In 1990, the prevalence of obesity in the United States was less than 15 percent of the nation’s population, according to the Centers of Disease Control and Prevention (CDC). Current data from the CDC and The Journal of American Medicine (JAMA) report that more than one-third of (34.9 percent or 78.6 million) adults in the U.S. are obese.
Furthermore, three states (Arkansas, Mississippi and West Virginia) have a prevalence of obesity over 35 percent (CDC). Even more alarming is the increased rate of childhood obesity. JAMA reports that more than 17 percent of children and young adults nationwide are obese. Early onset of obesity has become so prevalent that it has been deemed “one of the most serious public health challenges of the 21st century” by the World Health Organization, which estimates the number of overweight children under the age of five to be more than 42 million worldwide.
With the persistence and spread of this “obesity epidemic,” what can be done to help reverse the negative side effects of obesity on the health of the nation? For some nurses, the answer starts with one patient at a time. Michelle MacDonna, CRNP, MSN, MPH, is an occupational and environmental health nurse practitioner for Healthstat, Inc., in Raleigh-Durham, N.C. She operates a clinic located and targeted for the employees at a textile manufacturing facility in rural North Carolina with the primary goal of helping employees stay healthy. MacDonna said that in in her clinic, obesity is often a co-morbidity and symptom for other medical problems such as depression, high blood pressure, high cholesterol, diabetes and joint pain. According to the CDC, obesity is often associated with multiple medical conditions such as heart disease, stroke, Type 2 Diabetes and can even cause certain types of cancer.
To combat some of these health problems, MacDonna helps patients incorporate increased physical activity into their day and make healthier lifestyle decisions. With intervention, MacDonna says her patients can lose roughly 10-50 pounds within a year. After losing weight, some of her patients no longer need to take blood pressure medication or statins to reduce their cholesterol.
“Some employees have started recruiting others to join them in living a healthier lifestyle,” said MacDonna. “Their engagements have resulted in a safe and acceptable weight loss, improved body image, and increased productivity in the workplace.”
According to MacDonna, the process of helping patients change their habits for a healthier lifestyle can be lengthy and at times cumbersome. She notes the key to creating sustainable, permanent change is empowering patients to take their health into their own hands.
“Nurses should involve the patient and allow them to make the decision to change. This encourages patients to be involved in their health decisions and allows patients to make the necessary decisions about their weight loss goals and nutritional needs on their own terms. Nurses must be knowledgeable about nutrition as well as encouraging with patients to effectively inspire lifestyle changes.”
MacDonnna uses the Transtheoretical Model to inspire change in her patients. This theoretical model of behavior change describes six “Stages of Change” which involve cognitive and behavioral activities that facilitate health behavior change. The “Stages of Change” as outlined by the University of Rhode Island involves the assessment of a patient’s cognitive readiness to change, acceptance of a needed change, intention to change, implementing the change and maintaining the change in behavior. This technique allows patients to make their own decisions of a healthy lifestyle rather than making a change because of pressure from others; therefore, patients are more likely to maintain a healthy lifestyle change. Although the path to weight loss and improved health may take time, MacDonna finds the long-term commitment to her patients inspiring.
“My favorite part of improving a patient’s health is watching them transform over a period of time,” she said. “I watch them go from being scared and feeling defeated to feeling accomplished and confident. You realize how important your role is as a nurse in helping to shape patients’ lives.” According to MacDonna, nurses are not the only ones helping to decrease the rise of the “obesity epidemic.”
“Part of helping people stay healthy includes persuading them to have regular visits with their primary care provider so that it becomes a multi-disciplinary team effort,” she said. “Everyone in healthcare has such an important role in reducing obesity, and it takes an entire team of dedicated individuals to ensure people receive the best personalized care.”
To learn more about obesity and nutrition, read “Understanding the American Obesity Epidemic” from the American Heart Association.