Health care initiative for obesity among individuals of United Kingdom

Health care initiative for obesity among individuals of United Kingdom

 

Introduction: Obesity is a pre-eminent medical concern before it is an aesthetic concern. Increasing trends of obesity in the United Kingdom (U.K.) forecasts a health emergency, and studies show no foreseen reduction in obesity prevalence. Excessive weight gain is studied in different age groups, ethnicity, and among various classes of society. The trend of increase in body mass index (BMI) of adults is seen globally, with the rise in BMI of male adults from 28.8% in 1980 up to 36.9% in 2013, and for female adults, from 29.8% in 1980 to 38% (Ng, M et al. 2014). Similar trends were seen among children of the U.K., the increase in obesity among boys was seen from 1.2% in 1984 up to 6% in 2002-3, whereas an increase from 1.8% to 6.6% was found among girls (Stamatakis, E et al. 2005). El-Sayed, A.M, Scarborough, p and Galea, S studied the prevalence of obesity among ethnic populations relative to the Caucasian population and reached no consensus on the prevalence of obesity among South Asian, Black children, or South Asian adults in comparison to Caucasian adults. The risk of obesity among the children of low-income quintile at the age of 5 years was 2.0 of being obese and 11, 3.0 compared to high-income quintile (Goises, A, Sacker, A and Kelly, Y 2015). Obesity is coupled with various non-transmissible chronic conditions that may lead to suboptimal quality of life and increased morbidity and mortality among individuals. A well-known correlation exists between obesity and diabetes mellitus, hypertension, dyslipidemia, and ischemic heart disease (Malnick, S.D.H, and Knobler, H 2006). With these problems posing as health care threats, both in the long and short term, an immediate need exists for implementing health care policies to minimize the predisposing factors and comorbidities associated with obesity.

 

Physiology and Pathophysiology of obesity: Obesity can be accredited to increased activity of adipocytes, which renders an individual vulnerable to many associated diseases. The amount of fat in the body is attributed to energy homeostasis, whether energy expenditure is as same as energy (food) intake. The major organ regulating the homeostasis of energy is the brain, whereas different organ systems provide their share. It is also documented that energy expenditure decreases with age. Being a major contributor to metabolic dysfunction, obesity disrupts the metabolic function of glucose and lipid on a wider spectrum; it further influences organ dysfunction, affecting cardiac, liver, pulmonary, intestinal, endocrine, and reproductive functions (Reidinger, R.N 2007). There exists a remarkable amount of literature regarding the pathophysiology of obesity. Obesity can be ascribed to genetic, molecular, and environmental grounds. The inheritance pattern of obesity is complex. The approximate heritability of BMI concluded by Faith, M.S, and Kral, T.V.E in their book, ranges between 20 – 80% in family studies comparing parent-child and siblings, up to 50 – 90% estimated twin studies. Hypothalamus and signalling molecules play a crucial role. Obese individuals have declined basal and stimulated growth hormone release, also diminished prolactin release, increase urinary glucocorticoid metabolites excretion, increased cortisol clearance with, in turn, increases ACTH (Barness, L.A, Opitz, J.M and Barness, E.G 2007). The concept of environmental chemicals playing a role in epidemics of obesity gained great interest. Thayer, K.A et al., in their study, concluded that increased exposure to environmental chemicals alters adipocyte differentiation or neural circuits set in motion that regulate feeding behaviour. Apart from all these factors, lifestyle has a large share of predisposition towards increased weight and obesity. Lifestyle intervention, according to individual and addressing behavioural barriers in treatment, was found fruitful in the early treatment of obesity (Burgess, E, Hassmén, P and Pumpa, K.L 2017).

 

Public health initiative for obesity: Skyrocket high levels of obesity prevalence in populations put through as need of health care initiatives, individual and community levels, for adequate resolution and consequences of overweight and obesity. The mass awareness of obesity has led to calorie deficit diets and changes in lifestyle among wider populations, but these changes are not sufficient for severe obesity. The abstinence from food is not the solution, as a healthy life requires a nutritious diet. Unfounded perceptions exist regarding obesity, and the health profession is inadequately trained in behavioural changes needed that may hinder the care of obese patients. The psychological and social reverberations of obesity should also be attended. The psychological aspects of obesity have more questions than answers. A well-known phenomenon of oral compensation mechanism among obese individuals should be studied and addressed; in case of any evidence found, psychotherapy should be started before implementing any other type of modification in the lifestyle of the patient.

Following health care initiatives can help reduce obesity, its frequency, and severity, on individual and population levels.

