Program project design and grant proposal development

Obesity Proposal

There is a serious problem facing the citizens of America today that could lead to a variety of problems down the road, health problems that could further strain the health care industry and ultimately affect the future economic viability of the United States. That problem is the percentage of obese individuals and the ensuing diseases and health issues that come along with it.

Many health care professionals realize the seriousness of this problem and many state and national agencies have created programs designed to address this important issue. Much of the educational instruction being espoused by this proposed project will be in conjunction with those types of programs, though smaller in scale, of course. This project will focus on the citizens residing in Brooklyn, NY and in particular the Borough Park Community. The project will concentrate on assessing and educating those citizens who are most at risk or are currently suffering from the effects of this problem.

The situation is that many of the nation's citizens are eating a less-healthy diet and a diet that is rich in fats and sugars. This type of diet can lead to obesity and the problems associated with being overweight. Diseases such as diabetes and hypertension are prevalent in high-risk individuals such as people suffering from obesity.

Assessing the problem as it pertains to Borough Park is the primary goal of this project. Once the assessment is finished, then a further objective would be to create an educational program that will allow for nutritional instruction designed for this specific community and its citizens.

The type of situation the community of Borough Park is facing is one that faces many of the communities across the nation, but there are unique factors to consider in Borough Park. "Culturally and religiously, the neighborhood is considered one of the most Orthodox in the world. Many families do not own televisions or attend movies. The children attend yeshivas instead of public schools. Adolescent girls do not leave the house without making certain that their knees and elbows are covered, and at weddings and funerals alike, women and men sit separately to avoid physical contact, as required by religious law" (Confessore, Farmer, 2006, p. B.3)

The citizens living in this type of community traditionally will eat only certain types of food, often times cooked only in particular ways. The goal, then, for this project is to educate children, young adults and parents concerning nutrition in regards to obesity and the many problems that can develop without weight control and discipline. This program will attempt to provide the citizens of Borough Park community with enough nutritional information and guidelines to slow the onslaught of obesity in their community which should lead to longer, healthier lives for all involved.

Literature Review

The Department of Health in New York shows the following statistics in its 2005 annual report on the health of its citizens.

The percentage of New York State adults who are overweight or obese increased from 42% in 1997 to 57% in 2002.

The percentage of obese adults in New York State more than doubled from 10% in 1997 to 21% in 2002.

Obesity among children and adolescents has tripled over the past three decades.

Among children in grades K-5 from New York City, 24% are obese.

Among third grade children in upstate New York, 21% are obese.

29.5% of high school students from New York City, and 24% of high school students from upstate New York are overweight or are obese. (based on self-reported height and weight).

Obesity-related illnesses cost the United States an estimated $117 billion and New York State more than $6 billion. (NY Dept of Health 2005)

According to New York's Department of Health poor diet and physical inactivity are the second leading causes of preventable death in the United States. Those two items can and should be addressed. Evidence of a 15% jump of overweight adult individuals in only a five-year period is evidence that action must be taken, especially considering that the obese category of adult individuals more than doubled in that same time frame. Finding the time and energy to exercise as an adult can be much more difficult than when an individual is a teenager or a child. However, statistics show that it is not just the adult citizen that is suffering from this situation, but it is the children, and the young adults of the community as well. Almost 30% of high school students from New York City are obese or overweight, and almost 25% of elementary students from K-5 are in the same category.

These figures are all disseminated from the New York Department of Health and what could be really disturbing about them is the fact that it is costing America and the state of New York billions of dollars per year to cope with obesity-related illnesses. New York State alone is spending over $6 billion on this problem. Much of the problem could be alleviated if the citizens were taught what foods to eat and what foods not to eat. Additionally the citizens could also be given direction in how to integrate physical activities into their daily schedules.

One of the reasons why Borough Park community was chosen for this particular project is due to the very large population of children in the community. "Borough Park has been described as being the "baby boom capital" of New York City, because of its high birth rate. The neighborhood recorded 4,523 births in 2004, the highest in the city" (Fertile, 2006. p. 7). This high birth rate translates into future community growth and provides the opportunity for a project such as the one being proposed to have the greatest effect on a community. This project will target every citizen in the Borough Park community, but will emphasize the educational aspects of teaching children good nutritional and physical activity habits. By accomplishing this objective, it is hoped that the children will retain this learning, integrating it in to their daily activities in order to live long, fruitful and prosperous lives. One recent study showed that increased risks during pregnancy are associated with obesity. "The authors concluded that hypertensive disorders of pregnancy are associated with increased weight gain" (Callaway, McIntyre, O'Callaghan, Williams, Najman, Lawlor, 2007, p. 421).

Keeping this study in mind, one immediate benefit of the project could be a decrease in the level of hypertension among those women who are pregnant. This is beneficial because if the women are not hypertensive, then they are less likely to suffer any of the affects of high blood pressure, including death.

