Health Promotion for Obesity in Adults

Introduction

This is a health promotion proposal for preventing obesity among adults in the US. People get obesity when they acquire a given body mass index. People with 25-29.9 BMI are considered overweight, whereas others with 30 or more BMI are considered obese. Obesity is related to several chronic conditions such as heart diseases, diabetes, cancer and stroke among others.

Health Problem

According to CDC (Centres for Disease Control and Prevention), more than one-third of U.S. adults (over 72 million people) while 17% of U.S. children are obese (Centers for Disease Control and Prevention, 2011). Between 1980 and 2008, the rates of obesity doubled across all age groups (Centers for Disease Control and Prevention, 2011). During the past several decades, obesity rates for all population groups—irrespective of age, sex, race, ethnicity, socioeconomic status, education level, or geographic region—have increased markedly (Centers for Disease Control and Prevention, 2011).

According to the US Surgeon General, obesity is responsible for nearly 300,000 deaths in the US (US Surgeon General, 2010). Obesity has become a national health problem. Today, it is linked to other chronic diseases, such as hypertension, coronary heart diseases, diabetes, stroke, osteoarthritis, and some types of cancers. Although several factors could be responsible for obesity in the US, poor diets and a lack of physical activities, seem to be the major contributors to obesity.

Vulnerable Population and Setting

Although people of all ages are prone to obesity and overweight, this proposal focuses on obesity among adults in the US. According to Fakhouri, Ogden, Cynthia, Kit, and Flegal (2012), by the year 2050, there would be many older adults (people aged 65 years and over) in the US. The number will double from 40.2 million to 88.5 million. Older adults have become prone to obesity due to inactivity and diets. Hence, aging and obesity are likely to strain the available healthcare services. Moreover, they are also likely to increase spending on healthcare services. Therefore, given the expected demographic changes in the US in the next two decades and possible impacts on public health and costs due to obesity, it is imperative to understand the prevalence of obesity among seniors based on their sex, age, race, educational achievement, socioeconomic status, and other relevant factors.

Kruger, Ham, and Prohaska (2009) noted that obesity among older adults was growing steadily. They also noted that both overweight and obesity prevalence in every age group among adults rose significantly (Kruger et al., 2009; Fakhouri et al., 2012).

The problem of rising cases of obesity has become a global concern due to excess weight gain. Moreover, obesity in older adults is associated with several chronic diseases, such as cardiovascular conditions, cancers, and diabetes (Samper-Ternent & Al Snih, 2012).

Several studies have indicated that the rate of obesity has risen steadily in the US, developed countries, as well as developing ones. Fakhouri et al. (2011) showed various in the rise of obesity among older adults in different age categories since 1999 to 2010.

Risk Factors among Adults

Genetic factors

Nurses have often noted that obesity cases tend to be common in families. This observation may support the conclusion that obesity is associated with the genes, which people inherit across generations (Newman, 2009).

Environmental factors

Environmental factors also have a role to play in obesity. The environment influences individuals’ access to workplaces, healthy diets and recreational facilities among others. Individuals’ “diets, level of physical engagement, lifestyles and behaviours” (Newman, 2009) are under the influence of environments. The common trends involve “eating out’ rather than preparing food in the home; high-fat, high-calorie foods at workplace vending machines; neighbourhoods that often lack sidewalks; and a deficit of readily accessible recreation areas” (Newman, 2009).

Sociological factors

Poverty and low-levels of education have also contributed to obesity among certain populations. It is noted that economically disadvantaged people tend to seek for high-calorie, readily available processed food, which are less expensive and easier to prepare relative to fresh fruits and vegetables (Newman, 2009). These are unhealthy foods, which are linked to high rates of obesity among such populations.

Other studies have established that obesity is severe and common among people with “arthritis-related disease progression, activity limitation, disability, reduced quality-of-life, total joint replacement, and poor clinical outcomes after joint replacement” (Hootman, Pan, Helmick, & Hannan, 2011). Specifically, people with obesity who also suffer from arthritis could have trouble with exercise and weight loss because of pain. Pain may limit the level of physical activities and mobility, which are critical aspects of weight loss. People with arthritis could rely on aquatic exercise, walking or stationary cycling to reduce pain and pressure in their joints. In addition, such activities would also enhance “weight loss and promote healthy living for obese people with arthritis” (Hootman et al., 2011).

