Obesity and Unhealthy Lifestyle, Capstone Project Example

Introduction

Obesity and unhealthy lifestyle are the major issues in the United States. The increasing rate of overweight and obese population has several aspects, and in order to fully understand how to create effective intervention plans, researchers need to review the problem from the epidemic, environmental health, policy, and socio-behavioral perspective. The below paper is designed to examine the health issue and the current intervention plans to create a framework that would reduce both obesity and co-morbidity associated with unhealthy lifestyles and diets. Obesity was selected, as obese adults – according to Archer et al. (2011) – require more treatment, and are more likely to develop serious or chronic conditions, therefore, cost more for the health system.

One of the major health risk factors determined by the Department of Health and Human Services (2014, p. 4) is obesity. According to the statistical analysis, the percentage of men and women aged 20 and over in the United States being overweight, grade 1, 2, and 3 obese has been rising since 1998. The report states that “reducing the prevalence of obesity is a public health priority because obesity is correlated with excess morbidity and mortality. In particular, Grade 2 or higher obesity [a body mass index (BMI) of 35 or higher significantly increases the risk of death” (Department of Health and Human Services, 2014, p. 4). The CDC Lean report (n.d.) also found that the treatment of diet-associated heart conditions, stroke, diabetes, and cancer cost the health care budget a total of $70.9 billion in 1995.

The above finding indicates that there is still a lot to do to support the public in making healthy lifestyle choices. The previous practicum project examined various workplace health promotion policies, including the programs offered by Naval Medical Portsmouth, designed to sustain military readiness by increasing awareness, providing education, and intervention to promote healthy lifestyle for Sailors, Department of Defense personnel, and other beneficiaries.  The organization’s educational approach has been found effective. The main thesis the author would like to examine in the following paper is that work health initiatives focusing on health behavior change and education can be effective in reducing the impact of health epidemics, such as obesity, diabetes, and smoking-related cancer.

The workplace health promotion tools offered by the CDC Lean Works! Website (n.d.) offer a workplace obesity cost calculator. Using the calculator tool, the authors found that The total medical and work loss costs associated with the BMI is a total of $4,963,000.  The cost of obeisty is broken down into categories:

• prescription costs: $1,092,600
• inpatients cost: $693,00
• all medical costs: $1,706,600;

The assessment also found that individual medical cost range from $86 -$304 per person, the work loss cost: $48-$128 per person; and the annual workdays lost: 1299 days – 5826 days.

The author based the thesis on the findings of the C3 Collaborating for Health (2011) report, indicating that workplace health initiatives can reduce health care costs, improve employees’ productivity, and reduce employee absence (p. 6).

Epidemplogical Background

The main questions regarding lifestyle choices from the epidemic perspective based on the WHO’s research (2055) are:

1. What is the cause of chronic diseases prevalent in the United States?
2. The main risk factors of chronic diseases associated with obesity
3. How chronic diseases can be prevented and controlled

According to the recent practicum project’s findings, and the WHO’s (2005) findings, the main causes of chronic diseases in the United States are inadequate screening, lack of health literacy, and unhealthy lifestyle. The WHO (2005) estimated that “chronic diseases will take the lives of over 35 million people in 2005, including many young people and those in middle age… Without action to address the causes, deaths from chronic diseases will increase by 17% between 2005 and 2015 ” (WHO, 2005). The report also found that chronic disease epidemics have a long duration, and take decades to become fully developed. The study found that lifestyle-related diseases are not only influenced by individual choices, but also the living environment of communities. While unhealthy lifestyle and diet are the main causes of obesity epidemics, it is also stated that prevention and control of these illnesses requires a systematic, long-term approach.