• Supportive weight loss: a supportive environment for positive health goals and weight services at hospitals must be ensured. Different support environments such as commercial programs and a clinic-based group that depend on group strengthening are good options. However, a vast amount of study is still directed towards continuing positive lifestyles after group treatment ends. This aspect of the health care initiative is largely dependent on the individual. Yet, equally great efforts are to be made by health workers and other elements of society for spreading positive body goals and embracing healthy lifestyles. Adoption of a healthy lifestyle, clean eating, consumption of calorie-free beverages, increased physical activity, and limited screen time is found to have positive effects. Villareal, DT et al. suggested that a combination of weight loss and physical activity provides greater results in physical function than practising either intervention alone. Good sleep is also proven to be an essential component of a healthy lifestyle

 

• Food labelling: combating obesity requires educating the population on nutrients and healthy life choices. Nutrition labelling and calorie count on food product packaging helps to allow the consumer to make an informed choice regarding the consumption of food, either provided at restaurants or bought for consumption at home. Often reported a problem with labels is that they are not highlighted enough or appears in very small fonts or in the areas of packaging that are not usually visualized. Reeves, S, wake, Y, and Zick, A in their study, found 67% of restaurants do not provide portion size and calculation in London. Reale, S, and Flint, S.W in their research, showed menu labelling as a promising strategy for promoting healthy eating and encouraging weight loss. Another frequent problem addressed regarding menu labelling is the inadequate education of nutrient contents. A large population still finds comprehension of nutrient labelling an uphill task. It is largely assumed that increased knowledge regarding calorie count and nutrients will help inadequate calorie consumption to maintain proper weight, but the amount of literature present to support these claims is minimal. Nutritional labelling strategy may be an effort towards a healthier lifestyle, reducing obesity and its consequences still require larger measures.

 

• Lower trans-fat consumption: Trans-fat is a low cost, suitable for commercial use oils with longer shelf lives, making it easier for the commute. An upper limit from trans-fat consumption is 5g per day. The average consumption of trans-fat per day is usually less than the upper limit, but large quantities of trans-fat are found in cheap imported food. Kavanagh K et al. showed increased weight gain and intra-abdominal fat deposition among monkeys fed on a trans-fat diet. Trans-fat is directly associated with cardiovascular disease and type 2 diabetes. DeSouza, R.J et al., in their study, demonstrated in their study the relationship between trans-fat and coronary heart disease. Decreasing trans-fat consumption would require nutrient education and nutrition labelling. Health care workers should provide counselling regarding the trans-fat content of food, and the consumption of safer fats should be advocated. Restriction of artificial trans-fat in various ingredients after Denmark’s food policy showed a reduction of cardiovascular associated death by 14.2 deaths per 100,000 people (Restrepo, B.J and Rieger, M 2016). According to the Guardian report of 2015, a ban on trans-fat could save 7,200 lives by 2020 and insist on putting a ban on bad cholesterol and improving health status.

 

 

• Restricted promotion: another proposal is a too limited promotion and advertisement of food rich in fat and sugar, most likely to cause childhood obesity. Fast food advertisement is largely associated with the BMI of obese and overweight children.The food industry spends billions of dollars on junk food marketing each year, which largely influences what children eat and give their parents a hard time to buy. Easy access to multimedia and time watching screens, an increase of non-nutritious food choices is seen with the increased advertisement. Repeated exposures lead to product preference and cause nature exploitation of children

 

• Taxation of unhealthy and high caloric food items: with gnawing levels of obesity and diabetes, the debate on controlling large portion size and high caloric beverages is still inconclusive. Larger servings and greater availability of fruit juices, soft drinks, and other calorie-rich drinks are easily accessible and are posing a major contribution towards epidemiologic obesity. A large amount of public health experts believes in the taxation of unhealthy food and sugar-sweetened beverages. Taxation of sweetened beverages has been adopted globally to reduce diabetes among populations, thereby reducing health care costs. Jou, J, and Techakehakij, W concluded that sugar-sweetened beverages and soft drinks tax policy implementation might succeed in reducing obesity trends where obesity prevalence and soft drink consumption is high. Many nutrients can be targeted for taxations, such as fat, salt, and artificial sweeteners. The accelerated heath care expenditure and increased burden of disease due to poor diet choices require immediate decisions on the population level, thereby justifying taxation policies.

 

Conclusion: health is one of the basic rights of citizens and the obligation of the state. The health risks owing to obesity are large and potentially life-threatening. Implementation of health care initiative is not an option but the need of the hour. The epidemiologic trends of obesity show no viable information regarding any foreseeable reduction in the frequency of obesity. Obese children are proven to be even more obese adults. Under such circumstances, a need for a full protocol for obese and individuals at risk is essential. Regular screening for obesity should be conducted in schools, workplaces, and as randomized screening to reduce the incidence and risk of obesity.  Health awareness programs should be held at hospitals and educational centres, and knowledge regarding nutrients should be made more accessible and understandable. Healthy lifestyles should be promoted with more nutritious food choices and physical training, whereas a guilt tax should be implemented on unhealthy food options to reduce their availability. Psychological and social support should be provided for the obese population to help reduce any psychosocial elements of overeating, and a positive environment should be maintained to encourage self-betterment. With absolute enforcement of health care initiatives, more research should be directed at pathophysiology and various causes that may lead to obesity. Reducing obesity would reduce the capita spent on health care and sustain longer and healthier life. Wadden, T.A et al., in their study, concluded that an extensive program of lifestyle modification could reduce initial weight by 7 – 10% and meaningful betterment in clinical cardiovascular risk factors. The most effective behavioural approach to address obesity epidemics is the combined implementation of physical activity and dietary modifications (Jakicic, J.M, and Otto, A.D 2005).