An additional factor when consider obese women and pregnancy is the fact that some studies have shown that women who are obese during a pregnancy can have an affect on their male offspring's fertility, or lack thereof. "Obesity is a strong predictor of fecundity (the ability to have children, usually lots of them with ease) and could have a programming effect on semen quality through hormonal factors or links to fetal growth" (Ramlau-Hansen, Thulstrup, Bonde, Olsen, 2007, p. 568). Ironically enough, since the women in Borough Park obviously believe in bearing children, their children could be denied the same belief if the mother happens to be obese. This project can help to address those concerns and issues.

In a program developed by the New York Department of Health to address the increasing obesity problem the risks of obesity are stated in now uncertain terms. A report on the program states that risks associated with obesity include: Type 2 Diabetes, high blood pressure, joint problems, asthma, sleep disturbances and depression. The report also states,

Obesity is making children old before their time. Many young people are overweight because they do not exercise enough and/or they eat unhealthy or too much food. Overweight and obesity can lead to learning problems in school as well as health problems. Children who do not eat properly or do not get enough exercise are more likely to become overweight or obese and may increase their risk of developing other diseases and conditions. These diseases are more common in adults, but are increasingly being seen in children.

Since there are so many children being born in Borough Park it is important to address this issue. The end result of the project is to affect as many of the citizens in the community as possible, for as long as possible. With a large population of children, the project can be most effective by instructing these children first and foremost, before any of these diseases stemming from obesity can enter into their lives. The educational needs of the community are quite obvious, and filling those educational needs with the correct information and knowledge could have a large impact on the community. The problem does not stem from the fact that the citizens of Borough Park wish to become overweight or obese. In fact, the opposite is more likely true. They are, however, affected by the traditions and cultures found in almost every society, but especially in a society such as the one in Borough Park. The key to this program's success is changing the way the citizens approach their daily lives, without changing the traditions and practices that are unique to the community.

Teaching children how to cope with this unique conundrum will be difficult but could be the most successful approach in the long run. If the program is successful in slowing down the rate of obesity found in the younger citizens, then it could have longer lasting effects than the same program instituted with older citizens. One study showed that obese children are much more susceptible to diseases, especially diabetes than adults are with the same body mass index.

The study concluded that, "After stratification age and body mass index (BMI) the risk ratio for diabetes in Anti-HCV+ participants increased when age decreased and body mass index levels increased" (Wang, Wang, Yao, Chang, Chou, 2007, p. 202). Diabetes is currently a non-curable disease and costs society billions of dollars per year to combat. Insurance companies are acknowledging that younger individuals contracting diabetes will have a long-term detrimental affect on their business and on society at large.

Carol Hamett, the national disability and life practices leader for the group benefits division at Hartford Life Inc., a unit of Hartford Financial Services Group Inc., Hartford, gave an assessment recently on the subject of diabetes and how it currently viewed by Hartford. Harnett states that there is a general sense of alarm concerning the obesity and diabetes statistics for members of the generation born after 1985. She said, "Childhood obesity rates seem to be soaring, and so is the percentage of children who suffer from Type 2 "adult onset" diabetes" (Bell, 2006, p. 41). The report went on to state that years ago, Type 2 diabetes was rare among children. Harnett says, "now childhood Type 2 diabetes is so common that we've seen the average age of onset of Type 2 diabetes go down 10 years" (Bell, 2006, p. 41). Whereas the project will seek to be all inclusive, it is obvious that the most beneficial method of approach will be to target the children. The social and economic impact of the project will be much more viable when keeping that target audience in mind. Not only that fact should be kept in mind, however, but also the fact that it is easier to get children to participate in activities that are beneficial for them.

It should make it easier as well to keep them away from activities that are not beneficial. One of those activities is the consumption of sugar, candy and other sweets. Many times parents are the ones who acquiesce to a child's demands for candy or other sweets. This project will attempt to help parents understand the impact of eating such foodstuffs and also how to supply their children with other more nutritious substitutes. One recent article touted the fact that while sugar is "the fast track to obesity and related ailments such as diabetes, coronary-artery disease, hypertension, high-blood cholesterol and certain kinds of cancer" (Sachs, 2006, p. 77) other sugar-related problems can also lead to "sugar-induced psychological problems like depression and listlessness" (Sachs, p. 77).

The social impact of being obese is more covert than the obvious diseases that can be correlated to obesity. It is a relatively simple matter to show how being obese can be connected to different diseases such as diabetes and high blood pressure, but a much more difficult matter to show how being obese can weigh in on a social scale. "The deleterious effects of obesity on physical health are more documented than the effects on psychosocial health" (Wellbery, 2005, p. 1832). Wellbery' study showed that there was little negative social impact on young adults when obese, except when they were between the ages of 12-14. The study showed, "There were statistically significant correlations between BMI and general health and functional limitations, but not for illness symptoms, depression, self-esteem, and school/social functioning" (Wellbery, p. 1836).

