Tune in to any television talk show or news broadcast in America and somewhere in the line-up will be a discussion about weight loss, from diet pills to exercise.  Every year there is constant chatter about resolutions to lose weight and get back in shape.  Obesity is one of the top rated public health problems in the United States and has been gaining momentum during the past two decades.  Obesity is prevalent in American people, and it is not prejudice to age, race, religion, or gender.  Even though obesity is not prejudice it is growing at an alarming rate in women.  

Obesity

It is important to first to distinguish overweight from obesity.  The term “overweight” is defined as having more body fat than optimally healthy and a body mass index of 25 to 29.9. [4] Kirby, Liang, Chen, and Wang (2012) define obesity as a “medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems” and a body mass index (BMI) greater than 30. [5] Body mass index (BMI) is the ratio of an individual’s weight (kg) to height (m²).  Obesity is a disease process that has a trickling effect.  The effects of obesity are risk factors to numerous chronic conditions such as:

• heart disease,
• stroke,
• some forms of cancer,
• adverse lipid concentrations,
• musculoskeletal disorders,
• gall bladder disease,
• impaired infertility,
• respiratory complications such as sleep apnea, and
• type 2 diabetes. [5] [6]

These risk factors directly contribute to premature mortality and years of life lost. Death rates in the United States associated with obesity range between 250,000 and 300,000, coming in second to cigarette smoking. [5] The World Health Organization (WHO) (2018) presented key factors as it pertains to overweight and obesity:

• Worldwide obesity has nearly tripled between1975 and 2016.
• In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
• 9 billion: 39% men and 40% women) of adults aged 18 years and over were overweight in 2016, and 13% (650 million: 11% men and 15%) were obese.

     The etiology of obesity is not well understood; however, biological, psychosocial, and cultural factors are suggested contributory factors.  If obesity continues at its alarming rate, the younger generation is expected to have shorter life expectancy than the older generation. [5]

Economic Aspect

     As one age increases so does the possibility of acquiring chronic diseases.  It is wiser to address the condition when the population is younger over a long period for preventive measures, rather than chase and continuously feed it in a shorter term. [7] Studies show that $494 billion is spent annually on treating commonly preventable diseases.[6]  It is economically sensible to devise and implement preventable programs to reduce this cost and have individuals’ live longer healthier lives.  This type of program will assist with reducing cases of diabetes and hypertension (HTN) and the associated cost with treatments from medication to surgery. [6] The amount of revenue needed to address obesity is rather large.  In the first decade of this century, approximately 10% of all medical spending ($147 billion) in the United State is linked to disease processes associated with obesity and overweight. [5]

Women vs Men

     In prior discussion, the differentiation of overweight and obesity was established.  Research has shown that men are more likely to be overweight then women; however, women are more likely to be obese. [2] The obesity epidemic does not discriminate, but it is most prevalent in Hispanics:

• Among Hispanic adults, ~ 47 out of 100 were considered to have obesity.
• Among black adults, ~ 46 out of 100 were considered to have obesity.
• Among white adults, ~ 37 out of 100 were considered to have obesity. [4] [5]

The disproportion of obesity is attributed to several factors, such as income and education. [5]

Obesity Epidemic; Health Care Providers and Organization

     There has to be a plan of action to address this epidemic.  The plan of action has five components; ends, means, resources, implementation, and control.  The end component provides details of the goals and projected outcomes.  The means component identifies the factors that will be used to achieve the end component.  The resource component handles the types, amounts, allocation of the resources generated to perform the necessary duties of the plan.  Once the plan has been formulated, it must be implemented.  The implementation component addresses the decision-making process of how the plan will be carried out.  Last, is the control component that addresses the possible flaws in the plan of action and introduces methods of rectification. [3]

     There are several medical treatment plans for obesity such as gastric bypass, lap bands, and gastric sleeves. All of these methods are reactive solutions to the obesity condition.  One way to get a handle on avoiding sickness is to be proficient in disease prevention. Disease prevention consists primarily of knowing ones’ current conditions, risk factors, and measures needed to avoid health complications.  One way to deter a direct increase in cost is to incorporate health screenings and consults. [7] Methods that could attribute prevention and a decline in obesity include health literacy, proper nutrition, and physical activity. [1]

Health Literacy

     Blackburn (2010) defined health literacy as “the ability to obtain process and understand the basic information and services needed to make appropriate decisions regarding one’s health”.[1] Health literacy plays a major role with following and maintaining a healthy lifestyle.  Possessing health literacy covers a multitude of areas, including the ability to:

