Overweight and Obesity, Research Paper Example

Significance of Leading Health Indicator

Overweight and obesity is one of the most characteristic problems of United States. Thus, it is a very important health indicator. Let the statistics speak for them: approximately 66% of the U.S. population are overweight, and 33% of Americans are obese (CDC, 2009). As much as 16% of children and adolescents are obese (CDC, 2009). Historically, these rates doubled for adults and tripled for children since 1960. During last few years there was an insignificant increase: 31.1% in 2003 – 2004, and 33.3% in 2005 – 2006 for adult males; 33.2% in 2003 – 2004, and 35.3% in 2005 – 2006 (CDC, 2009). According to recent NHANES surveys, in the combined years of 2003 – 2006, 16.3% of children and adolescents aged 2–19 years were obese, at or above the 95th percentile of the 2000 BMI-for-age growth charts (CDC, 2009).

Such rates of obesity and overweight are disquieting and cause concern. Obesity increases risk of many diseases, different health conditions, and is to the detriment of the health as a whole. In particular, it can lead to type II diabetes, high blood pressure, cardiovascular disease, osteoarthritis, high level of cholesterol, cancers, coronary heart diseases, strokes, gynecological problems, to name but a few (CDC, 2009). It is an alarming fact that children and adolescents now suffer from type II diabetes caused by obesity as it has been considered an adult health problem. An increase of weight is associated with increase of the risk of death (CDC, 2009). And it cannot be denied that social and psychological consequences of obesity are also unavoidable, thus leading to social problems, conflicts, and dissatisfaction (Hopkins, 2003).

For the country and people who suffer from obesity, this disease sometimes costs enormous amount of money. For example, in 2000 the obesity-related health care costs totaled an estimated $117 billion (CDC,2009). According to Center for Disease Control and Prevention (CDC) publications (2009), diseases associated with obesity account for 27% of the increases in medical costs between 1987 and 2001. Medical expenditures for obese workers, depending on severity of obesity and sex, are between 29%–117% greater than expenditures for workers with normal weight (CDC, 2009). From 1979–1981 to 1997–1999, annual hospital costs related to obesity among children and adolescents increased, rising from $35 million to $127 million (CDC, 2009).

Healthy People 2010 national health main objectives are:

• to reduce the prevalence of overweight and obesity among adults 15% or less,
• to reduce the prevalence of obesity among children and adolescents to 5% or less. (Healthy People 2010)

In 2000, when the program Healthy People 2010 was launched, levels of obesity were lower – 23 percent of adults and 11 percent of children and adolescents were obese (Healthy People 2010). It seemed possible to reduce the prevalence of obese people by 8 percent and 6 percent respectively (CDC, 2009). Now this task looks literally impossible, as no reduction of obesity levels took place in the scale of the whole country. But CDC claims that some “early signs of success in the prevention and control of obesity—at both state and national levels—are now emerging” (CDC, 2009), because between 2003-2004 and 2005-2006 no significant increase was detected. In some states there are examples of policies that were successful and led to promotion of healthy lifestyle. In Michigan a 3-year plan was developed and realized, making it easier to lead a healthy life: local health departments were funded to create more opportunities for their residents to lead a healthy life. It included law corrections, city engineering, and involvement of many non-profit organizations, hospitals, universities, etc (CDC, 2009). In Texas a so-called Farm to Work program promoted fruit and vegetable eating by making these products available at the push of the button. In California, National Convergence Partnership was launched to govern the power of many organizations. It led to changes in policy, informing of leaders and increasing awareness of the aforementioned problems of obesity.

Theory of Change

Suitable models to improve the situation with overweight and obesity are health belief model, self-efficacy, and learning theories of change. The Health Belief Model implies that those who have health problems will correct health-related behavior after being informed about threats to their health; severity of the threat to the health is the main motivation factor. Understanding and intention to lose weight is an indivisible part of behavioral change.

