In the United States there are over seventy million adults that are considered obese. Conditions that can be related to obesity include but are not limited to diabetes, stroke, and heart disease. On an annual basis, the medical costs of obesity are over one hundred billion dollars with each individual costing fifteen hundred dollars more than those who are of a normal weight. Obesity is not only serious and costly it has become common Center for Disease Control and Prevention (CDC, 2015). Obesity affects groups as follows: Non-Hispanic blacks have the highest rates of obesity (47.8%) followed by Hispanics (42.5%), non-Hispanic whites (32.6%), and non-Hispanic Asians (10.8%). Obesity is also higher among middle age adults who are 40-59 years old (39.5%) than among younger adults, age 20-39 (30.3%) or adults over 60 or above (35.4%) adults (CDC, 2015). Non-Hispanic black and Mexican-American men with higher incomes are more likely to have obesity than those with low income. Higher-income women are less likely to have obesity than low-income women and there is no significant relationship between obesity and education among men. Among women, however, those with college degrees are less likely to have obesity compared with less educated women (CDC, 2015).
The nation, as a whole tends to eat well, exercise, and seek healthier lifestyles. Obese individuals are typically ridiculed and mocked regardless of the fact that it is simply insensitive and unjustified to do so. According to Kavic (2001), when addressing obesity, Americans should focus on the health consequences of individuals and for society as a whole. Obese individuals do not only suffer health consequences but are less likely to obtain employment—-and suffer from an increased risk of mortality.
There are many causes of obesity. First is a lack of energy in opposition to a balance of food intake. Many individuals may take-in too many calories, and fail to exercise or burn calories off. It is important to balance intake of food and beverages, while outputting energy by exercising. The National Institute of Health (2012) best describes intake and output as follows:
- The same amount of energy IN (food and beverage) and energy OUT (exercise) = weight stays the same
- More food intake than output over time = weight gain
- More output than intake over time = weight loss
Likewise, obesity will happen over time when an individual takes in more calories than they use. An inactive lifestyle also induces obesity.
Sadly, due to technology Americans aren’t as physically active as they used to be. Reasons for not being active include but are not limited to relying on cars instead of walking. There are fewer physical demands at work or home due to technology and conveniences, and as well as a fewer physical education courses, in schools (NIH, 2012).
The American environment in some populations do not encourage healthy lifestyle or habits as there are no safe places for recreation. There are lack of sidewalks, parks, trails, and affordable gym memberships. Many individuals work long hours and are unable to exercise due to the hours and long commutes. The American food portions have become oversized. There are overabundance of fast food restaurants with little health outcomes. Furthermore, access to healthy foods is limited. Some individuals live in neighborhoods that do not have grocery markets that sell healthy foods. Also, healthy foods can be costly for working class individuals (NIH, 2012).
Adaptive behavior is not the only reason individuals are obese. Studies have shown that genetics play a role in obesity, and tends to run in families. Chances of being obese are higher if an individual’s parents are obese. Furthermore, an individual’s genetic makeup may affect the amount of fat one’s body stores, and where the extra fat is carried. Health conditions are also the leading cause of obesity. Some individuals may suffer from hormone problems that can cause obesity or take medications that attribute to weight gain (NIH, 2012).
Public Health Vision and Outcome Goals
The issue of obesity has been not only tasking seriously but fiscally. It costs about $190 million a year in obesity-related medical expenses, American Heart Association (AHA). Facts from National Health and Nutrition Examination Survey (NHNE) 2009-2010 (Flegal, 2012) include the following:
- More than 2 in 3 adults are considered to be overweight or obese.
- More than 1 in 3 adults are considered to be obese.
- More than 1 in 20 adults are considered extreme obesity.
- About one third of children and adolescents aged 6 to 19 are considered to be obese.
Vision for public health is to reduce the mortality and morbidity rates of United States (US) population, by lowering the obesity rate. The rate of obesity has more than doubled, since 1980 from 15% to 39% currently– according to the CDC. The increased in obesity is multi-factorial–including access to healthy foods, social and economic status and culture. The attempt to decrease obesity to 20% by year 2018, 50% by 2025, and by 2030 will be questionable. This is due to the current public health provisions to reduce the scopes of obesity.
