Prof_Marcos A.

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Running head: OBESITY

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Running head: OBESITY

Obesity

NR503 Population Health, Epidemiology, & Statistical Principles

January 2018

Obesity

Obesity is a chronic medical condition and a significant health concern in the United States that is increasing worldwide. More than one third of the adults in the U.S. are obese. It is a leading cause of preventable illness and death (Centers for Disease Control and Prevention [CDC], 2016). This global epidemic is a leading concern for adults and for children who are predisposed to becoming obese as adults. This paper will discuss the significance of obesity in Florida, provide a background of the disease, review current surveillance and reporting methods, conduct a descriptive epidemiological analysis, discuss diagnosis and screening for prevention tools, develop an evidence based plan along with measureable outcomes to address obesity as an advanced practice nurse, and conclude with an overview of the main points presented.

Background and Significance

According to the CDC (2016), obesity is defined as “weight that is higher than what is considered as a healthy weight for a given height.” It involves excessive weight gain and accumulation of fat. In order to determine obesity, Body Mass Index or BMI is used to indirectly calculate a person’s body fat and health risk based on weight in relation to height. A BMI of 25.0 or above is considered overweight and 30.0 or greater is considered obese. Athletes with a greater amount of muscle mass may have a higher BMI even though they do not have excess body fat. Waist circumference is also used as a tool to diagnose obesity.

There are many causes that contribute to obesity, including behavioral, genetic, hormonal, environmental, and social factors. Increase in caloric intake, unhealthy eating habits, decrease in physical activity, certain medications, age, lack of sleep, quitting smoking, pregnancy, and certain medical disorders can contribute to weight gain (Mayo Clinic, 2018). Driving cars has replaced walking and riding bikes, technology has replaced engaging in physical activity, and easy access to cheaper foods has replaced nutritional importance. Most people are aware when weight is gained. Obvious signs and symptoms are tighter clothes, excess fat, and increased weight on a scale. Being overweight or obese increases the risk for many health diseases. Obesity may cause low endurance, breathing issues, excessive sweating, and joint discomfort. It can also lead to diabetes, gastroesophageal reflux disease, coronary heart disease, hypertension, high cholesterol, stroke, depression, and even certain types of cancer such as bowel, breast, and prostate cancer (Mayo Clinic, 2018).

Below is a map that highlights the obesity prevalence across the U.S. in 2016 according to the CDC. There is no significant difference in overall prevalence between men and women. The prevalence of women with a BMI > 35 is 18.3% compared to 12.5% of men. The highest prevalence of obesity is 32% in the South, followed by 31.4% in the Midwest, 26.9% in the Northeast, and 26% in the West. Globally, in 2016 more than 1.9 billion (39%) adults were overweight and over 650 million (13%) were considered obese (WHO, 2017).

Current Surveillance Methods

A surveillance system is used to examine public health issues and monitor long term trends, compare health, and determine improving or worsening factors (CDC, 2016). Behavioral Risk Factor Surveillance System (BRFSS) is one of the largest continuously conducted on going telephone health survey system in the world, completing more than 400,000 interviews yearly. BRFSS collects state data in all 50 states from residents regarding health related risk behaviors, chronic health conditions, and use of preventive services, which aids targeting and building health promotion activities (CDC, 2016). The National Health Interview Survey (NHIS) monitors the health of the U.S. population through the collection and analysis of data related to health topics. Data is collected through personal household interviews. This data allows to tracks the progress toward achieving national health objectives (CDC, 2016).

Descriptive Epidemiological Analysis

Florida has an estimated population of 20,271,272, and approximately 160 million Americas are overweight or obese. Florida is noted to have 36% of adults who are overweight and 26.2% of adults who have obesity (CDC, 2016). Locally, Pembroke Pines, Florida, has a prevalence of 24.8% among adults greater than 18 years of age (CDC, 2016). Obesity affects people of all ethnic and racial groups, all ages, and both males and females. The highest rates of obesity are among the non-Hispanic blacks (48.1%), followed by Hispanics (42.5%), non-Hispanic whites (34.5%), and non-Hispanic Asians (11.7%). Middle age adult’s, ages 40-59 (40.2%) are more at risk, as well as older adults over 60 years of age (37%) (CDC, 2016).

In Florida, 38% of adults consume fruit less than one time per day, and 20.8% of adults consume vegetables less than one time per day. Approximately 50.2% of adults engage in at least 150 minutes of moderate physical activity per week (CDC, 2016). These alarming statistics may help create a prevention plan by educating the community on the importance of consuming more healthy foods to reduce the rate of obesity.

