OBESITY 1 OBESITY 15

Obesity

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Introduction

Obesity is a global epidemic affecting almost all population cohorts. Rates of obesity are rising worldwide. According to the World Health Organization (WHO, 2013), the obesity epidemic “is not restricted to industrialized societies,” with millions of obesity-related cases burgeoning in developing countries (p. 1). With billions of cases worldwide, obesity has therefore been described as the “major health hazard of the 21st century,” (Zhang, Liu, Yao, et al., 2014, p. 5153). Given the global nature of the disease, clinical guidelines have become increasingly standardized, but it is still necessary to tailor interventions to specific populations to create age appropriate, culturally appropriate, and gender appropriate treatment interventions. After a brief discussion of obesity pathophysiology, this paper will evaluate standard practices at local, state, national, and international levels. Access to care and treatment options also determine disease outcomes. Therefore, this paper will also address the core factors involved in public health strategies and health policy.

Pathophysiology

Defined clinically as “an exaggeration of normal adiposity,” obesity is the condition of being excessively overweight based on quantitative measures like body mass index (BMI) (Redinger, 2007, p. 856). However, the pathophysiology of obesity is also linked to ancillary factors like metabolic and immune dysfunction. BMI alone is not a reliable assessment measure either, due to individual differences (Li & Cheung, 2009).

The biggest health-related problem with obesity is its comorbidity with a number of potentially fatal conditions including diabetes, heart disease, and cancer (Zhang, Liu, Yao, et al., 2014). Obesity is a complex problem linked to a number of variables, but lifestyle is typically implicated given that “overconsumption of calorie dense foods” is a known culprit in disease etiology (Zhang, Liu, Yao, et al., 2014, p. 5153). Increased availability and low cost of calorie dense foods has contributed to the proliferation of obesity, but there are also physiological and neurological factors that contribute to disease progression. Due to biological or genetic reasons, some individuals do seem predisposed towards obesity based on neuroimaging (Zhang, Liu, Yao, et al., 2014). Therefore, obesity is a result of both genetic and lifestyle factors, and a biopsychosocial approach to treatment interventions may be warranted in most cases.

Standard Practices

Standard practices involve preventative and ameliorative treatment interventions. Interventions may include individual interventions and also community or public health interventions including public policy and legislation. The Centers for Disease Control and Prevention (CDC, 2017), for example, offers public health strategies like building communities conducive to physical activity and removing barriers to healthy eating. Community practices coincide with primary care interventions, which include regular and ongoing assessments of risk status, assessment of patient attitudes and lifestyle, dietary and lifestyle recommendations, and also pharmacological interventions.

Pharmacology

Especially at the preventative and early intervention stages, obesity can be managed through lifestyle changes alone. When the disease has progressed, however, and when genetic or biological factors are involved in the persistence of the disease, pharmacological interventions may be warranted or necessary. Research shows that pharmacological interventions combined with lifestyle changes are more effective than lifestyle changes alone for some patients (Li & Cheung, 2009). However, the global healthcare community understands that pharmacological interventions alone are rarely efficacious in disease maintenance and that medications need to be combined with dietary and physical activity interventions (Apovian, Aronne, Bessesen, et al., 2015). Currently, there are only two medications that have been approved in the United States for the long-term management of obesity: Sibutramine and orlistat (Li & Cheung, 2009). The former reduces appetite to help the patient reduce food intake more reliably, while the latter is a drug that acts as a gastrointestinal lipase inhibitor, effectively interfering with fat absorption to prevent weight gain. (Li & Cheung, 2009).

Assessment and Diagnosis

The National Institutes of Health (2000) offer a practical guide for healthcare practitioners for standardized obesity assessment and diagnosis procedures. In addition the BMI measurements, the guide includes instructions for measuring waist circumference and testing for specific comorbidities like diabetes and blood pressure. Assessment and diagnosis procedures also entail differentiating between overweight, as a precursor and risk factor of obesity, and obesity itself. However, “there is no precise clinical definition of obesity based on the degree of excess body fat that places an individual at increased health risk,” (Lyznicki, Young, Riggs, et al., 2001, p. 2185). Measuring BMI is an “inexpensive” measure that can at...

