Role of Nursing in Promoting

Role of Nursing in Promoting Health

Responsibilities of Nursing Roles

The Role of Nursing in Promoting Health - Obesity

This paper will examine the issue of obesity and what role nurses can play in mitigating the negative effects this issue has on individuals and society. Promoting good health is a way of enabling people to increase control over and to improve their health. This process focuses on health, not illness, the empowerment of clients, recognition that health is multidimensional and an acknowledgement that health is influenced by factors outside a person's control (Casey, 2007).

Over the years nurses have been increasingly involved in health promotion projects because they have a more direct contact with patients as well as the community. Health promotion involves the application of certain strategies which reduce the spread of diseases, provide information on ways of maintaining those who are already infected and support behaviors that contribute to well being.

Impact of Obesity on Health and the Challenges this Creates

It is estimated that as many as one in five Americans is obese, a condition defined as being more than 30% above the ideal weight based on height. The frequency of obesity in the U.S. doubled among adults between 1980 and 2004 (Ogden, et al., 2007). Morgan Spurlock (2005) reports the average daily caloric intake for American adult women has gone up from 1,542 calories to 1,877 calories, while the daily average caloric intake for American males has risen from 2,450 to 2,618. Government recommendations are women take in about 1,600 calories a day and men around 2,200. For children the estimated daily caloric intake has risen anywhere from 80 to 230 calories. Every10 extra calories consumed a day translates to one extra pound of fat per year. If the average American over eats by 200 calories a day that is an extra 20 pounds of fat per year.

In 2000, the total cost of obesity for children and adults in the United States was estimated to be $117 billion, with $61 billion ascribed to direct medical costs (U.S. Department of Health & Human Services, NDI). Obesity is associated with increased risk of a number of health conditions, including diabetes mellitus, cardiovascular disease, hypertension, and certain cancers, and with increased risk of disability and a modestly elevated risk of all-cause mortality. Obesity is a consequence of complex factors including an increase in the consumption of calories and a decrease in physical activity. Many environmental factors contribute to the rise in obesity, foods are inexpensive and widely available, food portion sizes have increased, and individuals are eating out of the home more often. At the same time indications are that opportunities for physical activity may have decreased.

The U.S. Department of Health and Human Services (NDI) examined some of the various issues and behaviors that contribute to this phenomenon. Evidence is growing that watching television, time spent on the computer, video games and the like are impacting activity levels. Furthermore, the current trend in schools is to decrease the amount of free play or physical activity children receive daily. Approximately one third of elementary students have daily physical education, and less than one fifth have extracurricular physical activity programs at their schools. At the same time enrollment in physical education classes has been on the decline in high schools. Outside of school hours, only 39% of children ages 9-13 participate in an organized physical activity, although 77% report they engage in some form of free-time physical activity.

Parents influence the eating habits of their children in many ways. Everything from the choice of infant feeding method, the foods that are made accessible, the amount of time children are left unsupervised and eating interactions with others in a social context contribute to how a child consumes food. Studies indicate that children that are breast feed have a lower rate of obesity. There are various theories to explain this phenomenon. Bottle formulas expose children to complex sugars and fats which predispose them to weight gain later on in life. Breastfeeding may promote healthier eating habits because breastfed infants may eat until satiated, whereas bottle fed babies may be encouraged to eat until they have consumed all of the formula. Breast feeding also may expose babies to more variability in terms of nutrition and tastes since formula fed infants have experience with only a single flavor, whereas breastfed infants are exposed to a variety of flavors from the maternal diet that are transmitted through the milk. This translates to a greater acceptance of a variety of foods later on in life and a more nutritionally balanced diet.

Studies indicate that parents who eat a diet high in saturated fats had children that ate diets high in saturated fats. The exposure to foods that their parents prefer establishes preferences in children. Conversely, presenting children with healthier diets early in their lives establishes those preferences. Feeding practices that control the type and quantity of what children eat can also affect food preferences. Studies indicate that parents who attempt to encourage the consumption of certain foods may inadvertently cause children to dislike those foods, whereas parents that attempt to limit certain foods may actually promote increased preference and consumption of the limited foods. The social context in which a child experiences food also can influence food preferences. Eating is a social experience that for children often occurs in the presents of parents, older siblings, other adults and peers. These role models have been found to have an effect on future food selection, especially when the model is perceived as being powerful.

Still another factor that may contribute to obesity is the changing structure of the family unit. Over the past three decades the number of duel income families has been on the rise as more women enter the workforce and there has also been an increase in the number of women serving as the sole supporter for their families. There is some evidence that parental employment may be reflective of weight gains in children. Research demonstrates that children in single-parent families are more likely to be overweight or obese than children in two-parent families and that the rise in women working outside the home coincides with the rise in childhood weight problems. Several theories have been proposed to explain this phenomenon including the ideas that working parents probably rely more heavily than non-working parents on prepared, processed, and fast foods, which generally have high calorie, high fat, and low nutritional content and children who are unsupervised in the afternoons may make poor nutritional choices and engage in more sedentary activities.

Data indicates that genetic factors increase susceptibility to obesity. There is a 75% chance that a child will be overweight if both parents are obese and a 25-50% chance if just one parent is obese. Though this relationship is well established, the role of genetics in obesity is not well understood. Recent increases in weight observed in the American population are not correlated with genetics. The genetic composition of a population does not change rapidly, thus increases in the prevalence rates of obesity are likely due to behavioral and/or environmental factors, which have interacted with genes, and not the effects of genetics alone.

Finally, data on whether exposure to food advertising affects incidence rates of obesity is inconclusive. A positive correlation between body mass and the number of hours of television viewed has been documented, but the exact mechanisms through which this occurs are still being investigated. Estimates are that the average child watches 40,000 commercials a year, twice the number of thirty years ago. More than 50% of the advertisements directed at children promote foods and beverages such as candy, convenience foods, snack foods, sugar sweetened beverages and sweetened breakfast cereals that are high in calories and fat and low in fiber and nutrient density. Statistics indicate that annual sales of food and beverages to young consumers was in excess of $27 billion dollars in 2002, while food and beverage advertisers collectively spend $10 to $12 billion on advertising, with an additional $4.5 billion on public relations targeted at youths and $3 billion on packaging designed to attract young consumers. Though these statistics might lead one to conclude that there is a link between advertising and obesity, the connection is speculative and many questions still need to be answered using longitudinal studies designed with sufficient statistical reliability.

Taken together these issues create major challenges for healthcare workers to overcome in order to curb the current trend toward obesity.