Screening and Diagnosis

Health care providers use BMI as a screening tool to determine if one is underweight, healthy weight, overweight, or obese. BMI is calculated by dividing a person’s weight in kilograms by the person’s height in meters. A BMI of 18.5 is underweight, 18.5-25.9 is healthy weight, 25.0-29-9 is overweight, and 30.0 or above is considered obese. It is an easy and inexpensive method of screening for obesity. The sensitivity and specificity of BMI screening for men is approximately 73.7% and 72.5% and for women 76.3% and 100% (Vasconcelos, Cordeiro, Rech, & Petroski, 2010). Healthcare providers also take into consideration and assess additional risk factor such as diet, physical activity, and family history. Other more expensive screening methods that are used are skinfold thickness measurements, underwater weighing, dual-energy x-ray absorptiometry (DXA), and isotope dilution (CDC, 2017).

In 2008, obesity related medical costs estimated $147 billion in the U.S.; about $1,429 more per obese persons than healthy weight persons (Mennella & March, 2016). It is recommended for health care providers to screen all adults for obesity to identify at risk individuals for early intervention. For patients with a BMI > 30, health care providers should recommend intensive multi-component counseling, including behavioral management activities, diet and nutrition improvement, increasing daily physical activity, self monitoring, and addressing strategies on how to maintain lifestyle modification (Yao, 2013).

Plan of Action

As a future Family Nurse Practitioner (FNP), it is important to recognize the negative health outcomes, morbidity, mortality, and the costly healthcare costs associated with obesity. It is important for healthcare professionals to initiate evidence based practice strategies to treat and prevent obesity, regardless of age. Given the high prevalence of obesity in the U.S., this writer believes it is important to develop a rapport, initiate a discussion, and recommend non-pharmacological treatment goals about weight management with every patient. “While research has shown that patients are more likely to try and lose weight and to have a greater weight loss success if they have been advised by their health care provider to lose weight, research has also shown that only 27% to 42% of obese patients seeking medical help are advised to lose weight” (American Nurse Practitioner Foundation, 2013).

As a FNP, an example of a goal would be to work with local government officials and community leaders to create more farmers’ markets in different communities to advocate healthy living. The lack of education within communities plays a major role in the rising obesity rates. This writer would discuss with patients about setting daily caloric restrictions, maintaining portion control, and utilizing a daily food and activity diary to improve weight loss goals. Patients would then follow up during office visits to measure the outcomes. The 5 A’s is an evidence based approach to behavior change allowing patients to collaborate with their provider. Providers would ask about the patients health behaviors, assess patients readiness to change, advise about risks and benefits, assist with goal setting, and arrange follow ups to assess progress and reassess goals. (American Nurse Practitioner Foundation, 2013). Also, this writer would provide patients with community resources by identifying different farmer market with nutrition assistance programs, and different locations of local parks, pools, and health food stores.

Conclusion

The obesity epidemic continues to rise and has proven to be difficult to reverse. It is a complex public health issue and has been one of the most difficult to overcome. This paper discussed the significance of obesity in Florida, provided a background of the disease, reviewed current surveillance and reporting methods, conducted a descriptive epidemiological analysis, discussed diagnosis and screening for prevention tools, and developed an evidence-based plan along with measureable outcomes to address obesity as an advanced practice nurse. Obesity is a major public health issue, but by implementing the right polices and strategies, the growing epidemic of obesity can change. It takes a collaborative and comprehensive approach involving governments, media, health care providers, and individuals in reversing the U.S. obesity epidemic.

Reference

American Nurse Practitioner Foundation. (2013). Nurse practitioners and the prevention and treatment of adult obesity. Retrieved from http://international.aanp.org/Content/docs/ObesityWhitePaper.pdf

Centers for Disease Control and Prevention. (2017). About adult BMI. Retrieved from https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html

Centers for Disease Control and Prevention. (2016). Overweight and obesity. Retrieved from https://www.cdc.gov/obesity/adult/defining.html

Centers for Disease Control and Prevention. (2016). 500 cities project: Local data for better health 2014. Retrieved from ftp://ftp.cdc.gov/pub/MAPBOOKS/FL_Pembroke%20Pines_MB_508tag.pdf

Mayo Clinic. (2018). Obesity. Retrieved from https://www.mayoclinic.org/diseases- conditions/obesity/symptoms-causes/syc-20375742

Mennella, H. A., & March, P. P. (2016). Case management: Obesity. CINAHL Nursing Guide.

Vasconcelos F. A., Cordeiro, B. A., Rech, C. R., & Petroski, E. L. (2010). Sensitivity and specificity of body mass index for the diagnosis of overweight/obesity in elderly. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21229211

World Health Organization. (2017). Obesity and overweight. Retrieved from http://www.who.int/mediacentre/factsheets/fs311/en/

Yao, A. (2013). Screening for and management of obesity in adults: U.S. preventive services task force recommendation statement: A policy review. Ann Med Surg, 2(1), 18-21.