This essay will discuss the
public health issue of obesity and excess weight. The target population to be
discussed is pre-menopausal women.


Furthermore, national, and
global populations will be included to compare statistics. Additionally, the
impact obesity has on society and health services will be considered. As will
how, social determinants impact on obesity. Health promotion theories and
models will also be analysed to identify benefits and limitations.

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Also, being explored is how a
nurse can support and educate patients to manage their own health care. The
essay will consider the involvement of community and national policy’s in combatting
obesity. Partnerships of professionals will be explored. Including, how to
ensure people with barriers in accessing health care, such as those with
learning disabilities or mental health illness have their needs met.


The World Health Organisation
WHO (2017) state excess weight is a body mass index (BMI) over or above 25 and
obesity is a BMI of 30 or above. Additionally, obesity is excessive fat
accumulation, which results in increased health risks. Spiro and Stanner,
(2016) support this stating, obesity is caused due to an energy imbalance
between the number of calories consumed and those expended. Davidson (2015) adds,
reduced income and education increase the risk of obesity, especially for


Obesity has been selected due
to its high prevalence and its association to health conditions, for example,
diabetes, heart disease, and cancer, (NHS, 2016). PHE (2017) confirm this
stating, the risk of cancer is 3 times greater and type 2 diabetes carries a
risk 5 times greater when the person is obese.


The prevalence of obesity has exhibited
no signs of decline, quite the contrary. It is estimated by PHE (2017) that 63%
of adults in England were classified as obese in 2015. While in 2008 to 2009
PHE, Cornwall health profiles, (2009) claim the average for England was 23.6%,
the figure for Cornwall was 24% thus not a significant difference. The WHO
(2017) also estimate 40% of adult women are overweight and the worldwide figure
for obesity has tripled since 1975.


However, comparing these
figures to PHE Cornwall health profiles (2016) it is alarming to see the number
of adults with excess weight is 64.6% in England. The figure for Cornwall is
69.9% higher than the national average. The WHO (2017) estimate 2.8 million
people die globally each year due to being overweight or obese.


To understand the magnitude of
obesity the epidemiology is documented, providing statistics to inform a health
needs assessment of those at risk (Wills, 2014). The statistics confirm obesity
is prevalent across England. However, Cornwall has a higher incidence,
requiring provisions to improve health (Linsley, et al 2011). 


Public health surveillance
generates the data and statistics. The WHO (2017) state this is the systematic
collection, analysis, and interpretation of health-related data. This is
required for planning, implementation, and evaluation of public health practice.
There are limitations to this method of data collection such as underreporting,
homeless people or people who do not access health care will not be included in
the statistics. Nsubuga (2006) adds, researchers and practitioners collecting
data collaborate findings, enabling concerns to be addressed. Thus, ensuring
the implementation of health needs are focused to the required areas.


PHE (2017) state the financial
cost of obesity to society is £27 billion. Hughes and Kumar (2016) agree
suggesting, obesity impacts employability, subsequently raising expenses such
as job-seekers allowance.


Policy’s to diminish the
prevalence of obesity have been implemented for numerous years. Redmond (2008) identified
local government can reach high numbers within the community. Orme (2007)
states the development and implementation of policy’s is aimed at prevention.
Therefore, healthcare professionals are required to educate and encourage
compliance for obesity prevalence to be decreased.


Obesity brings personal risk,
as mentioned finances are reduced if the severity impacts employment
capabilities (Redmond, 2008). Furthermore, Porter and Coles (2011) declare
there is an abundance of health risks such as diabetes, heart disease and
depression all of which put time and financial pressures on the national health
service (NHS). Cornwall health profiles (2016) confirm these findings, adding
life expectancy is also reduced by 8 to 10 years due to severe obesity.


PHE (2017) notifies that the
NHS spent an estimated £6.1 billion on obesity related health care in 2014/15.
Cornwall health profiles state the cost for Cornwall was £60 million. Poor diet
contributes to 50% of heart disease and 33% of cancers. These figures
contribute to severely obese adults being 3 times more to likely to require
social care.