The outcomes envisioned include:
- Education of the general population about obesity.
- Additional teaching attempts and enlighten in schools and public health places.
- Improve government funded programs by offering healthier food options in Women, Infants, and Children (WIC) and food stamps.
- Expand access to healthy food options by providing grocery stores in underserved communities.
- Expand healthy incentives through insurance companies.
- More access to physical activities and at affordable rates— i.e. gyms at work, residential communities, etc
Barriers and Facilitators of Change
The barriers to decreasing obesity can be culture related. Many cultures eat high fat foods and carbohydrates, as a way of life. In the US, African American females are 78% overweight or obese compared to Caucasians at 29% (LA times, 2007). Access to healthy foods is another barrier to obesity. In 1963, Los Angeles inner city had 34 full-service supermarkets. By 1991, it dropped to 14. In 2002 there were only 5 full-service supermarkets (LA times, 2007). Secondary to the decline in supermarkets were limited transportation, as a barrier. An in those areas, if a family do not own or have access to a car, may not have access to supermarkets that sell healthy foods (LA times, 2007). In organizational barrier, there was the issue of zoning laws and tax incentive programs to encourage opening health supermarkets, in poor neighborhoods. Thus, better funding for schools are also critical– so they can provide healthier food choices to the children in school.
Foster Change Process
Using systems approach could foster the change process in obesity. Public health organizations can utilize system science, as a way of addressing health issues. Looking at the whole system would allow for more extensive review of obesity. It will further review the root causes of obesity. The system approach could potentially improve health initiatives while ensuring positive outcomes (Skinner & Foster, 2013). As identified in Skinner & Foster (2013), current approaches to obesity and fostering change process have led to limited outcomes. This also requires the use of system approach that has been beneficial to many other health practices. Using an effective approach to foster the change process could reduce the widespread of the disease.
The implementation of community health initiatives can be the start of fostering the change process. Effective programs can be utilized that provide the community with health care delivery changes. These programs can improve the treatment of obesity.
The systems may create long term program, designed to combat obesity. Additionally, equipping the program with team members that create activities, projects, and fundraisers to increase community awareness of the issue can also help to strengthen this long term strategy. The program should also utilize its position to compile data and to help improve the programs initiatives while increasing community participation (Okihiro et al, 2013). Creating community initiatives can help to improve the overall awareness of the community in combating obesity. It can also help to change the lifestyles of those in the communities.
Another method for fostering the change process would be to utilize current technologies and to better provide individuals with information regarding diet and weight loss plans. Obesity is an issue that is impacting individuals as young as children, however providing adolescents with information in regards to a healthier diet and lifestyle can help to not only improve their lifestyle but also create a permanent lifestyle change within these individuals. The current access to the internet by all generations provides a unique approach in providing information and tools needed to live a healthier lifestyle. By utilizing social networking technologies, and other mass communication technologies, health programs can be distributed to individuals via web access, (Napolitano, Hayes, Bennett, Ives & Foster, 2013).
Creative tension is the gap between the reality of an issue and the goal. In regards to obesity initiatives, the gap between the reality and the goal has created some real challenges for public health professionals and communities alike. The “creative tension” is currently at a state where it is apparent, i.e. obesity is a major health risk. However, there are number of current practices and factors, which go against initiatives in reducing obesity. Current school lunch standards provide children with poor nutrition and provide little to no health alternatives. Additionally, current physical education in some schools is far below what is considered the national-recommended intensity and duration of PE class (Kahan & McKenzie, 2015). The interaction and exercise of children during physical education class helps to control obesity. There are substantial gaps in fighting obesity, as a public health concern. There are many budgetary factors, genetic factors, and socioeconomic factors that also influence obesity.
A number of tensions have arisen from these gaps, such as the volume reduction in sugary drinks sold in New York City. The first lady, Michelle Obama has created public health awareness called, “Let’s Move” — to help spread consciousness of childhood obesity and open up dialogue. Additionally, the first lady spearheaded the campaign to create the Healthy
Hunger-Free Kids Act (HHFKA), which aims to hold the United States Department of Agriculture’s (USDA) nutritional standards of school meals to a much higher standard. These efforts helped to decrease childhood obesity while improving the overall quality of school lunches (USDA, 2014). These initiatives reduced obesity rates at the national health goals that were set. The current level of obesity remains the discussion of unknown. There are still many other issues to overcome obesity. Current health goals should provide better approach to tackling obesity disorder.
