Determinants of health:
According to WHO health is a ‘a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. Wellbeing can be defined as feeling good and functioning well. Public health is defined as the science and art of preventing disease, prolonging life and promoting human health through organized efforts and informed choices of society, organizations, public and private, communities and individuals. Analysis of health of particular population and risk factors associated with the population health are the basic foundations of the public health. Public health considers physical, mental and social well-being of the population. Interdisciplinary team need to work in integrated manner to work for public health (Larkin, 2013).
Obesity should not be considered as local or national issue; however, it is a global issue. In UK approximately 63 % are overweight or obese. BMI over 25 is considered as overweight and over 30 is considered as obese. In children, this issue is more serious. Nearly, every third chid in the age group 2 to 15 child are overweight. Prevalence of obesity is increasing on yearly basis in UK. In men, obesity increased from 13 % in 1993 to 26 % in 2015. In women, obesity increased form 16 % in 1993 to 26 % in 2015 (Aldhafiri et al., 2014). Even though, there is decline in the rate of obesity after 2001, its trend is in the upward direction. These children become obese in the early childhood and it remain with them in adulthood also. Obesity put tremendous burden on NHS. NHS is spending approximately £6.1 billion every year. Hence, obesity put burden on economic development of UK (Wang et al., 2011).
Health determinants are the factors which affect together to impact health of individuals and communities. Health of people can be determined by their circumstances and environment. Determinants of health comprises of social and economic environment, physical environment and person’s individual characteristics and behaviours (Ratcliff, 2017).
Obesity need to be tackled considering multiple factors because multiple factors are responsible for the occurrence of obesity like behaviour, environment, biology and physiology and culture. Consumption of healthy diet and physical activity can be helpful in preventing occurrence of obesity. However, it is difficult for few of the people to maintain healthy diet and regular physical activity. It is mainly due to obesogenic environment which comprises of more calorie intake and without physical activity. According to Public Health Education (PHE), approximately 50,000 fast food and takeaway outlets are there in UK. It is evident that major reason for the occurrence of obesity is consumption of takeaway food. Most of the food outlet clusters are present around the schools. More than 25 % adults and more than 20 % children eat food from the fast-food centres. Food form the outlets comprises of sugar, fat and salt and its portion is more as compared to the normal food. This composition is major risk factor for obesity. There is year-on-year increase in consumption of fast from outlets in UK (Cetateanu and Jones, 2014). School going children and their family members need to be educated for healthier choices of food. However, it is difficult to find healthy food in menus of these fast-food outlets. According to health matters, food environment need to be changed to support children and their family members to make healthy choices of food consumption. These fast food centres have significant impact on the lives of the people (Williams et al., 2014).
Food environment can be changed by improving accessibility of healthy food, by accomplishing collaborative work and partnerships among public, private and voluntary sectors at local, national and global level. Councils can act on these fast-food outlets and seek improvements in it to produce healthy food environment. Local councils can make simple changes to improve food environment. These changes include reducing portion size of food, reducing fats and frying practices, reducing salts and sugars, increasing amount of fruits and vegetables, promoting healthier options, producing healthier ingredients and providing calorie information (Ellaway et al., 2012). Local councils and local communities can work in partnerships to influence positively on the food environment. Influence of food environment is mainly evident in the older children and children those are already overweight. There are multiple health determinants responsible for the obesity and unhealthy food environment. These determinants include policymaking, social factors, health services, individual behaviour and biology and genetics. Policies need to be implemented at local, state and national level for promoting healthy food environment. Social norms, attitudes, social support, social interaction and socioeconomic conditions can impact food environment and obesity (Hawkes et al., 2015). Hence, these social determinants need to controlled. Healthcare services in the deprived locality can be improved by improving availability of healthcare services, reducing cost and providing insurance coverage. Positive change in the individual behaviour can be helpful in reducing burden of chronic conditions like obesity. Individual behaviour can be changed in the form of diet, physical activity, alcohol, cigarette and hand washing. Biological and genetic factor are responsible for the occurrence of obesity (Freisling et al., 2017).
