Obesity and Low Health Care Accessibility, Research Paper Example

Introduction

In the United States, prevalence of obesity among children, adolescents, and adults is a growing health concern (Smith, 2009). The lack of physical activity, health care and dietary advice, low cost availability of convenience or ready foods has managed to contribute towards the growth of obesity across all populations (Odgen et al. 2010). For the past few decades, the abundant supply of tempting food in supermarkets available at low prices and increased leisure time, technological developments, such as television and cinema. The risks associated with obesity include the increased risk of diabetes mellitus, hypertension, stroke, cardiovascular disease, arthritis, and cancer among other diseases. As a result, the rapid rise in obesity has resulted in wide-spread concerns over public health implications (Odgen and Carroll, 2010). That indicates that almost 40 percent of the U.S. population needs to face increased risk of the above diseases and illnesses. The significance of the obesity epidemic will be examined in this integrative literature review, in particular focus on at-risk populations, policies, environmental and lifestyle factors related to obesity and diabetes.

Thesis statement: The main thesis statement to examine through the below integrated review of related research and literature is that low health accessibility, influenced by financial and social circumstances, increases the risk of obesity, not only through the lack of support available for low-income population but also the limitation of lifestyle choices related to different demographic segments of the American society.

Purpose

The purpose of this integrative literature review is to address the issue of obesity and low health care accessibility by diverse populations around the US and the impact of social status on risks associated with diabetes.  In this review, the authors would like to examine the correlation between socio-economic status and risk of obesity.  The authors would like to base the study on the previously confirmed statement that obesity results in increased health risks and increases the cost associated with treating related illnesses (McCormick, 2006). The causes of higher obesity rates identified by researchers includes social exclusion, low access to health care, prevention and healthy lifestyle options. As a result, the problem does not only exist on an individual level but on a socio-economic level, too. The review will look into the plan of action undertaken by health professionals in tackling the problem of obesity in reference to those adults or individuals not able to meet their expense of visiting primary care providers. In addition, the authors would like to create awareness on pertinent data that address individual’s weight, height, calorie intake and output, and these indicators’ effects on overall health. The literature review is integrative in nature, as it looks at frameworks previously developed, related research literature, methodology, and results.  The significance of health disparities between social classes, its, implications, and future intervention framework recommendations will also be reviewed.

Theoretical Framework

Swinburn, Gill and Kumanyika (2005) developed a framework that is designed to “translate evidence to action”. The above risk assessment framework takes into consideration existing evidence regarding correlation between obesity and health access will be used to:

1. determine the level of elevated risk associated with low health access
2. develop a program that is designed to target the most vulnerable demographic population with low level of access to health care with obesity prevention education programs.

The importance of this theoretical framework to obesity addresses the previously reviewed correlation between low health care accessibility and the epidemic of obesity. Swinburn et al. (2005) examine three main forces in relation with the obesity epidemics: environments, behaviors and physiology. They indicate that – based on the framework – policy interventions, health promotion programs and surgery/drug interventions need to be balanced in order to tackle the spread of obesity and the related health conditions. Most individuals do not fully understand the health implications of obesity. Therefore, it is important to reduce the ignorance present in today’s society concerning weight issues in the health care setting. The evident solution is creating a framework that does not focus on treating diabetes, but preventing it through offering education on healthy lifestyle choices for the most “at-risk” population. It is evident that the intervention cannot be successful without the education and commitment of the individual. Therefore, health care practitioners dealing with individuals from a “high risk of obesity” population should conduct a thorough assessment on the individual on obesity and co-morbid conditions. Thereafter, counseling and treatment follows to reserve and prevent the progression of obesity and health care inaccessibility (Robinson & Kish, 2001).

Evidence-based obesity prevention framework, developed by Swinburn et al. (2005) has the potential to deliver results in addressing health care disparities. While it is not possible to provide free health care access to people without an adequate level of service, it is possible to create community education projects that educate them about their rights to information, their health and lifestyle choices, targeting the populations that are most at risk.