Ethical Implication of Public Health Model
Public health model, as a holistic approach to health focus on the whole population rather than individuals. This is an ideal method in combating obesity. There are several public health models addressing public health concerns. When confronting issues of public health, it is necessary to follow ethical principles.
In the public health sector, there have been growing concerns regarding health care autonomy and equality, and how to effectively deal with the normative and descriptive issues of autonomy and equality in promoting population health (Munthe, 2008). Munthe (2008) further states that the issues of freedom and equality are resolved by implementing a multidimensional model to population health. Guttmann and Salmon (2004), emphasizes public health need that considers ethical issues. Ethical issues are important in applying public health strategies. It is imperative to note how wrong data could have a huge impact on the ethical distribution of information, thereby widen the gap in the healthcare disparity. Therefore, public health models must be designed to improve public health, yet follow a framework of ethical principles and data delivery that address both normative and descriptive concerns.
In addressing obesity, the healthcare model that maybe suited to guide obesity reduction is the Ecological Model of Health Behavior (EM-HB). Ecological models of health behavior emphasize the environmental and policy contexts of behavior, while incorporating social and psychological influences. Ecological models lead to the explicit consideration of multiple levels of influence, thereby guiding the development of more comprehensive interventions. According to Sallis, Owen, and Fisher (2008), there are four fundamental principles of the EM-HB. They are a multi-level approach to behaviors. Additionally, the model is a behavior-specific, most effective in changing and influencing behaviors across all levels. Indeed, one study limitation of this model is the communication barrier to inform target population, which may not result in behavior changes (i.e. For example, will the initiatives be implemented fairly across the target population?) Additional research limitation of the model is ensuring the accuracy of data in the report, and the methods of obtaining data. Proper legal procedures should be maintained when minor children are involved in initiatives relating to the model.
It is also important to use normative and descriptive principles to formulate needed action in reaching the desired outcome. The information within this public health model must be validated by evidence-based research. Munthe (2008), stressed the important of autonomy, therefore; an ethical approach to outcome initiatives addressing obesity must allow for rights of individual to make personal choices.
Leadership Challenges
Additional ambiguity on the leadership challenges of implementing effective reduction approach to obesity can be seen by in population reach. Public health initiatives in obesity preventive measure have relied on the use of population reach as an exclusive metrics for intervention (Mc Tigue, Harris, Hemphill, Lux & al, 2003). Even though other federal and state initiatives in obesity prevention have suggested the use of evidence-based community strategies, uncertainty occurs since less in known about the outcomes of the strategies. In respond to such limitation and ambiguity, Robles et al. (2014), suggested the substantial challenges that are posed by funding agencies and other program initiators, tasked with setting metrics model for selecting interventional approach for a city or local community.
Conclusion
One of the roles of public health professions and organizations in reducing obesity epidemic is to educate the population of the risks and co-morbid conditions that occur, and provide resources, such as access to healthy food options— to decrease the overall obesity population. Expand research and access to government-funded food assistance programs that offer incentives for healthy eating; and mandating health insurance companies to cover healthy physical exams.
References
Adult Obesity Facts. (2015) Retrieved December 22, 2015 from www.cdc.gov
American heart association Understanding the American Obesity Epidemic retrieved www.heart.org/HEARTORG/gettinghealthy/weightmanagement/obesity/understanding-the-american-obesity-epidemic
Caprio,Sonia MD; Daniels,S, MD,PhD; Drewnowski,A. PhD; Kaufman,F, MD; Palinkas, PhD; Rosenbloom,A, MD; Schwimmer,Jeffrey MD (2008) Influence of Race, Ethnicity, and culture on childhood obesity: Implications for prevention and treatment published American Diabetes Association
CDC. (n.d.). The Power of Prevention. Retrieved from http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf
Cheadle, A., Schwartz, P.M., Rauzon, S., Beery, W. L., Gee, S., Solomon, L. (2010).The Kaiser Permanente Community Health Initiative: overview and evaluation design. American Journal of Public Health, 100(11):2111- 2113.
