Diabetes in the United States

1. Problem

Obesity was first recognized as a disease in the United States in theory around 1948 by the world health organization (WHO). It was then taken to the International Classification of Diseases, but prior highlights concerning its potential health problem were disregarded 35 years ago in the United States. The condition became common in both children and adults and became an epidemic. According to Temple, the obesity epidemic in the U.S. emerged between 1976 and 1980 before spreading across Westernized countries. Obesity is associated with multiple diseases, remarkably increasing the risk of developing type 2 diabetes, cardiovascular disease, coronary artery disease, stroke, and certain types of cancer. Hence, Obesity became a public health concern.

Over the years, Obesity has recorded an increasing prevalence. According to Temple, the prevalence of Obesity among adult Americans between 1971 and 1980 was around 0.5% but followed by a rapid progressive rise. Adults aged between 20 and 74 reported a prevalence rise from 15.0% from 1976 to 1980 to 23.3% between 1988 and 1994 (Loos and Giles). The prevalence rose further up to 30.9% between 1999 and 2000. Epidemiologists noted that the rising trend in American adults was equally observed in children, both genders, and all major races, such as African American, Caucasians, and Mexican Americans. A similar rise in prevalence maintained the trajectory from 1999 to 2016. From the 2017-2018 obesity statistics, two in every five adults have Obesity, and one in eleven adults has severe Obesity. One in five children and adolescents have Obesity (National Institute of Diabetes and Digestive and Kidney Diseases Overweight & Obesity Statistics U.S. Department of Health and Human Services).

Obesity and its associated conditions contribute to a high mortality rate and poor quality of life. For instance, nearly 50% of diagnosed diabetic patients are obese, 60-70% with cardiovascular disease, 20% with airway complications, and 60% with kidney disease. In the U.S., deaths associated with obesity account for about 280000, while nearly 325 000 are from non-smokers and those who never smoked (Abdelaal et al.). The mortality rate in 1999 was 5.89 and rose to 14.1 in 2016 (D’Souza et al.). Hence, Obesity is public health concern due to its morbidity, mortality, and impacts on the quality of life.

2. Etiology

Many factors are considered to play a significant role in the development of Obesity. Diet, lack of exercise, environment, and genetics are among the common factors associated with Obesity and overweight in America. Good evidence suggests the relationship between diet and Obesity, whereby poor nutritional choices lead to the development of Obesity. Individuals gain weight by eating more calories than they burn by exercising activities, leading to imbalanced energy distribution in the body. A cross-sectional study on adult nutrition and chronic disease investigated the association between obesity and diet quality. The findings indicated that diet quality is significantly associated with Obesity (Jia et al.). A poor diet is categorized as food rich in cholesterol, added sugars, and other fatty foods. Such foods contribute to adiposity in the body leading to increased weight and Obesity (Jia et al.). The environment around an individual significantly influences the development of Obesity. For instance, the lack of area parks, sidewalks, and affordable gyms affects individuals’ physical activity.

Additionally, environments that lack affordable and healthy food stores and supermarkets contribute to Obesity. Also, food advertisements and increased availability of unhealthy food, such as fast foods, high-fat snacks, and sugary drinks, are predisposing factors. A randomized control study to investigate the relationship between environment and Obesity in preschoolers. Notably, children often depend on their parents’ nutritional decisions and way of living, which may affect their health. In this context, Ek and colleagues investigated parenting and care provided in terms of nutrition in an intervention program to determine how the environment influences the development of Obesity. The results indicated that children in the intervention group are less likely to develop Obesity compared to the control group. Also, there has been evidence concerning the probability of the association between genetics and Obesity. However, the Centres for Disease Control and Prevention (CDC) observes that Obesity rarely occurs in families considering the clear inheritance pattern related to the changes in a single gene. According to the CDC, no single genetic cause is present in obese people, and more than fifty genes have been found to have a light effect. This suggests that Obesity is a multifactorial resulting from complex interactions involving many genes and environmental factors.

3. Recommendations

Primary

Primary interventions aim at influencing healthy directions of eating and activity behavior of the people. In this view, education concerning a healthy lifestyle constitutes physical activity healthy diet to derail or prevent the progression of the disease. Education helps by equipping individuals with skills and knowledge to make healthy choices concerning nutrition and stay healthy by maintaining body weight within the acceptable range (Hoelscher et al.). Education can be offered in every healthcare facility, local and state office, non-governmental organization, school, and place of worship. Educational intervention may require a multi-professional approach due to the complexity of the process. Also, education should include food vendors, stores, and supermarkets, especially on creating healthy food. This intervention is effective and can be graded A.

Secondary

Secondary prevention is implemented before symptoms. This may include strategies that facilitate early detection. For instance, ensuring adequate screening services are available and accessible for every person across the cultural divide. The expert committee and The National Heart, Lung, and Blood Institute Expert Panel recommend measuring body mass index (BMI) for obesity risk. Individuals aged two years and older qualify for the screening. BMI is feasible and accurate when identifying people with overweight (Khanna et al.). Hence, BMI is an effective screening measure, not a definitive risk measure. Studies comparing BMI and direct measures of body fat support using BMI. Khanna et al. review shows found BMI to be a reliable measure when determining Obesity but suggested additional measures such as waist circumference and waist-to-hip ratio. Based on the findings from studies, this intervention is graded B.