The factors which determine a person’s
health are often outside of their control. Social determinants such as
education, employment, living conditions or hereditary factors can all impact
health (Wills, 2014). The lower the social and economic status is, the
probability of a reduced life expectancy or living with ill health for longer
is increased (Marmot, 2010). This social gradient of health inequalities is
identified within the Fair Society, Healthy Lives report.


Education is strongly related
to social deprivation; higher educated individuals are less likely to suffer
ill health. Poor education generates a cycle which leads to social deprivation
(Linsley, et al 2011). Employment opportunities are reduced to low paid manual
jobs therefore, leading to lower salaries. The cycle continues, as low-income
results in inferior living environments in areas with higher poverty rates.
Additionally, living conditions are often cramped with families residing in
inadequate living space.  This is often
in built up areas with increased pollution levels and little green space to exercise
(Davidson, 2015).


Being born into or growing up
in poverty and deprivation is a difficult cycle to break, the disadvantages in
education and employment can potentially continue through generations. This
means ill health and reduced life expectancy can continue through generations
(PHE, 2017).


All the above is considered
within the Barton and Grant health map. However, it adds health can be impacted
by age, hereditary factors, and gender which cannot be changed (Wills, 2014).
However, as suggested within the Barton and Grant health map it goes much
wider; an individual’s lifestyle choices such as smoking, consuming alcohol or
not partaking in physical activity has detrimental effects on health (PHE,
2017). These damaging behaviours are more likely to be exhibited by those in a
lower social class (Linsley, et al 2011).


Personal responsibility plays
a vital role in minimising excess weight and obesity (Foresight, 2007).
However, it must be noted the obesogenic environment which has been created
makes this harder to achieve. Therefore, this is generating differences in
health which can be avoided with appropriate policy intervention being
implemented (Loring and Robertson, 2014). Policy objectives were set out in
Marmot (2010) review into health inequalities.


The above social determinants
all influence obesity levels of women. Davidson (2015) suggests disordered
eating patterns of poorly educated women increases the probability of obesity. This
is potentially due to being unaware of a healthy diet. Davidson (2015) adds
having periods of deprivation with limited food is over compensated for when
food is readily available.  


Employment also impacts excess
weight and obesity; lower salaries mean there is limited funds to purchase
healthy foods. Graham (2009) states the gender pay gap causes social-economic
inequalities. Therefore, if a woman is the main wage earner these funds are
limited further. This often results in cheap processed foods being purchased. Ward
(2015) claims this is due to the cost of processed foods falling and the cost
fresh fruit and vegetables increasing. Luiten, et al (2016) agrees stating
there is a difference between these costs, also arguing processed foods have a
low nutritional value, therefore, further impacting obesity and excess weight. Foodbanks
offer short-term solutions for those in need, however, these foods are often
processed, also contributing to excess weight (Davidson, 2015).


There is a higher prevalence
of fast food outlets among areas of social deprivation, therefore, the
consumption of low nutritional fast-food is greater. This leads to increased
levels of obesity (Wilcox, et al, 2013). Additionally, adults from deprived
areas are less active, with the figure for women being greater. There are
different thoughts for the cause of this. Firstly, women who must maintain
employment and care for a family or house do not prioritise physical activity
(Sport England, 2016). Secondly, obese women are more likely to have obese
friends within the area they live. This causes obesity to become socially
normal within the area (Draper, et al, 2015).


Nurses have a role in tackling public
health issues such as obesity and excess weight. Wills (2007) suggests this
includes preventing harm and protecting, individuals, communities, and the
wider population. Nurses use models of health to plan initiatives to enable
this. Public health focuses on the social and economic cause of ill health such
as poverty. Upstream strategies to combat the inequality’s which causes ill
health are policies focusing on preventative measures at macro level. They aim
at implementing interventions from the root cause (Mitcheson, 2008; Wills,


Beattie’s model of health promotion with
four quadrants of activity includes top-down expert led interventions and bottom
up community participatory approaches to improve health (Laverack, 2007).