There are also other causes of obesity. Studies have shown that certain conditions and illnesses may be related to obesity and weight gain. They include “hyperthyroidism, Cushing’s syndrome, polycystic ovary syndrome, and depression” (Newman, 2009). Older individuals who are obese are more prone to cases of depression relative to others who are not. Inadequate sleep and certain drugs could be contributing factors for obesity. Certain drugs, such as steroids and specific antidepressants may hinder the rate of “metabolism, enhance water retention and stimulate eating habits” (Newman, 2009). Functional abilities and lifestyle factors also contribute to obesity. Cases of joint pain, low-levels of mobility and poor physical activities could facilitate weight gain. Older adults, therefore, are prone to functional limitation due to some chronic conditions.

Literature Review

The nature of causes or risk factors of obesity require multiple interventions. As a result, many studies have presented several approaches to managing obesity among older adults. Nurses and physicians could help obese individuals to change their lifestyles and enhance healthier living.

The major aim of most intervention programmes is to attain sustainable lifestyle behaviours exhibited through dietary habits, physical activities, improved knowledge and community support. Perez et al. (2013) observed that most interventions targeted physical activity and/or diet behavioural modification focused on the target populations.

Interventions that promote lifestyle changes in older adults focus on eradicating “barriers that limit physical exercise and dietary modifications” (Perez et al., 2013). In this regard, certain intervention programmes have provided positive outcomes for older adults.

There are self-management programmes for obese older adults. Self-management programmes also focus on other chronic diseases, such as diabetes, heart conditions, and arthritis among others (Newman, 2009). The aim of self-management programmes is to ensure that older adults learn to manage their chronic conditions by enhancing the level of self-efficacy.

Such programmes allow individuals to develop self-confidence and ability to modify their behaviours and focus on the changes required to facilitate healthier habits and lifestyles by taking part in various activities as scheduled. Self-management interventions address issues related to when, frequencies, how and what to ensure that older adults can follow such plans without assistance.

Self-management interventions, however, have not been highly successful because of chronic conditions among the target populations. Nevertheless, they provide the most basic approaches that nurses may adopt and assist older adults to modify their behaviours and lifestyles.

There are also blueprints to help older adults to enhance the rates of their physical activities (Newman, 2009). Such interventions have various options that match different needs, interests, functional limitations and lifestyles. Consequently, interventions aim to encourage older adults to pursue various activities and enhance their physical well-being. Interventions on physical activities point out barriers that affect physical activities among seniors. In addition, they note that care providers should address factors related to home and community, healthcare policy and advocacy programmes and other related issues to overcome challenges to physical activities. The main approaches in these interventions have been the following. First, such interventions disseminate information about advantages of physical exercise for older adults. Older adults can gain access to such information through professional journals, specialised magazines, meetings or from health professionals. Second, interventions aim to identify and provide specific physical activities that meet various needs of older adults with obesity and other chronic conditions, including arthritis. They help patients to pursue activities that will improve their physical well-being. Finally, they also offer resources that describe physical exercise opportunities for seniors. This allows nurses and other care providers to offer appropriate support, referrals and recommendations.

It is imperative to note that older adults present unique challenges when focusing on behaviour changes, diets, lifestyles and physical activities. Generally, increase in and several cases of chronic conditions in older adults affect diets and the level of physical activities and exercise engagement. These factors results in difficulties in losing weight among seniors. In addition, it is necessary to focus on depression and related causes among older adults. Older adults, therefore, require other people to take part in these activities to encourage them.

It is important to refer older adults to appropriate “nutritional counselling programmes and dieticians to ensure that they meet and consume their daily recommended nutritional requirements with the aim of losing excess weight” (Newman, 2009). It is therefore important to consider advantages of weight loss in seniors since a loss of “lean body mass, which is already diminished in older adults, may not be appropriate in persons over 65 years of age while a loss of fat-free mass in older adults is associated with significant morbidity and mortality” (Flood & Newman, 2007). Any weight loss initiative for older adults should not facilitate muscle and bone loss. Obese older adults can benefit from such activities, especially if they have functional limitations and metabolic problems that weight loss may enhance. The most important approach is to reduce average calorie consumption. In addition, dieticians must be available to ensure that older adults meet their daily dietary recommendations. It is necessary to ensure that the diet has all the required nutrients in the correct proportions as indicated.

Interventions aim to ensure that obese older adults have improved physical activities, which help in maintaining muscle and bone mass. Regular exercise is recommended for such older adults. The process demands enhanced “flexibility, endurance and physical strength with the aim of reducing excess weight in older adults” (Newman, 2009). In this regard, physical activities that involve stretching, strengthening and aerobic are extremely useful for older adults with obesity. They can avoid muscle strains and injuries by starting at low intensity and ensuring endurance with positive, gradual progress over a prolonged period.

