The Epidemiology of Obesity: An American Epidemic

Obesity continues to be a growing epidemic in America. According to the Center for Disease Control (CDC), one in three adults are considered obese, (2015). Obesity is associated with numerous risks to physical, mental, and emotional health. Those suffering from obesity are susceptible to depression, diabetes, and even cancer. It reflects social constructs such as socioeconomic status, isolation, and discrimination. “Being extremely obese means you are especially likely to have health problems related to your weight”, (Mayo Clinic, 2015). As a result, obesity remains a significant issue within the healthcare field to be addressed. This includes understanding the various dimensions of obesity such as its definition and presence in society. By reviewing current methods, diagnosis, cost, and characteristics of obesity, heath care agents can implement a plan of action to promote change.

Overview

Obesity is most commonly defined as an “access of body fat”, (US Surgeon General, 2010). This is when weight is above normal relative to height and age. More specifically it is defined as, “weight that is higher than what is considered as healthy”, (CDC, 2015). When one’s weight becomes a contributing factor for poor health, the individual is considered overweight or obese. As a result, health is strongly associated with obesity. Obesity is recognized by the Surgeon General as an epidemic in American society. This is because 35% of adults and 17% of children are obese, (CDC, 2015). However, the rates of obesity continue to change from state to state. California is only one of seven states with obesity rates well below the national average. In this region, 24% of the general population is obese. (See Table 1).

There is a significant difference between being overweight and being obese. Alarmingly, 60% of Americans are overweight. When the percentage of body fat reaches a certain percentage, he or she is considered obese. Men must have a percentage of body fat greater than 25% and 33% in women. The World Health Organization (WHO) classifies overweight and obesity into 3 grades: overweight (BMI of 25-29 kg), obesity (BMI 30-39 kg), and morbid obesity (BMI 40kg +), (Hamdy, 2015). It is most often the result of limited exercise and poor nutrition.  In the medical field it is recognized as a comorbid condition. This means that obesity is a disease that has co-occurring disorders and implications. The list of comorbid conditions is long and extensive. Obesity has negative consequences which affects individual mental and physical health. So much so that is can significantly limit one’s quality of life and life longevity. Obesity is associated with poor social experiences such as discrimination, isolation, and stigma. It affects mental health such as depression and anxiety. Obese individuals have limited physical functioning and prone to medical conditions including the following: diabetes, mellitus, cardiovascular disease, arthritis, sleep disorders, hypertension, dyslipidemia, stroke, gallbladder disease, hyperuricemia, gout, osteoarthritis, cancer, and death, (CDC, 2015). (See Table 2).

Epidemiology

Aome people are more susceptible to obesity than others. These represent several disparities and inequalities found within American society. It relates to the “racial and ethnic socioeconomic and geographic disparities in obesity rates”, (CDPH, 2014). This is seen in California and mimicked throughout the nation. African Americans, specifically African American women are more likely to suffer from obesity than Latino and White adult females, (CDC, 2015). Disparities can also be found within the Hispanic population where 33% of Hispanic men are obese compared to 23% of White males, (CDPH, 2014). Other ethnicities with a predisposition to obesity include, Pima Indians of Arizona, American Pacific Islanders, Mexicans Americans and Puerto Ricans. However, race is not the only association to obesity. There are also disparities found within low income and high income households. Low income communities have limited access to healthy foods which are often found at higher cost. For this reason, those who are low income are more likely to be obese than those from higher incomes, (CDPH, 2012). Research found that, “low income persons who were assigned to live in higher income neighborhoods gained less weight over time and had a lower risk of diabetes than did low income persons who remained in predominately low income neighborhoods”, (Hamdy, 2015).  Obesity continues to impact other social factors including health and age. Those between the ages of 40 and 60 are more likely to be obese; they are also more likely to have negative outcomes, (Surgeon General Office, 2010). This includes death. Research indicates that 18% of individuals will die as a result of obesity, (Hamdy, 2015).

Obesity has a negative effect on society as observed in rising health care cost. It attributes to $150 to $200 billion in medical spending, (CDC, 2015). This is because those who are obese account for an additional $1,500 per person in cost compared to individuals of a healthy weight.  “California has the highest obesity-related costs in the United states, estimated at $15.2 billion with 41.5% of these costs financed through Medicare and Medi-Cal”, (CDPH, 2014, p.4). Obesity accounts for health related conditions, trips to the emergency room, and other hospital charges. This significantly impacts greater society. Individuals who are obese have limited mobility and physical functioning. Due to disability, mobility, stigma, and discrimination obese people are limited economically due to work and/or disability. “Obesity has linked with reduced worker productivity, chronic absence from work, and medical expenditures that total 73.1 billion per year for full time employees”, (CDPH, 2014, p.4).

Diagnosis

Obesity is diagnosed by calculating the BMI or Body to Mass Index ratio. The BMI calculation determines the level of obesity, health risks, and treatment, (Mayo Clinic, 2015). It does this by measuring excess fat stored in the body. This is calculated by dividing body weight in kilograms by height in meters squared, (US Surgeon General, 2010). Once the BMI is determined professionals can assess morbidity and mortality. Obesity is related to cardiovascular disease. Those with a BMI between 25 and 28 are likely to suffer from heart disease. Those with a BMI greater than 33 are at an increased risk of stroke and heart failure, (Hamdy, 2015).