Methodology

In this integrative literature review, it is showed that a comprehensive database search was conducted that included PubMed, Google Scholar, CDC, and MEDLINE, which identified recent peer-reviewed articles of between 2005 and 2013. The keywords and subject terms used in locating the research articles included words like obesity, low health accessibility, minority, Pacific Islanders, Latino, Black, African-American, and Hispanic black among other diverse groups of the population in the US. In some articles, sample weights were given to be able to adjust for probable differences existing between selected samples and designs used in deriving the representative estimates of based-population. Statistical analysis were also performed in determining the existing correlations between obesity and low health accessibility. Aspects of obesity looked at measuring the heights and weights of their participants in order to be able to compute their body mass index (BMI). In calculating the BMI, the answer was weight in kilograms, which was divided by height in meters squared. Obese participants were those with BMI over 30 kg/meters squared. There were those articles not written in English, but they were not used in this integrative literature review. The articles used had a title and brief abstract introducing the topic under review, which identified articles that had original research work. Moreover, there are those that did not utilize established research designs, which were excluded because they lacked editorials, correspondence, and commentaries. A total of 30 articles were able to meet the selection criteria and hence, were included in this integrative literature review.

The NM Plan to Promote Healthier Weight (New Mexico Department of Health, 2005) finds an interesting correlation between social, behavioral and environmental factors and obesity.  According to the publication (p. 25), income differences contribute towards unhealthy eating habits. Appendix A shows that a lower income and education level contribute towards eating less fruit and vegetables. The same results are confirmed by Annette &  Gizlice (2008), and the study confirmed that social exclusion is a contributing factor for obesity. Spanish speaking Hispanics’ health status was compared with English speaking Hispanics, and the study showed that the level of cultural diversity negatively influenced health outcomes.

The We Can! Solution, provided by the We Can! Foundation (Odgen et al. 2010) is a proactive, targeted framework that could be implemented in the United States. While it focuses on support provided for young people, it does target at-risk populations in particular, even though not all of them. The education program focuses on reducing screen time, increasing the access to advice related to eating, lifestyle and promoting physical activity.

Integrated Literature Review

Beginning the research with one of the initial statements that some social and demographic groups are more at risk of obesity than others, the authors would like to review the research created by Ebbeling et al., (2002) examining the relationship between social class, minority status and risk of diabetes. The authors clearly state that “in the USA,  prevalence rose more than twice as fast among minority groups compared with white groups, exacerbating pre-existing racial-ethnic disparities (Ebbeling et al., 2002, p. 473.) These health outcome disparities would certainly be caused by the lack of  healthy food in one’s diet and the lack of funds for  participating in healthy recreation facilities.  It is also important to note that disadvantaged groups have a significantly lower access to health care, advice and support than the rest of the population. This indicates that their participation level in preventive programs and access to information regarding healthy lifestyles will be reduced. Also, as a conclusion, these low socio-economic groups would be disadvantaged based on their healthcare access level.

A recent publication by the U.S. Department of Health and Human Services (2007) states that “patients who are obese may delay seeking medical care”. This adds another risk factor to the list. They may also be less likely to receive certain preventive care services, such as Pap smears, breast examinations, and pelvic examinations” (p. 2). This indicates that those who have a low access to health care would be even more disadvantaged than the rest of the population, as their access to preventive and advisory services is initially limited and they are less likely to seek help based on their attitude. This combination of circumstances makes obese population at an extremely high risk of related diseases, such as diabetes and cardiovascular problems.

One of the most important factors contributing to obesity in America, as identified by the Dietary Guidelines for Americans (2005) is lack of physical inactivity combined with poor diet, resulting in energy imbalance. Obesity epidemic disproportionately affects specific sub-group populations,  particularly the African Americans. According to the research, between 2007 and 2008, non-Hispanic black women obesity rate was 49.6% and 45.1% among Mexican-American women.  Therefore, it is evident that the relationship between socioeconomic status and obesity is influenced by sex and ethnicity group. For example, the prevalence of obesity among non-Hispanic white women increases as income, poverty income ratio (PIR), decreases. However, for the non-Hispanic black and Mexican-American men their obesity prevalence decreases as their PIR decreases. For minority ethnic groups, cultural diet variations, local area characteristics, migration and socioeconomic status, and levels of physical activity play a vital role in determining risk of obesity (Bhopal, 2007).

