 months of treatment. Structured approaches such as meal replacements and food provision have been shown to increase the magnitude of weight loss (Foster, 2002). Stuart (1967) suggests that behavioral treatment of obesity developed from the belief that obesity is the result of maladaptive eating and exercise habits, which could be corrected by the application of learning principles.Models of Health for Obesity Intervention Essay
Behavioral treatment is based primarily on principles of classical conditioning, which suggest that eating is often prompted by antecedent events, for example cues, that become strongly linked to food intake. According to Brownell (2000) Behavioral treatment helps patients identify cues that trigger inappropriate eating behaviors and help them learn new responses to these cues. Treatment also seeks to reinforce the adoption of positive eating behaviors. This treatment also incorporates cognitive therapy due to the fact that, in cognitive therapy ones thoughts or cognitions directly affect feelings and behaviors (Beck, 1976). Negative thoughts are predominantly associated with negative outcomes. When one over indulges in food and they are dieting, they tend to think they have messed up their dieting schedule therefore proceed to eat even more secondary to feelings of failure and hopelessness. Beck (1976) in his book on Cognitive Behavior therapy mentions that cognitive therapy patients learn to set realistic goals for weight and behavior change, enabling them to realistically evaluate their progress in modifying eating and activity habits, and to correct negative thoughts that occur when they do not meet their goals. Fairburn, C.G, & Wilson G.T. (1993) agree with Beck (1967) that Cognitive interventions for weight management are based on those developed for the treatments of depression, anxiety, and bulimia nervosa. Programmes such as Weight Watchers can be incorporated in Behavioral Therapy as Weight Watchers meetings promotes goal setting and advices on low calorie food intake.Models of Health for Obesity Intervention Essay
Arguably, although the policy set by Department of Health on obesity seeks to promote programmes like change4 life which supports eating five vegetable or fruit a day, it does not completely tackle the issue of affordability. Fresh vegetable, fruit and fish is expense meaning those who have low income cannot afford these foods. It then means it comes back to the fact of them not affording the healthier food so they opt for cheaper processed food. A lot of literature that has been written on the subject matter, obesity, is from the United States of America because they are a nation who are also trying to tackle obesity. They have much a bigger issue of obesity and I believe as a nation we can learn a lot from them.Models of Health for Obesity Intervention Essay
In the case of Troy, Behavioral therapy would be ideal as it involves cognitive therapy, so he can talk about his problem and set realistic goals for himself helping and improving his quality of life. The best interventions have been in the fields of dietary management and behavioural change.
This essay aims to determine how different models of health promotion can be used to improve effectiveness of pharmacist-led campaign in reducing obesity in socioeconomically deprived areas. The health belief, changes of stage and ecological approaches models are some models discussed in this brief. These models are suggested to be effective in underpinning pharmacist-led campaigns for obesity in the community. This essay also discusses the impact of obesity on individuals and the community and its prevalence in socio-economically deprived groups. Challenges associated with uptake of healthy behaviour are discussed along with possible interventions for obesity. It is suggested that a multi-faceted, community based intervention will likely lead to a successful campaign against obesity.Models of Health for Obesity Intervention Essay
Introduction
Blenkinsopp et al. (2000) explain that health promotion is aimed at maintaining and enhancing good health in order to prevent ill health. Health promotion encompasses different issues and activities that influence the health outcomes of individuals and society. Health promotion involves the creation and implementation of health and social care policies that are deemed to prevent diseases and promote the physical, social and mental health of the people. Blenkinsopp et al. (2000) observe that pharmacists are perceived to have crucial roles as health promoters in the community. Since health promotion incorporates a range of actions that are aimed in promoting health, it is essential to understand the role of pharmacists in promoting health. In this essay, a focus is made on health promotion for individuals suffering from obesity in socioeconomically deprived areas. A discussion on the different models of health promotion will also be done. The first part of this brief discusses models of health promotion while the second part critically analyses how these models can be used to underpin pharmacist-led campaigns in reducing obesity. The last part of this essay will summarise the key points raised in this essay.Models of Health for Obesity Intervention Essay
Models of Health Promotion
Blenkinsopp et al. (2003) argue that, in the past, perspectives of pharmacists on ill-health takes the biomedical model approach to health. This model considers ill health as a biomedical problem (Goodson, 2009) and hence, technologies and medicines are used to cure the disease. Pharmacists are regarded as ‘experts’ in terms of their knowledge on a health condition and its cure. Hence, when the biomedical model is used, pharmacists’ response to a health-related query likely takes the disease-oriented approach to medical treatment and referral. This approach limits the care and interventions for the patients. Bond (2000) observes that while not necessarily inappropriate for pharmacy practice, the biomedical approach results to ‘medicalisation’ of health.Models of Health for Obesity Intervention Essay