BMI has become the national standard when diagnosing obesity. It is also used throughout reports to classify individuals and group populations as obese. Although it is used to measure the amount of fat stored, the BMI is applied to youth where the age and sex of the child must be considered. Along with this information and the BMI, professionals determine obesity using a percentile. However, when assessing obesity in children the BMI cannot be used as a sole factor for diagnosis. This is because BMI changes are significant during child growth and development. It causes BMI to be higher in younger people. For this reason the CDC implements a growth chart to provide further guidance for health care professionals. Researchers and scholars recognize that diagnosis through BMI works for some, and not all. This is because the BMI fails to consider background, such as obesity severity, onset, waist circumference, cardiorespiratory fitness, comorbidities, clinical assessment, and other markers. “It may overestimate body fat in athletes and others who have a muscular build. BMI also may underestimate body fat in older people and others who have lost muscle”, (National Institutes of Health, 2015).  Despite the setbacks, BMI is useful tool to determine obesity, especially when used with other diagnostic measures. It is free and easy to use by applying simple equations and comparisons.

Surveillance and Reporting

There are several national and state surveillance systems that monitor and report on obesity. It includes individuals from all regions and populations across the country. These include: the Behavioral Risk Factor Surveillance System (BRFSS), National Health and Nutrition Examination Survey (NHANES), Youth Risk Behavior Surveillance System (YRBS), National Health Interview Survey (NHIS), and the National Collaborative on Childhood Obesity Research (NCCOR), (CDC, 2015). These national surveillance systems are conducted regularly to observe the obesity trend and its effect on public health. It tracks obesity rates, but also examines obesity over time. This allows researchers and healthcare providers to compare and contrast obesity throughout demographics. States across the country uses these same surveillance systems to monitory obesity in their region. This can be seen in California where officials use the BRFSS system to examine obesity trends. The only surveillance system in use for Californians is the California Health Interview Survey (CHIS). This system, “provides adolescent obesity rates for youth ages 12 to 17”, (CDPH, 2014, p.8). BRFSS and CHIS are similar in data collection. Both BRFSS and CHIS conduct randomized telephone surveys. Survey participants self-report height and weight information. The only difference between BRFSS and CHIS is age. The California survey system only gathers information on obesity seen in adolescents and teens. In addition, the California Department of Publish Health (CDPH) has developed a system to evaluate surveillance and communicate data between the state and community partners. This helps healthcare services develop and implement assessments and evaluations of obesity for a plan of action.

Obesity and Practice

The Centers for Disease Control and the California Department of Public Health agree that obesity is a multidimensional problem. Obese individuals are affected by their location, ethnic background, socioeconomic status, mental health, and age. Due to the complexity of the problem, there is no single approach or solution. The CDC and CDPH plan of action to reduce obesity requires assistance from community partners, government agencies, changes in infrastructure to promote exercise, and making healthy foods affordable and accessible, (2015). These actions offer little help from the health care professions. The common denominators of obesity include “inactivity, unhealthy diets, and eating behaviors”, (CDPH, 2014, p.7). To implement action and make an effort to reduce obesity in this country, care providers must educate, educate, and educate. This means to educate about lifestyle changes, educate about risk factors, and educate about weight loss options.

To help reduce rates of obesity health professionals must educate patients on risk factors. The first step is to diagnose individuals as overweight, obese, or morbidly obese. “Patients who received a formal diagnosis of overweight/obese from a healthcare provider demonstrated a higher rate of dietary change and/or physical activity than did whose condition remained undiagnosed”, (Hamdy, 2015). This can be used as a scare tactic to promote change. By giving an analysis of comorbid disorders and risks, this may motivate individuals to improve their life expectancy. It can be especially helpful for families, parents, and children. Educating individuals and their families about mortality as it relates to obesity is especially significant. This includes the fact that “overweight and obesity were associated with nearly 1 and 5 deaths among adults”, (Hamdy, 2015). Along with other health consequences such as endometrial cancer, breast cancer, colon cancer, kidney cancer, gallbladder cancer, and liver cancer, there are other risk factors including stroke, heart disease, poor respiration, and fertility, (Hamdy, 2015). The reduced health and increased risks of sickness or death, individuals are likely to make lifestyle changes to extend their life for family and loved ones.

Healthcare professionals must also educate patients on the lifestyle changes required to lose weight and improve health. This includes making resources and information available to patients. Weather this is brochures providing information on physical activity and balanced nutrition, or encouraging patients to make an appointment with a nutritionist or dietitian. Many different things can be done to encourage physical activity and balanced diet. It is important to help patients and professionals understand that weight loss does not occur over night. It is a long and enduring process. Professionals do not take into account the environmental or social factors which stimulate obesity. For this reason, professionals should practice patience and understanding when helping individuals make positive choices to promote good health. Encouraging individuals to drink water instead of soda and sugary drinks are simple measures that people do for change.

Lastly, health care providers must educate individuals on their options for weight loss. This includes traditional methods of weight loss and alternative options such as medication or surgery. Some may be against weight loss surgery. This may be due to stigma, myths, or fears regarding the procedure. Providing individuals with resources and information on surgery can improve their confidence in the procedure. Others may require information on ways to lose weight the traditional way such as by improving nutrition and exercise. Dieting is helpful to some people but not all. Patients should be educated and provided relevant information on diet and nutrition. This includes healthy foods, unhealthy foods, and maintaining nutrition balance. Listing the options and resources for weight loss can help educate patients on obesity prevention.