Environmental Health Issues

Swinburn et al. (2004) found that lifestyle choices, such as whether or not taking on smoking, exercising, eating healthy are related to people’s living environment. This indicates that workplace (and community-based) prevention and health education programs that do not only provide information about risks, but also offer alternatives can successfully improve health outcomes of target populations. The main interventions that have been found effective in the United States by the paper prepared by C3 Collaborating for Health (2011) are: workplace and community immunization programs, fitness and gym membership discounts, executive screening, developing a health website, and on-site classes on health. These interventions are designed to tailor communities’ environments to provide more opportunities for engaging in healthy activities. In order to improve living and working environments to allow individuals to make informed healthy choices, according to the Healthy People 2020 Initiative, US health services, employers, and communities need to provide supportive social and physical work environments, offer programs integrated in the organization’s structure, and provide health education. A good example for implementing these interventions at the workplace was examined in the recent practicum project research. The NMCP teaching hospital created various health programs for staff members in order to “facilitate readiness and resilience, prevent illness and injury, hasten recovery and promote lifelong healthy behaviors and lifestyles”.  (Practicum Project, 2014). The programs offered by the organization were: tobacco workshops, Right Weight awareness health education sessions, and the Ship Shape program, designed for active-duty personnel,  family members, and retirees, to provide them with effective tools to manage their weight.

Health Policy Implications

Executive Order of the 13058 by President Clinton provides federal employees protection from tobacco smoke in federal workspace. The NMCP implemented a tobacco-free policy, and created health education programs that are related to smoking cessation and support. Providing a wellness program at the workplace can support the execution of policies related to work environments. According to Bronnum (2013, p. 10), “throughout the twentieth century, public health governance in the United States shifted from a federal-focused to a more state-focused approach, and then to a more local-focused public health system, with the increased development of local health agencies”. This indicates that local communities, such as workplaces, health organizations, and schools are currently under pressure to provide local solutions for populations at risk of chronic illnesses.

The CDC (n.d.) introduced a Workplace Health Model in order to provide employers with effective tools to create employment-based health promotion and prevention programs. The authors of the study based their recommendations on the Healthy People 2020 initiative, focusing on the following objectives: providing health education for employees, providing a supportive environment, integrating the program in the structure of the organization, linking health promotion programs with employee assistance programs, and providing workplace screening. The CDC workplace health model, in line with the purpose of the Healthy People 2020 initiative focus on risk assessment, the planning process of the health program, implementation, and evaluation of the intervention’s effectiveness.

Tobacco use at the workplace is one of the most significant health risks identified by researchers. The practicum project completed previously has identified the NAVMEDCENPTSVINST 6280.1H Naval Medical Center Policy of the Surgeon General of the Navy as relevant to developing guidelines for creating workplace policies eliminating the use of tobacco products on site. The policy, however, has several limitations, and is unable to fulfill its objective for several reasons. First, members of the Navy who were hired before 2008 are exempt and are provided with a special badge, allowing them to smoke in the designated area. While smoking is prohibited in the building, and during performing official duties, smoking at residential accommodations is not regulated by the order.

It is recommended that the Naval Medical Center Policy of the Portsmouth facility follow the guidelines set by the CDC Workplace Health Model. The essential elements of a government facility workplace health intervention program identified by the authors (CDC, n.d.) are: workplace health assessments, program planning, program implementation, and determining the objective (impact).

A workplace health assessment is to be designed to target a given employee population, and the survey’s main goal is to determine the main factors that influence employee health. The assessment should focus on lifestyle choices, living and working environment, and evaluate existing workplace practices. In the practicum project, the Health Promotion and Wellness Department of Naval Medical Portsmouth identified weaknesses to the current policies that needed to be changes. The exception of civilian workers recruited before 2008, the lack or regulation regarding residential accommodation and the existence of designated smoking areas prevented the Naval Medical Portsmouth from qualifying as a smoke-free facility. While policies executive order compliance are important, the main aim of work based programs should be to effectively protect employees’ heath.

