Prevention of Obesity

Obesity in Los Angeles County

The United States, while being one of the most technologically developed countries in the world, is not a healthy nation. Typically, when we think of disease pandemics we think of things like Swine Flu, Ebola, Lyme disease, etc. However, in the 21st century, we have a new pandemic that affects our children, adults, and eventually the whole population. Because of a more sedentary lifestyle, a proclivity for fast food, a high-fat diet, and hundreds of sugary drinks, obesity is now statistically so rampant that it is having a serious effect on American's health. Almost every researcher, whether medical or academic, as well as the public health sector, agree that there are statistical links between what we ingest and the consequences to our overall health profile. Certainly, all we need to is walk down any grocery store aisle, open up most magazines and newspapers, or watch advertisements and pop-up ads on the Internet to see just how obsessed Americans are with their weight (Robins, 1998). There are no real negatives to eating better, but certainly in our fast-food society it is often more difficult and expensive to opt for fresh fruits and vegetables and healthy alternatives that high-carb, high-sugar, processed foods (Overweight, 2008).

Assessment

Los Angeles County is the most populous county in the United States, with a 2010 population of almost 10 million. This is more than 42 individual U.S. States The county seat is Los Angeles City, which is the largest city in California and the second largest in the United States. As a county, Los Angeles is home to over 25% of California residents and one of the most diverse in the U.S. Geographically the county is 86% land and 14% water and has a diverse bio-system (mountains, valleys, forests, islands, lakes, rivers, and deserts). While the county's economic health is most often associated with the entertainment industry, it is also home to the Ports of Los Angeles and Long Beach, and over 20 major corporations are headquartered there. The county is also home to about 1/3 of the State's illegal alien population, and more than 10% of the county are also illegal alien residents (Johnson & Hill, 2011). The county is also quite diverse in terms of religion, with hundreds of Christian churches, Jewish synagogues, Buddhist temples, Islamic mosques, Bahai centers, Hindu temples, Tenriko churches, Shinto centers and Sikh gurdwars. The Los Angeles Catholic Archdiocese is the largest in the country with over 5 million members (USC Center for Religon and Civic Culture, 2005).

The racial make up of Los Angeles County is complex, particularly when using the definition of non-hispanic whites and anyone of hispanic or latino origin:

Because the county is so populous, there are of course very divergent racial and economic sectors within different cities. The population density is about 2,500 people per square mile with over 3.5 million housing units. What is also not so evident because the county has so many people is that it has the largest Native American population in the nation, even though it is small compared to the numbers of other ethnic groups. In terms of households, the breakdown shows:

The county has the highest number of millionaires in any county, almost 300,000 households. In contrast, the county has the largest number of homeless people, with over 50,000 people living on the streets. The median income is roughly $45,000 and the per capita income just under $25,000. 17.4% of the population lives at or below the National poverty line; of that 24% are under 18 and 11% over 64 (Nagopurney, 2010). As might be expected in an area of this size and diversity, there are a number of health issues despite a plethora of social service outlets, hospitals, clinics, and health care providers.

Health Concerns

Healthy People 2010 and now Health People 2020 is a governmental sponsored program in which there are science-based objectives for the health of all Americans. The program was established to: 1) encourage collaboration across regions and communities; 2) empower individuals to make informed decisions about their health and to take some responsibility for their healthcare, and 3) to measure the impact of health prevention activities across the nation. The power of the initiative is that it encourages prevention and communication across states, regions, ethnicities, and communities (About Healthy People, 2012). One of the major concerns for the initiative is obesity, and the resultant issues directly related.

Children are particularly at risk for obesity in developed societies. In fact, the obesity issue is epidemic in the fast-food, high-sugar cultures of the developed world. It is characterized by any condition in which excess body fat (BMI) has a negative effect upon health. There are a number of effects this has on children, so many that it has become a public health concern that has reached national proportion, The information age in which we live certainly has changed education, the way children learn, and how much information they can easily access. Unfortunately, a combination of these changes has resulted in a rising prevalence of obesity in children which, in combination with numerous negative health effects has resulted in a public health epidemic (Brinkley, 2010). The statistical increase in obesity and its health related consequences has become so serious in the past few years that First Lady Michelle Obama declared it a "national health hazard" that should be a top priority in Washington. The subject is now part of a national political task force, with the goal of eliminating the problem within one generation (Hills, 2007).

It is clear that childhood obesity is a direct result of the combination of lifestyle and eating choices. Likely because of advertising, ease, and constant pressure, modern children are not educated enough in their diets to understand choices. Thus, they prefer products with lots of refined sugars, snack foods, high carbohydrates, and those that are easy to prepare and find. When this is combined with playing computer games or watching television instead of playing outside there is an imbalance in caloric input/output. Most American youth, for instance, do not exercise as much because there are so many stationary, electronic, games and activities that interest them: computer games, internet surfing, chatting via text messages, and watching television (Lluch, et.al. 2000).

Further, it is not just obesity that is problematical. Health problems associated with anorexia nervosa, bulimia nervosa, and binge eating can also stunt growth, cause cognitive and attention problems, suppress the immune system, cause problems with puberty and adolescent development, weaken bones and muscles, and have serious image and psycho-social consequences. Children and adolescents often develop eating disorders do to social and cultural pressures to attain the "perfect body image" as exemplified by advertising and the media. They are actually considered an epidemic by the Centers for Disease Control and are particularly serious because the teen years are so crucial for growth, maturation and organ development. If unchecked, eating disorders and/or obesity, can lead to serious and life-long effects (CDC, 1996).