Conclusion

Obesity affects nearly 40% of American and is associated with poor health. It is the leading cause of various conditions such as heart failure, diabetes, and stroke. It also remains a contributing factor to hypertension, diabetes, mellitus, cardiovascular disease, arthritis, and sleep disorders, (CDC, 2015). It includes comorbid conditions, incidents of mortality, and reduced quality of life and life expectancy that have driven public health concerns, especially considering that more than half of the population is overweight. Obesity and overweight not only puts one’s health at risk, it also accounts for high medical cost throughout the healthcare field. One study indicates that by the year 2030 medical costs related to obesity will rise above $1 trillion, (Weigntraub et al, 2011). However, obesity is a multidimensional problem. It is associated to different aspects of society such as nutrition, environment, education, economy, and community. It goes further to reflect the limited access to recreation and reduced nutritional options in underserved communities. Changes in public health and obesity can only occur with the collaboration of health communities and community partners working together.

 

References

  1. (2015). Division of Nutrition, Physical Activity and Obesity. Atlanta, GA: U.S Department of Health and Human Services. Retrieved from: http://www.cdc.gov/obesity/strategies/index.html

 

  1. (2014). Obesity in california: The weight of the state, 2000-2012. Sacramento, California Department of Public Health Nutrition Education and Obesity Prevention Branch. Retrieved from: https://www.cdph.ca.gov/programs/cpns/Documents/ObesityinCaliforniaReport.pdf

 

  1. (2012). California state nutrition, physical activity, and obesity profile. Sacramento, CA. National Center for Chronic Disease Prevention and Health Promotion, CDC. Retrieved from: http://www.cdc.gov/obesity/stateprograms/fundedstates/pdf/California-State-Profile.pdf

 

  1. Hamdy, O. (2015). Obesity: Drugs and Disease. In Medscape. Boston, MA: WebMD Journal of Medicine. Retrieved from: http://emedicine.medscape.com/article/123702-overview#showall

 

  1. (2015). Obesity: Diseases and Conditions. Mayo Foundation for Medical Education and Research. Retrieved from: http://www.mayoclinic.org/diseases-conditions/obesity/basics/treatment/con-20014834

 

  1. (2012). Explore overweight and obesity. Alexandria VA. National Institutes of Health Department of Health and Human Services. Retrieved from: http://www.nhlbi.nih.gov/health/health-topics/topics/obe/diagnosis

 

  1. Office of the Surgeon General (US). (2010). The Surgeon General’s Vision for a Healthy and Fit Nation. Rockville (MD): Office of the Surgeon General (US); 2010. Background on Obesity. Retrieved from:  http://www.ncbi.nlm.nih.gov/books/NBK44656/

 

  1. Weintraub, W., Daniels, S., Burke, L., Franklin, B., Goff, D., Hayman, L., Lloyd-Jones, D., & Pandey, D. (2011). American heart association policy statement. Circulation, 12(4), 967-90. Retrieved from http://circ.ahajournals.org/content/124/8/967.long
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Reducing Obesity through Policy

Obesity affects as many as 30% of the population and associated with a variety of comorbid conditions. It remains a contributing factor to hypertension, diabetes, mellitus, cardiovascular disease, arthritis, and sleep disorders, (Weintraub et al, 2011). This causes increased concern for public health. It attributes to high medical costs in a number of fields and areas. Studies suggest that by the year 2030 medical costs related to obesity will rise above $1 trillion, (Weigntraub et al, 2011). However, the dynamics of obesity is complex and multi-layered. It is related to many facets of society including nutrition, environment, education, and community. This can be observed in low costs of high calorie foods, limited access to recreation, and reduced options in underserved areas. For this reason, there is a growing concern to reduce obesity. Help from the state and district representatives are required to ensure the good health of the communities they serve. The most effective way to attack this problem is to apply government policy and community partnership. Enacting, the Community Health Initiative for Promoting Exercise and Nutrition (CHIPEN), will provide policies and programs, education, taxation, and environmental infrastructure to improve public health and reduce obesity.

Strategy, Message, Recommendations

To ensure long term success, assistance from local and state government is needed for community action. This can only be accomplished through change in policy to provide incentive programs and improve community infrastructure. The suggested policy is called, Community Health Initiative for Promoting Exercise and Nutrition, CHIPEN.  The initiative is created to improve health, one community at a time. It is multi-layered to work in coordination and partnership with nongovernment institutions. The message and recommendation is to use a variety of environments in collaboration to improve public health. The aim is to reduce the rate of obesity from 30% to 20% by the year 2020.

To promote nutrition, policies must be created under CHIPEN to discourage unhealthy foods and encourage the consumption of healthy foods.  This can be done by, “food policies to reduce obesity: altering relative food prices, shifting our exposure to food, and improving the image of healthy food while making unhealthy food unattractive”, (Frieden, Dietz, & Collins, 2010). There are many ways to achieve this. This includes increased taxes on sugary drinks which accounts for the significant rise in obesity. Policies like this are currently in place in various cities across the state including San Francisco and Berkeley. Additional avenues are to promote fruits and vegetables through community based programs and incentives. Vouchers will be provided to Women Infants and Children’s, Special Supplemental Nutrition programs and Food Stamps. To ensure these families have access to healthy foods, grocers and corner stores must be improved. This includes creating community gardens, incentive programs for health food stores to build in underserved communities, and farmers markets.

However, stimulating health through improved nutrition is also aimed at high calorie food.  CHIPEN involves community zoning. Zoning restrictions will be applied to fast food establishments that can distance locations from high risk communities, schools, and residential areas.  Zoning will also be applied to public schools to restrict high calorie foods from the cafeteria. In conjunction with counter advertisement, the image of unhealthy foods will educate the public of its harmful agents. The public will be less tempted to consume foods that encourage obesity. In this way, these “polices improve market competitive and promote more consumption of fruits and vegetables”, (Frieden, Dietz, & Collins, 2010).

