Introduction
According to (NHANES), over 1/3rd of United States citizens are obese. Increasingly, the prevalence of obesity in the United States has been cited by health practitioners and the government as a major health issue that needs health policy enactment and reform. Statistics further indicate that the United States obesity predicament is the highest in the entire world with more than 74.1% of American adults being obese. Statistics also show that despite tremendous efforts made by the health systems. Obesity in American adults has steadily increased with 24.5 in 2004, 26.6% in 2007, and 34.7% in 2009. Nevertheless, studies have shown that obesity has dramatically increased in all United States population groups. From 1990 to 2006, severe obesity prevalence (BMI≥40kg/m2) has quadrupled from one obesity case in 200 Americans to one case in 20 Americans (CDC, 2011).
The increase has also been evident in adolescents and children as their estimates amount to 9 million obese children and adolescents. Children from 6-11 years are most afflicted with a tripled obesity rate of 6.5% to 19.6% for the last five years. Analyses also show that 16% of U.S. military personnel are obese. Further, NHANES statistics show that all United States have increased obesity cases with Alabama State leading with 30.1% and Wyoming ending with 24.0%. This clearly shows that irrespective of age, geographical location, and job type, all Americans are at risk of being obese. This has made the government incur hefty costs in obesity and indirect loss of economy associated with obesity amounting to more than $75 billion. In 1995, the cost incurred was $95.5 million, $117 billion in 2000 and the cost has been on the rise for subsequent years. This clearly shows that government relationship with the health care sector needs to be analyzed in order to pave ways for new obesity health reforms that could save Americans from the health hazardous obese condition (CDC, 2011).
Pertinent issues in obesity
Obesity and Chronic diseases
Obesity is said to be the major cause of chronic diseases including stroke, type 2 diabetes, hypertension, gallbladder disease, coronary heart diseases cancers such as colorectal, kidney, osteoarthritis, endometrial, and breast cancer, hypertension coupled with serious health complications such as sleep apnea and breathing problems, menstrual irregularities, and high LDL pregnancy complications. To counter these effects, pertinent issues in the delivery of health care in regard to obesity that should be addressed include:
Lack of cooperation among health care professionals
As we know, obesity is a multifactorial condition that is determined by lifestyle, social-cultural factors, and genetics. However, there remains a major question as to who is supposed to play a major role in obesity treatment. For instance, research has proven that physician-led weight management is not workable from an epidemiological perspective. However, physicians remain important in the management of obesity in the provision of diagnostic, medical training, and prescriptions on how to address obesity. On the other hand, even though dietitian’s management of obesity through energy restriction has a poor success rate, other dietary approaches such as dietary fat subtypes choice, paying attention to the glycemic index, scheduling, seasonal and daily nutrient timing, and altering the macronutrient profile have proved that they improve the obese patients’ health (Bloch, 2007).
It is also noted that among the 50 states, only Louisiana State enforces the Exercise Physiology licensure, and hence, exercise treatment is handled with the absence of physician supervision or by physical therapists, personal trainers, and dieticians. However, exercise physicians are still fundamental in obesity control in offering an-all rounded exercise regime that none of the professionals involved in eradicating obesity can. This clearly shows that eradication of obesity requires collaboration from multiple health care professionals whereby physicians can refer patients to the dieticians and whereby dieticians can refer patients to exercise physiologists. However, this is not the case as most health professionals are competent for obese patients. This hinders the facilitation of a unified message needed by the public in order to fight collaboratively against obesity and diminishes the values of obesity interventions. The health care policy has greatly contributed to this. For instance, contests for the scope of practice are evident in the proposed California and Indiana bills that sought expansion of physical therapy to include wellness and fitness. Likewise, organizations such as Sports Cardiovascular and Wellness Nutritionists and the International Society of Sports Nutrition are annexing other professions’ competencies on their own. Such attitudes and contests are making referrals and collaboration in the eradication of obesity and should therefore be addressed (Bloch, 2007).
Health facilities and health care staff
With increased obesity prevalence, hospitals see more patients weighing 100, 200, and more pounds which are over the ideal. Most hospitals lack professional staff which is adequately trained in treating obesity. For instance, nurses provide the daily basic functions of patient care. When examining extreme obese cases, most patients with this condition are unable to dress and bathe and therefore, the nurses have to help them. It is important to note that the nursing profession lacks sufficient human input and this makes it hard for the hospitals to cater to obese patients. Nurses are supposed to maintain hospitalized patients’ skin integrity and in order to do this, there has to be frequent repositioning and turning of the patient. They also have to transfer the patients from the beds to chairs and lift them in order to dress, feed and bathe them. While dealing with clinically severe obese patients, a nurse has to call more than one or two nurses to assist in the activities. This will result in the concentration of resources on a single patient and owing to the deficit in human capital in the nurse profession; other patients’ needs might be neglected (Keller, 2008).
