Epidemiology of Obesity and Public Health Promotions - Essay Example

Obesity in United Kingdom Health promotion and Public health Introduction       Obesity has become an alarming issue in the present world, particularly in the westernized society. The percentage of overweight children is increasing at an alarming rate all over the world. In U.K. itself the rate of growth of obese people seems to be very scaring. Researches show that in U.K. the percentage of obese men who are aged between 16 and 64 among total population had increased from 14 percent in 1994 to as high as 25 percent in 2006. The extent of prevalence of obesity among women has been much alarming. In U.K. 19 percent of women were obese in 1994, while in 2006 the rate increased to as high as 29 percent. Another interesting findings about obesity in U.K. is that the rate of increase in obesity was highest among middle aged (55-64) men. In 1994, around 18 percent of total middle aged men were obese, while in 2006 the rate stood at around 36 percent. (Trends in the prevalence of overweight and obesity)        Today people irrespective of their ages are less interested in spending time in exercising or other outdoor activities. Along with it the busy families of today’s world have little free time to prepare nutritious, home-cooked meals. Eating out on a daily basis is becoming a part of everyday life of adults as well as adolescent members, particularly in westernized culture. Obesity poses a great problem to society.       Looking at the severity of the issue the present paper seeks to examine several epidemiological issues related to obesity in U.K., different health promotion initiatives taken by the government to tackle this problem, the possible public health care interventions using health promotion theories, and finally make some evaluation of the programs under taken by the U.K. government.                                    Epidemiology of obesity and public health promotions         Having a few extra pounds in one’s body does not imply obesity. Usually, in medical terms a person is considered to be obese when his weight is at least 10 percent more compared to the recommended weight for his height and frame of the body. For obese people, their excessively heavy weights endanger their health. Obesity is gaining much attention because in the westernized societies including U.K is increasingly being found to be responsible for higher degree of mortality as well as morbidity. The more alarming thing regarding obesity is that initially the problem of obesity have been concentrated among adults only, but over time, increasing problems related to obesity are being diagnosed among children also. According to the Health Survey of England 2002, 16 percent of total children and teenagers (aged 2 to 15) were obese. (Obesity- The size of the Problem)       In U.K. more than half of total women and more than two-thirds of total men are suffering from overweight or obesity. It simply implies that the prevalence of obesity has become so high in U.K. that only half of total women and a mere one-third of total men living in U.K. have a body mass index less than equal to 25 (Obesity- The size of the Problem). With increase age, the number of obese people also tends to rise. Today in U.K., obesity has become one of the two major causes of premature deaths, the other being smoking. According to a survey, obesity causes around 30,000 premature deaths a year (Obesity- The size of the Problem). It has also been estimated that obesity also causes huge loss in workings days for working adults. It has been found that around 18 million total working days is lost each year due several illnesses caused by obesity (Obesity- The size of the Problem). In the year of 2008, a project commonly known to be as the Foresight project made some predictions regarding future trend in obesity in U.K. The project predicted that as high as 60 percent of total adult population living in England will become obese or over weight by 2050. (Trends in the prevalence of overweight and obesity)       According to the health surveys for England, in 1994 around 15 percent of adult men and 17.5 percent of adult female were obese in south –west England, while in 2002 the proportions of adult obese men and women increased to around 18 percent and 19 percent, respectively.       Today a number of factors are being cited as the causes of obesity. These factors include family history, individual’s lifestyle, nature of regular diet, and several socioeconomic factors. Obesity poses great threat to health. A number of health risks arise for an obese person. For example, obesity is responsible for causing diseases like Type 2 Diabetes, colon cancer, stroke, osteoarthritis, hypertension etc. among both men and women, although in varied extents. Among women, it also causes diseases like breast cancer, different types of ovary diseases, chest infection etc. (Crossley, 2004; Eugenia, 1999)       Apart from different health problems, obese people, particularly children, are also exposed to several psychological problems, viz. a number of studies has found out that obese adolescent suffer from very low self esteem. Children, who are extremely over weight, are exposed to very high risk of emotional problems which very often last into adulthood. Factors like rejection from peer, teasing of classmates in school, etc. largely diminish the self confidence of an obese child. Adults also face several Psychological problems due to their overweight, particularly in case of socialization. (McMillan, 2006; MacLean, 2009)       To address all these obesity related issues, U.K. government has taken several initiatives. “Healthy weights, Healthy” is one of the famous steps taken by the government to reverse the increasing trend in obesity. Through this program the government has aimed to reduce the prevalence of obesity and to help people in gaining healthy life by obtaining a healthy health.         Government efforts in handling obesity are still at infant age. The government needs to become more serious regarding the problem of obesity and has to plan effective strategies that would help in mitigating this problem.  