It is estimated that 34.9% of adults and 17% of youth in the US are obese (Ogden, Carroll, Kit & Flegal, 2014). Compared to national data, the average obesity rate for Maryland is lower than the national average with the adult obesity rate of 26.7% and the low-income preschool obesity rate of 15.5% (City-data.com, n.d.). Although the average statistics for Maryland indicate a lower prevalence of obesity, the data for Bowie, MD indicates that obesity in that city is still a significant problem with 30.7% of adults and 16.7% of low-income preschool children being obese (City-data.com, n.d.). Therefore, a community-based intervention utilizing tertiary health prevention strategies is warranted to decrease the existing rate of obesity while an intervention utilizing primary and secondary health prevention strategies is warranted to maintain low obesity rates and prevent the growth of obesity rates in the future.
Current Health Interventions
In order to reduce obesity rates, the Maryland Department of Health and Mental Hygiene (2006) implemented the Nutrition and Physical Activity/Obesity Prevention Program (NPA/O). The strategy covers a variety of settings and populations, including the healthcare settings, school settings, business settings, and community settings. In community settings, the goal is to increase access to green spaces, increase access to healthy food options, and promote urban planning that encourages more physical activity; in business settings, the program aims to increase the number of healthy food options in supermarkets and the availability of healthy foods in workplaces; in community settings, the objectives include offering physical activity programs in community and promoting healthy choices through media; in healthcare settings, the aims are to implement patient education and screening procedures for measuring, treating, and preventing obesity (Maryland Department of Health and Mental Hygiene, 2006).
However, specific strategies, interventions, or results for the city of Bowie, MD are not reported. The Health Improvement Plan proposed for Prince George’s County, where the city of Bowie is located, indicates that obesity is a major problem in the county because the residents are more likely to be obese than residents from other counties within the state of Maryland (Creekmur & Preneta, 2012). The plan addresses only diverse priorities, such as controlling infectious disease, promoting mental health, or enhancing access to substance abuse treatments, while obesity is mentioned once under the objective that considers educating mothers about the benefits of breastfeeding in obesity prevention (Creekmur & Preneta, 2012). Because the issue of obesity has been addressed only at state-level, implementing a public health intervention in Bowie, MD is considered necessary to improve the population’s quality of life.
Recommended Interventions for Obesity
Nursing Diagnoses
According to the nutrition and physical activity profile for the state of Maryland reported by the Centers for Disease Control and Prevention (CDC, 2012), only 20.8% of adolescents were physically active every day for at least 20 minutes while 64-87.4% of them did not consume the recommended amounts of fruit and vegetables. Furthermore, 38.8% of schools in Maryland did not offer nutritious foods and beverages, and daily physical education classes were attended by 20% of adolescents (CDC, 2012). Adults reported higher physical activity levels than adolescents with 43% of adolescents reported working out, but only 28.7-36.9% of them reported eating the recommended amounts of fruit and vegetables. The appropriate nursing diagnoses for both populations are sedentary lifestyle and altered nutrition: more than body requirements.
Prevention Planning and Implementation
An intervention to address obesity needs to focus on improving physical activity levels and dietary habits among the entire population, but it should also address the needs of people who are identified as obese. Tertiary health promotion is required to help people with obesity to prevent immediate adverse events (i.e. joint disorders, cardiovascular risk factors, etc.) and long-term adverse events (i.e. type 2 diabetes, heart disease, etc.) associated with it (CDC, 2014). The goal of this intervention in healthcare settings is to improve the accessibility of patient education and counseling to all individuals with obesity.
Furthermore, healthcare settings should also implement secondary health promotion to identify individuals with risk factors for developing obesity. Screening programs need to be implemented in various healthcare facilities to measure obesity risk indicators, such as blood cholesterol. Individuals at risk for obesity will also receive patient education to help them understand how nutrition and physical activity affect their health.
In workplaces, interventions that address nutrition and physical activity issues simultaneously are the most effective interventions for reducing obesity rates (Katz et al., 2005). This intervention will support the development of workplace policies that provide workers with exercise breaks and healthy food choices in cafeterias. Employers will also be encouraged to provide their employees with various resources (e.g. nutrition guidelines, nutrition tracking software, etc.) to help them improve their dietary habits.