Self-efficacy is an individual estimation of their ability to tackle the problem. It is usually based on previous experiences, psychological state, and support. Self-efficacy is more a part of other theories than an independent model of behavioral change. For example, it is a main idea of Social Cognitive theory which deems expectations to be the key point in behavioral change. This theory is not as good as Learning theories because weight loss requires constant work and the results of this work are not immediate as most people expect them to be. If some obese person does not see notable changes after a month or so, he or she will give up changing the lifestyle. And if they he or she is a part of group which is trying to lose weight it will be to the detriment of their determination and decrease their self-efficacy.  It is difficult to modify the complex behavior so as to make it healthier or more active; it is especially difficult to convince hundreds of people that they are able to lose weight and that they should do it themselves. Learning theory provides decent alternative to radical changes that may be unacceptable by overweight or obese people.

Health Belief model is not suitable for this health indicator. The matter is that people tend to perceive information about potential threats seriously within several days. After the lection about threats to the health people might think that it is really vital for them to change their lifestyle. One week ago they will think that it is great to change their lifestyle, but it is too difficult. After a month the idea of changing eating habits and the lifestyle as a whole will seem ridiculous. So, obese people need constant support and incentives – social or intrinsic.

Learning Theories state that some new and complex behavior pattern, like change of lifestyle and eating habits, is learned gradually through the modification of simpler behaviors that make up the complex behavior. Such a principle can be exemplified with a walking habit – in order to get yourself into a long walking habit one can break a long walk into smaller walks; or with losing excessive weight – a difficult behavior that involves change of sedentary lifestyle that includes change of food ration, physical activity, psychological attitudes, and other behavior patterns. Small behaviors can be imitated and reinforced, and it plays the vital role as it is difficult to change a habitual patterns. When a person develops a proper or supported small behavior, some reward is usually needed to maintain a new skill and stimulate the further development of the target behavior. When several small behaviors are established they form a more complex behavior: a complication to the change process is that new patterns of physical activity behavior must replace former patterns of inactive behaviors like television watching which can be satisfying, habitual behavior, or behavior cued by the environment.

Reinforcements are essential because they can motivate people to continue behavior or to drop it. Most behaviors are learned and maintained under fairly complex schedules of reinforcement and anticipated future rewards. Future rewards or incentives can include physical consequences (for example, increased stamina or looking better), extrinsic rewards (for example, change of social status, compliments, receiving a T-shirts), and intrinsic rewards like feeling of satisfaction because of achieving a personal goal. It is important to note that despite the fact that extrinsic rewards can help people adopt positive lifestyle behaviors just external reinforcement cannot be relied upon when it comes to long-term change (Grizzel, 2007). This theory also allows influencing people on different levels – individual level may include lections, incentives, training, etc. while community level intervention may include change of policy or laws, public promotion and stimulating programs.

A target population of the health intervention is first of all minorities, as American Indians, Alaska Natives, Afro-American, Hispanic and Mexican people suffer most from the obesity (Welty, 1991); also, people with low income tend to be more obese or overweight than those with middle or high income. Adolescents, and especially children and infants must be cared about, as there are still a lot of loopholes in laws that correct public advertisement. In general, taking into consideration that only 26 percents of Americans are involved in vigorous leisure physical activity (Weight Control Information Network, 2007), healthy lifestyle must be widely promoted.

The problem of obesity is a complex and differential problem. Obesity among children is a problem that no one can be blamed for as it has a lot of reasons (Harkin, 2008); obesity prevalence among minorities and distribution between males and females is increasingly social and dependent problem. Intervention in lifestyles of people who are passive and need constant support and praise to achieve some tangible changes in their lifestyles needs a lot of money and social organizations working together to reach a complicated goal. Learning Theories need no radical instant changes and involve important external factors making this an appropriate theory of behavioral change.

Implementation Challenges

Ethics

There may be not any general ethical challenges to the implementation of the learning theory applied to Overweight and Obesity. Unlike responsible sexual Behavior, overweight and obesity implementations affect common social life and are easy to control and estimate. But when it comes to particular aspect there can be some problems with populations like national minorities and children.

