The Obesogenic Environment and its Contribution to the Development and Management of Adult Obesity - Essay Example

The 'Obesogenic Environment' and its Contribution to the Development and Management of Adult Obesity 203HLM Weight Management 5 January 2009 The 'Obesogenic Environment' and its Contribution to the Development and Management of Adult Obesity Introduction Obesity has grown to become a worldwide phenomenon, with its levels in certain lower-income and developing countries growing as high as, if not higher than, those in the developed countries. There are several significant factors that contribute to this worldwide trend. A major factor has been the modern food supply patterns with availability of ready for intake high-fat foods for consumption at home and away from home. There have also been marked shifts in patterns of physical activity both at work and during recreation. Adult Obesity in the UK In the UK, the incidence of overweight and obesity has been increasing dramatically, which is associated with, apart from increased workload, a 30 percent increase in prescription rates (Campbell 2003:73). Obesity, in England, has grown by almost 400% in the last 25 years with around two-thirds of the population now being overweight or obese. On present trends, obesity will soon overtake smoking as the greatest cause of premature death. It will put enormous strains on the health service, perhaps making a publicly funded health service unsustainable (House of Commons 2004:7). Type 2 diabetes mellitus is a major health problem with an increased risk of nearly 13 percent for obese women, which is more than that for men (Campbell 2003:74). Obesity is the underlying factor for hyperglycaemia, hypertension, hyperlipdaemia and cardiovascular disease. Obesity is also associated with angina, gall bladder disease, ovarian and colonic cancer, osteoarthritis, respiratory disease and stroke. Increase in BMI increases the rate of risk for these diseases. On average, those with obesity-related health issues die nine years early (Campbell 2003:75). Obesogenic environment Obesogenic environment refers to an environment that is conducive to gaining, and not losing, weight. It refers to the role environment plays in determining the nutrition and physical activity level of the population (Jones et al. n.d.:5). "A generation is growing up in an obesogenic environment in which the forces behind sedentary behaviour are growing, not declining" (House of Commons 2004:7). The trends are so rapid that what used to be overweight or obese would soon be regarded as normal. Environmental influences on diet involve availability and access to foods for consumption at home and as takeaways and restaurants. The major factors related to food that contribute to obesity include high energy density, high fat, portion size, sweet-fat combination, sugary drinks, etc. along with snacking, TV viewing and others. Children growing up without adequate knowledge in preparing healthy meals, reduced time spent for preparing meals and increased consumption of alcohol are other noteworthy factors leading to obesity (House of Commons 2004). Overweight or obese children are likely to become overweight or obese adults; overweight and obese adults are more likely to bring up overweight or obese children - a vicious circle. Children grow up without access to healthy food choices, having to resort to unhealthy foods provided by the vending machines installed in schools. A study was conducted by FSA in 12 secondary schools. All the 12 schools installed vending machines containing healthier drinks, such as milk, water and fruit juice, and approximately 70,000 healthier drinks were bought during the 24-week duration of the trial (www.food.gov.uk cited in House of Commons 2004:37). This can lead one to the conclusion that if given the choice, children can and do make healthy choices. However, the study, having been undertaken over a short duration, need not guarantee that the result would sustain over a longer term when the novelty fades out. Nevertheless, the school environment can be made use of in shaping the dietary patterns of an individual. All individuals living in the same environment do not become obese. Some are more susceptible to weight gain than others. This means that psychosocial factors also affect weight gain (Blundell n.d.:1). Such factors include preferences for and selection of foods in the habitual diet. The environmental factors affecting physical activity can be categorised into different perceived variables like "safety, availability and access, convenience, local knowledge and satisfaction, urban form, aesthetics, and supportiveness of neighbourhoods" (Jones et al. n.d.:5). These factors have different patterns of association with men and women. They affect physical activity in different ways. For example, though walking has a significant relationship to convenience of local neighbourhoods, it is also affected by sociodemographic variables whereby an environment may be perceived differently by different individuals. Besides perceived measures, there are objectively measured environmental variables also of deprivation, availability and access, urban form, aesthetics and quality, and supportiveness. These environmental characteristics, with their marked impact on diet and activity, significantly influence the body mass indices of the population. According to Jones et al., residents in highly walkable areas are more active and have less body weights than those in less walkable areas. The same is the case with residents in areas with high-land use mix. A report by the Department of Health suggests that around 6,659,000 men will be obese in 2010 as compared to 4,302,000 in 2003 and 1,230,000 more women will be obese as compared to 2003 (Zaninotto et al. 2006:11).Obesity will also have its economic consequences. The cost of treating obesity and related illnesses in England is estimated to be 3.5 billion by 2010 (National Audit Office 2001 cited in Jones et al. n.d.:6). Weight gain is a result of increased calorie consumption that is in excess of daily energy expenditure over a prolonged period of time. Energy expenditure takes place in three ways - resting energy expenditure to maintain basic body functions (around 60% of total daily energy requirements), energy expenditure for processing of food, (around 10%), and non-resting energy expenditure or physical activity, (around 30%) (Jones et al. n.d.:9). Both energy intake and expenditure should be addressed to tackle the problem of obesity. Other environmental contributors to obesity include pre-natal exposures, viruses, toxins and sleep-deprivation (New Mexico Health n.d.:26). Genetic factors