Flegal,KM; Carroll,MD; Kit,BK and Ogden,CL. (2012) Prevelence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. Journal of the American Medical Association 307:(5):491-97
Finkelstein, E. A., Ruhm, C. J., & Kosa, K. M. (2005). ECONOMIC CAUSES AND CONSEQUENCES OF OBESITY. Annual Review of Public Health, 26, 239-57. Retrieved from http://search.proquest.com/docview/235224548?accountid=14872
Healthcare Georgia Foundation (2014). The Logic behind Logic Models: A Brief Guide
Guttman N Solman C T 2004 Guilt, Fear, Stigma and Knowledge Gap: Ethics issues in Public Health Communication Intervention [Abstract].Guttmann, N., & Solman, C. T. (2004). Guilt, Fear, Stigma and Knowledge Gap: Ethics issues in Public Health Communication Intervention [Abstract]. Bioethics, 18(6), 531-552. 201601192158061623952031
Kahan, D., & McKenzie, T. L. (2015). The Potential and Reality of Physical Education in Controlling Overweight and Obesity. American Journal Of Public Health, 105(4), 653-659 7p. doi:10.2105/AJPH.2014.302355
Kavic, Michael. (2001). Obesity – An “Acceptable” Prejudice. Journal of the Society of Laparoendoscopic Surgeons. 5(3): 201-202. Retrieved from: http://www.ncbi.nlm.nih.gov
LA Times Culture matters in the obesity debate retrieved www.latimes.com/la-op-dustup21sep21-story.htnl
Mc Tigue, K. M., Harris, R., Hemphill, B., Lux, L., & al, e. (2003). Screening and interventions for obesity in adults: Summary of the evidence for the U.S. preventive services task force. Annals of Internal Medicine, 139(11), 933-49. Retrieved from http://search.proquest.com/docview/222235244?accountid=14872
Munthe C 2008 Public Health Ethics: the Goal of Public Health an Integrated, multidimemsional Model.Munthe, C. (2008). Public Health Ethics: the Goal of Public Health an Integrated, multidimensional Model. Oxford Journal, 1(1), 39-52.
Napolitano, M. A., Hayes, S., Bennett, G. G., Ives, A. K., & Foster, G. D. (2013). Using Facebook and text messaging to deliver a weight loss program to college students. Obesity (Silver Spring, Md.), 21(1), 25-31. doi:10.1002/oby.20232
National Health Institute. (2001). What Causes Overweight and Obesity. Retrieved from: http://www.nhlbi.nih.gov.20160119211410957317114
Okihiro, May,M.D., M.S., Pillen, M., PhD., Ancog, C., M.D., Inda, C., R.D., & Sehgal, Vija,M.D., PhD. (2013). Implementing the obesity care model at a community health center in hawaii to address childhood obesity. Journal of Health Care for the Poor and Underserved, 24, 1-11. Retrieved from http://search.proquest.com/docview/1382342927?accountid=14872
Robles, B., M.P.H., Kuo, Tony,M.D., M.S.H.S., Leighs, M., M.P.P., Wang, M. C., DrP.H., & Simon, Paul,M.D., M.P.H. (2014). Using population reach as a proxy metric for intervention impact to prioritize selection of obesity prevention strategies in Los Angeles County, 2010-2012. American Journal of Public Health, 104(7), e14-9. Retrieved from http://search.proquest.com/docview/1545530684?accountid=14872
Sallis J F Owen N Fisher E B 2008 Health Behavior and Health EducationSallis, J. F., Owen, N., & Fisher, E. B. (2008). Ecological Models of Health Behavior. In Health Behavior and Health Education (4 ed. pp. 466-468). San Francisco, CA: Jossey -Bass. 201601220111431004448295
Skinner, A. C., & Foster, E. M. (2013). Systems Science and Childhood Obesity: A Systematic Review and New Directions. Journal of Obesity, 2013, 129193. http://doi.org/10.1155/2013/129193
USDA (2014, March 3). School Meals. Retrieved January 18, 2016, from http://www.fns.usda.gov/school-meals/healthy-hunger-free-kids-act