As described above, there are some major special population issues that must be addressed. For example, 79.6 % of Black women, 73% of Mexican-American women are overweight; 50% of Black women, 40% of Mexican American women are obese; 67% percent of  Non-Hispanic Black men and  74.6 % Mexican-American men are overweight  (WIN, 2007; Hopkins, 2003). These prevalences are big enough to tackle separately. Of course, people want to be healthy. But, according to Thomas Hopkins (2003), African-Americans tend to receive less medical help because of lower income, to be physically inactive, to have excessive alcohol intake, to have lower socioeconomic status, to live in areas with poor socio-environmental conditions and thus to be at risk of being obese. Also, traditional lifestyles can be of vital importance for health implementation programs. Native Americans are the most live examples of traditional lifestyles that must be taken into consideration when composing health implementation programs. Thus, there are some challenges that are connected with introduction of new lifestyles – mostly it is a kind of challenges that needs a research on the certain population group.

Another challenge is children and adolescent overweight and obesity. According to racial and socioeconomic statuses oriented research, frequency of eating breakfast, eating fruits and vegetables, and exercising, number of hours youth spend per week watching television proved more important than the family/parenting variables examined (Delva, Johnston, & O’Malley, 2007). It means that family impact is less that that of advertising, social interaction and personal addictions. Differences in lifestyle behaviors and family characteristics might help to explain these subgroup differences starting at an early age. While there is growing need to modify these behaviors in the population at large, the need is greatest among minorities and low-socioeconomic status youth (Delva, Johnston, & O’Malley, 2007).

Values

When developing social implementing programs, one should possess certain skills and values. As a health professional, I will need personal and professional values to succeed. First of all, profound knowledge of laws that concern health practice, because they prescribe, set limits, and protect those who work in the branch of national health. If some laws are broken, both health professional and the person that was served by can suffer. Of course, competence will be needed to succeed and thus I need a good knowledge of the subject I am going to work on. And knowledge of human rights will help me to protect people and guide them to healthy way of life.

My own values that can help me most are patience and sociability, humility and probably realism as well. I know well that to set a serious goal (such as lifestyle change) and to achieve it one should possess an extraordinary will and character. As most obese and overweight people do nothing to change their lifestyle, I deem it logical that the most effective way to influence habitual patterns is to change them step by step. In order to change your life dramatically, one must be extremely decisive. In order to change it insignificantly, one can be passive but open to offers. And this position will lead to small steps to healthy lifestyle; being provided with help, support, and government programs a determined person can do wonders.

There are some values that one needs to govern such behavioral change implementation. First of all, it is an ability to persuade people who think that their way of life is the only possible one and nothing can be changed about it; an ability to encourage and persuade that the threat to the health of obese people is formidable and all they need is decide and act. It is my perspective that women tend to be more conscious about diets and active lifestyle, and it makes them more open to suggestions about hoe to improve their health. Men are less susceptible and they mostly do not perceive diets as a possible solution of their problems. Psychological skills are absolutely necessary for health professionals who will represent any kind of health implementation as it is a basic skill for those who work with people.

Other Challenges

Of course, every attempt to change the usual lifestyle, especially if it is convenient (elevators, sedentary lifestyle, no physical activity, fast food) meets resistance. It is obvious and predictable, though somebody can claim that people want to be healthy. It is true that all ill people want to be healthy, but another truth is that they always choose the way of the least resistance. Here a challenge around the fidelity versus adaptability arises. And it is one of the reasons why the learning theory of behavioral change is appropriate – it does no require fast and dramatic changes. It is possible to build a new park and stimulate obese people to walk there for several minutes per day. It is possible to organize a fruit and vegetable farm delivery to homes of people who want to change their ration. These measures are just an initial impetus for further changes. They are small behavior modifiers. But such small changes will reduce the fidelity to usual lifestyle and slowly change it to the better one – to the healthier one.