like hormonal imbalances also contribute to obesity as they can affect metabolism and growth. For example, damage to the central nervous system can lead to hypothalamic obesity with or without pituitary growth hormone deficiency. Early onset of obesity suggests a genetic cause, and short duration of obesity suggests an endocrine cause. Disorders like Cushing syndrome are also associated with obesity (Farooqi 2008:28). Overcoming barriers to weight loss Studies in England have revealed that healthcare providers are reluctant to address obesity due to lack of belief in the efficacy of the treatment options, lack of time, lack of skill in counselling patients and perceived non-compliance of patients. Cognitive behavioural interventions, like self-monitoring, life-style strategies and behaviour therapy are most effective in treating and maintaining weight loss (Noel & Pugh 2002:758). Educating patients on the hazards of overweight, helping them set realistic goals for change in behaviour and commending their success in reaching goals can motivate patients towards successful weight loss. Empathizing with the individual's problems in undertaking obesity treatment, praising his/her efforts, being non-judgmental, helping him/her set goals, correcting misunderstandings and educating on the need for treatment can help clients cross barriers to weight loss. The client should be made aware that hunger should be expected during a dietary weight loss programme and that it is a positive sign. He/she should be advised to cut down on energy-dense food intake so that he/she can increase the quantity of intake. The client should be encouraged to eat at regular intervals and not to eat too little. He/she can also be encouraged to engage in distracting activities, as hunger "tends to wane over time" (Cooper, Fairburn & Hawker 2004:73). The client must be advised not to skip meals, to avoid evening snacks and not to eat between meals. This can be helped by removing stocks of high-risk foods, storing such foods out of sight and avoiding places where between-meal snacking tends to occur (Cooper, Fairburn & Hawker 2004:75). Delaying responding to urges to eat between meals can help reduce such urges over time. Addressing triggering factors, like boredom, anxiety, depression and anger, can also help overcome this tendency. This will also help avoid binge eating, which is another prominent cause for obesity. Reducing portion sizes and helping the client make right choices of food can help successful weight loss. Gidus suggests simple measures like starting a walking club at lunch time, choosing stairs instead of elevator and using them several times a day, keeping healthy foods in the desk drawer for quick snacks, etc. (Gidus 2007). The basic treatment for obesity involves changing to a diet with less energy content and regular exercise to increase energy expenditure. Campbell (2003:73) refers to the case study of Alison, a 31-year-old, married lady with two children, who had a BMI of 44 and was suffering from lack of self-esteem and depression. Suspecting her underlying problem to be obesity, she was put on a weight management programme involving dietary, exercise and behavioural changes. In four months, she was down from 122 kg to 68.5 kg and this changed her outlook on life, making her happy with herself. However, this strategy does not work with all, as obesity may be related to morbidity, medication, genetics etc. A major problem in treating obesity is that obesity often returns. Successful weight loss requires long-term commitment and high motivation and involvement. Positive results have been found to sustain in cases where the initial weight reduction has been substantial (Ostman 2004:6). Maintaining life-style modifications even after successful weight loss will help keep obesity at bay. Gastric surgery is an option in cases with severe obesity that tend to fail all other treatment strategies. Conclusion Obesity is a health concern worldwide that has to be tackled, as it leads to several comorbidities which in turn lead to premature death. Tackling environmental factors contributing to obesity could begin with more intensive public education on the hazards of obesity and on strategies for weight reduction along with working towards prohibition of promotion of unhealthy foods, providing water fountains to reduce consumption of energy-dense drinks, providing environments conducive to better physical activity, etc. List of References Blundell, J. (n.d.) Resistance and Susceptibility to Weight Gain: Individual Variability in response to diet [online] available from [3 January 2009]. Campbell, I (2003) 'The view from primary care.' In Adult Obesity: A Paediatric Challenge. ed. by Wilkin, T. J., Voss, L. & Wilkin, T. CRC Press. Cooper, Z., Fairburn, C. G. & Hawker, D. M. (2004). 'Module III: Addressing Barriers to Weight Loss' In Cognitive-Behavioral Treatment of Obesity: A Clinician's Guide. Guilford Press: 63-87. Farooqi, S. (2008) 'A Practical Guide to the Clinical Assessment and Investigation of Obesity' In Genetics of Obesity Syndromes [online]. ed. by Beales, P. R., Beales, P. L., Farooqi, S., Scambler, P. R. & O'Rahilly, S. Oxford University Press US:25-36. Available from [4 January 2009]. Gidus, T (2007) "Obesogenic" Environment. [online]. Available from [3 January 2009]. House of Commons Health Committee (2004) Obesity [online]. House of Commons London: The Stationery Office Limited. Available from [4 January 2009]. Jones, A., Bentham, G., Foster, C., Hillsdon, M. & Panter, J. (n.d.) Tackling Obesities: Future Choices - Obesogenic Environments - Evidence Review [online]. Foresight Programme of Government Office for Science. Available from [3 January 2009]. National Audit Office (2001) Tackling Obesity in England London: National Audit Office. Cited in Jones, A., Bentham, G., Foster, C., Hillsdon, M. & Panter, J. (n.d.) Tackling Obesities: Future Choices - Obesogenic Environments - Evidence Review [online]. Foresight Programme of UK Government Office for Science. Available from New Mexico Health (n.d.) Social, Environmental, Behavioral, and Other Contributors to Obestiy [online] available from [3 January 2009]. Noel, P. H. & Pugh, J. A. (2002) 'Management of overweight and obese adults' BMJ [online] 325, 757-761. Available from [3 January 2009]. Ostman, J. & Britton, M. (2004) 'Treating and Preventing Obesity: A Systematic Review of the Evidence' In Treating and Preventing Obesity: An Evidence Based Review. ed. by Wiley-VCH: 1-12. Zaninotto. P, Wardle, H., Stamatakis, E., Mindell, J. & Head, J. (2006) Forecasting Obesity to 2010 [online]. National Centre for Social Research. Available from [4 January 2009]. Read More