This project does not necessarily hinge on individuals who are of that particular age but could incorporate a certain emphasis when including those individuals within that age group. Other studies have shown differently however especially concerning older individuals who may be much more self-conscious than younger students. This could also be true as evidenced by the numbers of obese and overweight students prevalent in the New York Department of Health numbers as discussed above. Many overweight and obese individuals now view themselves as totally 'normal'. If such a view is acceptable to those individuals who are overweight or obese, then it would necessarily translate into acceptance from others, including New York youth who may think that it is 'normal' to be overweight or obese. One author recently wrote in regards to obesity that "All feelings are equal, and all feelings are more important than rational thought" (Cooke, 2006, p. 135). The author was being 'tongue-in-cheek' while she lamented the fact that so many people are now 'normal'. The most important question she asked in her article was " How to make people understand that "normal" is not necessarily "good"?" (Cooke, p. 135).

This is the same problem being faced in Borough Park community. It is a tight-knit community where the majority of citizens are of the Jewish faith, and have set religious standards and traditions that govern their daily actions. These actions will have to be considered when a project of this scope is set into motion.

On the plus side, at least in terms of this project, is the discipline these citizens live by can be an advantage when attempting to get them to be disciplined enough to eat correctly, watch their diet, and exercise on a daily basis. They have been disciplined their entire lives, being influenced by further discipline will not seem nearly as difficult for them as it could be for others who have not been so influenced. Learning of the exact foods that can and cannot be eaten according to a healthy diet is similar to learning what foods can or should not be eaten according to one's religion.

The Borough Park community can also benefit from this project economically. The economic impact goes hand in hand with the entrepreneurial spirit already displayed by many of the businesses and merchants already encamped in the area. In a recent article the area was touted as, "Their increase in profits and business is attributed to the use of entrepreneurial spirit among their storeowners, the increasing density of the Hasidic population in Borough Park, and the Internet" (Roan, 1999, p. 1.1). Observing the entrepenurial spirit is a display that bodes well for this project since it seems that new ideas, growth and the change that comes with such attitudes is prevalent in the Borough Park community, which will make it much simpler to introduce a project like this. That citizens in this community are entrepreneurial also affects the study in another oblique manner. Most entrepreneurs are intelligent, creative and confident enough to believe in their own ability to succeed, often when and where others have failed.

Since science has proven that new brain cells are constantly being created inside the brain based on the individual's activity level (at least in part). One recent study showed, "Exercise, estrogen, antidepressants, marijuanalike compounds, stimulating environments, and high social status, along with strokes and other injuries, all rev up production of new brain cells. Aging, stress, sleep deprivation, barren environments, and methylphenidate (Ritalin) damp it down" (Vastag, 2007, p. 376)

The same study showed that pharmaceutical companies understand the issues and are eagerly working towards creating drugs that may provide relief for some of the problems associated with diabetes and obesity. "Animal studies suggest that such drugs may provide novel treatments for depression and anxiety, Parkinson's disease, Alzheimer's disease, stroke, and even overeating and obesity" (Vastag, p. 376). By introducing the citizens of Borough Park to the rigors of a daily exercise and nutrition regime, they are actually gaining brain cells.

Some of the causes of this problem stem from not only people's attitudes as discussed above, but also from the physical challenges faced by not just the people of Borough Park but the average American as well. Many American citizens find themselves much busier than previous eras, and much more likely to eat on the run, or eat fast food, which is not the healthiest diet. These factors as well as less time to devote to exercise and sleep are all influences to consider in regards to this project.

Columbia University study in April said adults older than 32 who slept less than six hours a nigh were more likely to develop high blood pressure, hypertension, obesity, depression and stroke" (Mullman, 2006, p. 49). With less time to complete daily tasks and more demands placed on individuals, oftentimes what suffers is the individual's health.

The Plan recent article, "Objectively Measured Physical Activity and Fat Mass in a Large Cohort of Children" (Ness et al. 2007) presents material that defines the need for an ongoing and comprehensive research study. The study would define the association between physical activity and obesity in children that previous studies have been unable to characterize.

Many experts have acknowledged the fact that lack of physical activity in the lives of obese children could be a major factor in their condition. This study will attempt to further define exactly what type of physical activity is most likely to lead to lean body mass in children. Previous studies have had difficulty in providing this specific information, and in fact defining obesity itself is a rather difficult task as well, since, "as a person of above-average height may be 'carrying' a lot of fat or a lot of muscle." (Ness et al. 2007-page 484)

While documenting whether a person is overweight or obese may not be as simple as it seems, documenting the effects of being overweight or obese is a simple matter. It can be accomplished in a relatively easy fashion.

It can be accomplished primarily due to the reason that most experts have read the studies, have observed the facts and have seen health-care issues abound throughout not only Borough Park, but America and the world as well. Citizens around the globe are quickly becoming more affluent than in previous generations and many of the third-world countries are seeing democratic governments and capitalism introduced into their economies. With the wealth being produced by such actions it is a simple matter to understand how our bodies react to that affluence. What we do about that influence can sometimes be a matter of life and death. How we eat, how we exercise and how we treat our bodies can mean living a vigorous and active lifestyle or being hampered by the very bodies we should be striving to care for.