OBESITY IN LOS ANGELES COUNTY

As in most of the nation, the obesity epidemic threatens public health in Los Angeles County. Obesity increased from 13.6% to 22.2% in adults between 1997 and 2007. Most of the research shows there are marked disparities in the county based on income, education, and lifestyle choices. There are, however, similar risk factors that everyone in the county shares. This is actually crucial to an overall analysis of county problems. In 2006, the cost of obesity just for LA County was over $6 billion in health care and loss of productivity. Like other parts of the nation, this results from obesity increasing risks for diabetes, stroke, and coronary disease. Of special concern to the county is the increased prevalence of obesity among children and adolescents which, if not solved, will result in an adult population even more at risk (California Center for Public Health Advocacy, 2009).

Overall, adult obesity rates in LA County increased between 1997 and 2008 by approximately 9%. Deaths from coronary heart disease and stroke declined, but diabetes, CHD, and other obesity related illnesses are still the leading cause of premature death before 75 years. As we can see, though, adult obesity is disparate depending on the community. The belief is that the higher the economic status of the community, the more available fresh fruits and vegetables and other food opportunities. Many of the less expensive fast-foods with high carbohydrates and sugars are, in fact, located in lower-income areas of the county. In addition, there is a statistical correlation between the prevalence of adult obesity and the mortality rates for diabetes, stroke, and cardiac disease even without economic hardship. In other words, the probability of early death from obesity transcends economic lines, but the prevalence of obesity still focuses on the economically underprivileged (Office of Health Assessment and Epidemiology, 2011).

It is also interesting to note the data ties together between education and poverty regarding obesity; the more education, the less percentage obese; the greater the economic standard, the less percentage obese. Note the similarity in percentages between those with no High School and those at or below the federal poverty level. Also note the decrease in obesity rates as education and income increase (Los Angeles County Public Health, 2003). Further, when we track populations over time based on ethnicity, we do see that obesity is rising across the board, but at a more rapid rate for latino and African-American populations than for Whites or asians. This trend is particularly alarming for the African-American community, with an almost 10 point jump in just 5 years (Office of Health Assessment).

Community Resources

Clearly there is an obesity problem in Los Angeles County. The overall conclusions as to the reasons are very similar to that of other communities, particularly those with large ethnic populations: lack of nutritional education, fast-food availability, lack of home mealtime, excessive snacking, sedentary lifestyles, and no consistent community plan to offer healthy alternatives. The county does have the advantage of being located near a large agricultural center, but that product does not always make its way into the inner city environment. Still, in the last decade, the county has identified a number of issues that can directly impact the obesity impact:

Ban schools from selling soda pop or high sugar drinks.

Continue with program to prohibit all forms of advertising of candy, fast food, and soft drinks.

Increase percentage of students who participate in PE or intramural activities

Increase standards at the schools so 100% of all students have at least 1 health education class dealing with nutrition

Continue to prioritze parks and support community recreation options

Use tax incentives to allow Farmer's Markets or stands to become regular parts of the inner city

Encourage employers to establish and maintain a Health Maintenance Program

Include BMI as part of all physical exam

Establish a referral network (nutrition counseling, peer support, etc.) (Office of Health Assessment).

Diagnosis

On June 22, 2010, President Obama issued an Executive Order to promote fitness in the schools and workplace and has proclaimed May as "National Physical Fitness and Sports Month." The Executive Order states a presidential request that "Americans work toward meeting the National Physical Activity Guidelines for Americans as set by the Department of Health and Human Services." By implementing Healthy Community Initiative Program (HCIP) within our community we can provide our employees an incentive to join with other Americans to participate in healthy physical activity, fitness, sports participation, and good nutrition (Executive Order on Physical Fitness, 2010). Because of the rising rates of obesity in Los Angeles County, it is important that we start with a basic HCIP plan to address the majority of the community's needs.

Outcome Identification

Evidence shows that work site and community health related programs can decrease obesity, improve quality of life, and provide a greater sense of community development and morale within the community. For Los Angeles County, then we can form these overall initiatives through a series of both medical and Public Health programs:

Nursing interventions -- Education based on both public school systems and companies and organizations regarding increased physical activitiy which improves several bodily functions. Second, the weight loss and improved uptake of insulin reduces inflamation. Third, the reduction of weight reduces stress on the bones, reducing arthtitis issues. Fourth, a combination of a healthy diet and a reduction in weight significantly reduces Type II Diabetes, Hypertension, and Heart Disease (Carnethon and Craft, 2008).

Opportunities -- Provide incentives through workplace initiatives that tie with the school system. The design, implementation and evaluation stages of a health promotion program is to have a number of commonalities across platforms. Before any program can even hope for success, it must have critical mass from community leaders to even hope to be successful. State, regional, and local leaders, along with significant time and tactical management from business leaders and local Public Health Officials tend to produce far more favorable results (Watts, Donahue, Eddy and Wallace, 2001).

Replacement and Implementation -- Since there really is no community-wide health intervention program and the local healthcare facilities are primarily focused on treatment rather than prevention, the programs will be new. Particularly with the Government's new focus on the health of the nation, epitomized in the Healthy People 2010 Initiative, a realization that worksite health promotion is critical is shown by emphasizing it in eight different objectives. For example, the target range for Object 7-5 is that 75% of worksites with 50 or more employees will offer a comprehensive employee health promotion program to their employees (Healthy People 2010). Our proposal moves that number to all worksites with at least 5 employees and includes 100% of employees and students at all County Public Schools.