A nurse is associated with the top-down
authoritarian approach using health persuasion techniques to encourage an
individual to change their lifestyle. Regarding obesity the nurse will inform
the patient how a healthy diet and regular exercise will benefit health. The
nurse will additionally advise the patient how changes could be made.  However, change will be unachievable, if no
consideration is given to the patients living and financial circumstances
(Laverack, 2007).


This technique is valued, as it is believed
patients listen to the advice of a nurse as it is presumed they know best
regarding health. Additionally, advice can be given relatively quickly during a
consultation (Wills, 2007). However, this technique does not consider if the
patient is ready, skilled, or able to make changes (Laverack, 2007).


Advice created from legislative action may
be given, this is another top-down approach. The eat-well guide and change for
life are examples of campaigns to tackle excess weight and obesity. These
policies, developed from research, to bring change nationally and locally are
designed to encourage obese and over-weight patients to make healthier choices
to improve health (PHE, 2017). The nurse is required to deliver the information
in a way which would persuade the patient to comply with these interventions to
improve health. However, such policies may be resisted if it is believed to be
an enforcement. It is argued people have the right to live how they want,
eating, and drinking what they want even if this has a negative impact on
health (Wills, 2007). This conflicts with opinions stating intervention is
required to combat the rising obesity epidemic (Porter and Coles, 2011). Obesity
increases the risk of developing noncommunicable diseases, therefore,
increasing time and financial pressure on the NHS (WHO, 2018).


A nurse can provide a role in participatory
bottom-up approaches to health such as community based development. A nurse
within the community such a district nurse or health visitor can work with
communities to empower them. The nurse works with key professionals in
identifying needs and establishing community based initiatives to improve
health (Mitcheson, 2008). In deprived areas where obesity is prevalent the
nurse can provide diet and exercise advice to groups of patients. Additionally,
patients can be referred to community weight loss groups such as slimming
world. This approach allows large numbers to be targeted (Wills, 2014).  Financial and living circumstances must be
considered when interventions are being devised. People on low incomes would be
unable to afford fees for the gym or weight loss clubs (Laverack, 2007).


The final quadrant is personal counselling.
This is based on one to one work with the patient. The nurse is required to
negotiate with the patient to empower them to make the necessary changes to
improve their health (Naidoo and Wills, 2009). A nurse working with a patient
who is over-weight or obese can identify ways to develop skills such as cooking
to improve the diet. Patients who feel empowered and enabled to manage their
own care can make changes which, may influence the health of their family or
friends within their community. Providing information and support promotes
confidence for the patient to continue in the management of their own care
(Wills, 2007).  However, the nurse needs
to be aware if the patient has social and economic barriers preventing them
from changing their health. Additionally, if the patient feels they have been
blamed for their increased weight, this may cause them to give up trying to
change (Porter and Coles, 2011).


Wills (2007) states Beattie’s model
provides a framework when planning health promotion interventions. Wills (2007)
adds the four different approaches in isolation would be ineffective in
promoting health or reducing inequality. Therefore, a combination using all
approaches is required. Holland (2007) is also critical of Beattie’s model
claiming health promotion is often opportunistic, occurring during a
consultation, which, the patient did not request. Additionally, top-down health
promotion has little chance of success simply because it is imposed from above.


Naidoo and Wills (2009) claim Beattie’s
model has the assumption that people want to change, ignoring the fact some may
be happy with taking risks.


Nurses additionally use the health belief
model to explain a patient’s health related behaviour (Mitcheson, 2008). It is
suggested health-related behaviour change is based on four beliefs,
susceptibility, and severity of the disease, and, benefits and barriers of
actions taken (Linsley, et al, 2011).