An Appropriate Health Promotion Model (Theoretical or Conceptual)

The Public Health Intervention Wheel or the Intervention Wheel is a “population-based practice model that encompasses three levels of practice (community, systems, and individual or family) and 17 public health interventions” (Keller, Strohschein, Lia-Hoagberg, & Schaffer, 2004). Every intervention and related practice enhances public population health. Nurses can use the Intervention Wheel to improve the health of older adults with obesity.

A Health Promotion Program Using an Evidence-based Intervention

Continuous public education and awareness

Working class adults do not easily get relevant information about obesity due to their busy schedules. Nurses should encourage public awareness and campaigns that focus on older adults.

Collaboration

Nurses should encourage different stakeholders to work together in the fight against obesity among older adults.

Advocate for resources

For a long time, available resources on obesity have focused on individuals who can afford medication, physical activity resources and healthy diets. Nurses should advocate for resources that meet obesity needs of older adults, particularly the underserved and uninsured groups.

Working with the community to improve obesity cases

Continuous education and collaboration are the best approaches to fighting obesity in older adults. Nurses should use their knowledge to educate the community about obesity. At the same time, the community members must also cooperate and attend public seminars about obesity. This would enhance creation of awareness and public education.

Public and private partnership

This would involve collaboration among independent stakeholders in the health sector and the government to improve obesity outcomes.

The government should formulate policies that support healthy living and diets. The focus should be on restricting junk foods and other simple carbohydrates among working class adults. In addition, the government must also finance and support obesity-related programs.

The private sector should support nurses, outreach programs, and provide free medical checkups for obese and at-risk older adults. They can directly fund such projects or engage in such activities themselves.

Intended Outcomes

The major objectives of implementing these activities are to reduce obesity in older adults and improve healthy living. These activities would improve access to information, knowledge on obesity, treatment, and medical checkups, and increase intake of fruits and vegetables and physical exercise.

The evaluation activities would include a weekly monitoring of changes and adherence to recommended diet intakes and physical activities.

Results from the evaluation may be used to improve interventions for obese older adults.

Barriers for Completion of the Proposed Project and Potential Solutions

Obesity is a complicated, multifactorial disease with several outcomes and risks to patients. Consequently, interventions may face many barriers. First, there are financial constraints for patients with obesity due to its chronic status. Second, many patients and nurses may not find adequate time to educate, train and counsel their patients on weight loss and maintenance. Third, many people have failed to recognise obesity as a chronic condition that is difficult to manage and presents various health complications. Obesity requires long-term, continuous management strategies. Fourth, there are insufficient data to support long-term safety and efficacy of the available interventions. Fifth, some of the patients are not interested or ready for interventions. Patients bear negative perceptions associated with a lack of self-discipline and self-control regarding lifestyles and eating habits. Finally, patients also lack effective training and training strategies, particularly with regard to physical activities (El Ansari & Lovell, 2009).

Physicians have critical roles to play in managing obesity in older adults. The rising cases of obesity in older adults have also highlighted the need for physicians to identify and manage the condition.

By taking into account obesity implications on public health, it is necessary for healthcare providers to increase their “knowledge, training and education on obesity and understand that the condition is complex and requires long-term, continuous care” (Flood & Newman, 2007). Nurses must rely on scientific advice and evidence-based outcomes to manage their patients’ conditions, make recommendations and sound referrals. This would ensure maximum improve in patient care. Moreover, nurses need to understand specific causes of obesity, challenges in treatment and relevance of all interventions. Physicians must overcome challenges associated with managing obesity at their levels.

Physicians should evaluate their patients’ body weight and recommend suitable interventions alongside counselling. In this regard, physicians have the responsibility of assisting their patients to develop appropriate interventions, including weight loss and healthy diet programmes. In addition, they must monitor, evaluate and refer patients to other care providers. When evaluating the effectiveness of any weight management programme, it is necessary for patients and nurses to understand that the ultimate goal is weight loss alongside weight management for better health and improved outcomes.

Older adults should consult their physicians before embarking on any weight loss and diet programmes. Physical examination is necessary to determine an individual’s specific requirements and suitable programmes. Physicians must collaborate with other specialists, such as psychologists, therapists, dieticians and physiologists to ensure that older adults receive appropriate interventions.