Finally, two interventions will take place in public schools. First, in order to increase the physical activity levels among adolescents, schools will make physical education classes mandatory and offer extracurricular physical activities to students (Sobush et al., 2009). Second, adequate food programs that offer healthy food choices and health education need to be introduced in school because the lack of those programs can contribute to increased obesity levels (Veugelers & Fitzgerald, 2005). Because a survey in the state of Maryland showed that 21.3% of students drink at least one artificially-sweetened beverage (CDC, 2012), the health education program should also aim to educate adolescents about the health benefits of choosing water over artificially-sweetened beverages (James, Thomas, Cavan, & Kerr, 2004).
Evaluation of Recommended Interventions
The main outcome measure for evaluating the intervention is the obesity rate among adults and adolescents. Other outcome measures that will be used to evaluate the effectiveness of the interventions include dietary habits and physical activity levels. Several measures will be taken to determine whether this intervention had an effect on those outcomes. First, it is expected that the number of adults who participate in moderate physical activity at least 300 minutes per week or intense physical activity at least 150 minutes per week. Second, it is expected that school-based interventions will increase the number of adolescents who engage in physical activity for at least 60 minutes every day. Third, it is expected that nutrition education and the availability of health food choices will improve the decisions people make regarding their dietary habits, so the program will be considered successful if it shows a reduction in fast food consumption, a reduction in the consumption of artificially-sweetened beverages, and an increase in the consumption of fruit and vegetables.
Conclusion
Although obesity has been identified as a significant issue in Prince George’s county and the city of Bowie, local policies and prevention programs have not addressed the issue in detail. Their efforts in public health interventions do not focus on obesity and lack measurable goals. This intervention focuses on improving the dietary habits and physical activity levels among the adult and adolescent populations through interventions in workplace and school settings, but it also considers delivering tertiary care to individuals already affected by obesity. The evaluations for this intervention will be conducted by measuring obesity rates, physical activity levels, and dietary habits among the citizens of Bowie, MD in order to determine the effectiveness of the intervention and identifies areas that warrant improvement.
References
Centers for Disease Control and Prevention. (2012, September). Maryland: State nutrition, physical activity, and obesity profile. Retrieved from http://www.cdc.gov/obesity/ stateprograms/fundedstates/pdf/maryland-state-profile.pdf
Centers for Disease Control and Prevention. (2014). Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm
Creekmur, P. B. & Preneta, F. (2012). Prince George’s County health improvement plan 2011 to 2014: Blueprint for a healthier county. Retrieved from http://www.sph.umd.edu/umdprc/ docs/LocalhealthPlanPrefinal.pdf
James, J., Thomas, P., Cavan, D., & Kerr, D. (2004). Preventing childhood obesity by reducing consumption of carbonated drinks: Cluster randomised controlled trial. British Medical Journal, 328(7450), 1237-1239.
Katz, D. L., O'Connell, M., Yeh, M. C., Nawaz, H., Njike, V., Anderson, L. M., & Dietz, W. (2005). Public health strategies for preventing and controlling overweight and obesity in school and worksite settings. Morbidity and Mortality Weekly Report, 58(RR07), 1-12. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5410a1.htm
Maryland Department of Health and Mental Hygiene. (2006, May). Maryland nutrition and physical activity plan 2006 – 2016. Retrieved from http://phpa.dhmh.maryland.gov/ cdp/pdf/npaplan.pdf
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806-814.
Sobush, K., Keener, D., Goodman, K., Lowry, A., Kakietek, J., & Zaro, S. (2009). Recommended community strategies and measurements to prevent obesity in the United States. Morbidity and Mortality Weekly Report, 58(RR07), 1-26. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm
Veugelers, P. J., & Fitzgerald, A. L. (2005). Effectiveness of school programs in preventing childhood obesity: A multilevel comparison. American Journal of Public Health, 95(3), 432-435.