This means that health and illness are both determined biologically. It should be noted that the primary function of pharmacists is to dispense medications. Hence, when making health-related advice to patients, this often involves information on medications appropriate to the health conditions of the patient. However, the role of pharmacists in providing medicines has expanded to include advice on the therapeutic uses of medications and information on how to maintain optimal health (Levin et al., 2008). Taylor et al. (2004) also reiterates that pharmacists are beginning to promote health through patient education that supports positive behaviour and actions related to health.Models of Health for Obesity Intervention Essay
This new approach is consistent with health models for individuals such as health belief model and stages of change. The health belief model teaches that individuals have to acknowledge the perceived threat and severity of the disease and how positive health behaviour can give them benefits (Naidoo and Wills, 2009). The benefits of the new behaviour should outweigh perceived barriers to the physical activity behaviours (Naidoo and Wills, 2009). This model requires that individuals have cues to action to help them adapt a new behaviour and gain self-efficacy. The latter is important since individuals suffering from chronic conditions need to develop self-efficacy to help them manage their condition and prevent complications (Lubkin and Larsen, 2011). It is well established that obesity, as a chronic condition, is a risk factor for development of type 2 diabetes, hypertension, cardiovascular diseases, orthopaedic abnormalities and some form of cancer (Department of Health, 2009). When individuals receive sufficient patient education on obesity and the risks associated with this condition, it is believed that they will take actions to manage the condition.Models of Health for Obesity Intervention Essay
While the health belief model has gained success in helping individuals take positive actions regarding their health, Naidoo and Wills (2009) emphasises that patient education alone or informing them on the severity and their susceptibility of the disease may not be sufficient in changing or sustaining behaviour. Although individuals are informed on the benefits of the health behaviour, there is still a need to consider how environmental factors help shape health behaviour. It should be considered that obesity is a multifactorial problem and environmental factors play crucial roles in its development.
Public Health England (2014) notes that in the last 25 years, the prevalence of obesity has more than doubled. This rapid increase in overweight and obesity prevalence shows that in 2010, only 30.9% of the men in the UK have basal metabolic index (BMI) within the healthy range (Public Health England, 2014). In contrast, the proportion of men with healthy BMI in 1993 was 41.0%. Amongst women, proportion of women with healthy BMI in 1993 was 49.5% but this dropped to 40.5% in 2010. It has been shown that almost a third or 26.1% of UK’s population is obese. If current trends are not addressed, it is projected that by 2050, 60% of adults will be obese (Public Health England, 2014). The effects of obesity are well established not only on the health of individuals but also on the cost of care and management of complications arising from this condition (Public Health England).Models of Health for Obesity Intervention Essay
Managing obesity at the individual level is necessary to help individuals adopt a healthier lifestyle. It has been shown that a diet rich in fruits and vegetables (Department of Health, 2011) and engagement in structured physical activities (De Silva-Sanigorski, 2011) improve health outcomes of obese or overweight individuals. The stages of change model (Goodson, 2009) could be used to promote health amongst this group. This model states that adoption of healthy behaviours such as engagement in regular physical activity or consumption of healthier food requires eliminating unhealthy ones. The readiness of an individual is crucial on whether people will progress through the five levels of stage of change model. These levels include pre-contemplation, contemplation followed by preparation, action and maintenance (Goodson, 2009). Different strategies are suggested for each level to assist an individual progress to the succeeding stage.Models of Health for Obesity Intervention Essay
It has been shown that prevalence of obesity is highest amongst those living in deprived areas in the UK and those with low socio-economic status (Department of Health, 2010, 2009). Families with ethnic minority origins are also at increased risk of obesity compared to the general white population in the country (Department of Health, 2010, 2009). This presents a challenge for healthcare practitioners since individuals living in poverty belong to the vulnerable groups (Lubkin and Larsen, 2011). It is suggested that development of obesity amongst this group could be related to their diet. Energy-dense food is cheaper compared to the recommended fruits and vegetables. In recent years, the Department of Health (2011) has promoted consumption of 5 different types of fruits and vegetables each day. However, the cost of maintaining this type of diet is high when compared to buying energy-dense food. The problem of obesity also has the greatest impact on children from low-income families. Research by Jones et al. (2010) has shown a strong link between exposures to commercials of junk foods with poor eating habits. It is noteworthy that many children in low-income families are exposed to long hours of television compared to children born to more affluent families (Adams et al., 2012).Models of Health for Obesity Intervention Essay