Learning theory implies the intervention of different organizations into the lives of obese and overweight people. As an example, California shows that an effective coalition of federal organizations, state organizations, and non-profit organizations can work out an effective health intervention program. Also, a lot of inquiries need to be launched because of lack of satisfying and actual information. Different researches in the conclusions claim that more research is needed to compose a clear and complete impression of some health issue.

Speaking about power involved in the obesity in childhood problem resolving, Senator Tom Harkin said:

‘Perhaps the biggest challenge of all is the political one. Powerful interests and legions of lobbyists are arrayed against even commonsense proposals to encourage healthy choices and behaviors. And Americans themselves are generally wary of government—the “nanny state”—telling them what they should eat and drink, and how they should manage their own health. ’ (2007)

So, questions of power are of great importance here – general decisions depend on those who govern the whole way of life.

There may not be many potential threats to individual rights, as these programs not obligatory and voluntary. If some obese person will participate the program that will help to improve his or her health by changing their lifestyle (to the certain degree) it will be constitutional to help him or her by encouraging, educating about threats to their health and leading through the resolving process. Such endeavors are not illegal.

Evaluation

Stakeholders are an integral part of health intervention programs. The state will be a stakeholder in this scenario. When a problem gains a nationwide scale its solution becomes a national necessity. As two thirds of American population is overweight including obese, it is an epidemic that is really alarming. The Healthy People 2010 program is an attempt to hold the rise of overweight in the U. S. Overweight people are stakeholders, too, and they are an indivisible part of this program.

What a decision process making looks like can be seen from the Tom Harkin’s Preventing Childhood Obesity.  On this example it becomes clear how difficult it is to govern the health care programs. First problem that he underlies is abandoning the blame game as to ‘who or what is responsible for America’s epidemic of childhood obesity and related chronic diseases’ (Hopkins, 2003). There are too much establishments to blame: advertising corporations that promote unhealthy foods; schools that neglect proper physical education, sedentary society… He deems it obvious that any potentially successful effort to combat obesity, diabetes, strokes, and other preventable conditions must mobilize all sectors of the society and economy. Everybody, from individuals and families to corporations, from schools to government at all levels, must be involved in the process.

Second important thing, is a determined effort to transform the various research findings into practicable, sustainable interventions in our communities, schools, and workplaces. The links between researchers who work on evidence-based practices to promote public health and policy makers, elected officials who create public-information campaigns, incentives, and mandates must be strengthened and supported in order to make both processes effective.

Third important thing is prevention, beginning from the earliest days of children’s lives. Moreover, that there are still loopholes in the laws; for example, advertising policy affects children’s vulnerable minds greatly. Our public schools today are full of sugary beverages and fast food. And the task of updating the laws in accordance to the actual needs of obese and overweight people is the task of federal and state establishments.

The intervention itself must be really multifunctional. It needs certain funds, because selected learning theory of behavioral change underlies rewards and incentives for those who have chosen the way to change their lives by means of federal program. Even if only T-shirts will be needed it will be costly. Provided that a delicate change of lifestyle needs differentiated approach there will be certainly more ways to stimulate people to follow their new behavioral patterns. For organization of social actions, holding meetings and seminars, emitting souvenirs and incentives for those who want to change their lifestyle requires lots of money, it is obvious that this program must be carefully thought of and backed up by laws and government investments.

The offered main directions of change in the behavior are change of diet and change of sedentary lifestyle to active one.

The change of diet is a complex behavior. It can be divided into simpler behaviors such as counting calories, replacing fast food and semi-finished products with fresh cooked ones, setting the target to lose weight to the certain degree, plan your meals and limit it to several times per day, or try to cook ethnic food instead of usual. Each of these small behaviors are much more easily adoptable that complete change of diet. It must be taken into consideration that people must be strongly motivated to change their diets. Health care experts who can influence the self-efficacy, who can persuade those who were once in despair that they are able to change everything if they want to are needed.

The same can be said about active lifestyle – absolutely inactive people can start with short walks, and several exercises. In order to make them want to walk, state establishments can introduce new parks, public actions, meetings to attract people and distract them from their televisions.