The preventive approach, instead of the treatment approach, should be enforced to reduce the economic burden of obesity and the health care crisis that could emerge from obesity conditions. The effectiveness of health care implementations could be concluded after proper implementation and decent time-lapse. The elimination of barriers should be made effective like bedtime technology use, the habit of snack consumption, stress eating, lifestyle associated with poverty that may lead to obesity, and limitation of food industry strategies to make maximum profit. The ultimate success of eliminating obesity at an epidemiologic level lies with the individual. Further research on motivational factors and behavioural changes are needed would be crucial in battling obesity and other chronic conditions associated with it.

 

Reference list:

 

1. Barness, L.A., Opitz, J.M. and Gilbert‐Barness, E., 2007. Obesity: genetic, molecular, and environmental aspects. American journal of medical genetics part A, 143(24), pp.3016-3034
2. Burgess, E., Hassmén, P. and Pumpa, K.L., 2017. Determinants of adherence to lifestyle intervention in adults with obesity: a systematic review. Clinical obesity, 7(3), pp.123-135

 

3. De Souza, R.J., Mente, A., Maroleanu, A., Cozma, A.I., Ha, V., Kishibe, T., Uleryk, E., Budylowski, P., Schünemann, H., Beyene, J. and Anand, S.S., 2015. Intake of saturated and trans unsaturated fatty acids and risk of all cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. Bmj, 351, p.h3978.

 

4. El‐Sayed, A.M., Scarborough, P. and Galea, S., 2011. Ethnic inequalities in obesity among children and adults in the U.K.: a systematic review of the literature. Obesity Reviews, 12(5), pp.e516-e534

 

5. Faith, M.S. and Kral, T.V., 2006. Social environmental and genetic influences on obesity and obesity-promoting behaviors: fostering research integration. In Genes, behavior, and the social environment: Moving beyond the nature/nurture debate. National Academies Press (U.S.).

 

6. Goisis, A., Sacker, A. and Kelly, Y., 2016. Why are poorer children at higher risk of obesity and overweight? A UK cohort study. The European Journal of Public Health, 26(1), pp.7-13.

 

 

7. Jakicic, J.M. and Otto, A.D., 2005. Physical activity considerations for the treatment and prevention of obesity–. The American journal of clinical nutrition, 82(1), pp.226S-229S

 

8. Jou, J. and Techakehakij, W., 2012. International application of sugar-sweetened beverage (SSB) taxation in obesity reduction: factors that may influence policy effectiveness in country-specific contexts. Health policy, 107(1), pp.83-90.

 

9. Kavanagh, K., Jones, K.L., Sawyer, J., Kelley, K., Carr, J.J., Wagner, J.D. and Rudel, L.L., 2007. Trans fat diet induces abdominal obesity and changes in insulin sensitivity in monkeys. Obesity, 15(7), pp.1675-1684.

 

10. Malnick, S.D. and Knobler, H., 2006. The medical complications of obesity. Journal of the Association of Physicians, 99(9), pp.565-579.

 

 

11. Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., Mullany, E.C., Biryukov, S., Abbafati, C., Abera, S.F. and Abraham, J.P., 2014. Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. The lancet, 384(9945), pp.766-781.

 

12. Reale, S. and Flint, S.W., 2016. Menu labelling and food choice in obese adults: a feasibility study. BMC obesity, 3(1), p.17.

 

13. Redinger, R.N., 2007. The pathophysiology of obesity and its clinical manifestations. Gastroenterology & hepatology, 3(11), p.856

 

 

14. Reeves, S., Wake, Y. and Zick, A., 2011. Nutrition labeling and portion size information on children’s menus in fast-food and table-service chain restaurants in London, UK. Journal of nutrition education and behavior, 43(6), pp.543-547.
15. Restrepo, B.J. and Rieger, M., 2016. Denmark’s policy on artificial trans fat and cardiovascular disease. American journal of preventive medicine, 50(1), pp.69-76.

 

16. Stamatakis, E., Primatesta, P., Chinn, S., Rona, R. and Falascheti, E., 2005. Overweight and obesity trends from 1974 to 2003 in English children: what is the role of socioeconomic factors?. Archives of Disease in Childhood, 90(10), pp.999-1004.

 

17. Thayer, K.A., Heindel, J.J., Bucher, J.R. and Gallo, M.A., 2012. Role of environmental chemicals in diabetes and obesity: a National Toxicology Program workshop review. Environmental health perspectives, 120(6), pp.779-789.

 

18. Villareal, D.T., Chode, S., Parimi, N., Sinacore, D.R., Hilton, T., Armamento-Villareal, R., Napoli, N., Qualls, C. and Shah, K., 2011. Weight loss, exercise, or both and physical function in obese older adults. New England Journal of Medicine, 364(13), pp.1218-1229.

 

19. Wadden, T.A., Webb, V.L., Moran, C.H. and Bailer, B.A., 2012. Lifestyle modification for obesity: new developments in diet, physical activity, and behavior therapy. Circulation, 125(9), pp.1157-1170