Barriers Affecting Nurse Practitioners' Management of Obesity
Tamika Missouri
Coppin State University
Primary Care of the Adult/ Older Adult
NURS 660
Dr. R. Warren- Dorsey
BARRIERS AFFECTING NURSE PRACTITIONERS' MANAGEMENT 9
Barriers Affecting Nurse Practitioners' Management of Obesity
Introduction
There is a multitude of diseases and chronic health conditions that have evolved over the years and continue to debilitate populations. Obesity, a major health condition affecting the United States, is of great concern today. Parameters that define obesity are a body mass index, BMI, above 30 (Crawford, 2010). The sum is a combination of height and weight, related to an excess of fat accumulation. The prevalence of obesity has continually increased over the years. Approximately 1/3 (37.5%), of adult Americans are afflicted with being excessively overweight (CDC, 2013). Disproportionately, people living in lower socioeconomic dwellings account for higher obesity rates compared to wealthier jurisdictions (U.S. Census Bureau, 2010). This epidemic has spearheaded global initiatives that attempt to address the issue; however, factors related to obesity must also be examined. Obesity is a condition linked to other serious health complications. Nurse practitioners should have an awareness of unique contributing factors impeding the treatment of obesity in under privileged populations. The United States has targeted obesity in healthy initiatives by setting goals to evaluate behaviors regarding the consumption of wholesome diets and attaining and maintaining healthy weights (Healthy People, 2010).
Obesity
In 1998, the National Heart, Lung, and Blood Institute published guidelines on the identification, evaluation, and treatment of obese adults (NHLBI, 2013). Growth of obesity at alarming rates over the last 20 years make it a priority issue that deserves immediate attention from nurse practitioners. Nurse practitioners must be cognizant of these guidelines and must also be knowledgeable of factors affecting this chronic condition. Obesity is a multidimensional, public health issue. Therefore, nurse practitioners must offer diverse treatment strategies in order to reduce its increasing prevalence. Reducing populations affected by obesity will help to decrease the trend in other chronic disease nuisances, such as diabetes, heart disease, and cancer, thus promoting healthier patient populations. In order to effectively manage a patient that is obese, the nurse practitioner must recognize and treat obesity as a separate disease entity. Management should offer a unique approach, targeting special circumstances that perpetuate the condition. Taking a thorough history and carefully examining every facet that affects obesity would be instrumental in treatment.
Prevalence
Obesity has reached epidemic rates in the U.S. Disproportionately, underprivileged
populations show an upward trend of rates. Obesity as a healthcare concern is rampant in
communities, with low grossing incomes, low quality education, and high unemployment rates
(American Heart Association, 2013). Social aspects of being overweight deserves better
attention. Goals set by Healthy People 2010, was to lower obesity prevalence to 15%.
No state in U.S territory met that goal.
Obesity targets populations throughout a broad age range. In an entire household, obesity
can affect every individual in that family. The obesity trend impacts not only the adults, who are
the heads of households, but shows profound occurrences in the offspring. Consideration of
relatable factors such as culture, economics, and social factors is necessary to evaluate their
influence on obesity’s prevalence. These aspects have a direct correlation on affecting an
individuals tendency to be obese. According to Darmon &Drewnowski, communities with
considerable hardships
have a tendency to have a population that is significantly overweight (2009). Persons living in
underserved populations lack the educational resources that informs them of proper healthy
eating. Access to affordable, quality nutritious food choices are not readily available. Culturally
accepted norms of diet exist that are more traditional and may not follow the best nutritious
practices.
The rise in obesity rates has driven medical spending costs up to over $147
billion per year since 2008 (NHEA). This accounts for more than 10% of all
medical spending. Obese individuals’ medical spending is as much as $1,500 more than normal
weight individuals. Medicare alone sees an average increase of $600 per year for obese people.
compared to normal weight persons. The economic burden that obesity has placed on public
and private sectors has forced institutions to employ ways to lower obesity incidences
Resources
Increasing prevalence has made obesity a priority in public health. Primary prevention,
inhibiting the illness before it happens, is the single most effective measure that agencies can
institute to control obesity in underserved populations. Emphasis on good nutrition practices
and regular exercise that promote healthy lifestyle behaviors are incorporated in primary
prevention practices. Numerous initiatives have developed in recent years to address the
concerns of obesity. The rise in health care costs, along with its close relation to other
comorbidities, have made it a priority for health care agencies. Programs should have a multi-
dimensional approach to ensure all aspects of addressing the needs of the individuals are
accounted for.
Various funded partnerships with Young Men’s Christian Association (YMCA), The
Supplemental Nutrition Program for Women, Infants, and Children (WIC), and Children’s .
Health Insurance Program (CHIP) have all set goals that directly impact reducing the obesity
trend. Let’s Move Campaign, an initiative put forth by Michelle Obama raises awareness in
youth obesity (Obama, 2010). It strives to promote healthy living and weight reduction through
exercise and better food options. Communities Putting Prevention to Work (CPPW) is a U.S.
program that supports 50 communities in combating obesity. One in six Americans are expected
to benefit from this one program that targets obesity as a preventable disease (CDC, 2013).