When it comes to childhood obesity prevention, parents must be educated about healthy ways of life; certain federal laws need to be updated in order to limit the advertisement of unhealthy food to children and adolescents. Food provided to them by schools must be healthy and tasty. What is said on the health care lessons must be illustrated by what is sold in cafeteria. They also must be taught and informed about healthy way of life. Computer games that replace simple active games outdoors lead to motion deficiency in children.

The very thing that must be understood is that proper lifestyle does not include total dismissal of the persistent opinions and tastes – it is a sequential change to the perceptible degree. Nobody wants to influence children life directly and harshly – everything that is needed is a change of their circumstances. Change of socio-economical status of children is much more complicated and non-trivial task. The outcomes can be short-term and long-term. Short-term outcomes can be notable within several months. It can be the quantity of people who participate in the program, the scale of measures that were undertaken in order to involve people into active leisure, etc. Long-term outcomes must be decreasing of the overweight and obesity levels, introducing healthy foods in the schools, increase in fruit and vegetable sales, more people outdoors – walking, playing, meeting.

Of course, in order to achieve the decrease of the overweight and obesity levels a lot of measures must be undertaken. A lot of habits must be broken, many laws must be corrected, many organizations to be established and instructed. From the smallest behaviors to the behavioral patterns of the whole towns, a lot of things should happen. Now there are certain steps undertaken in order to promote the healthy way of life. Senators are preoccupied with the problem of children and adolescent obesity, states introduce programs that represent learning theory of behavioral change – Texas and its Farm to Work program represented change of small behavior – eating fruits and vegetables – and how it changed the lives of the participants. Laws should be corrected so as to make school and home nutrition healthier. Non-profit organizations may overlook certain groups of people; school nurses may control childhood obesity levels and instruct parents respectively.

In the long run, a summative evaluation will be made – it is more action-oriented. Having summarized everything that has been done to improve obesity situation in the country one will be able to estimate the efficacy and perspectives of the described theory. Programs and organizations that will have been involved should also be considered.

Main indicators of success are, of course, reductions in obesity and overweight rates. They can be evaluated annually in order to trace the successful programs. But the most notable changes will take place probably 20 years ago – one generation that will change its lifestyle will influence the next one.

Sustainability

Target level of change is individual and social. In order to change the social attitudes and behavioral stamps a change on the personal level is necessary. So in order to change the behavior and to make it a second-order change one needs to do a great deal. First-order changes occur when a person vows to himself or herself that he or she will change an attitude or behavior, but other part of the individual still insists on old behavioral patterns. It is a formidable threat to the effectiveness of obesity cure. Widespread examples of first-order changes are failed attempts to quit smoking, addictions, drinking, gambling, or to exercise. A benefit of learning theory of behavioral change is that is eliminates the necessity to make serious decisions and to follow strict rules right when the decision was made. Small and seemingly slow changes can do wonders and sequentially change the habits. Just compare the vow to walk every day for an hour (for a couch potato) and a possibility to walk for 5 minutes. Given the fact that imitation and reinforcement plays vital role in the Learning Theory, it will be easier for people to walk together and to support each other than to walk the whole hour alone.

Second-order changes means shifts in basic attitudes and priorities that cause stable behavioral changes, and it is the main target of the national behavioral change.

In order to achieve as profound results as possible, a lot of researches need to be launched. National Cancer Institute agreed that there are several crucial points in further development of obesity agenda and obesity policy. Thus the next themes may need to be researched as well: the embryonic nature of obesity policy research, the need to study “natural experiments” resulting from policy-based efforts to address the obesity epidemic, the importance of research focused beyond individual-level behavior change, the need for economic research across several relevant policy areas, and the urgency of taking action in the policy arena (McKinnon et al., 2009)

In the whole, it is rather difficult to make all organizations work well in order to ensure proper and timely and effective realization of the intervention program. As a lot of factors influence the effectiveness of the health intervention programs it is essential for all parts of state apparatus to work well. As research shows, it is a desirable, but not existent situation.