Tertiary

At this level, the state can implement several interventions. For instance, establishing legislation that prohibits the sale of unhealthy foods within the country. This will ensure every food vendor avails healthy food to the community. Also, the state and the federal government can facilitate the creation and functionality of the quality department to regulate the quality of foods sold in the country (Tseng et al.). This will ensure every food vendor meets acceptable quality to promote healthy living in the community. Studies such as Tseng et al. investigating the effectiveness of programs, policies, and built environmental changes suggest that these interventions have no significant effect in reducing Obesity and thus can be graded C.

4. Implementations

Since there is no single or simple solution for preventing the obesity epidemic, there is a need for a multifaceted approach. Therefore, State and local organizations, healthcare professionals, policy-makers, community leaders, schools, businesses, and individuals must collaborate to create an environment that promotes healthy lifestyles (“Toolkit for Developing a Multisectoral Action Plan for Noncommunicable Diseases: Module 3: Establishing a Framework for Action.”). Implementing the interventions should be a continuous process as it affects daily living involving a multi-sectorial approach. Individuals of all ages and gender are at risk of developing Obesity. However, children, adolescents, and older adults are at increased risk. Also, studies showed that the major ethnic groups in the U.S. are at increased risk of developing Obesity. Occupations such as behind the desk and others that do not involve physical activities are risk factors, and individuals in these occupations should be targeted. Also, food-related businesses such as groceries and supermarkets, schools, health care facilities, and homes should be targeted.

Implementing a change in an organization must be carried out step-wise to ensure an effective transition. Americans are used to fast foods, probably due to the schedule and complexity of preparing homemade foods. Therefore, abrupt change may result in many people rebelling and resisting. Similar incidences may occur in organizations, businesses, schools, and healthcare facilities. Therefore, all the stakeholders must be adequately informed and prepared for the change and introduce the implementation process by integrating the change in a progressive manner until everyone is on course. Each stakeholder must be actively involved to create a sense of belonging.

5. Evaluation

Patient education has been widely considered the primary preventive measure against obesity development in public health. This is because increased knowledge allows individuals to make healthy lifestyle choices without relying on public health professionals. As a primary intervention, Hoelscher et al. found that it is influential on a two-year approach. Although the study participants were children aged 2-12, the efficacy of the educational intervention is achieved on a long-term basis. Many obese patients face challenges of restricting diet or locating physical exercise services leading to failure of the intervention as it is used in public health practice. Patient education is often accepted positively as it does not require much effort from the patient. On the other hand, policies are often disputed, especially by the food vendors, due to fear of losing profits. Policy implementation may take a long and its effect may be felt years later, which may not be relied on as an immediate intervention for the obesity crisis. Screening services are accepted in the U.S., and many individuals have taken it positively as it helps in the early detection and prevention of diseases.

Works Cited

“Genes and Obesity.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 17 May 2013, https://www.cdc.gov/genomics/resources/diseases/obesity/obesedit.htm#:~:text=Rarely%2C%20obesity%20occurs%20in%20families,people%20in%20various%20ethnic%20groups.

“Overweight & Obesity Statistics.” National Institute of Diabetes and Digestive and Kidney Diseases, U.S. Department of Health and Human Services, https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity.

“Toolkit for Developing a Multisectoral Action Plan for Noncommunicable Diseases: Module 3: Establishing A Framework for Action.” World Health Organization, World Health Organization, 1 Jan. 1970, https://apps.who.int/iris/handle/10665/353161.

Abdelaal, Mahmoud, et al. “Morbidity and mortality associated with obesity.” Annals of translational medicine vol. 5,7 (2017): 161. doi:10.21037/atm.2017.03.107

D’Souza, Malcolm J et al. “Data Talks: Obesity-Related Influences on U.S. Mortality Rates.” Research in health science vol. 3,3 (2018): 65-78. doi:10.22158/RHS.v3n3p65

Ek, Anna, et al. “A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study-an intervention within the STOP project.” BMC Public Health 19.1 (2019): 1-13.

Hoelscher, Deanna M., et al. “Incorporating primary and secondary prevention approaches to address childhood obesity prevention and treatment in a low-income, ethnically diverse population: study design and demographic data from the Texas Childhood Obesity Research Demonstration (TX CORD) study.” Childhood obesity 11.1 (2015): 71-91.

Jia, L., Lu, H., Wu, J., Wang, X., Wang, W., Du, M., … & Zhang, N. (2020). Association between diet quality and obesity indicators among the working-age adults in Inner Mongolia, Northern China: A cross-sectional study. BMC Public Health, 20(1), 1-10. https://doi.org/10.1186/s12889-020-09281-5

Khanna, Deepesh et al. “Body Mass Index (BMI): A Screening Tool Analysis.” Cureus vol. 14,2 e22119. 11 Feb. 2022, doi:10.7759/cureus.22119

Loos, Ruth JF, and Giles SH Yeo. “The genetics of obesity: from discovery to biology.” Nature Reviews Genetics 23.2 (2022): 120-133.

Riegelman, Richard K., and Brenda Kirkwood. “ Evidence-Based Public Health.” Public Health 101: Improving Community Health, Jones & Bartlett Learning, Burlington, MA, 2019.

Temple, Norman J. “The Origins of the Obesity Epidemic in the USA-Lessons for Today.” Nutrients vol. 14,20 4253. 12 Oct. 2022, doi:10.3390/nu14204253

Tseng, Eva, et al. “Effectiveness of policies and programs to combat adult obesity: a systematic review.” Journal of general internal medicine 33.11 (2018): 1990-2001. https://doi.org/10.1007/s11606-018-4619-z