Generally, many obese patients have difficulties in achieving and maintaining the recommended weight. This challenge requires a long-term engagement to physical activities and healthy diets to avoid possible regain of the lost weight. Patients require encouragement to reduce their body weights and therefore, helpful interventions must promote weight loss merits and ensure that patients maintain the recommended body weight.

It is not simple for many patients to maintain weight loss over a long period. As a result, prevention of overweight is the most effective solution for avoiding obesity in older adults. Physicians and nurses have the primary role of ensuring that patients maintain healthy weights and avoid overweight. In addition, they must promote healthier lifestyles and behaviour change in their patients. Efforts to avert obesity across populations should start in childhood with the aim of creating awareness about overweight and obesity.

Recommendations

  • It is imperative for physicians and other care providers to recognise obesity as a complex, multifactorial disease with several adverse outcomes and therefore, it requires diet control and adequate physical activities.
  • Physicians should collaborate with other specialists and seek for further training on obesity management.
  • Interventions should be specific. In this regard, physicians must identify specific risk factors for a given patient, evaluate long-term efficacy and safety of interventions and determine outcomes of counselling and education programmes to patients.
  • It is important to educate and train people about obesity-associated risks and offer information on healthy living practices.
  • Healthcare providers should evaluate older adults’ weight conditions during regular medical reviews and advice obesity prone patients about their weight gain and potential interventions.
  • Patients should maintain their recommended weight and avoid further weight gains.
  • Obese patients should readily access the required resources and information.

Conclusion

Cases of obesity continue rise globally. Obesity is a serious health condition that put people at risk of other chronic health challenges. Older patients face unique challenges due to old age and other chronic diseases, which reduce their functional capabilities and physical activities. Consequently, they may have challenges with weight loss through physical activities. It is necessary for physicians and other healthcare providers to ensure that older people understand their obese and other chronic conditions because of possible limitations and assistance they may require.

Physical activities and healthy diets are the most preferred interventions by many scholars. There is a need to improve public awareness, healthy diets, and physical activities in order to curb obesity. A focus should be on preparing and consuming healthy meals for the family, encouraging access to information, collaboration, regular medical checkups, and incentives to encourage outdoor activities.

This health promotion proposal has identified the Intervention Wheel as an appropriate model that can guide the fight against obesity among older adults. Nurses and physicians can adopt the model to assist patients manage their weight and enhance weight loss.

References

Centers for Disease Control and Prevention. (2011). Obesity: Halting the Epidemic by Making Health Easier. Web.

El Ansari, W., & Lovell, G. (2009). Barriers to Exercise in Younger and Older Non- Exercising Adult Women: A Cross Sectional Study in London, United Kingdom. International Journal of Environmental Research and Public Health, 6(4), 1443– 1455. Web.

Fakhouri, T., Ogden, C., Carroll, M., Kit, B., & Flegal, K. (2012). Prevalence of obesity among older adults in the United States, 2007-2010. NCHS Data Brief, (106), 1- 8.

Flood, M., & Newman, A. (2007). Obesity in older adults: Synthesis of findings and recommendations for clinical practice. Journal of Gerontological Nursing, 33, 19- 35.

Hootman, M., Pan, L., Helmick, G., & Hannan, C. (2011). State-specific trends in obesity prevalence among adults with arthritis, Behavioral Risk Factor Surveillance System, 2003–2009. The Journal of the American Medical Association, 305(23), 2404-2405. Web.

Keller, L., Strohschein, S., Lia-Hoagberg, B., & Schaffer, M. (2004). Population-based public health interventions: practice-based and evidence-supported. Part I. Public Health Nursing, 21(5), 453-68.

Kruger, J., Ham, S., & Prohaska, T. (2009). Behavioral Risk Factors Associated With Overweight and Obesity Among Older Adults: the 2005 National Health Interview Survey. Preventing Chronic Diseases, 6(1), A14.

Newman, A. (2009). Obesity in Older Adults. OJIN: The Online Journal of Issues in Nursing, 14(1), 3. Web.

Perez, G., Arredondo, M., Elder, P., Barquera, S., Nagle, B., & Holub, K. (2013). Evidence-based obesity treatment interventions for latino adults in the U.S. A systematic review. American Journal of Preventive Medicine, 44(5), 550-560.

Samper-Ternent, R., & Al Snih, S. (2012). Obesity in Older Adults: Epidemiology and Implications for Disability and Disease. Reviews in Clinical Gerontology, 22(1), 10-34.

US Surgeon General. (2010). Childhood Obesity Prevention. Web.

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