Abstract
The growing
obesity epidemic is becoming a global issue, contributing to numerous health
concerns and is associated with a short lifespan. It is estimated that over 50%
of the public in developed countries will be obese by the year 2050 (McPherson,
Marsh, & Brown, 2007). Despite the growing body of evidence procured by
in-depth research on the impacts of obesity, the rates continue to skyrocket,
leading to a need for a different approach in order to address the unique
issues with a changing population, as the current tactics do not appear to be
effective. The nursing community is essential in bridging the gap between clients
and their health, thus training and techniques would be the most effective at
the nursing level, which the following paper will address, including associated
health problems, treatment, and the various factors that contribute to obesity.
What
is obesity?
The definition of obesity has
changed over the years, and now includes different categories, ranging from
obese to super-super obese, with body mass indexes (BMI) ranging from 40 to 60
(Leykin et al., 2006). As a reference, for an individual to be considered in
the “healthy” range, their BMI is under 25. There are many factors that
contribute to obtaining the BMI used in determining the level of obesity,
including gender, age, height, and weight of the individual. Additionally,
obesity can be determined by taking waist measurements, with a circumference
over 35 inches (88 cm) for women, and 40 inches (102 cm) for men, as an indication
of possible obesity-related issues being present (Alpert, 2009). However, it is
important to note that some body types may fall within the “obese” range as
defined by the two aforementioned measurements, but are not classified as obese
due to lean muscle mass and body fat percentage (Romero-Corral et al., 2008). In
general terms, obesity is an overabundance of fatty, or adipose tissue, caused
by a positive energy balance, or an intake of energy (in the form of calories
from food) that is in excess of what the body needs to sustain life and support
activity level (Lake, 2011).
Obesity once had a useful purpose,
when food was scarce and the energy reserves found in stored body fat could
provide sustained nourishment during the times of famine (Haslam, 2007). A
robust and full figure was signs of wealth, indicating that there was an
abundance of food. However, times have changed and food is more than plentiful,
with a wide range of options, including a growing number of poor nutrient
choices. We no longer face uncertainty regarding access, thus humans are in
essence fighting against evolutionary instincts, further hampering the pursuit
of health (Haslam, 2007).
Health
implications of obesity
While the aesthetic aspect of
obesity is easy to see, there are many health issues that are associated with
obesity, which are not as readily observed, including cardiovascular disease,
diabetes, cancer, and stroke (El-Sayed, Scarborough, & Galea, 2012).
Serving as a contributing factor in a depression and a decreased life
expectancy, the obesity epidemic is one that deserves more attention and
research in finding a more appropriate approach. Obesity is not as simple as an
excess amount of body fat, as the distribution of said adipose tissue can
influence the associated health implications. For instance, an accumulation of
abdominal fat (android obesity pattern) is associated with hypertension and
glucose dysregulation (National Task Force on the Prevention and Treatment of
Obesity, 2000), whereas body fat around the hips and thighs (gynoid obesity
pattern) is not associated with a high incidence of neither cardiovascular
impairment nor myocardial infarctions (Wiklund et al., 2010).
In addition to the differences
between locations of excess adipose tissue, researchers have also identified
differences between males and females in the development of health problems
that are associated with obesity. While obesity itself may not be a direct
cause of the differences observed between the genders, it is a contributing
factor to quality of life issues, socioeconomic class, and even the ability to
earn an income. Researchers have found that overweight females are less likely
to obtain employment as compared to overweight males (Cawley, 2004), thus
affecting the quality of life.
Contributing
factors to obesity
As the abundance of food has
essentially rendered the storage of excess body fat on the human body
unnecessary, societal factors have contributed to the accessibility of
unhealthy choices, which combined with a more sedentary lifestyle, have led to
the growing obesity epidemic. While a small amount of obesity can be attributed
to genetic causes (less than 1/3 of all reported cases), there are other
factors that are within the control of an individual, and addressing such
issues will engage obese clients in an active role in their health (Jebb,
2004).
Since the 1980s,
the rates of the various categories of obesity have steadily risen, and with
it, the incidents of obesity-related health problems such as diabetes, cancer,
and sleep apnea, have presented more often in hospitals and health care
facilities (Finkelstein, Ruhm, & Kosa, 2005).
The primary
contributing factors involve a surplus of energy (in the form of calories from
food), and a lack of physical activity. The food choices that are present in society
are quite different from those offered a generation ago, with the sizes,
ingredients, and availability increasing on a regular basis.
Several studies have suggested that
an increase in physical activity, in conjunction with a healthier diet is the
best combination in winning the battle over obesity. The sedentary lifestyle,
including the amount of time spent watching television, contribute to the
accumulation of additional adipose tissue, with a positive correlation existing
between the number of hours spent watching television and impaired glucose
metabolism, a key indicator in obesity-related diabetes (Hansen et al., 2012).
In addition to insulin resistance diabetes, increased sedentary time is also
associated with lower high-density lipoprotein cholesterol (the good kind), and
a greater waist circumference (Cooper et al., 2012), which has been linked to
an increase in cardiovascular disease.