The nurse will advise the patient of the
increased risk of noncommunicable diseases because of obesity and excess
weight. Additionally, the nurse can provide facts of the seriousness of further
the health issue (Wills, 2007). This could cause a cue for the patient to act
to address their obesity (Mitcheson, 2008).


Benefits of changing health behaviours
include reducing the risk of more health problems and providing an influence on
friends and family to encourage them to act on their own health (Wills, 2007).


Health-related behaviour change has
barriers such as time restraints or insufficient finances which can deter
patients embarking change (Linsley, et al, 2011). Incentives to promote change
such as a significant person developing an illness or medical tests signifying
detrimental effects due to health behaviour may also be a cue to act (Wills,


Davies and Macdowall (2005) suggest this
model illustrates the importance of individual beliefs and a change in beliefs
will change behaviour. They add it is also useful in allowing patients to
assess and manage their own health. However, Mitcheson (2008) claims it is
criticised for focusing on a medical approach and discounting the wider social
determinants which impact health. Despite these criticisms, due to the
simplicity of the model is still frequently used in planning interventions for individuals
and communities.


Partnership working is also used to tackle
issues such as obesity and excess weight. PHE (2015) suggest communities, the
NHS, local authorities, the voluntary sector, and public health need to form a partnership
to tackle obesity and excess weight. PHE (2015) add current approaches to
tackle this issue are not making progress due to the complexity of the social determinates
associated with increased levels of obesity. Partnership working which includes
information from all the above and that of service users allows collectively agreed
goals to be set. Additionally, involving service users can help ensure all
sub-groups within a community are heard. Therefore, when forming policies which
aim to reduce excess weight and obesity they will be applicable to all service
users (Mitcheson, 2008). Anthony (2008) states working in partnership offers
more than any person or agency alone could possibly achieve.


The department of health (DOH) (2011) state
in the healthy lives healthy people report, local authorities will become responsible
for commissioning programmes that prevent and address excess weight and


Practitioners such as nurses are to be
responsible in providing health promotion advice to address such issues (Linsley,
et al, 2011). However, if the issue has become severely unmanageable and
additional health issues are arising, there is a duty to provide onward referral
to the appropriate clinician. This could include referrals for bariatric
surgery (DOH, 2011). However, essentially the best course of action is
preventative health promotion. This is financially better for the NHS and
provides less invasive actions for the patient.


Sub-groups within communities, such as
those with learning disabilities and mental illness may not benefit from any
interventions of health promotion (Linsley, et al, 2008). Ensuring equitable
access to health care is challenging and it is suggested those who already have
an illness have less access to health care. Therefore, their risk is further
increased (Orme, et al, 2007). The sub-groups mentioned may feel stigmatised
causing them to avoid or delay seeking health promotion advice. Communities
have a responsibility ensuring the inclusion of sub-groups and discouraging
stigmatisation (Linsley, et al, 2008). Nurses have a duty to ensure the needs
of all are met. For this to be achieved a community nurse or community support
workers can work with individuals or groups within the sub-group to provide
health promotion advice (Mitcheson, 2008). Sub-groups who do not engage with
health professionals are not included in the epidemiology of an illness, this
creates a false recording. Therefore, insufficient resources are provided to
the areas in greatest need (Linsley, et al 2008). 


To conclude, it is that evident social deprivation
impacts on excess weight and obesity. Additionally, inequality and deprivation increases
poor health. Furthermore, increasing financial pressure on the NHS (PHE, 2016).
Policies have been implemented to reduce obesity prevalence, however, this appears
unachievable in deprived communities and individual’s due to lack of education,
which impacts employability and finances (Linsley, et al, 2011). Nurses have a
vital role in in tackling public health issues, by working at a national,
community, and individual level, to educate and encourage change, by providing
health promotion advise (Wills, 2007). Working in partnership with a variety of
health care professional and inclusion for all is also vital for health
promotion (Mitcheson, 2008).  However, this
is only achievable when people are ready and willing to attempt making change
(Naidoo and Wills, 2009).