The multi-factorial nature of obesity suggests that management of this condition should also take a holistic approach and should not only be limited to health promotion models designed to promote individual health. Hence, identifying different models appropriate for communities would also be necessary to address obesity amongst socio-economically deprived families. One of models that also address factors present in the community or environment of the individual is the ecological approaches model (Goodson, 2009). Family, workplace, community, economics, beliefs and traditions and the social and physical environments all influence the health of an individual (Naidoo and Wills, 2009). The levels of influence in the ecological approaches model are described as intrapersonal, interpersonal, institutional, community and public policy. Addressing obesity amongst socio-economically deprived individuals through the ecological approaches model will ensure that each level of influence is recognised and addressed.Models of Health for Obesity Intervention Essay
Pharmacist-led Campaigns in Reducing Obesity
The health belief, stages of change and the ecological approaches models can all be used to underpin pharmacist-led campaigns in reducing obesity for communities that are socio-economically deprived. Blenkinsopp et al. (2003) state that community pharmacists have a pivotal role in articulating the needs of individuals with specific health conditions in their communities. Pharmacists can lobby at local and national levels and act as supporters of local groups who work for health improvement. However, the work of the pharmacists can also be influenced by their own beliefs, perceptions and practices. Blenkinsopp et al. (2003) emphasise that when working in communities with deprived individuals, the pharmacists should also consider how their own socioeconomic status influence the type of care they provide to the service users. They should also consider whether differences in socio-economic status have an impact on the care received the patients. There should also be a consideration if there are differences in the culture, educational level and vocabulary of service users and pharmacists. Models of Health for Obesity Intervention Essay Differences might influence the quality of care received by the patients; for instance, differences in culture could easily lead to miscommunication and poor quality of care (Taylor et al., 2004).
Bond (2000) expresses the need for pharmacists to examine the needs of each service user and how they can empower individuals to seek for healthcare services and meet their own needs. In community settings, it is essential to increase the self-efficacy of service users. Self-efficacy is described as the belief of an individual that they are capable of attaining specific goals through modifying their behaviour and adopting specific behaviours (Lubkin and Larsen, 2011). In relation to addressing obesity amongst socio-economically deprived individuals, pharmacists can use the different models to help individuals identify their needs and allow them to gain self-efficacy. For example, pharmacists can use the health belief model to educate individuals on the consequences of obesity. On the other hand, the stages of change model can be utilised to help individuals changed their eating behaviour and improve their physical activities.
Uptake of behaviours such as healthy eating and increasing physical activities are not always optimal despite concerted efforts of communities and policymakers (Reilly et al., 2006). It is suggested that changing one’s behaviour require holistic and multifaceted interventions aimed at increasing self-efficacy of families and allowing them to take positive actions (Naidoo and Wills, 2009). Models of Health for Obesity Intervention Essay There is evidence (Tucker et al., 2006; Barkin et al., 2012; Davison et al., 2013; Zhou et al., 2014) that multifaceted community-based interventions aimed at families are more likely to improve behaviour and reduce incidence of obesity than single interventions. Community-based interventions can be supported with the ecological approaches model. This model recognises that one’s family, community, the environment, policies and other environment-related factors influence the health of the individuals. To date, the Department of Health (2010) through its Healthy Lives, Healthy People policy reiterates the importance of maintaining an active and healthy lifestyle to prevent obesity. This policy allows local communities to take responsibility and be accountable for the health of its community members.Models of Health for Obesity Intervention Essay
Pharmacists are not only limited to dispensing advice on medications for obesity but to also facilitate a healthier lifestyle. This could be done through collaboration with other healthcare professionals in the community (Goodson, 2009). A multidisciplinary approach to health has been suggested to be effective in promoting positive health outcomes of service users (Zhou et al., 2014). As discussed in this essay, pharmacists can facilitate the access of service users to activities and programmes designed to prevent obesity amongst members in the community. Finally, pharmacists have integral roles in health promotion and are not limited to dispensing medications or provide counselling on pharmacologic therapies. Their roles have expanded to include providing patients with holistic interventions and facilitating uptake of health and social care services designed to manage and prevent obesity in socio-economically deprived individuals.Models of Health for Obesity Intervention Essay
In conclusion, pharmacists can use the different health promotion models to address obesity amongst individuals with lower socioeconomic status. The use of these models will help pharmacists provide holistic interventions to this group and address their individual needs. The different health promotion models discussed in this essay shows that it is crucial to allow service users gain self-efficacy. This will empower them to take positive actions regarding their health. Finally, it is suggested that a multi-faceted, community based intervention will likely lead to a successful campaign against obesity.Models of Health for Obesity Intervention 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).