Subsequent to diagnosis, healthcare teams should offer patients a range of options based on their current lifestyle and their willingness and ability to change. Unfortunately, “national studies have shown that obesity counseling rates remain low among healthcare professionals,” (Kushner, 2012, p. 2870). Even if assessment and diagnostic procedures remain complex and individualized, healthcare workers need to develop more comprehensive protocols for treatment intervention plans. Assessments are also based on patient risk factors for developing comorbid conditions (National Institutes of Health, 2000).
Patient Education

Patient education is the cornerstone for obesity awareness, early detection, risk management, and treatment. Yet there is no national standard for patient education, and also no established local or state program for patient education on obesity. Instead, there are a plethora of public awareness campaigns that often fail to target structural and socioeconomic issues that are major factors in disease progression, such as the lower cost of calorie-dense and nutritionally vacant food products, or the overall sedentary lifestyle practiced by an increasing number of people worldwide. Overall awareness of the problem of obesity is high, but compliance with recommended interventions can be astonishingly low due to a multitude of factors including weaknesses on the part of the healthcare team to properly communicate and educate clients (Kushner, 2012). It is important to frame patient education in ways that are culturally appropriate but also sensitive to the need to avoid stigmatizing and judging patients based on their appearance (Kushner, 2012). Yet political correctness should not override the need for patient education, particularly as obesity is preventable yet presents a tremendous cost burden to all affected societies (Li & Cheung, 2009). It is therefore an ethical objective to commit more to patient education and obesity prevention.

Local, State, and National Practice Alignment

Because obesity is a multifactorial disease, there is an understandable lack of standard guidelines. Aligning local, state, and national practices would help healthcare workers come up with consistent and comprehensive interventions that are still adaptable to target populations. The CDC (2017) offers suggestions for local, state, and federal officials to implement prevention strategies including education-based interventions that prevent childhood obesity. Likewise, the CDC (2017) encourages standard practices for early childhood obesity risk factor identification and nutritional and lifestyle counselling. Standard practices for obesity management in this community does align generally with state and federal policies, each of which recognizes there is a problem and understands the wealth of evidence showing how obesity is linked to a number of comorbid conditions that are essentially preventable.

Effective Disease Management

Effective disease management for obesity depends on a number of critical factors, including the patient’s overall health status, socioeconomic demographics, geography, culture, lifestyle, and overall commitment to health. To effectively manage obesity, the patient needs to demonstrate readiness and willingness to change and a commitment to long-term changes to diet and exercise habits. Compliance with recommended health behaviors will effectively manage symptoms and prevent complications.

Access to Care and Treatment Options

Access to care may prevent a large number of at-risk and obese patients from seeking medical attention and receiving education. Barriers to care may include the fear of stigma, causing some obese patients to avoid seeing their doctors until a health problem has progressed. On the other hand, a patient who deftly manages their symptoms will have improved health outcomes including longer life expectancy and reduced risk for comorbid conditions. Access to care also includes access to treatment options that go beyond just dietary and lifestyle factors. For example, the patient needs to have access to a team of healthcare workers who are knowledgeable about the latest pharmacological interventions and other evidence-based practices that can help reduce symptoms and promote health and wellbeing. Successful disease management is not just about losing weight but about maintaining a healthy body weight and reducing risk factors for heart disease, diabetes, and other comorbid conditions.

Access to care and treatment options also have geographic, cultural, and socioeconomic implications as well. Patients living in communities where healthy lifestyles are normative are more likely to participate in healthy behaviors versus their counterparts in communities without access to healthy choices. Research shows that in low income neighborhoods where calorie dense foods like fast foods are more readily available than healthy foods, patients were still unlikely to change their eating habits when exposed to healthy options (Cummins, Flint & Matthews, 2014). The…