From a medical perspective, obese patients have increased fat mass that alters their metabolic profiles and therefore need unique nutritional and medical regimes. On top of this, increased body fat complicates surgical procedures, delays the healing of wounds, and exacerbates respiratory ailments which need to be taken care of. Obese inpatients also need unique facilities such as special beds that are wide enough to accommodate them, bigger hospital rooms, chairs, and types of equipment such as patient lifts, wheelchairs, walkers, shower chairs, and benches. Since most of them have difficulty moving, they need an automatically controlled bed that can convert into a chair (Keller, 2008).
Quality control
Quality should be at the forefront in delivering and discussing treatment options available for the patient. All patients measure the quality of care given to them and therefore expect respect and dignity during treatment. As Kelle (2008) states, quality care focuses on preservation, promotion, and restoration of health and should therefore be delivered appropriately in a setting and manner which satisfies the patients. It is however important to note that quality care can only be given to patients if there is appropriateness (delivery of care on time), accessibility (obtained when needed), technical excellence (provided in a correct manner), and acceptability (satisfaction) of the care by the patient. However, several components that ensure quality care miss when it comes to treating obese patients. The imaging types of equipment do not specify the dose range for patients who are obese. Longer radiation which is required to image obese patients might place the patient at risk for overexposure. The BMI used in determining the extent to which a person is obese can sometimes overestimate the level of body fat in muscular persons and underestimate the level of body fat in persons who have less muscle mass such as the elderly. This questions the extent to which obese patients receive quality medical care.
Financial issues
As noted, obesity has a huge financial impact on our health care delivery system. With a hundred billion being used by the government, the outlook is expected to be worse in years to come. This has increased insurance coverage demand for obese-related therapies and treatments. Coupled with other nine organizations, the AOS (American Obesity Association) campaigned for IRS (Internal Revenue Service) weight loss treatment recognition. In 2002, IRS made sure that anti-obesity treatment was claimed as a tax reduction. This ruling allowed participants’ contribution of pre-tax money into a flexible spending account that could be used for weight loss treatment. However, there is increased insurance coverage under Medicaid and Medicare and even though some states and Medicare reimburse an obesity surgery, the coverage is quite a law and hence, most patients are not fully catered in terms of their obesity medical expenses (Keller, 2008).
Government involvement
Government involvement within states
With increased fast food joints and increased obesity cases, both the federal administrative agency and the state have become more active in responding to this concern. This is eminent in lawsuits such as Pelama v. McDonald’s Corp that have been filed against fast food in order to regulate the distribution of fast foods. The state as well as the Federal government agency have in addition executed new (CDC) nutritional programs and physical activity programs in order to assist people to manage their body weight (Institute of Medicine, 2009). In addition, the local governments have managed to regulate fast-food chains found in a certain area by using zoning laws. On the other hand, the federal state, and local governments are working collaboratively to improve the health environment in local schools. To achieve this, the two bodies ensure that food vendors distribute snacks meeting the RDA recommendations and ensuring that schools promote the school’s health program (Institute of Medicine, 2009). It is believed that these efforts will fight obesity at the forefront and provide a healthy environment for an obese-free future generation (Institute of Medicine, 2009).
Government involvement in eradication of children and adolescent obesity
The government has acknowledged that childhood and adolescence obesity has tripled in the last 30years and made tremendous efforts to eradicate it. The government has come up with SHPP (School Health Policies and Programs) to enable schools to cultivate an obese-free environment for the children. The policy requires schools to impact health education pertaining to obesity to students. Schools focus on causes of obesity such as eating unhealthy foods and encourage participation in school-based healthy weight intervention programs. The government has also come up with the Fit, Healthy, and Ready to Learn: A School Health Policy Guide to help schools induct health programs that promote healthy eating and physical; activity among the students (Institute of Medicine, 2009).
The government has also set programs for beverages and meat sold outside the School Meal Programs. The government requires the school to ensure that the food vendors sell healthy foods to the children. Most schools, therefore, require vendors to sell healthy snacks and drinks such as skimmed milk, fruit juice, bottled water, vegetables, fruits, low-fat cakes, cookies, pastries, crackers or baked goods, 100% fresh juices, and salty snacks low in fat such as cheese puffs and potato chips. Some states require that schools prohibit soft drinks, candy, and fast food advertisements on school property (Institute of Medicine, 2009).