Supporting evidence

There is significant supporting evidence by researchers and organizations to reduce obesity and improve public health. Representatives of the American Heart Association developed a policy statement for recommendations to prevent cardiovascular disease often related to obesity. They indicate the “primary prevention is an environmental model that maintains that an individual’s behavior is influenced by his or her surrounding physical, social, and cultural environments… workplaces, schools, homes, and communities”, (Weintraub et al, 2011). Other associations to combat obesity include city and county programs. Thus, by providing policy that incorporates various influences associated with obesity it improves the objective of policy initiatives.

Taxation on unhealthy foods and beverages is proven to raise billions per year for the state (Salis et al, 2012). A study conducted by the Journal of Health Affairs found that, “taxes would reduce average per capita consumption by 8,000 calories annually, potentially preventing about 2.3 pounds per year of weight gain” (Frieden, Dietz, & Collins, 2010). Pennsylvania was one of the first states to create a program improving access to healthy food options in underserved communities. This community created 5000 new jobs and $190 million annually in revenue by building health food stores in these areas, (Weintraub et al, 2011). They further renovated existing stores and developed a partnership with businesses to market and promote reduced priced produce. It more than quadrupled the initial government investment of $30 million. Reducing prices of low-fat items has proven to increase the purchase and consumption of healthy goods. This was seen even when reducing produce price by 10%, (Chan & Woo, 2010).

Improving community infrastructure has also shown to promote physical activity and recreation, thus curbing the rate of obesity. “A study … found that for every $1 invested in building (walking) trails, nearly $3 in medical cost savings may be achieved”, (Weintraub et al, 2011). Additional studies conducted by the Urban Institute found that investing $10 per person in community based prevention programs saves the country $16 billion annually for 5 years, (Weintraub et al, 2011). Suggested examples include improving current parks and recreation facilities to promote activity. This is seen as many underserved communities have limited access or desire to use parks and recreation centers due to distance, safety, and infrastructure. From creating bike trails to updating and innovating community parks, individuals will have access and resources to move. Other programs have shown positive results to improve physical activity. Federal funded program, Safe Routes to School, promoted safe and active commuting to school improving walking by 64% and biking by 114%, (Foltz et al, 2012).

Impact and Importance

Various organizations in health have shown interest in this problem and addressed ways to curb the obesity epidemic. This has the potential to reduce healthcare costs and improve the overall health of communities across the nation. Organizations including, “the US Preventive Health Services Task Force and the Task Force on Community Preventive Services, sponsored by the Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention, respectively have evaluated the evidence for the effectiveness of preventive services”, (Weintraub et al, 2011). These organizations have conducted researched and collected evidence for recommendation. The American Heart Association recommends this be addressed as a policy strategy to make obesity prevention a priority. Organizations such as the Centers for Disease Control and the American Heart Association recommend targeting the context of daily lives. It includes recreation, transportation, built environments, schools, and worksites to improve physical activity, (Sallis, Floyd, Rodriguez, & Saelens, 2012).

Conclusion

Policy provides laws to regulate government, corporate, health, and educational practices. Thus, it is the responsibility of government representatives to hear, process, and generate legislature to maintain the health of society. Obesity continues to be a growing problem of concern. It has generated attention from high profile people such as former First Lady Michelle Obama, physicians, health organizations, and the general public. To sustain public health and the security of future generations, policies must be enacted. This includes to improve the health of individuals and families, social equality, and the American economy. Obesity and the health complications associated with it are preventable and reversible. Its enactment will reduce health care costs and improve the overall quality of life. Not only does it improve health it is also cost effective. AHA policy statement “suggest that public policy, community efforts, and pharmacological interventions are likely to be cost-effective and often cost saving compared with common bench marks”, (Weintraub et al, 2011). This only substantiates the need and effectiveness of combination intervention strategies as observed in CHIPEN. With the involvement of school, community, government, health, and organizational institutions, it can substantially slow the epidemic of obesity in the United States to 20% by 2020.

 

References

  1. Chan, R., & Woo, J. (2010). Prevention of overweight and obesity: How effective is the current public health approach. International Journal of Environmental Research and Public Health, 7(3), 765-83. Retrieved from http://www.mdpi.com/1660-4601/7/3/765/htm

 

  1. Foltz, J., May, A., Belay, B., Nihiser, A., Dooyema, C., & Blanck, H. (2012). Publication-level intervention strategies and examples for obesity prevention in children. The Annual Review of Nutrition, 3(2), 391-415. Retrieved from http://www.genhkids.org/Downloads/Obesity Prevention Strategies – Peer Reviewed.pdf

 

  1. Frieden, T., Dietz, W., & Collins, J. (2010). Reducing childhood obesity through policy change: Acting now to prevent obesity. Journal of Health Affiars, 29(3), 357-63. Retrieved from http://w.banpac.org/pdfs/sfs/2010/reduc_child_obes_11_04_10.pdf

 

  1. Sallis, J., Floyd, M., Rodriguez, D., & Saelens, B. (2012). Recent advances in preventive cardiology and lifestyle medicine. Circulation, 12(5), 729-37. Retrieved from http://circ.ahajournals.org/content/125/5/729.full

 