• understand health language, which will assist in accurately completing medical forms,
• comprehend instructions provided by a health care provider, express symptoms and concerns at visits, and
• play a proactive role regarding alternative measures to medical treatment. [1]  

Physical Activity

     “Physical inactivity is the fourth leading preventable cause of death in the United States (US); and when combined with its associated effect of being overweight or obese, it becomes the second leading attributable cause of death”.[9]  By changing the composition of muscle or muscle metabolism, contribution to either the development or prevention of many common pathological conditions and chronic diseases, such as aging muscles and mitochondrial dysfunction, metabolic syndrome (cardiovascular disease), fibromyalgia, rheumatoid arthritis, and cognitive dysfunction.[9] When discussing physical activity, the implementation of mere strength training can conquer many feats, developing more muscle burns more fat even when resting.

Proper Nutrition

     The United States (US) has the highest expenditures on prescription drug, and the result is that many are dying too young. [8] Age-related deaths have been an acceptable explanation, if in fact other contributing factors, such as poor dietary choices are culprits in the early deaths of Americans.  Generally speaking, the American public lacks good, basic nutrition knowledge.  Because of this lack of knowledge “people are unable to sort out the misinformation passed along by any entity ranging from the media to their next-door neighbor”. [8] In addition the status of foods nutrition value and benefits are constantly changing.  Many Americans neglect proper nutrition and replace it with the intake of supplements, not comprehending that most nutrition can come from the foods consumed daily. Incorporating the correct supplements in proper dosage can assist with maintaining a healthy status. Implementing supplements such as 2000 milligrams Omega-3 aids in combating stress and cortisol damage, depression and anxiety, metabolic syndrome, cancer, along with kidney and liver functions. [8] Emphasis should be placed on what to eat, how much to eat, understanding the information on labels, and how to incorporate all these components into ones’ lifestyle.

Conclusion

     Overweight and obesity has been on a steady climb, tripling since 1975 with no means of slowing down.  There is no single mechanism attributed to this cause, but with the assistance of descriptive and analytical epidemiology the problem can be addressed.   There are ways to address overweight and obesity, but one of the most effective ways is to implement preventative measures. American Heart Association (AHA) provides several ways to increase health and quality of life through proper nutrition, exercise, stress management, and weight management.  Health care organizations and providers must use the information and tools provided to combat this ongoing epidemic.  All individuals need to take the A.P.P. Life Approach, being active and proactive of one’s health to possibly prevent undesirable outcomes.

References

1. Blackburn, M. L. (2010). Cognitive and motivational factors support health literacy and acquisition of new health information in later life. California Agriculture, 64(4), 189-194.
   
   
2. Flegal K.M., Kruszon-Moran D., Carroll M.D., Fryar C.D., & Ogden C.L. (2016). Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 315(21):2284–2291.
   
   
3. Fleming, S. T. (2008). Managerial epidemiology: Concepts and cases (2nd ed.). Chicago, IL: Health Administration Press.
   
   
4. Johnson, P., & Wesley, Y. (2012). Scholarly Perspectives on Obesity among Black Women. ABNF Journal, 23(3), 46-50.
   
   
5. Kirby, J. B., Liang, L., Chen, H., & Wang, Y. (2012). Race, Place, and Obesity: The Complex Relationships Among Community Racial/Ethnic Composition, Individual Race/Ethnicity, and Obesity in the United States. American Journal Of Public Health, 102(8), 1572-1578. doi:10.2105/AJPH.2011.300452
   
   
6. Ogden, C.L, Carroll,M. D.,  Kit, B. K., & Flegal, K. M. (2012).  Prevalence of obesity in the United States, 2009–2010.  Centers for Disease Control and Prevention National Center for Health Statistics (82), 1-8.
   
   
7. Schwartz, S.M., Ireland, C., Strecher, V., Nakao, D., Wang, C., & Juarez, D. (2010).  The economic value of a wellness and disease prevention program.  Population Health Management, 13 (6), 309-317. doi: 10.1089/pop.2009.0070.
   
   
8. Wilder, D. (2011). Slash your risk for Premature Death with OMEGA-3s. Life Extension, 17(10), 28-38.
   
   
9. Hurley, B.D., Hanson, E.D., & Sheaff, A.K. (2011). Strength training as a countermeasure to aging muscle and chronic disease. Sport Med 41 (4), 289-306. 10.2165/11585920.