Obesity and health inequalities:
Even though, no one is immune to obesity development, prevalence of obesity is not uniform throughout the population in UK. Various determinants like income, social deprivation and ethnicity are the important aspects for the occurrence of obesity. There is direct correlation between obesity and social deprivation. Socially deprived people are more prone to obesity. Obesity prevalence is approximately two times more in most 10 % deprived children as compared to the 10 % least deprived children. Obesity prevalence is highest in most deprived areas and low-income areas and it is continuously getting worse. Most of these fast food outlets are there in deprived areas as compared to the affluent areas (Karlsen et al., 2014). People from the specific ethic groups like South Asians are more likely to develop overweight and obesity as compared to other ethnic groups. Low income people of all the racial and ethnic groups are healthier as compared to the unhealthful food vendors. There is the inverse association between the neighbourhood and obesity. Lower income people can not afford more healthful food at higher cost; hence they need to purchase less healthful food at lower cost. These people can not afford to go to the supermarkets in the other area, hence they need to purchase unhealthy food from the nearby stores and fast-food centres (El-Sayed et al., 2012).
Policies need to be implemented for “strategies for encouraging healthier food provision”. PHE toolkit can be helpful in improving healthy food environment by : ensuring stores and supermarkets selling the healthy food should be within walkable distance or it can be reached by local transport, requiring centres like schools, community centres, hospitals and leisure centres which can provide catering services and vending machines for heathy foods and ensuring accumulation of many hot food takeaways in the centre of the town and near to schools and hospitals. Planning policies in place can be helpful for the councils for refusing permission of new fast-food outlets. Policy implementation can be helpful in the improving authority of the local authority’s in the improving food environment (Oyebode and Mindell, 2013). National Institute for Health and care Excellence (NICE) pathway can be helpful in implementing policies and working with the local communities (Chalkidou, 2013). It empowers the local authorities for giving permission for opening fast-food retails.
Local planning authorities need to be encouraged to restrict giving permission to open fast-food centres within the walkable distance. Supplementary Planning Documents (SPDs) need to be developed by local councils for restricting opening of new takeaways near schools, leisure centres and sports centres which are mostly visited by children. In UK, SPD approach proved beneficial for creating healthy food environment and preventing obesity. Planning decisions can be made successful by supporting evidence and making local policy clear. Good linkage need to be established between SPDs, health strategies and local plan (Lake, 2018).
UK Government’s childhood obesity plan put soft drinks industry levy. Implementation of the childhood obesity plan is important in UK because according to the National Diet and Nutrition Survey approximately 26 % of the sugar intake in school going children is through sugary soft drinks. In UK revenue generated from this levy used in the programmes to reduce obesity through increasing physical activity and providing healthy food. PHE implemented another policy in UK which is called as sugar reduction programme (Rayner et al., 2015). This policy states that sugar should be removed from the products which children eat the most. Food and drinks industry need to remove sugar by 20 % by 2020. This policy implemented on the family everyday foods like breakfast cereals, yoghurts, biscuits, cakes, confectionery, morning goods eg croissants, muffins, crumpets, pastries, puddings, ice cream, and sweet spreads, toppings, sauces. PHE implemented marketing policies and campaigns like Change4Life and One You campaign. Change4Life provides information to reduce the amount of sugar in the children’s food. One You campaign provide advise to the adult people about healthy eating and encouraging physical activity (Piggin and Lee, 2011).
Healthcare access need to be improved for the more vulnerable people. Obesity and unhealthy food environment is associated with poor people and deprived locality. Moreover, health access in these areas is less. It is mainly due to the un-willingness of healthcare professionals to work in these deprived areas and lack of proper transport facilities. Healthcare access in these areas can be improved by affordable healthcare services. Healthcare professionals can be given extra compensation for working in these areas (Correa et al., 2016).