  1. Weintraub, W., Daniels, S., Burke, L., Franklin, B., Goff, D., Hayman, L., Lloyd-Jones, D., & Pandey, D. (2011). American heart association policy statement. Circulation, 12(4), 967-90. Retrieved from http://circ.ahajournals.org/content/124/8/967.long
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Encouraging Federal Policy and Regulations against Childhood Obesity

Childhood obesity must be addressed by policy makers to curb the epidemic of poor nutrition and exercise among American youth. According to the American Journal of Public Health 17% of youth are clinically obese, (Golust, Kite, Benning, Callanan, Weisman, & Nanney, 2014). When including young people who are overweight into the statistics the number rises to 30%, (John Hopkins University, 2013). This indicates that 1 in 4 children is considered overweight or obese. Obesity is a serious health concern that increases the risk for a host of problems and issues. It negatively affects physical, mental, and social health.  Many of the problems associated with obesity concern diabetes and heart disease. Additional health concerns are increased risk of cardiovascular disease, hypertension, high blood pressure, high cholesterol, liver disease, sleep apnea, asthma, poor joints, and cancer, (CDC, 2014). Health conditions are psychological to include depression, psychosocial disorders, and increased chance of discrimination, (John Hopkins University, 2013). Those who are overweight and obese as children often grow up to be obese adults. Obese adults are at advanced risks of poor health which can lead to premature to death. For this reason and more, healthcare affiliates have increased demand to promote preventive strategies against obesity. They go further to encourage the government to get involved, to take action through policies, programs, and initiatives. By creating policies on a federal level that encourage healthy living, children and their families have equal opportunities to resources that encourage wellness and reduce risks relating to obesity.

Problem

Obesity negatively affects children and their families. It has become a growing trend due to changes observed in America society overtime. This includes the increases supply and demand for high calorie foods and sugar. From high portion sizes, lack of exercise, and poor food choices, many children do not receive appropriate nutrition. Furthermore, with the increase use of gadgets and technology, young people are easily entertained and do basic duties while remaining stagnant. This has fundamentally changed daily living for many Americans. However, the populations most affected by obesity are those living in underserved communities. These are impoverished areas with limited access to information and healthy lifestyle choices. Many of these populations include minorities, the poor, and people of color. “Obesity is the result of biological, behavioral, social, environmental, and economic factors and the complex interactions among these facts that promote a positive energy balance”, (John Hopkins University, 2013). To address this problem there are various governmental regulations and policies in place. On the federal level, the Centers for Disease Control enacted the Cooperative Agreement DP13-1305, Doman 2 Enhanced Strategies. This simply promotes strategies, preventive measures and resources required to reduce the epidemic. The strategies for enforcement can be found in the DNPAO recommended domain entitled, “State Public Health Actions to Prevent and Control Diabetes, Heart Disease Obesity and Associated Risk Factors and Promote School Health FOA”, (CDC, 2014).

There is an increased need to draw awareness to the issue and create strategies for change. The Centers for Disease Control (CDC) has addressed the need to improve health for children. The initiative is on a federal level however it does not affect the laws and regulations including those from the Food and Drug Administration (FDA). However, various cities and counties nationwide have created laws to limit and restrict high calorie foods and drinks in different locations. For instance, the city of Berkeley, California has increased taxes on the sale of sodas to discourage purchases. Additional California laws restrict the sale of food and beverages that do not meet school meal programs as observed in the Senate Bill 12, Chapter 235, Statues of 2005 Senate bill 965, (California Department of Education, 2015). This includes prohibiting vending machines that offer soda, chips, sweets, and candies found in schools and profile areas. Furthermore, first lady Michelle Obama has become a catalyst and spokesperson against childhood obesity. Since 2008 the first lady has created an initiative for change called, “Let’s Move!”, “a comprehensive initiative… dedicated to solving the problem of obesity within a generation, so that children born today will grow up healthier and able to pursue their dreams”, (Letsmove.gov, 2014). Although these avenues have driven awareness of the issue it has not curved the rate of obesity in children and has done little to help the problem.

Context

There are various laws that can be found across the states that restrict high calorie foods in schools and underserved communities to encourage healthy food choices. However, the laws, strategies, and initiatives in place are not enough. “Small declines in obesity rates have been recently observed [but] a comprehensive evidence-based policy approach is needed to continue to make a meaningful impact”, (Gollust et al., 2014). To reduce obesity, restrictions against high calorie foods must be made on a federal level. Collaboration must occur between government agencies including the CDC, FDA, and the Department of Parks and Recreation. The goal of federal initiatives is to reduce the rate of obesity among youth by 10% over the next several years. Considering the slow decline of obesity and the awareness campaign presented by the first lady this goal is both realistic and obtainable. The CDC provides various strategies and initiatives for states and local communities to curve the epidemic. Initiatives that local governments can provide is additional zoning areas for parks and recreation to promote physical activity, (CDC, 2014). Ranging from bike facilities for alternative transportation, recreational spaces, and resources, more can be done to promote healthy lifestyles. While many subdivisions and communities offer tennis courts to residence, this sport is less likely to encourage young people to exercise. More basketball courts should be provided to underserved communities. It is a sport that requires little resources for those who are low income and is also popular among youth. Furthermore, all communities, especially those in impoverished areas, should have healthy food retailers made available as well as farmers markets that honor EBT or food stamp programs for those who qualify, (CDC, 2014). While increasing taxes and restricting sugar and high calorie foods to certain facilities is a start, it is not enough to promote and encourage quality nutrition and healthy lifestyles.

