This essay will discuss thepublic health issue of obesity and excess weight. The target population to bediscussed is pre-menopausal women.
Furthermore, national, andglobal populations will be included to compare statistics. Additionally, theimpact obesity has on society and health services will be considered. As willhow, social determinants impact on obesity. Health promotion theories andmodels will also be analysed to identify benefits and limitations.
Also, being explored is how anurse can support and educate patients to manage their own health care. Theessay will consider the involvement of community and national policy’s in combattingobesity. Partnerships of professionals will be explored. Including, how toensure people with barriers in accessing health care, such as those withlearning disabilities or mental health illness have their needs met. The World Health OrganisationWHO (2017) state excess weight is a body mass index (BMI) over or above 25 andobesity is a BMI of 30 or above.
Additionally, obesity is excessive fataccumulation, which results in increased health risks. Spiro and Stanner,(2016) support this stating, obesity is caused due to an energy imbalancebetween the number of calories consumed and those expended. Davidson (2015) adds,reduced income and education increase the risk of obesity, especially forwomen. Obesity has been selected dueto its high prevalence and its association to health conditions, for example,diabetes, heart disease, and cancer, (NHS, 2016). PHE (2017) confirm thisstating, the risk of cancer is 3 times greater and type 2 diabetes carries arisk 5 times greater when the person is obese. The prevalence of obesity has exhibitedno 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 2009PHE, 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 figurefor obesity has tripled since 1975. However, comparing thesefigures to PHE Cornwall health profiles (2016) it is alarming to see the numberof adults with excess weight is 64.
6% in England. The figure for Cornwall is69.9% higher than the national average. The WHO (2017) estimate 2.8 millionpeople die globally each year due to being overweight or obese.
To understand the magnitude ofobesity the epidemiology is documented, providing statistics to inform a healthneeds assessment of those at risk (Wills, 2014). The statistics confirm obesityis prevalent across England. However, Cornwall has a higher incidence,requiring provisions to improve health (Linsley, et al 2011). Public health surveillancegenerates the data and statistics. The WHO (2017) state this is the systematiccollection, analysis, and interpretation of health-related data. This isrequired 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 inthe statistics. Nsubuga (2006) adds, researchers and practitioners collectingdata collaborate findings, enabling concerns to be addressed. Thus, ensuringthe implementation of health needs are focused to the required areas. PHE (2017) state the financialcost of obesity to society is £27 billion. Hughes and Kumar (2016) agreesuggesting, obesity impacts employability, subsequently raising expenses suchas job-seekers allowance. Policy’s to diminish theprevalence of obesity have been implemented for numerous years.
Redmond (2008) identifiedlocal 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 encouragecompliance for obesity prevalence to be decreased. Obesity brings personal risk,as mentioned finances are reduced if the severity impacts employmentcapabilities (Redmond, 2008).
Furthermore, Porter and Coles (2011) declarethere is an abundance of health risks such as diabetes, heart disease anddepression all of which put time and financial pressures on the national healthservice (NHS). Cornwall health profiles (2016) confirm these findings, addinglife expectancy is also reduced by 8 to 10 years due to severe obesity. PHE (2017) notifies that theNHS 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 dietcontributes to 50% of heart disease and 33% of cancers. These figurescontribute to severely obese adults being 3 times more to likely to requiresocial care.
The factors which determine a person’shealth are often outside of their control. Social determinants such aseducation, employment, living conditions or hereditary factors can all impacthealth (Wills, 2014). The lower the social and economic status is, theprobability of a reduced life expectancy or living with ill health for longeris increased (Marmot, 2010). This social gradient of health inequalities isidentified within the Fair Society, Healthy Lives report. Education is strongly relatedto social deprivation; higher educated individuals are less likely to sufferill health. Poor education generates a cycle which leads to social deprivation(Linsley, et al 2011).
Employment opportunities are reduced to low paid manualjobs therefore, leading to lower salaries. The cycle continues, as low-incomeresults in inferior living environments in areas with higher poverty rates.Additionally, living conditions are often cramped with families residing ininadequate living space. This is oftenin built up areas with increased pollution levels and little green space to exercise(Davidson, 2015). Being born into or growing upin poverty and deprivation is a difficult cycle to break, the disadvantages ineducation and employment can potentially continue through generations. Thismeans ill health and reduced life expectancy can continue through generations(PHE, 2017). All the above is consideredwithin the Barton and Grant health map.
However, it adds health can be impactedby age, hereditary factors, and gender which cannot be changed (Wills, 2014).However, as suggested within the Barton and Grant health map it goes muchwider; an individual’s lifestyle choices such as smoking, consuming alcohol ornot partaking in physical activity has detrimental effects on health (PHE,2017). These damaging behaviours are more likely to be exhibited by those in alower social class (Linsley, et al 2011). Personal responsibility playsa vital role in minimising excess weight and obesity (Foresight, 2007).However, it must be noted the obesogenic environment which has been createdmakes this harder to achieve. Therefore, this is generating differences inhealth which can be avoided with appropriate policy intervention beingimplemented (Loring and Robertson, 2014). Policy objectives were set out inMarmot (2010) review into health inequalities.