Michimi & Wimberly (2010),  state that neighborhood of residence has a strong relationship with BMI. Therefore, researchers need to understand that health policy and initiatives of intervention should focus on environmental issues. As there is no clear evidence for the impact of environment on obesity risks, further research needs to be conducted to evaluate geographic variations in relation to obesity (Willms, Tremblay & Katzmaryzk, 2012).

Obesity disproportionately affects low income and education population in America.  Still,  the patterns differ in low-income and high-income countries. Swinburn et al. (2011, p. 804) state that “in low-income countries, obesity mostly affects middle-aged adults (especially women) from wealthy, urban environments; whereas in high-income countries it affects both sexes and all ages, but is disproportionately greater in disadvantaged groups”.  Generally, women below the income poverty level have higher obesity prevalence compared to those women with higher incomes. Education level has an impact of healthy lifestyle awareness. (Ogden, Lamb, Carroll & Flegal, 2010) When it comes to education, men and women with college degrees have lower obesity prevalence compared to those with some college education. Furthermore, college educated women are less likely to be obese compared to those who have less than a diploma. Nevertheless, between 2005 and 2008, obesity prevalence in adults increased at all education and income levels (Ogden et al., 2010). Diverse populations with low incomes in the U.S. have in the past decades reduced consumption of healthy foods like vegetables and fruits, and increased consumption of foods that are energy-dense. In such communities, this lifestyle and dietary change is a strong trigger of obesity and increased prevalence of chronic diseases, such as type 2 diabetes.

Recent research conducted on supermarkets show that the risk of obesity is decreased when people live closer to supermarkets rather than the convenience stores (Michimi & Wimberly, 2010). Therefore, there is a need for identifying environmental and policy factors relating to physical activity and eating habits in order to develop effective intervention methods (Sallis & Glanz, 2009). In the developed world, most research on obesity has determined lifestyle and neighborhood environments as obesity contributors. Health disparities elimination was one of the goals stated by Healthy People project (2010). The goal of the research is to obtain baseline data for American sub-groups to determine their risk levels,

Migration associated with cultural and lifestyle changes also contributes to lower physical activity levels. The westernization of diet leads to increased body weight. For example, the Africans who migrated to the US show higher levels of obesity than those living in Africa (Mellin-Olsen & Wandel, 2005). Migrants find it difficult to maintain their traditional eating habits, since familiar foods are scarce and are hard to find and are more expensive. For many young migrants, they enjoy consuming processed foods and the change of diet is determined by two major factors: generation and age (Finney & Simpson, 2009).

According to Flegal, Carroll, Ogden & Curtin (2010), obesity prevalence for most age and gender groups in the US exceeds 30%. However, for men of ages between 20 and 39, this does not apply. In terms of gender, obesity is prevalent among 72.3 percent of women and only 68 percent of men (Flegal, Carroll, Ogden & Curtin, 2010). According to the National Center for Health Statistics, 4.0% of people with drug prescription could not afford medications prescribed for them, therefore, they were forced to go without the medicine (2012). Economic status does not only affect treatment, but also preventive care. Those who cannot afford regular clinical visits miss out on preventive care, and this results in an increase of health related costs associated with chronic illnesses.

Brown (2007) conducted a quantitative research design using semi-structured interviews and the stratified random sampling method. The study was conducted to determine how different factors contributed to the prevalence of obesity. The author looked at the different strata in order to obtain results of the subjects employed in the study. The case study consisted of results from 11 players who had different roles to play to examine the correlation between different lifestyle choices and risks of obesity.  The study looked at different health care centers in relation with future outcomes of obesity. The study looked into obesity from the financial, legislative, and bureaucratic challenges’ perspective faced by health care centers in providing services to their population. The results of this research aimed at calculating and determining the BMI of registered women and children through the use of weight measurements gathered by health care providers in the centers.  The most important findings established from this article are that women at the peak of their fertility are at a higher risk of being obese than the rest of the female population. This article is relevant in this study because it gives an overview of how health centers have helped the population in reducing their obesity problem through determining their BMI.