Center for Disease Control and Prevention (CDC)- Division of Nutrition, Physical Activity, and
Obesity (DNPAO) coordinates and funds a partnership between 25 states and various private
partners to troubleshoot obesity. CDC’s DNPAO program uses evidenced based nutrition
improvements and physical activity to tackle obesity. The target is to change people’s
environment through altering the way people live, learn, work, and play. One example of the
program’s efforts is through the “Farm to Where You Are Program”, which promotes increased
consumption of high quality fruits and vegetables through better access and availability. Other
initiatives surround limiting sugary content in beverages and menu labeling in restaurants and
fast food chains. Increasing the consumer’s awareness of nutritive choices allows better
decisions of proper foods to consume. The Affordable Care Act funded several research grants
for the Childhood Obesity Research Demonstration project (CORD). The focus of this research
tracks obese children through four different settings that include home, education, community,
and health to impact the expected needs of obese children. The multi-dimensional approach
seeks to include not only the individual, but the friends, family, educators, and providers to
change the obesity trend. Communities Putting Prevention to Work (CPPW), sponsored through
the U.S. Department of Health and Human Services (HHS) and CDC, has worked to address
obesity by promoting environmental changes. Some interventions include providing bicyclists
and pedestrian passageways throughout public routings. They’ve also made strides to improve
healthy food and beverage choices in school settings.CDC awarded $103 million for the
Community Transformation Grant (CTG) Program, which focuses on partnerships that improve
health and wellness within communities (Healthy Americans, 2014). The goal of CTG
encompasses efforts to decrease chronic disease by increasing clinical and community preventive
services. Approximately 9 million Americans, will benefit from CTG’s push for access
to healthier environments.
All of the approaches strive to produce long-term positive health outcomes through repetitive
positive practice. The foundational dynamics of all the programs focus on strategizing
interventions that eradicate obesity, thus minimizing the effect that obesity has on
individuals’ overall health.
Barriers
Nurse Practitioners’ increasing awareness of the trend of obesity within underserved
communities directly impact management. Understanding the contributory factors associated
with the evolution of obesity in individuals will aid in rendering effective long term treatment.
Recognizing and understanding the environmental components concisely depicts the individuals
surroundings and allows the nurse practitioner to make decisions and set goals based on realistic
expectations. First, being aware of cultural practices concerning diet is important. Quality of
diet correlates with socioeconomic status. Individuals in underserved populations consume
meals that are high in fat, added sugars, and refined grains versus whole grains. Prepared
meals are usually packed with energy but lack nutrients, which leads to obesity (Darmon &
Drewnowski, 2009). Existing poverty and high food prices is another barrier in underserved
communities. Individuals simply cannot afford nutrient dense food items, therefore less
nutritious substitutes are chosen for consumption, leading to obesity. Access to quality food is
also characteristic of poverty stricken communities. Supermarket availability is not
plentiful in these areas. Food stores that exist, stock lesser quality, processed food
items that impoverished individuals use most often. Lack of transportation to access
food stores that have varietal food choices, as well as fresh fruits, vegetables, and fish
is another obstacle. Many individuals living in poverty also have lower levels of education
attainment, predisposing them to less healthy lifestyles (OECD, 2010). There is an unawareness
in individuals in lower socioeconomic classes having proper nutrition knowledge. This
knowledge deficit has to be considered when caring for individuals of this class. Utilization of
appropriate educational tools should be used to meet the needs of the clientele. Being well
informed about the importance of proper nutrition, variations in food preparation to preserve
nutrients, lowering salt and sugar in food consumption, and importance of well balanced diet
with fruits and vegetables will all assist in diet playing a role in lowering obesity. Disussions
of abstaining from local fast food choices that offer a quick solution to hunger, but lack
having essential dense nutrients and minerals should also be taken into account.
Compliance with some form of physical activity is another common barrier exhibited in
underserved populations. Individuals lack the resources of fitness availability, recreation centers,
biking trails, and parks to leisurely take advantage of generalized body movement. Restrictive
access of to such resources, facilitates sedentary lifestyles, thus promoting obesity. Nurse
Practitioners making note of limited resources as well as considering a possible disinterest or
lack of motivation is instrumental in tailoring care plans that meet realistic goals for that patient.
Conclusion
Obesity is a chronic condition that affects Americans to a large degree. Underserved
populations have shown a pattern of increased rates for over two decades. The increased costs of
obesity in healthcare monies, has forced public and private health agencies to examine its
trend closely and institute measures to decrease the incidence of the condition. Nurse
Practitioners fully understanding the scope of obesity and the facets of the disease helps to
better manage the health concern. Treating it in primary prevention stages through effective
patient education, will help to decrease the prevalence in urban settings. Management of obesity
as a separate entity will help to better manage chronic diseases such as diabetes and heart
diseases. A noticeable decline in obesity will decrease populations affected with these
chronic conditions.
References
CDC Center for Disease Control and Prevention- Overweight and Obesity- Division of
Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease
Prevention and Health Promotion, August 16, 2013 www.cdc.gov
Center for Disease Control and Prevention. Divison of Community Health. Communities Putting
Prevention to Work. 2013 Healthy Americans.Org healthyamerican Community-
Transformation-Grants1.pdf s.org/.../FY14
Darmon, N., & Drewnowski, A. (2009, July 6). Does social class depict diet quality? The
American Journal of Clinical Nutrition, 87, 1107-1117
Editor- D. Crawford. Obesity epidemiology: From aetiology to public health. Oxford University
Press 2nd edition 2010 New York, New York pg 29 of chapter child and adolescent
obesity definitions, diagnosis, and terminology
Obama, M. (2010). First Lady Michelle Obama Launches Let’s Move: America’s Move to Raise
a Healthier Generation of Kids. The White House.
U.S. Census Bureau. Income, Poverty and Health Insurance in the United States 2010.
Washington, DC 2010
U.S. Department of Health & Human Services- National Heart Lung and Blood Institute, 2014.
www.nhlbi.nih.gov Clinical guidelines on the identification, evaluation, and
treatment of overweight and obesity adults.
U.S. Department of Health & Human Services, Healthy People 2010. ( 2009, June 5). Obesity:
Overview.