Current Status

The Center for Disease Control provides the most up to date statistics regarding obesity in youth. Not only do they describe and outline the cause, rates, strategies, and solutions to the problem, they go on to describe resources available for local communities to curve the epidemic. This includes local, state, and federal programs, highlights, and the federal Implementation Guidance and Resources for Cooperative Agreement DP 13-1305 Doman 2 Enhanced Strategies (DNPAO). This information and more can be found on their Division of Nutrition, Physical Activity, and Obesity website at CDC.gov, (http://www.cdc.gov/nccdphp/dnpao/index.html). CDC provides a long list of state programs across the country such as, Active Transportation to School, Enhanced School-Based Physical Education, Food Policy Counsels, Improving Retail Access for Fruits and Vegetables, Limiting Access to Sugar-Sweetened Beverages, Applying Nutrition Policies in Child Care, School, and Worksite Settings, and many more. All of these work in collaboration and agreement of the federal initiative found in the DNPAO. The CDC provides these comprehensive strategies to curve the epidemic in underserved communities. These are children and families who are low income and with limited access to healthy choices and lifestyles. This population lives in underserved communities where a nutritious diet can be not only costly but also unrealistic and unobtainable. By providing serves to these communities, the obesity rate can decline drastically by providing improved options and resources to this special population.

Conclusion

There are many initiatives that can be observed on a local level to combat obesity in various cities such as Berkeley, San Francisco, New York, and Oklahoma City. Although cities are doing what they can to curve the epidemic, such strategies should be implemented on a state and federal level. Reaching communities on the local level is just a start. Once these strategies reach a federal level, underserved communities across the country will have improved access to healthy diets and activities. Not all states and jurisdictions are committed to combat childhood obesity. Many of these locations are observed in places throughout the South and Midwest. These are conservative states that are less focused on health and nutrition and more focused on issues unrelated to improving the quality of life for all Americans.  Tackling the problem on the federal level will provide equal opportunities to all people regardless of community and location. Obesity is not a local problem and but is witness the country. Not one state holds an obesity rate less than 10%. The majority of the states (33) have an obesity rate of 25%, however some states have an obesity rate of 30% or more including, Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Tennessee, and West Virginia, (CDC, 2014). With so many states witnessing a widespread epidemic of obesity it is clear that this is a federal problem which must be met on a federal level.

 

References

  1. California Department of Education, (2014). Restrictions on Food and Beverage Sales.  Sacramento, CA. Retrieved from: http://www.cde.ca.gov/ls/nu/sn/mb06110.asp

 

  1. Centers for Disease Control, (2014). Division of Nutrition, Physical Activity, and Obesity. Centers for Disease Control and Prevention. Retrieved from: http://www.cdc.gov/nccdphp/dnpao/policy/obesity.html

 

  1. Gosllust, S., Kite, H., Benning, S., Callanan, R., Weisman, S., Nanney, M. (2014). Use of Research Evidence in State Policy Making for Childhood Obesity Prevention in Minnesota. American Journal of Public Health. 104 (10) 1894-1900.

 

  1. Johns Hopkins University Evidence-based Practice Center, (2013). Childhood Obesity Prevention Programs: Comparative Effectiveness Review and Meta-Analysis. Effective Health Care Program Comparative Effectiveness Review Number 115. Agency of Healthcare Research and Quality, Rockville, MD. Retrieved from: http://www.effectivehealthcare.ahrq.gov/ehc/products/330/1524/obesity-child-report-130610.pdf

 

  1. Let’s Move (2014). Childhood Obesity Task Force Report. The Epidemic of Childhood  Obesity. Retrieved from: http://www.letsmove.gov/about
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Healthy Nutrition in Infants

Adequate nutrition is vital for good health in all people, especial for infants and children. It is required for healthy growth and development and without it they can suffer incurable physical, biological, and neurological damage. Nutrition in young people continues to be of interest to dietitians and medical scientist. As growing families to adapt to the changes in modern society such as food access, variety, and processes many struggle to maintain a nutritious diet. This can be observed in the rising obesity epidemic. While adults are getting larger and heavier from poor nutrition and exercise, so are infants and children. It is reported that, “nearly 1 in 3 children in America is overweight or obese”, (American Academy of Pediatrics, 2016). These populations may consume large portion or high calorie foods, yet still suffer from malnutrition due to their poor eating habits. A growing health concern, it is important that young families are aware of infant nutrition, eating patterns, and healthy habits. By providing adequate nutrition to infants, parents can ensure their infants grow to reach their full potential of health.

The relationship between obesity and poor nutrition in children can be observed in the case study of “Steven”. Steven represents the average infant who has become overweight with time. When Steven was born he was 8 pounds and 20 inches. He continued to grow at an average weight during the first and second month. At 2 months old, Steven was at an average weight and height at 12 pounds 8 ounces. When Steven turned 3 months old that’s when things started to change. This is because he put on 2 pounds in 3 months putting him in the 95th percentile on the growth chart. Today, Steven is 5 months old. He weighs 18 pounds and 26 and one-half inches tall. Although he is a very healthy child, Steven is overweight and falls well above the 95th percentile according to CDC standards. If Steven continues at this rate, he will continue to be overweight as he enters his toddler years and yearly childhood.