McCormick (2006) created a study through sampling different country regions using questionnaires. The adults participating in the study were  over 20 years old, from poor and unemployed families and aimed at looking at the connection of mortality, social exclusion, discrimination, and morbidity in relation with obesity. One issue highlighted in this article is that  obesity imposed further health care costs on disadvantaged families. The three families randomly selected in this study have given the researcher rough estimates on their income and expenditure. This qualitative research design showed the importance of having government interventions in reducing issues of obesity in the nation.

The American Heart Association (2013) looked at cases if 10 women and men over the age of 20 from different races. This discursive research design of the subjects is from simple random sampling and questionnaires were used in collecting the information from participants of the study. The document looked into the significant growth of obesity problems. The results of the National Health Examination Survey (NHES) were used to examine statistics for this study. The use of two-sample tests applied in this research was appropriate because it allowed the authors to compare risk levels and health outcomes across genders and ages. It is evident that women at the child bearing age are more prone to obesity problem and a need arises for health care centers to systematically develop a program that targets this high-risk population. Future research is needed, however, in order to educate the public on how to reduce their risks of obesity among the population.

Sallis & Glanz (2009) looked at the risks of obesity by investigating the aspects of physical activity and food environments. In order to create a healthy population, environmental, societal, and policy changes all related to eating habits and physical activity need to be made. The authors looked at recent reviews and synthesized information, which has enabled them provide representative studies as examples. In addition, innovative intervention methods have also been described and evaluated, in order to give readers an overview of policy changes needed to meet the research objective: reducing obesity through promoting healthy lifestyle choices. The article suggests that communities with access to good recreational facilities and healthy food options are at a lower risk of obesity. Environment disparities and policies create a disadvantage to low-income communities, because they do not have the finances or social connections, education to use the recreational facilities or enjoy the pleasure of having healthy foods. The article suggests that there is room for improvement for developing programs to tackle the obesity problem through health education. The article also emphasizes the role of each individual in making healthy lifestyle choices. Health education, according to the authors,(Sallis & Glanz, 2009)  will enable future generations to have a longer, healthier life.

Burgos, et al. (2005) discussed the importance of generational status in relation with the access and utilization of Mexican American children’s health care services. It is indeed important for researchers to look into the problems faced by minority groups to be able to get a clearer picture of what can be done to improve their health outcomes. The article provides readers and researchers more information on what is to be undertaken in order to reduce the disparities of health by Mexican Americans. The authors state that it is paramount for people to have full access to health facilities because it contributes to the nation’s output and economic status of all individuals. The article indicates that health care providers and researchers should look into options to facilitate the promotion of children’s health across all races and sexes. Taking ethnic and cultural diversity into consideration is an important aspect of making health promotion and preventive programs more effective. Understanding at-risk population’s needs, preferences and constraints in seeking health care is extremely important in order to effectively communicate health initiatives.

Goldman, Smith & Sood (2005) document on legal status and health insurance of immigrants, is a good topic that covers all aspects of obesity and low health accessibility among diverse populations in the nation. This article covers two essential parts of health accessibility among diverse populations, which need to be evaluated carefully to give a clear definition of where the health statuses of these groups of people stand. It is their right as human beings to be accorded the due respect they deserve and should have access to medical covers that are affordable for them. Most countries do not put into consideration their living status and this has become a major contributing factor in the rise of obesity and overweight individuals. Therefore, it is essential for health professionals to look into the aspects of legal status for their patients because this spills down to their ability to cater for their health plus that of their children and maintain healthy living styles. Immigrants are human beings and they have rights that need to be met because they contribute to the growth of the economy in any given nation. Therefore, legal status is a way of representing the rights and privileges of adults and children, which is all presented in the article.

