This paper examines the roles of professional nurses in combating obesity at three distinct intervention levels: upstream, midstream, and downstream, drawing on McKinley's framework. At the upstream level, nurses advocate for food marketing regulation and public health campaigns. At the midstream level, they deliver nutrition programs in schools and youth organizations. At the downstream level, they counsel individual patients on behavioral change. The paper also responds to the Obesity Action Coalition's concerns about stigmatization, arguing that anti-obesity awareness campaigns and anti-bullying programs can and should operate simultaneously rather than being treated as mutually exclusive goals.
The professional nurse has numerous opportunities to advocate for changes in social policy, community awareness, and behavioral risk factors associated with the choices of individual patients. With respect to obesity intervention, nurses can contribute their efforts to upstream, midstream, and downstream interventions. McKinley describes a framework that details the manner in which professional nurses can intervene to reduce obesity risk factors at three distinct levels: upstream, midstream, and downstream.
The types of obesity risk factors that exist at the upstream level include the prevalence of poor dietary choices in the community, advertisement campaigns for unhealthful food choices targeted at children and other vulnerable populations, and the absence of government regulation in areas where appropriate legislation could reduce some of those risk factors. Such legislation could mandate socially conscious behavior on the part of food manufacturers that profit from the advertising and sale of food products known to contribute to obesity in the population.
More specifically, upstream nursing interventions would include advocating for regulation of food marketing, lobbying fast-food chains to reduce their concentration in low-income neighborhoods, and promoting healthful dietary information through public service campaigns and community health programs.
The types of obesity risk factors that exist at the midstream level include school and other youth programs that maintain non-nutritious food choices and that allow the sale of junk foods from vending machines on their premises. At the midstream level of intervention, nurses can provide dietary information and nutrition-improvement programs in schools and other facilities that are typically responsible for maintaining lunch programs for children and adolescents. Effective school-based nutrition strategies championed by nurse educators can reshape the food environments in which young people spend the majority of their day.
At the downstream level, obesity risk factors include the lack of knowledge on the part of individual patients about healthful nutrition and the failure to appreciate the gravity of various obesity-related diseases and chronic conditions. Nurses can intervene at the downstream level by addressing specific behavioral patterns of individual patients — both directly, in conjunction with treatment for obesity-related illnesses, and indirectly, such as by furnishing important nutritional and diet-related information in the general context of healthcare services.
In principle, the upstream intervention opportunities emphasize the role of professional nurses as patient advocates, giving the nursing profession considerable leverage over large corporations that profit from unhealthful food products as well as over government legislators. The midstream intervention opportunities emphasize the role of professional nurses as educators. Finally, the downstream intervention opportunities emphasize the role of professional nurses as both counselors and patient advocates. Understanding the multifactorial nature of obesity is essential for nurses operating effectively across all three levels.
"Coalition response to Georgia billboard campaign analyzed"
The most practical approach to considering both issues is not to forsake obesity prevention awareness; rather, the optimal approach would be to provide simultaneous obesity-prevention awareness programs and bullying and discrimination-awareness prevention programs. These goals are not mutually exclusive, and professional nurses are well positioned to advance both agendas — serving as advocates for healthful policy, educators in community and institutional settings, and compassionate counselors for individual patients navigating the complex realities of weight and health.
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