A variable that is not associated
with physical activity, yet has an influence on the incidence of obesity pertains
to the socioeconomic levels of individuals. Lower socioeconomic positions
within a population are often associated with a poor health, depression, and
obesity, with those in the lower socioeconomic position reporting a higher
likelihood of obesity (Sobal & Stunkard, 1989). The disparity between the
upper and lower socioeconomic positions influence the resources and food
available for a particular group. Those in the lower part of the scale able to
afford lower-quality diets, when compared to those found in the upper part of
the scale that are able to benefit from being able to afford healthier food
choices and a more dynamic marketplace (Hawkes, 2006). However, research that
is more recent has lessened the previous association between socioeconomic levels
and obesity, and points more towards a social phenomenon rather than an
income-based occurrence, focusing on the economic growth, modernization of
technology, and the globalization of the food industry (McLaren, 2007).
The
level of education one obtains is yet another variable that influences the
occurrence of obesity, with low education being associated with a higher risk
for obesity and obesity-related diseases (Lawlor et al., 2005). On a familial
level, a head-of-household member was associated with a higher weight (Rona
& Morris, 1982), as was access to a car (Riva, Curtis, Gauvin, & Fagg,
2009), receiving government aid, and living in rental housing (Wardle, Waller,
& Jarvis, 2002). Other studies have
found a link between adolescent obesity and the likelihood of attending college
(Crosnoe, 2007). However, it is important to note that the educational
disparity was not even among the genders, as it was more indicative in females
when compared to obese males of the same age category.
Health
promotion strategies
The
variety of variables contributes to the need of a precise and targeted approach
to intervention methods in the health care industry. One recent study used
20-minute interventions with obese clients, conducted over 11 sessions over a
period of 2.5 years (Vermunt et al., 2012). However, the results were not
favorable, indicating a need to specialize the training involved for the health
professionals, in addition to tailoring the message for the intended
population. Early intervention, prior to the onset of obesity appears to be an
important aspect in the educational process, however, the approach is essential
in the reception of information being presented.
When
it comes to obesity intervention, health care professionals are called upon to
monitor the ethical implications that could be associated with intervening,
which is rather unique to the topic, as opposed to offering education on the
topics of cancer or prenatal smoking. When approaching high-risk groups for
obesity education and intervention, it is essential to refrain from further
stigmatization of the condition, as the individuals are already aware of the
social stigmatization that occurs within society (Holm, 2007). Striking the
delicate balance between providing effective information and it reaching the
intended audience is essential in addressing obesity. Ultimately, the decision
is up to the individual, but through effective and individualized intervention
methods, the choice may be easier to make.
Instilling
the sense of responsibility for their choice can help clients to feel more
empowered, increasing their level of self-efficacy, which has been linked to a
positive outcome and improved self-esteem (Mitchell & Stuart, 1984).
Self-efficacy, a theory attributed to the psychologist Albert Bandura, is in
essence the belief that a client has in their ability to be successful.
However, it is important to remember that clients may not be ready to make the
change, as their lifestyle habits may provide a sense of well-being, serving as
a comfort and substitution for other things that may be lacking or insufficient
in their lives (Holm, 2007). The addition of a counselor or psychologist in the
healthcare treatment team may be useful when asking clients to make drastic
life changes.
Regardless
of intervention technique, a few aspects remain constant as predictors of
success. The incidence of childhood obesity, which has more than tripled in the
past 30 years (McTernan & Meiri, 2011), benefits greatly from early-life
intervention methods, as it provides tools to both the child and their family
members. A focus on healthy options, alternatives to previous comfort foods,
smaller portions, and reducing the number of sugar-sweetened soft drinks are
some key areas for addressing childhood obesity (Osei-Assibey et al., 2012).
Another
determining factor in the success rate of obesity interventions is the length
of program used, with shorter (less than 6 months in duration), being linked to
a higher rate of failure, as compared to longer programs (Sharma, 2007).
Worksite health interventions provide a potentially long-term exposure to healthy
messages, food choices, and physical activity incentives. Some companies
incorporate healthy habits into their core values, and offer discounted or even
free gym memberships to their employees (Williams et al., 2007). Sites that
offer such health-focused opportunities see a reduction in sick days and
medical costs, thus providing a win-win situation.
For
a more healthcare or nursing environment, there are several options to choose
from when it comes to obesity interventions, which is important, as individuals
vary. One study effectively used the Cycle of Change, first introduced by
Prochaska and DiClemente in 1984, which assesses the stage of willingness to
change (Perkins, Wall, Jones, & Simnett, 1999). Doctors used the six stages
to evaluate their own process of incorporating health promotion and change in
behavior. The six stages include unmotivated (stage 1), undecided (stage 2),
motivated (stage 3), action (stage 4), relapse and/or maintenance (stage 5),
and the final stage, exit, when change is achieved. The approach in each stage
is different, thus the Cycle of Change is instrumental in personalizing the
intervention method used with clients.
Occupational
health nurses may play an important role when working with obese professionals
to make lifestyle changes. A recent study of overweight train drivers provided
insight into the way food choices and a sedentary job have combined, resulting
in an increase rate of obesity (MacGregor, 2009). Occupational health nurses
can bring education to the workplace, offer suggestions on healthier choices,
and have the clients set their own goals, pointing them on their way to health.
Conclusion
The obesity epidemic is costly, not
only in the economic impact on the health care industry, but also a more
valuable resource, the health of society. Technology continues to improve,
which often brings a sedentary lifestyle and an influx of new, cheap, and
unhealthy food choices. The addition of sugary drinks spiked with high fructose
corn syrup provides empty calories, contributing to the obesity-related health
problems. Early education is imperative to stave off the increasing obesity
epidemic.
**References available upon request**