The above social determinantsall influence obesity levels of women. Davidson (2015) suggests disorderedeating patterns of poorly educated women increases the probability of obesity. Thisis potentially due to being unaware of a healthy diet.
Davidson (2015) addshaving periods of deprivation with limited food is over compensated for whenfood is readily available. Employment also impacts excessweight and obesity; lower salaries mean there is limited funds to purchasehealthy foods. Graham (2009) states the gender pay gap causes social-economicinequalities. Therefore, if a woman is the main wage earner these funds arelimited 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 costfresh fruit and vegetables increasing. Luiten, et al (2016) agrees statingthere is a difference between these costs, also arguing processed foods have alow nutritional value, therefore, further impacting obesity and excess weight. Foodbanksoffer short-term solutions for those in need, however, these foods are oftenprocessed, also contributing to excess weight (Davidson, 2015).
There is a higher prevalenceof fast food outlets among areas of social deprivation, therefore, theconsumption of low nutritional fast-food is greater. This leads to increasedlevels of obesity (Wilcox, et al, 2013). Additionally, adults from deprivedareas are less active, with the figure for women being greater. There aredifferent thoughts for the cause of this. Firstly, women who must maintainemployment and care for a family or house do not prioritise physical activity(Sport England, 2016). Secondly, obese women are more likely to have obesefriends within the area they live. This causes obesity to become sociallynormal within the area (Draper, et al, 2015). Nurses have a role in tackling publichealth issues such as obesity and excess weight.
Wills (2007) suggests thisincludes preventing harm and protecting, individuals, communities, and thewider population. Nurses use models of health to plan initiatives to enablethis. Public health focuses on the social and economic cause of ill health suchas poverty. Upstream strategies to combat the inequality’s which causes illhealth are policies focusing on preventative measures at macro level.
They aimat implementing interventions from the root cause (Mitcheson, 2008; Wills,2007). Beattie’s model of health promotion withfour quadrants of activity includes top-down expert led interventions and bottomup community participatory approaches to improve health (Laverack, 2007). A nurse is associated with the top-downauthoritarian approach using health persuasion techniques to encourage anindividual to change their lifestyle. Regarding obesity the nurse will informthe patient how a healthy diet and regular exercise will benefit health.
Thenurse will additionally advise the patient how changes could be made. However, change will be unachievable, if noconsideration is given to the patients living and financial circumstances(Laverack, 2007). This technique is valued, as it is believedpatients listen to the advice of a nurse as it is presumed they know bestregarding health.
Additionally, advice can be given relatively quickly during aconsultation (Wills, 2007). However, this technique does not consider if thepatient is ready, skilled, or able to make changes (Laverack, 2007). Advice created from legislative action maybe given, this is another top-down approach. The eat-well guide and change forlife are examples of campaigns to tackle excess weight and obesity.
Thesepolicies, developed from research, to bring change nationally and locally aredesigned to encourage obese and over-weight patients to make healthier choicesto improve health (PHE, 2017). The nurse is required to deliver the informationin a way which would persuade the patient to comply with these interventions toimprove health. However, such policies may be resisted if it is believed to bean 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 onhealth (Wills, 2007). This conflicts with opinions stating intervention isrequired to combat the rising obesity epidemic (Porter and Coles, 2011).
Obesityincreases the risk of developing noncommunicable diseases, therefore,increasing time and financial pressure on the NHS (WHO, 2018). A nurse can provide a role in participatorybottom-up approaches to health such as community based development. A nursewithin the community such a district nurse or health visitor can work withcommunities to empower them. The nurse works with key professionals inidentifying needs and establishing community based initiatives to improvehealth (Mitcheson, 2008). In deprived areas where obesity is prevalent thenurse can provide diet and exercise advice to groups of patients. Additionally,patients can be referred to community weight loss groups such as slimmingworld.
This approach allows large numbers to be targeted (Wills, 2014). Financial and living circumstances must beconsidered when interventions are being devised. People on low incomes would beunable 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 tonegotiate with the patient to empower them to make the necessary changes toimprove their health (Naidoo and Wills, 2009). A nurse working with a patientwho is over-weight or obese can identify ways to develop skills such as cookingto improve the diet. Patients who feel empowered and enabled to manage theirown care can make changes which, may influence the health of their family orfriends within their community. Providing information and support promotesconfidence for the patient to continue in the management of their own care(Wills, 2007). However, the nurse needsto be aware if the patient has social and economic barriers preventing themfrom changing their health. Additionally, if the patient feels they have beenblamed for their increased weight, this may cause them to give up trying tochange (Porter and Coles, 2011).