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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.Models of Health for Obesity Intervention Essay
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. 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).Models of Health for Obesity Intervention Essay
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).
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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 95th percentile (Grundy 2004, p.557).Models of Health for Obesity Intervention Essay
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). These global statistics indicate that obesity is ha no physical boundary and what happens in one country can happen in another country.Models of Health for Obesity Intervention Essay
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).
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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).Models of Health for Obesity Intervention Essay
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.Models of Health for Obesity Intervention Essay
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.Models of Health for Obesity Intervention Essay
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.
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)
5th– 85th percentile BMI is taken normal, 85th to 95th percentile BMI is at risk of obesity, and more than 95th 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).Models of Health for Obesity Intervention Essay
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)Models of Health for Obesity Intervention Essay
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. 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).Models of Health for Obesity Intervention Essay
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).Models of Health for Obesity Intervention Essay
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 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.Models of Health for Obesity Intervention Essay
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).
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:Models of Health for Obesity Intervention Essay
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,Models of Health for Obesity Intervention Essay
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).
Governments’ interventions
According to the recent research findings, protein-energy malnutrition and obesity interrelate among many populations in global villages especially families in Africa, Asia, Middle East and Latin America (WHO 2002, p.54).Models of Health for Obesity Intervention Essay
The new evidence show that nutrition deprivation in early childhood and even in pregnancy results in much more chances of getting obesity in children and adulthood, since the child and the unborn baby is susceptible to the selective deposition of abdominal fat, “with all its enhanced morbid effects, when weight gain subsequently occurs” (James 2002, p.32).
It is a common knowledge that malnutrition is basically common among the low socio-economic group of people, clear evidence that obesity has not spared even the poor. In fact, obesity in women is mainly linked to the low nutrition transition phase common in developing countries (Leddy 2006, p.59).
As stated earlier, the availability of cheapest food stuff which is high in fat and sugar, and weight-inducing especially in urban settings, and the poor access to more nutritious staple foods composed of vegetables and fruits are the major cause of obesity (Walford & Ha 2004, p.54).Models of Health for Obesity Intervention Essay
Furthermore, many universal approaches to eliminating malnutrition among the disadvantage groups in the society have also been associated with obesity prevalence among the members of these communities, as the focus on the provision of substantial meal and hospitality may not conform to the dietary requirements of these individuals hence the possibility of weight gain, obesity, and even diabetes (Stevens, Raferty & Mant 2004, p.646; Baranowski et al. 2003). It is therefore prudent to conclude that policies that are focused towards eliminating or reducing obesity should be inclined towards nutrition problems.Models of Health for Obesity Intervention Essay
The UK Government has also tried to establish some of the strategies that would guide the management of obesity through the population based approach. This follows the establishment of the A new Direction for Hunter New England Health Service Strategy Plan Towards 2010 (House of Commons Health Committee, 2004, p.78).
The plan gives the strategic guideline on the area’s population corporate vision, objective as well as strategic initiatives up to between 5 and 10 years (p.95). This plan outlines specific details targeting a particular group of population that would ensure their continual access to high quality health services responsive to guide the consumption of health products.Models of Health for Obesity Intervention Essay
According to the plan, the framework to support the identified adults manage obesity is to ensure the objective of improved health and well- being for all, thereby doing the evaluation with the use of percentage factor of the number of people who have adopted the healthy eating and exercise habit.
Just as has been highlighted, population based approaches are commonly used but the limitations and their ineffectiveness have been worrying many scholars and the authorities alike (Seidell et al. 2001, p. 912; Barlow 2002, p.55).Models of Health for Obesity Intervention Essay
According to Hillsdon et al. (2004, p.11), targeting individuals through balanced diet educational initiatives or even more physical activities is “either naïve, or in keeping with the western food industrial drive to dissemble while continuing to amplify sales, using tactics that remarkably parallel those employed by the tobacco industry.”
The fact that the pre-school and school- going children in England are targeted by the commercial brands in an attempt to popularize their brands among this group is a clear indictor that things are yet to change, since it is what increases the poor eating habits among the students.