Socio-Behavioral Perspectives

The C3 Collaborating for Health (2011) report talks about risk-factor specific programs. These programs are extremely relevant to the current research, as they target employee populations that currently engage in behaviors that endanger their own health and others’. In the practicum project, smoking and obesity have been identified as risk factors. Health promotion programs in community (and workplace) setting should focus on education and promotion of healthy choices in order to improve health outcomes of populations. The report by C3 Collaborating for Health (2011, p. 8) found that “tackling the three major risk factors of chronic non-communicable diseases – poor diet (including misuse of alcohol), tobacco use and lack of physical activity – is essential for ensuring long-term health”. Therefore, in order to change health-related attitudes and behaviors,  Naval Medical Portsmouth should develop a program that helps workers

1. increase physical activity
2. reduce obesity
3. help employees with smoking cessation.

The proposed benefits of developing a work based health program in Naval Medical Portsmouth, based in the C3 Collaborating for Health report (2011, p. 10), founded on research of 56 peer reviewed studies are: 27 percent reduction of sick leave absence, a total saving of 26 percent on health care related costs, 32 percent reduction in payments for disability management and worker compensation related costs, and a return on investment ratio of 6 to 1.

Swinburn et al. (2004, p. 133) found that socioeconomic status’ “underlying determinants are closely linked to the wider environment, especially to social, economic, employment and education policies”. Behaviors linked to work, social status, and lifestyle are also related to the environment: whether or not it provides opportunities for healthy eating, low-cost recreational and exercise facilities. The more healthy, cost-effective choices the individual’s environment offers the more likely they will be to make better choices. This is the reason why workplace setting for health promotion programs can be extremely successful.

Conclusion

The above review has revealed that community-based and work-based health promotion programs can have a positive economic and health outcome on large populations. The analysis of the Naval Medical Portsmouth intervention project has found that government agencies and organizations implementing health promotion, screening, and education programs can reduce absence rates, sick leave payments, and increase the organization’s compliance with current workplace regulations.

References

Archer, W.R., Batan, M.C., Buchanan, L.R., Soler, R. E., Ramsey, D.C., Kirchhofer, A., & Reyes, M. (2011). Promising practices for the prevention and control of obesity in the worksite.  American Journal of Health Promotion, 25 (3), e12-e26.

Bronnum, A. (2013) Public health financing & governance. Retrieved from http://www.mphpublichealthpractice.uw.edu/pdfs/bronnum.pdf

Centers for Disease Control and Prevention. (2010).  CDC LEAN works! A Workplace Obesity Prevention Program.  Retrieved October 31, 2014, from http://www.cdc.gov/leanworks/costcalculator/index.html

CDC (U.S. Department of Health and Human Services Centers for Disease Control and Prevention) (2013) Health, United States, 2013. Retrieved from http://www.cdc.gov/nchs/data/hus/hus13.pdf

(U.S. Department of Health and Human Services Centers for Disease Control and Prevention) (n.d.) Workplace Health Model. Retrieved from  http://www.cdc.gov/workplacehealthpromotion/model/

CDC (2010) CDC LEAN works! A Workplace Obesity Prevention Program. Centers for Disease Control and Prevention. Retrieved October 31, 2014, from http://www.cdc.gov/leanworks/costcalculator/index.html

C3 Collaborating  for Health. (2011) Workplace health initiatives: evidence of effectiveness. Retrieved from http://www.c3health.org/wp-content/uploads/2009/09/Workplace-health- initiatives-review-of-the-evidence-v-1-20111205.pdf Executive Order 13058

Policy for the Navy, NAVMEDCENPTSVAINST 6280.1B

Swinburn, B., Caterson, I., Seidell, J. & James, W. (2004) Diet, nutrition and the prevention of excess weight gain and obesity. Public Health Nutrition: 7(1A), 123–146

WHO (World Health Organization) (2005) Preventing chronic diseases. A vital investment. Retrieved from http://www.who.int/chp/chronic_disease_report/full_report.pdf