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.
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).
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).
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.
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.
- (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
- (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
- (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
- 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
- (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
- (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
- 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/
- 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