To explore possible effective healthcare interventions, several health promotion theories can be applied. The present paper, however, will put its focus mainly on two behavioral theories- behavioral learning theory, and health belief model- for exploring possible public health promotion interventions that might be undertaken by healthcare personnel of U.K for tackling the increasing problem of obesity. (Naidoo and Wills, 2005) Behavioral Learning theory: For tackling the problem of obesity, one important thing that needs to be changed is behavior and attitude. Hence, health promotion interventions should be planned in such a way that it improves behavioral pattern of people in the society. There exists one behavioral theory, known to be as behavioral learning theory which can effectively be used for exploring potential health promotion interventions that can be undertaken by healthcare personnel of U.K to fight against obesity. (Raynor et al1998; Strauss; 2001)       According to behavioral learning theory, behaviors are considered to be such actions that are performed against some stimuli. Not only that, this theory tells that after certain stimulus, the frequency of a particular behavior will increase if it is reinforced by someone. The stronger is the impact on behavior, the more is the value of reinforcing of the reinforcer. Very often it is believed that reinforcement strategies work as they are capable of reducing various psychological drives like hunger, thirst etc.  Under this kind of framework role of thought process in the process of explaining a certain behavior gets reduced significantly.       Behavioral learning theory was initially applied for explaining behavioral patterns of animal. After getting desirable results it has started to be widely applied for explaining behavior of human beings. Under this theoretical framework, the major motive for performing some particular behavior is mainly some psychology driven aspect like reduction in hunger. Any kind of personal or other types of resources are not given much importance within the behavioral learning framework. According to this theory, behavioral changes are actually reinforced. Behavior changes randomly, when a stimulus takes place. With reoccurrence if the stimulus, reoccurrence of the same behavior takes place.  A close association between a stimulus and a particular type of behavioral change in response to that stimulus helps in increasing the probability of occurrence of similar type of responses to the same kind of stimulus in future period. (Raynor et al, 1998; Strauss; 2001)       In case of controlling obesity, a modern version of behavioral learning theory compared to the above discussed traditional one seems to be more effective. The modern version of this theory is commonly known as the Behavioral Economic model. Within the framework of this modernized behavioral learning model, any kind of behavior is considered to be an outcome of costs and benefits. Here, benefits are actually reinforcers. The reinforcing values as well as their outcomes differ from person to person. It is generally found that for obese people the extent of impact of reinforcer from foods is much higher that for the nonobese people. If a person has an ability to wait for longer time to obtain much higher reinforcer instead of immediately taking a smaller reinforcer, then the person is said to have much self control on his desire.  In contrast to the case of food, in case of physical activities, the things get just reverse, i.e. physical activity seems to be more reinforcing for nonobese people than for obese people. It has been found that if distance from a preferred activity increases, it leads to a decrease in reinforcing value of that activity. Hence, people who are obese are found to have a tendency to choose those behaviors that cause weight to increase more, for example consumption of higher fat foods.( Strauss, 2001; Raynor et al, 1998; Strauss; 2001; Cullen, et al 2001; Motl, 2001 ) Health promotion interventions for the obese people should be designed in a such a way that it increases reinforcing values of low calorie foods and high energy physical activities among those people for whole inactive behaviors and high fat diet are highly reinforcing. This can be done by making provision of other type of reinforcers, like money, which could be able to attract obese people towards high energy activities and low fat diet. Apart from this, some ways of creating balances between highly effective or less effective reinforcing behaviors, or reducing reinforcing values of those behaviors which are undesired , are required to be found. For instance, among obese people, physical activity can be increased by decreasing the reinforcing values of inactive behaviors. However, to apply these kind of health promotional strategies, highly trained people are required who are exceptionally capable of controlling behaviors of obese people. it is generally perceived that most of the parent, although not all, are able to perform the act of this controller of behavior of their children since their early childhood. Public health strategies like increasing awareness among parents regarding encouraging their children in highly physical activities and low consumption of high energy foods, designing a neighborhood with parks that can attract people to perform some physical activities during their leisure hours are capable of influencing the values of reinforcement that would be able to act in favor of reducing weights for obese. ( Wood W. 2000; Epstein and Saelens 1999; Corcora, 2007; Crawford and Jeffery, 2005)       Health Belief Model: among all the behavioral models, health belief model was the first theoretical framework that had been conceptualized with an aim to deal with several public health issues by developing desirable behaviors among the targeted population. The primary framework of this health belief model takes into account a number of perceived issues like an individual’s perceived vulnerability to a particular illness or health condition, an individual’s own perception regarding the impact of certain disease on him or her, an individual’s own ideas regarding the type of benefits that he or she could be able to obtain by undertaking certain actions, particularly in an effort to decreasing his or her vulnerability to the illness, an individuals own perception regarding the obstacles that could cause difficulties in performing those specific actions and several types of negative things that could take place while performing those actions. Along with taking into account all these perceived aspects, traditional health belief model also considers an individual’s ability to catch the signals of certain action. The modern version