Healthypeople.gov. (2012) created a quantitative descriptive survey of specific population groups and behavioral management practices. Screening tests are applied in this article in relation to calculating the BMI of adults over 20 years using their height and weight. One sample tests are performed due to the premeditation ability the data collected has and thus, determination of higher risk groups by race, age, and gender were established. From the information collected, it is deduced that at a particular age, women are prone to become more obese compared to men. This shows that it is necessary to implement strategies that look into educating women on ways of improving their eating habits in order to prolong their life. This should be applied at a particular age and will enable the women population have nutritional benefits when it comes to their eating habits. It is paramount that this article be used in this research because it gives an outline of the causes of obesity for women at certain ages and should be used by the health care professional in establishing intervention programs that look into promoting their health status.

National Center for Health Statistics (2012) performed a quantitative descriptive survey of complex, multistage design and questionnaires and physical measurements to collect their data. This quantitative design carried out at CDC/NCHS, NHANES (National Health and Nutrition Examination Survey) investigated on obesity prevalence among adults in the year 2011. The findings were compared to statistics provided concerning socioeconomic status by looking at varying ages, gender, race and or ethnicity. The article was able to display that the prevalence numbers of men was constant in some years, yet that of women keeps changing over time. Therefore, women need to consider having physical activity, change of eating habits, and healthy living conditions, which relates to reducing obesity and overweight issues.

Elbel, Kersh, Brescoll & Dixon (2009) looked into aspects of calorie labeling, which is significant when it comes to ascertaining the BMI of adults and children in a given population. The article was relevant for use because it looked into the effects of having low-income earners and related the information to food choices. The information collected showed that low-income people are not in a position to afford healthy and nutritious food because they have other expenses to look after. Furthermore calorie labeling among low-income people is considered a waste of time and money since they lack the knowledge to conceptualize on the importance of having balanced meals at all times. The article is relevant for this review because it touches on the most important aspects of the problem, which is low health accessibility. Moreover, it talks about obesity when it refers to calorie labeling, which should be promoted among diverse populations.

Obesity, as a subject, in adults over 20 years of age encompasses significant gaps that address key elements, which include their ability to pay for health care, learning proper ways that helps them determine weight, calorie input and intake, and understanding weight; when it comes to their overall health. This necessitates the development of new strategies in order to change issues of obesity in America. As a result, this paper intends to look at issues of obesity and low health care accessibility, which is a major problem to diverse groups in the US.

Intervention Methods Identified

After reviewing the evidence provided by observation, monitoring, experimental studies, policy documents, as well as surveys (Swinburn et al., 2005), the government, in collaboration with community health services and charity organizations need to build a case for action on obesity. Next, it is important to identify all the contributing factors and the most successful intervention methods. There is also a need for evaluating potential interventions and selecting the most feasible solutions from the pool of policies, programs and initiatives to implement.
Outcome Measures      

Physical activity, demographic information, health risks, and intervention programs are the outcome measures presented by most researchers in their conducted work. In the study, physical inactivity among adults impacted their obesity rates negatively, which led to an increase in their BMI. Eventually, this resulted in cardiovascular diseases like diabetes (Healthypeople.gov, 2012; Flegal, Carroll, Ogden & Curtin, 2010; Ogden, Carroll, McDowell & Flegal, 2007). Among the adults population, it was evident that the intervention programs depicted an increase of nutritional knowledge and a reduction of body mass index (BMI), but this had no difference in the results obtained from adults in the study (Healthypeople.gov, 2012; Flegal, Carroll, Ogden & Curtin, 2010; Ogden, Carroll, McDowell & Flegal, 2007).

Results

Lifestyle

In this review, it is evident that lifestyle plays a significant role in identifying obesity and low health accessibility in the U.S. among disadvantaged populations (Ogden, Carroll, McDowell, & Flegal, 2007; Healthypeople.gov, 2012; Flegal, Carroll, Ogden, & Curtin, 2010). The New Mexico Department of Health, (2005) states that “employing a multi-level approach that creates supportive environments to address these behavioral factors may be the most promising direction to take”. Therefore, the examination of groups within the society with low access to health care is essential. Their lifestyle, eating habits and knowledge about health needs to be assessed in order to develop a plan that addresses their increased risks.