Health needs assessment need to be initiated prior to the initiation of the treatment; hence it can be helpful in believing treatment can be effective. Systematic approach need to be implemented for health needs assessment. Nurse required to perform health needs assessment in effective and accurate manner. Nurse should not ignore needs assessment of the patient because it can lead to exaggeration of the existing health condition in the patient. Nurse need to effectively distinguish between the individual need of the patient and wider need of the community while health needs assessment. Nurse should use historical, epidemiological and clinical data for the health needs assessment. Social and environmental changes need to be considered while health needs assessment (Grant et al., 2015).
Children need healthy and balanced diet to promote proper growth and development. Family members and schools environment can significantly impact healthy food needs and choices of children. Critical nutritional safety net need to be provided for the children during their school lunch. Local needs can be identified through planning, economic development and public health. Identification of local needs can be helpful in setting target to provide healthy food environment. Obesity trend is similar in both men and women; however, overweigh prevalence is more in men (Garawi et al., 2014). Hence, health and food needs in men need to be altered accordingly. In adults’ prevalence of obesity is less as compared to the overweight; while in children prevalence of obesity is more as compared to the overweight. Hence, requirements of intervention in adult and children are different. 20 % children in the age group 10 – 11 years are obese and 14 % children in the same age group are overweight (Christie and Channon, 2014).
Rapidly, obesity is becoming the fastest cause of preventable death. Health needs for the prevention of occurrence of obesity need to be identified and positive food environment need to be created for the prevention of obesity. Obese people are more prone to development of different diseases like colon cancer, high blood pressure and type 2 diabetes. As compared to the normal population, obese people are likely to develop colon cancer, high blood pressure and type 2 diabetes by 3, 2.5 and 5 times more respectively. It can lead to change in the intervention. Intervention need to be provided for complete well-being of the patient, instead of focusing on the specific health issue of person. In most of the co-morbid disease conditions of obesity, at least one of the pathogenic mechanism is similar to obesity. Hence, prevention of one disease condition can be helpful in preventing other co-morbid conditions also. According to PHE, primary health need for obese patients is to reduce obesity (Zeller et al., 2015).
Role of nurse:
Needs of obese and overweight adults include reduction of body weight, consumption of healthy food and performing physical exercise on regular basis. Barriers to meet needs of obese and overweigh patient include lack of healthy food choices, consumptions of medicines responsible for weight gain and alteration in the appetite, physical limitations responsible for reducing individual’s capability to perform physical exercise, lack of accessible environment for good food and lack of resources for making healthy choices of food. Nurse need to identify these barriers in the early stage and plan effective strategy to eliminated these barriers which can be helpful for the people to make healthy food choices, performing exercise and reducing body weight (Nic Philibin et al., 2010).
Nurse can play significant role in health promoting activities in improving food environment and preventing obesity or overweight. Nurses can act as educators and role models for individual, family and population. Nurse need to consider multiple factors like medical, nursing, cultural, social and psychological for providing effective intervention for the prevention of obesity. Nurse need to manage various difficulties like Skin care, respiratory challenges, resuscitation, medication absorption and difficulties in mobility while providing nursing intervention to overweight and obese patients. Nurse need to assist in the identifying exact cause for obesity like environmental, genetic and metabolic. Identifying exact cause of obesity can be helpful in the implementing accurate intervention (Nolan et al., 2013). Nurse need to provide one-to-one support and interventions related to dietary and lifestyle interventions. Nurse need to encourage every patient and family members to adapt healthy food habit and perform physical activity on the regular basis. Nurse need to co-ordinate with the dietician and physical trainer for providing optimal healthy food and for carrying out optimal physical activity respectively (Fillingham et al., 2014). Nurse need to educate children, family members, school teachers and adults for importance of healthy eating and physical activity. Nurse can provide counselling related to breastfeeding, physical activity, regular meals, and nutrition. Nurse can provide weight related health information to the people. Nurse can use evidence-based nursing research for designing health policy for the specific population in the society. Nurses can monitor childhood obesity education programme. Nurse need to implement comprehensive assessment tool for early identification and prevention of obesity. Nurse need to identify multiple needs of the patient and collaborate with other healthcare providers for providing effective intervention to the patient (Redsell et al., 2013).
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