of the health belief model takes into account the idea of self-efficacy along with undertaking all the components that were in the traditional model. Self-efficacy actually implies an individual’s belief that he will be able to successfully perform a particular behavior in order to reduce his or her susceptibility towards some particular undesirable health condition. (Fischhoff, 1995; Janz et al, 2002; Jones et al, 2000; Weinstein, 2000)       This health behavior model has the potential to be effective applied in undertaking some preventive measures to fight with obesity. Health belief model can be applied to change lifestyle behavior of targeted population. Under the framework of health belief model, major motivation for changing certain lifestyle style behavior comes from the degree of perceived threat or risks from certain undesirable health condition. In other words to say, the higher is the degree of perceived level of seriousness and the vulnerability towards a particular illness, the greater would be the motivation to change such behavior that could increase vulnerability or risk. Modern version of the health belief model puts its major focus on the issue of self-belief. It says that behavior can be changed in effective way only if a person has huge amount of confidence on him/herself regarding his/her ability to change the behavior in such a way that the risk of a particular disease gets reduced. (Wise and Trummell, 2001; Baggott, 2000; Carr et al, 2007)       Within the framework of health belief model, behavior does not change instantly. Behavioral change is actually a process which goes though several stages. This process can be interpreted with an example in the following way: suppose a person obtain a cue regarding possible diseases from obesity from some program on heart attacks broadcasting on a TV channel. This cue acts as a stimulating factor in increasing the extent of perceived threat from obesity related diseases by significantly affecting the perceived level of vulnerability to the disease. Cues become more powerful if they are obtained from any kind of personal relevance, for example occurrence of death from obesity or some other disease from obesity among close relatives or friends. To decrease the level of threat, then the individual will look for some actions that could be undertaken for reducing the risk from the diseases. As far as selection of a particular action is concerned, the individual takes into account the perceived benefits, the perceived obstacles, the perceived costs of alternative actions along with his or her self-efficacy in performing alternative actions. Among possible alternatives, that action is chosen which seems to provide the highest level of perceived benefit,  the lowest level of obstacles that could not be overcome, the lowest level of costs that need to be incurred, and the highest level of self confidence that the individual would be able to perform the action effectively. An effective public health promotional strategy for tackling obesity is initiating fear-based communication which could sufficiently increase perceived threat from obesity related diseases and prompt people to undertake effective actions. (Wise and Trummell, 2001; Baggott, 2000; Wills, 2007; Naidoo and Wills, 2000; Tones. and Green, 2004; Hubley and Copeman , 2008)        Evaluation of existing health promotional intervention for obese: “Healthy weight, Healthy Lives” is considered to be the first serious step of the U.K. government towards fighting with increasing dangers from obesity. This public health promotion program has been effective in dealing with obesity in U.K on an overall basis. It would be now interesting to see to whether it has been effective in producing sufficient impacts on all socio-cultural or socio-economic groups across all ages and gender. (Healthy Weight, Healthy Lives)       As far as effects of this program on people of different ages is concerned, evidences suggest that people of all ages have been benefited from this program as different set of policies have been undertaken for different group of people realizing the need that although prevention of the problems of excess weight in very early ages is the most important one its also very important to help adult and elderly people in obtaining healthy weight. (Healthy Weight, Healthy Lives)       One major problem that can be encountered with this public health promotion is that it has befitted male more than female. One of the main causes of this could be that the policy under this program which has been directed towards providing incentive to the employers for reducing their weights has failed to influence female as level of employment in females is much lower than that in male. (Healthy Weight, Healthy Lives; Consortium, et al, 2007)                                                                                                                             Conclusion       Unhealthy weight gain mainly due to unhealthy diet and lack of exercise is becoming one of the most serious health issues in U.K which needs to be tackle very carefully. Obesity is that kind of an illness which is triggered by unhealthy lifestyle. To fight with this serious health issue, the best way is to undertake such strategies that would be helpful in changing behavioral pattern of targeted population. For designing effective model of public health promotion behavioral theories can be applied. As found in the discussion above, Behavioral theories like Behavioral Learning Theory or Health Belief Model can effectively be used in constructing effective health promotion plan for obese that would be able to change lifestyle of obese by directing them towards more physical activities and low fat diet along with encouraging the non-obese to continue their existing lifestyle or to undertake effective measures for reducing perceived threat from obesity.       As far as the issue of making the existing programs like Healthy Weights and Healthy Lives more effective is concerned, one possible way to enhance is effectiveness could be that it take sufficient measures to provide sufficient benefits to female as prevalence of obesity is higher among them and they are very often deprived of the opportunities given by the government as many of them are not in workforce.      References: 1. Baggott, R. 2000. Public Health: Policy and Politics. London: Macmillan Press Ltd 2. 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