The government also requires schools to ensure that schools engage children in physical activities and health education. Statistics carried out by CDC show that the government policy has been effective in ensuring teachers impact students with health education that has decreased sedentary activities such as watching television and has encouraged the student to engage in activities such as muscular endurance, body composition, and cardiovascular. Most school also offers a variety of physical activities such as ball games, swimming, and dancing among others. The government also offers numerous publications such as Make a Difference at Your School: Key Strategies to Prevent Obesity, Body Mass Index Measurement in Schools, Nutrition: School Health Guidelines, and Physical Activity: School and Community Guidelines to aid schools in the eradication of obesity. Since most adolescents and children are a huge part of their lives at school, it is believed that the government will play a huge role in curbing children and adolescent obesity prevalence (Institute of Medicine, 2009).
Government initiatives
The government has launched a series of initiatives in an attempt to combat obesity prevalence. OBESITY: Halting the Epidemic by Making Health Easier initiative aims at increasing fitness and decreasing weight loss in order to increase longevity and mitigate the obesity co-morbidities. Most of the government initiatives focus on enhancing the accessibility of fitness opportunities. The Food Standard Agency is working with the government to ensure that healthy foods are developed and processed. The Surgeon General’s Vision for a Healthy and Fit Nation 2010 is an initiative launched by General Regina Benjamin that enlightens the public on issues pertaining to obesity. The initiative publication outlines the causes of obesity, how to reverse obesity, and its prevalence. The Let’s Move campaign headed by Michelle Obama has been launched by the government to ensure that childhood obesity is mitigated by supporting parents, providing healthy food to schools and communities, and encouraging physical activities (Institute of Medicine, 2009).
Current Obesity drive bills
Policy and legislation enactment by the government
Bill H.R. 2044 is currently advocating that the Directors for Centers for Disease Control and Prevention coupled with Health and Human Service Secretary develop a nationalistic strategy that will reduce obesity by 10% this year. The bill also advocates that grants be given to local governments and educational agencies in order to reduce obesity through anti-obesity initiatives and wellness policies. The bill also advocates that existing programs aimed at preventing obesity be evaluated to determine how effective they are (Waters, Seidell & Swinburn, (2010).
Obesity driven Policy and legislation enactment by the government
Just recently, the California Senate Bill 1210 was introduced to fight against obesity. The bill advocates for the taxation of sugar-sweetened drinks and including sodas which are believed to play a major role in childhood obesity. The revenue gained from taxes will be used for battling obesity in children by directing the money to schools and cities to cater to the numerous obesity prevention programs. Schools will be able to get enough funds for healthy school meals and good PE programs. Statistics reveal that America’s calorie intake amounts t 3003 daily and 433% of the calories are derived from soda consumption. It is therefore believed that an increase in taxes will increase the cost of sodas and this will result in a modest reduction in soda consumption (Waters, Seidell & Swinburn, (2010).
Conclusion
As we have seen, there pre-exists a relationship between the health caregivers and the government in regard to the solutions need to eradicate obesity. However, the government is more inclined toward forming policies, legislations, and initiatives that eradicate obesity in children and adolescents and seems to have forgotten irrespective of one’s age, social status, geographical location, or profession, one can be a victim of obesity. Nevertheless, the government seems to have forgotten that there are pertinent issues that need to be addressed in the health care system in order to enhance the efficiency and efficacy of delivering medical care to obese patients.
The government should therefore collaborate with the health practitioners in ensuring that there is increased availability, access, and quality control in managing obesity. Programs aimed at building the health care system’s capacity in identifying, preventing, and treating obesity should be formed. The programs should train health caregivers on how to manage obesity, aggressively collect BMI, increase obese patients’ facilities, enhance reimbursement and coverage for obese related services and diversify ways through which intervention can be offered such as the use of self-care materials, multiple or single-session programs or web based programs. The use of information technology should also be considered as the key tool in enhancement of obesity management whereby accurate BMI’s and other obesity equipment such as automated beds should be used o ensure that obese patients are catered for with quality care the health care professionals with the help of the government should also ensure that they work collaboratively to ensure that they can incorporate all medical intervention needed in eradicating obesity. All this can be made effective by setting up health policies that will pave way for an effective and efficient health system that can cater to obese patients successfully (Kersh, 2010).
References
Bloch, A.S. (2007). Issues and choices in clinical nutrition practice. New York: Lippincott Williams & Wilkins
Centers for Disease and Control Prevention (2011). U.S. Obesity Trends: Trends by State 1985–2009. Web.
Institute of Medicine (U.S.). (2009). Local government actions to prevent childhood obesity. New York: National Academies Press
Keller, K. (2008). Encyclopedia of obesity, Volume 1.New York: SAGE
Kersh, R. (2010). Obesity & the New Politics of Health Policy. Web.
Waters, E, Seidell, J & Swinburn, B. (2010). Preventing Childhood Obesity: Evidence Policy and Practice. New York: John Wiley & Sons