Steven is at the right age to start considering solid foods. However, he must meet his developmental milestones to determine if Steven is prepared to add variety to his diet. For instance, when babies are born they have something that is called protrusion reflex. It is a natural response that tells babies to suck when they want food. Because of this response, babies cannot consume food unless you give it to them through a nipple, (Feeding Your Infant, 2012). Between the age of 4 and 6 months this response will begin to subside. Although this is a good sign, Steven must hit other developmental milestones as well. This includes “being able to move tongue from side to side without moving his head…keep head upright and sit with little support”, (Brown, 2014, p. 239). Also he should be able to reach out, grab, and hold on to objects. If he is able to do this, Steven and other children with these developmental achievements, can start on solid foods.

When introducing new food to infants, parents should begin with spoon feeding them cereal. It may take a while for babies to catch on, so be patient. Sometimes it can take a while for a baby like Steven to get used to eating this way. Just start off feeding the infant a teaspoon at a time, first one teaspoon and then work your way up to two and then three and so on. You can do this once a day and then you can eventually start feeding the infant twice a day. However, you must remember, breast milk or formula will continue to be the main source of nutrition.

Between 6 to 9 months it is okay to start introducing infants to different foods other than cereal. “Texture should start as strained then advanced to smooth to mashed to chopped”, (Feeding Your Infant, 2012, p.4). It is good for babies to begin with fruits and vegetables. However, when you give it to them, introduce the foods just one item at a time. Allow your infant to get used to eating one food before you give them another. Although babies are just starting off with the food basics of fruits and vegetables, you will eventually lead your infant to eating high protein foods starting at 7 months. Until then, it isn’t recommended that infants eat meat. Some good meat substitutes for your infants include cottage cheese, yogurt, beans, peas or lentils, (Feeding Your Infant, 2012, p.5). These things are natural foods and because they are still babies, they are free from additives such as salt and sugar.

At 9 months to a year, babies are able to pick up things using their thumb and forefinger. Also, they will start to grow teeth. When Steven and other infants have reached these milestones it a good sign that he or she is ready for different kinds of foods. These are foods with different texture. This is a good time to introduce your infant to finger foods like crackers or toast. You can also give your baby soft foods that are chopped such as bananas or cook vegetables. However, it is important to be aware of allergies and stay aware from foods that these small bodies are not ready for. For instance, babies should not drink cow’s milk until they are one years old, (Feeding Your Infant, 2012). Also you should not feed them corn syrup or honey because it may have harmful bacteria that can be hard on the immature digestive system. Other foods that have potential allergies include “eggs, wheat, corn, beef, peanuts, seafood, potatoes, soy products, and oranges”, (Feeding your Infant, 2012, p. 2). When your baby is around 9 months of age it is okay to begin to introduce them to meat. It is important to consider food texture and how your infant may react. Introduce them to foods in the appropriate order starting with soft and strained foods then to the harder textures as the infant grows and develops.

Infants are able to get all of their nutrients from breastfeeding and formula during the first 6 months. This is because they have micronutrients stored in their body from the gestation period. Some of these nutrients include iron and zinc. At 6 months of age it is important that infants receive this nutrition from the solid foods they eat. This can be seen as “older infants receive iron through iron-fortified baby cereal at six months of age”, (Brown, 2014, p. 247). Other babies will receive iron if they are bottle fed or drink breast milk. Infant formula often include the valuable nutrients that babies need including zinc, and vitamin A and D. Many breastfeeding mothers take vitamin supplements to ensure their infants receive the important nutrition they need. Although eating solid foods, it is important that infants continue to maintain their diet of formula or breast milk to supplement their nutrition. Introducing to infants to healthy foods like fruits and vegetables helps to prepare them for good health and nutrition in the future. It not only helps them to achieve their developmental milestones but also prevent them from health risks associated with malnutrition and obesity.

 

 

References

  1. American Academy of Pediatrics. (2016). Childhood Nutrition. Retrieved from: https://www.healthychildren.org/English/healthy-living/nutrition/Pages/Childhood-Nutrition.aspx
  2. Brown, J.E. (2014). Nutrition Through the Life Cycle. Fifth Edition. Stamford, CT. Cenage Learning.
  3. Family and Consumer Science, Centsible Nutrition Program. (2012). Feeding your infant: A solid start. Retrieved from University of Whyoming website: http://familynutrition.ext.wvu.edu/r/download/144395
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Nutrition in Older Adults

As people grow older the human body will begin to experience changes that alter the role and effects of food and nutrition. This means that what you eat, or do not eat, can dramatically affect your health. Studies show that nutrition plays a vital role in modulating the changes that occur in the body after the age of 50. These include changes in the body’s composition, metabolism, and tissue function, (Danford, & Munro, p. 3) As a result, older adults will experience “the loss of skeletal muscle strength, mass, and quality”, (Brown, 2014, p. 36). Sometimes the body is able to try to combat this by gaining more body fat. When older adults eat very little, the body is receives little nutrition and is unable to gain the fat that it needs for good health.  To better manage health and nutrition in old age, individuals must be aware of the changes that occur in the body and the importance nourishing foods.

It is normal to experience a reduced appetite during old age. This is due to sensory changes that affect different parts of the body. Loss of vision can make it hard to do many common things around the home and community such as cooking and shopping. Some hearing loss is natural, but must are surprised to learn that sense of taste and smell will also change. “If food doesn’t taste appetizing or smell appealing, we don’t want to eat it. If we must cut back on salt, sugar or fat, we may tend not to eat”, (Anderson & Prior, 2007). This helps to explain the loss of appetite and desire to eat the foods that were once enjoyable in older adults.