Wills (2007) states Beattie’s modelprovides a framework when planning health promotion interventions. Wills (2007)adds the four different approaches in isolation would be ineffective inpromoting health or reducing inequality. Therefore, a combination using allapproaches is required. Holland (2007) is also critical of Beattie’s modelclaiming health promotion is often opportunistic, occurring during aconsultation, which, the patient did not request. Additionally, top-down healthpromotion has little chance of success simply because it is imposed from above. Naidoo and Wills (2009) claim Beattie’smodel has the assumption that people want to change, ignoring the fact some maybe happy with taking risks.
Nurses additionally use the health beliefmodel to explain a patient’s health related behaviour (Mitcheson, 2008). It issuggested health-related behaviour change is based on four beliefs,susceptibility, and severity of the disease, and, benefits and barriers ofactions taken (Linsley, et al, 2011). The nurse will advise the patient of theincreased risk of noncommunicable diseases because of obesity and excessweight. Additionally, the nurse can provide facts of the seriousness of furtherthe health issue (Wills, 2007).
This could cause a cue for the patient to actto address their obesity (Mitcheson, 2008). Benefits of changing health behavioursinclude reducing the risk of more health problems and providing an influence onfriends and family to encourage them to act on their own health (Wills, 2007). Health-related behaviour change hasbarriers such as time restraints or insufficient finances which can deterpatients embarking change (Linsley, et al, 2011).
Incentives to promote changesuch as a significant person developing an illness or medical tests signifyingdetrimental effects due to health behaviour may also be a cue to act (Wills,2007). Davies and Macdowall (2005) suggest thismodel illustrates the importance of individual beliefs and a change in beliefswill change behaviour. They add it is also useful in allowing patients toassess and manage their own health. However, Mitcheson (2008) claims it iscriticised for focusing on a medical approach and discounting the wider socialdeterminants which impact health. Despite these criticisms, due to thesimplicity of the model is still frequently used in planning interventions for individualsand communities. Partnership working is also used to tackleissues such as obesity and excess weight. PHE (2015) suggest communities, theNHS, local authorities, the voluntary sector, and public health need to form a partnershipto tackle obesity and excess weight. PHE (2015) add current approaches totackle this issue are not making progress due to the complexity of the social determinatesassociated with increased levels of obesity.
Partnership working which includesinformation from all the above and that of service users allows collectively agreedgoals to be set. Additionally, involving service users can help ensure allsub-groups within a community are heard. Therefore, when forming policies whichaim to reduce excess weight and obesity they will be applicable to all serviceusers (Mitcheson, 2008). Anthony (2008) states working in partnership offersmore than any person or agency alone could possibly achieve. The department of health (DOH) (2011) statein the healthy lives healthy people report, local authorities will become responsiblefor commissioning programmes that prevent and address excess weight andobesity. Practitioners such as nurses are to beresponsible in providing health promotion advice to address such issues (Linsley,et al, 2011). However, if the issue has become severely unmanageable andadditional health issues are arising, there is a duty to provide onward referralto the appropriate clinician.
This could include referrals for bariatricsurgery (DOH, 2011). However, essentially the best course of action ispreventative health promotion. This is financially better for the NHS andprovides less invasive actions for the patient. Sub-groups within communities, such asthose with learning disabilities and mental illness may not benefit from anyinterventions of health promotion (Linsley, et al, 2008). Ensuring equitableaccess to health care is challenging and it is suggested those who already havean illness have less access to health care.
Therefore, their risk is furtherincreased (Orme, et al, 2007). The sub-groups mentioned may feel stigmatisedcausing them to avoid or delay seeking health promotion advice. Communitieshave a responsibility ensuring the inclusion of sub-groups and discouragingstigmatisation (Linsley, et al, 2008).
Nurses have a duty to ensure the needsof all are met. For this to be achieved a community nurse or community supportworkers can work with individuals or groups within the sub-group to providehealth promotion advice (Mitcheson, 2008). Sub-groups who do not engage withhealth professionals are not included in the epidemiology of an illness, thiscreates a false recording.
Therefore, insufficient resources are provided tothe areas in greatest need (Linsley, et al 2008). To conclude, it is that evident social deprivationimpacts on excess weight and obesity. Additionally, inequality and deprivation increasespoor health. Furthermore, increasing financial pressure on the NHS (PHE, 2016).Policies have been implemented to reduce obesity prevalence, however, this appearsunachievable in deprived communities and individual’s due to lack of education,which impacts employability and finances (Linsley, et al, 2011).
Nurses have avital role in in tackling public health issues, by working at a national,community, and individual level, to educate and encourage change, by providinghealth promotion advise (Wills, 2007). Working in partnership with a variety ofhealth care professional and inclusion for all is also vital for healthpromotion (Mitcheson, 2008). However, thisis only achievable when people are ready and willing to attempt making change(Naidoo and Wills, 2009).