Physical inactivity

In addition to their lack of accessibility to health care facilities, groups of people with low health care access rarely understand the importance of physical activity and its impact on obesity.  Many obese people are do not have the finances required to access health facilities like the gym, but it is not only working out in the gym that reduces obesity levels. Children, adolescents, and adults need to engage in work outs like walking, jogging, and even mountain climbing activities that will help them burn out the fat taken in order to convert them and breakdown the fat that was to be produced.

Obese people can also reduce their weight by performing physical activities that will leave them feeling light and flexible. Daily exercising will enable them get back into shape and hence, they will be in a position to handle house chores like vacuuming the carpet among other house chores that were difficult. The ability of one to move from one place to another should be an indication that they are capable of working out in order to prolong their lifespan. For example, if they are working and living near their office, it is advisable for them to engage in walking to work to be able to keep fit and this is a good way of maintaining their weight.

Level of education

The level of education is also another factor that has contributed to obesity and low health accessibility. Educated individuals have a wider knowledge about their rights, health risks and consequences of their lifestyle choices. However, it is not too late to bring health education up to standard across all social classes.  It is vital for disadvantaged populations to be educated on the importance of eating healthy foods, which contributes in having a population rich in young adolescents who are healthy and energetic.

Household income

Financial status is another factor that has contributed low health accessibility among diverse populations in the US, and it has been already confirmed that low health accessibility can result in higher risk of obesity. Therefore, an indirect correlation exists between low income and obesity risk. Low income is mostly experienced by minorities living in the US because they do not have the right papers to be able to attain a good paying job with additional benefits that will help them live comfortably in the US. This low income has resulted in many households eating foods with no nutritional value, which has affected their BMI because they cannot even afford health facilities. Furthermore, high income is associated with high intake of junk food due to their inability to cook nutritious foods. However, it is not necessarily so for all high income earners in the US. There are those individuals who watch what they eat and ensure that their food proportions and intake are in collaboration with expected standards of nutrition. From the reviews researched, it is significant for individuals to have access to health care facilities that will help in determining and monitoring their BMI. Eating healthy is all that should be investigated in order to ensure that children and adults have quality lives that will be able to prolong their lives.

Findings

The study has revealed aspects that have arisen from today’s society’s dependency on technology. As Swinburn et al. (2011, p. 807) confirm: “the energy expenditure needed for daily life has decreased since the beginning of the 20th century because of increasing mechanisation,

urbanisation, motorisation, and computerisation”. Today, adults and children face with high risk of obesity due to their lack of physical exercise and poor eating habits. Therefore, it is worth noting that individuals need to consider eating healthy foods, vitamins, and nutrients that add value to their health. This fact will help reduce the chances of having obese people in the population and hence, will have a nation that has healthy individuals. Secondly, low health accessibility has also been investigated in this review, which gives governments a clear idea of how inequality in the health sector is ever increasing. The research provides health care professionals information on what needs to be undertaken in order to reduce obesity among diverse groups in the nation. Furthermore, using evidence-based studies, policymakers and health care professionals will be able to create targeted intervention programs that facilitate the increase of health accessibility among adults. This will enable the health sector to promote equality among diverse populations. If effective, targeted health promotion and intervention programs are designed, the entire population can have quality life and reduced risk of chronic diseases.

Another significant finding of this study is to reveal methods to conceptualize and understand or comprehend the major steps in effectively dealing with health problems of obese individuals. It is evident that obesity is on the rise in the US.  It is vital that measures will be taken for reducing the impacts of the epidemics and obesity at the same time. The review has been able to identify gaps that need to be investigated in future to determine further risks associated with obesity.