Pender, Murdaugh & Parsons (2006, p.657) state, “schools and parents are now the focus of marketing schemes, including those touting increased portion sizes, to enhance inappropriate purchase and consumption. The intense lobbying coupled with heavy political and financial support by industry ensures the maintenance minimum restriction on “free trade” and marketing” (Seedhouse 1997, p. 912; Pate et al. 1995, p.76)Models of Health for Obesity Intervention Essay
In essence, many of the population- based programs to control obesity have been quite successful in many aspects of behavioral changes and the establishment of good health habit among the child and adolescent population in UK. However, it has not been effective in lowering the BMI as widely expected, a critical aspect in the control of obesity among the population (Bartholomew et al. 2006, p.42).
According to Guo et al (1994, p.143) the success and sustainability of the population- based program in schools depends on the ability of the implementers to involve the whole community stakeholders, and the ability of the implementers to grasp the some fundamental cultural practices.
Several studies have intimated that modification of environment into a healthy desirable factor is one step for the management of obesity and its consequential diseases. Some of the modifications are based on improved fast food, media control and increased involvement of the community (Green & Kreuter 1999, p.10).Models of Health for Obesity Intervention Essay
However, the challenge is greater since majority of people in the UK have no basic knowledge on the mechanism for controlling obesity Green & Kreuter 1999, p.785; Garrow & Summerbell 2000, p.1843. This has led to drastic response from various governments and regional bodies, who have designed various charters in the UK to manage and control on environmental factors (Chenoweth 2007, p.996; Edelman & Mandle 2006, p.61).
European charter on Environment and health
“The World Health Organization (WHO) strategy for health for all in Europe, the report of the world Commission on Environment and Development and the related Environmental Perspective to the Year 2000 and beyond (resolution 42/187 and 42/186 of the United Nations General Assembly) and World Health Assembly resolution WHA42.26 resolved among other things;
that it recognizes the dependence of human health on a wide range of crucial environmental factors,
that they consider the international character of many environmental and health issues and the interdependence of nations and individuals in these matters,
that taking into consideration the account existing international instruments (such as agreements on protection of the ozone layer) and other initiatives relating to the environment and health (WHO 2002, p.50)
These issues have been adopted by the UK government together with regional bodies in resolving the respective environmental issues. One such body is the European Union government.Models of Health for Obesity Intervention Essay
According to European charter, “every individual is the entitled to, among other things; an environment conducive to the highest attainable level of health and well being, and that all sections of society are responsible for protecting the environment and health as an intersectoral matter involving many disciplines; their respective duties should be clarified” (Sim & Mackie 2009, p.979).
With the increased cost of obesity in terms of healthcare cost and workforce redundancy, the countries in Europe UK in particular have state-based social systems to strengthen their social system to safeguard the health of the future generation (O’Donnell 2002, p.14; Cottrell, Girvan & McKenzie 2008, p. 99).Models of Health for Obesity Intervention Essay
Recommendations
World Health Organization proposed a broad strategy to combat health and diet related complications are widely considered the best approach that should be adopted by the governments of the world (WHO 2002, P.64). The WHO suggests a life-course approach that focuses on the development of obesity resistant generation from fetus to old age (Department of Health 2003, p. 71).Models of Health for Obesity Intervention Essay
The best approach to counter the barriers posed by large multinationals and corporations that criticize the World Health Organization is to establish government policies and regulations that will see changes in advertisements and marketing, especially the ones targeting children in the United Kingdom (Murray, Zentner & Yakimo 2009, p.54).
Additional regulations should be put on trade, financial, social, agriculture, urban panning, and traffic policies (Cheung 2007, p.657; Kurscheid & Lauterbach 1998, p.1321). Such protective measures have been observed in Norway and Finland, a method that has prompted dramatic improvement in national cardiovascular mortality rates in the two countries (Sim & Mackie 2009, p.980; Foster 2004, p.183).Models of Health for Obesity Intervention Essay
In essence, a population based approach will be more realistic if it targets the specific section of the population e.g. children, marginalized groups, elderly, disabled, etc, with proper objectives and measurable parameters for measuring results (Sim & Mackie 2009, p.980).
Such initiatives would involve across the board opening of reliable health centers, establishing appropriate UK’s school playing grounds, adequate road systems and networks that accommodate cycling and walking, promoting physical activities and breastfeeding, and reviewing the taxation policies on these food products (Green & Lewis 1986, p. 45; Garrow & Summerbell 2000, p.66).
The five life-course strategy that involve the monitoring obesity prevalence from fetus-infants-adolescents-adults-old age should be given priority, by the measurements of both children and the patients body mass indices, promoting infants and children feeding policies (Scand 2008, p.456; Edelman & Mandle 2006, p.77; Naidoo & Wills 2000, p.34) Models of Health for Obesity Intervention Essay