It’s important to be aware that the body can change in ways that go unnoticed. Aging affects the muscles, heart, kidneys, lungs, and liver, (Anderson & Prior, 2007). It also changes the immune system, making the body more susceptible to illness such as a cold, the flu, or even pneumonia. Older adults are likely to be slower, due to a lack of energy that occurs from a slowed metabolism. For all these reasons it is more important that the body gets the food it needs. It can help to change energy, mood, and overall good health. To do this older adults must “eat more calcium, fiber, iron, protein and vitamins A, C and folacin”, (Anderson &* Prior, 2007).  It sounds like a lot of food for people with a low appetite however there are different things that can be done to make eating enjoyable.

Eating nutrient rich foods can be challenging for those on fixed income, which is true for older adults. This can make it difficult to budget for food costs along with bills and other expenses. The healthy and nutritious foods that people need are also the most expensive. Furthermore, it can be challenging to access local farmer’s market or quality grocers in the area due to old age. This causes difficulties in finding a good source of nutrition at an affordable price. In this way, “socioeconomic, psychological, ethnic, physiological, and pathological factors all influence dietary intake, interacting in a complex and intertwining manner”, (Brown, 2014, p. 305).

Below is a sample meal plan that can be used as a guide to ensure that older adults get the proper nutrients needed for good health. Included are some basic items that are both convenient and affordable. The meal plan is a 1600 calorie diet that is appropriate for the average height and weight of adult women over the age of 65.

Day 1 Day 2 Day 3 Day 4 Day 5
Breakfast Cereal (1 cup, 124 cal, fiber)

Milk (1 cup, 103 cal, calcium)

Toast (1 slice, 64 cal, iron/fiber)

Orange Juice (1 cup, 40 cal, Vitimin A & C/protein)

Oatmeal (1 cup, 145 cal, fiber)

White Toast (1 slice, 64 cal, iron/fiber)

Fruit (1 cup, 65 cal, fiber)

Milk (1 cup, 103 cal, calcium)

Bagel w/cream cheese (1/2, 225 cal, calcium)

Watermelon (1 cup, 65 cal, fiber)

Milk (1 cup, 103 cal, calcium)

Yogurt (8 oz, 110 cal, calcium)

Banana (1, 105 cal, potassium)

Orange Juice (1 cup, 40 cal, Vitimin A & C/protein).

White Toast (1 slice, 64 cal, iron/fiber )

Scrambled eggs (2, 200 cal, protein)

Cheese (1 slice, 104 cal, calcium)

White Toast (1 slice, 64 cal, iron/fiber )

Milk (1 cup, 103 cal, calcium)

Lunch PB&J w/White bread (340 cal, protien)

Apple ( 40 cal, vitamin A &C/protein)

Milk (1 cup, 103 cal, calcium)

Egg salad w/White bread (220 cal, protein )

Fruit (1 cup, 65 cal, fiber)

Soft drink (12 oz, 160 cal, vitamin C)

Tuna (220 cal, protein/Omega 3)

Crackers (2 oz, 110 cal, vitamin E)

Banana ( 105 cal, potassium)

Soft drink (12 oz, 160 cal, vitamin C)

Turkey Sandwich (330 cal, protein/calcium/fiber)

Watermelon (1 cup, 65 cal, fiber)

Soft drink (12 oz, 160 cal, vitamin C)

Pea soup (1 cup, 160 cal, fiber/vitamin A)

w/Ham (3 oz, 100 cal, protein)

Toast (1 slice, 64)

Peach (1, 70 cal, fiber)

Snack Yogurt (8 oz, 110 cal, calcium) Potatoes chips (1 oz, 152 cal, vitamin E) Cottage cheese (1/2 cup, 110 cal, calcium)

Fruit (1 cup, 45 cal, fiber).

(3)Chocolate chip cookies (70 cal, Vitamin A/iron) Ice cream (1 cup, 140 cal, calcium)
Dinner Chicken (5 oz, 335 cal, protein)

Baked sweet potato (1 cup, 115 cal, calcium/potassium)

Steamed veggies (1 cup, 45 cal, Vitamin C/iron)

Salmon (5 oz, 295 cal, protein/Omega 3),

Brown rice (1 cup, 215 cal, calcium/ protein),

green beans, (1 cup, 31 cal, fiber)

Turkey (5 oz, 270 cal, protein),

Red beans (1 cup, 220 cal, protein/iron/vitamin C, fiber),

brown rice (1 cup, 215 cal, calcium/protein),

Pork chop (5 oz, 270 cal, protein),

Baked potato (140 cal, potassium/fiber )

Corn (2 oz, 60 cal, fiber)

Sausage (5 oz, 230 cal, protein)

Pasta (2/3 cup, 150 cal, fiber/iron)

Steamed veggies (1 cup, 45 cal, vitamin C/iron)

 

 

 

 References

  1.  Anderson, J. E., & Prior, S. U.S Dept of Agriculture, (2007). Nutrition and aging. Retrieved from Colorado State University website: http://www.ext.colostate.edu/pubs/foodnut/09322.html
  2. Brown, J.E. (2014). Nutrition Through the Life Cycle. Fifth Edition. Stamford, CT. Cenage Learning.
  3. Danford, D. E., & Munro, H. H. (2013). Human nutrition: Nutrition, aging, and the elderly. (3rd ed., Vol. 6). New York, NY: Plenum Press. Retrieved from https://books.google.com/books?id=t9UFCAAAQBAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0
  4. Mueller, P.S., Hook, C.C., & Fleming, K. (2004). Ethical issues in geriatrics: A guide for clinicians. Mayo Clinic Proceedings, 79(4), 554–562.

 

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