Implications

The review conducted above has a great significance on the practices of health care profession and policies related targeting high-risk populations with diabetes. The research looked into the importance of the problem and the risk factors associated with obesity and diabetes. Health care providers can draw conclusions from the findings of the study when implementing intervention strategies that will reduce obesity. It is evident that the government plays a critical role in developing and implementing programs that facilitate fair distribution of health resources in the nation. Diverse populations in America are at high risk of obesity, because of their low access to good quality medical covers, and because they do not have relevant health knowledge or legal representation that caters for their health problems. Therefore, the review conducted above looked into available solutions that will be able to mitigate the problem of obesity.

Additionally, the low accessibility to health care has been established as a contributing factor to the increased rates of obesity. As a result, solutions and programs implemented will be able to give long lasting solutions and improve life quality through prevention and health education programs. Another implication of this study concerns the role of sex related to risk of obesity. The research concluded that compared to men, women today face a higher level of obesity risk. As such, it is imperative for health care professionals to establish grounds that will target specific populations based on gender and socio-economic status. Community programs, aimed at women and at-risk socio-economic classes can reduce health disparities in the society related to risk of obesity.

Other factors determined by the study below are the contributors of the obesity epidemic on the global scale. The study revealed that contributors to the rise of obesity among adults include discrimination, low socio-economic status, and social exclusion. The aim of the conducted research was to be able to come up with solutions that will reduce the rate of which obesity spreads.  While the research supports policymakers and health care professionals in their task, there is still a need for further studies and a thorough examination of different contributing factors to the increased risk of society. However, being able to determine the at-risk population’s characteristics, targeted programs can be developed that increase the health awareness of individuals across all the U.S. population, supporting people in their journey towards a healthier life.

Conclusion

In summary, this integrative literature review was able to incorporate data on obesity and low health accessibility to demographic factors, physical activity, adverse health outcomes, and socioeconomic factors. It has been noted that the increase in BMI is an indicator of a high risk for type 2 diabetes, and lack of education, low socioeconomic status have been also identified as contributing factors of obesity. The risk of increased BMI is mostly associated to chronic disease that implies more finances for treating the chronic disease. The low accessibility of health care facilities has contributed to the increase the cost of treatment as well. The framework reviewed and implemented through the integrative review has indicated the following implications of further policies:

1. The government needs to look for strategies that will incorporate low-income earners in health programs to reduce the chances of having doctors and nurses open back door hospitals.
2. Research data and evidence needs to be used to identify the groups of society which are most “at risk”.
3. Education about healthy lifestyle is not always possible through the health care system. Community, school and family programs with the involvement of charities need to bee supported by the government to stop the epidemic of obesity.

The integrative literature review has confirmed the initial thesis statement. Indeed, evidence shows that the risk of obesity increases as the access to health care is lowered.

On completing the literature review, the existing relationship between obesity and health care facilities are predominant. Existing evidence portrays that most females are more prone to be obese compared to men and also, minority groups have low access to health facilities. The prevalence ratio of obesity among women is attributed to gender roles, discrimination, level of education, and financial situation. As a result, the findings are helpful to health care professionals because they will use the information to find ways of mitigating the menace of obesity and low health care accessibility. This integrative literature review is relevant and meets the Essentials of Master’s Education programs in Nursing because it emphasizes on collaboration between patients and health care providers. Furthermore, this improves outcomes of health and strives to curb obesity epidemic. For a master’s prepared nurse, it is important to collaborate with multiple disciplines like teachers, counselors, dieticians, and parents in meeting the objective of the study. Disciplines collaborative approach utilized enables an advance practice nurse assist in coordinating adult aspects that improve on health outcomes. Before the review was conducted, it was evident that physical activity and nutritional levels contributed to high levels of obesity. An advanced nurse can use this information in developing and implementing strategies that will combat obesity and evaluate treatment strategies and government interventions. Without the collaboration of community organizations, policymakers, sociologists and health care professionals, however, this task cannot be accomplished.

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Appendix A

Correlation between Income, Education and Eating Habits Source: (New Mexico Department of Health, 2005, p. 24)