In 2007, departmental activities around healthy eating, weight loss and physical activity were surveyed in order to reveal if all of them were working effectively for the state problem solution. Results revealed that on average less than half the health departments that were surveyed provided, supported, or advocated for programs targeting these activities (Slater, 2007). Although the majority of informants pointed out that these programs are of high priority, there is still an opportunity for health departments to expand these services (Slater, 2007).

In order to make the learning theory more sustainable, more research should be undertaken in order to reveal leading motivations and life priorities of national minorities, children, adolescents, obese people with hereditary diseases and other researches.

The learning theory is workable, sustainable and effective.

Conclusions

The Learning Theory, known as Behavior Analytic Theory, has a main idea of complex behavior (one that must be adopted) consists of smaller behaviors. Smaller behaviors are easier to adopt and thus more acceptable. They meet less resistance and are simple and understandable. In order to adopt a new small behavior pattern a person need to be motivated and sure that it is realizable – a so-called self-efficacy. Imitation of those who have adopted such small behaviors can help and serve as additional motivating factors. Results of the new adoption must be reinforced – externally or internally. Self esteem, good looking, wellness are internal rewards. Compliments, praise and approval of people around are external rewards.

The strength of this theory is its adaptability to state needs – it can be applied to individuals and to groups of individuals as well. Its strong feature is step-by-step character of introducing, no need for radical decisions. Though it is a rather strong approach, it has its deficiencies. It does not underline the intention to change the behavior as a key element of the theory. It also underestimates the influence of the severity of the threat to the health of participants.

The learning theory can be a very good theory that reflects inner barriers of obese people and traditional problems with losing weight. Being improved with strong motivation methods and properly researched it can be an indispensable helper for those who work on health intervention problems. Though the impact of health intervention programs is a theme for further investigation, the obvious workability of this theory can be exemplified. Given the fact that the human way of perception of the intervention does not change – only problems which need external intervention change.

Works Cited

Centers for disease control and prevention (February 24, 2009) Obesity. Halting the epidemic by making health easier. Retrieved March 19, 2009 from http://www.cdc.gov/nccdphp/dnpa/Obesity/ and http://www.cdc.gov/NCCdphp/publications/AAG/obesity.htm

Delva J., Johnston L. D, and O’Malley P. M. (2007) The Epidemiology of overweight and related lifestyle behaviors: Racial/ethnic and socioeconomic status differences among American youth American Journal of Preventive Medicine Volume 33(4S), p178-186.

Grizzell, J. Behavior change theories (January 27, 2007) Behavior change theories and models. Retrieved March 19, 2009 from http://www.csupomona.edu/~jvgrizzell/best_practices/bctheory.html#Learning Theories

Harkin, T. (2007) Preventing childhood obesity. The power of policy and political will. American Journal of Preventive Medicine Volume 33(4S), p165-166

Healthy People 2010. Retrieved March 19, 2009 from http://www.healthypeople.gov/document/html/uih/uih_4.htm

Hopkins, T. W. The impact of obesity in African-Americans. Retrieved March 19, 2009 from http://www.ama-assn.org/ama1/pub/upload/mm/20/hopkinsdec2003.pdf

McKinnon RA, Orleans CT, Kumanyika SK, Haire-Joshu D, Krebs-Smith SM, Finkelstein EA et al. (2009) Considerations for an obesity policy research agenda [Abstract] American Journal of Preventive Medicine Volume 34(4S), p351-357

Murkowski, L. (2007) Preventing Obesity in Children. The Time Is Right for Policy Action. American Journal of Preventive Medicine Volume 33(4S), p167-168

Weight control information network. Statistics related to overweight and obesity (May, 2007) Retrieved March 19, 2009 from http://www.win.niddk.nih.gov/statistics/

Welty T. K. (1991) Health implications of obesity in American Indians and Alaska Natives The American Journal of Clinical Nutrition,53. p.1616-1620