Obesity and its associated disorders are a growing epidemic across the world. Many genetic, physiological, and behavioral factors play a role in the etiology of obesity. Diet and exercise are known to play a valuable role in the treatment and prevention of obesity and associated disorders such as hypertension, heart disease, and diabetes. Therefore, the purpose of this review is to examine the prevalence, etiology, consequences, and treatment of obesity.
Major Details
Approximately 1.2 billion people in the world are overweight and at least 300 million of them are obese. According to the World Health Organization, obesity is one of the 10 most preventable health risks. Yet, at least 300,000 deaths every year in the United States alone can be linked to obesity. Obesity is associated with disorders such as hypertension, diabetes, hypercholesterolemia, and liver disease. Obesity has been thought to simply be related to an imbalance between energy intake and expenditure.
However, more recent research has suggested that genetic, physiological, and behavioral factors also play a significant role in the etiology of obesity. Thus, the management of obesity through exercise, nutrition, supplementation, and medical intervention is at the forefront of research. The purpose of this review is to examine the current literature as it pertains to the prevalence, theories, medical consequences, management, and future research directions in the study of obesity. Further, this review will provide practical recommendations for dealing with athletes and/or clients who are overweight.
Obesity Interventions
The theory of planned behavior addresses three aspects: attitude, subjective norm, and perceived behavioral control. The attitude is the values and judgment we hold about a healthy diet. The subjective norm refers to what is important to the patient’s family and friends. Perceived behavioral control is how much control the person believes they have over their ability to keep to a healthy diet i.e. whether or not they have the skills or resources to succeed.
These models assume all behaviors are based on conscious thoughts but people may not think of the ill effects on their health every time they eat an unhealthy meal. Many health-related behaviors are used as coping mechanisms and when you get rid of the behavior, this may result in an increase in stress levels. The change is therefore more likely to be unsuccessful. Perception of control should be increased to help people feel empowered and more likely to succeed. Those who take part in unhealthy eating may already understand the dangers of eating unhealthily and may already have ill health due to eating unhealthily but they enjoy the food and so continue. This can cause upset in an individual’s mind known as cognitive dissonance. Nurses can use this to persuade the individual to make a change.
A good way of introducing the concept of change to the individual is by brief intervention. The brief intervention has been shown effective when dealing with alcohol addiction within the primary care sector (Kaner et al, 2009). Minimal intervention is an opportunistic process where the health professional attempts to find out how the service user feels about the behavior, challenge the person’s views on eating healthy and help them to weigh up the pros and cons of the healthy diet. The main aim is to get the individual to engage cognitively about the behavior. When linked up with the stages of change, the person moves into the contemplating stage of change and is more likely to change their behavior and sustain change.
Related Concerns
Nurses can help prevent cardiovascular disease by promoting a healthy diet and hydration. Brief intervention can introduce people to a new concept in a short time and has been proven to be effective. Further help could be offered by combining the Health Belief Model with the Theory of Planned behavior. Within this, views should be challenged, coping mechanisms and perception of control examined and advice given, barriers identified, social networks and context discussed and the benefits reiterated. This should be a positive experience, leaving the individual empowered. Cognitive behavioral therapy may also be adapted and has been shown effective in preventing acute myocardial infarctions (Gulliksson, 2011).
Obesity Prevalence Worldwide
The prevalence values for obesity in Europe as well as other countries with established market economies is estimated to average 15–20% of the population. In 1995, obesity in Europe was estimated to be 10–20% for men and 15–25% for women [7]. More recently, European obesity has been estimated as high as 22% in children, and as high as 26% in men and 31% in women. Cockram and colleagues[8] reported that obesity and its related diseases such as type 2 diabetes have also been increasing in the Asia-Pacific region of the world. Obesity, especially central obesity, seems to be a primary reason for this increased rate of type 2 diabetes. Interestingly, the BMI values currently used appear to underestimate risk in Asians. This might be due in part to many Asian races being more likely to develop abdominal obesity[9]. Therefore, the health-related consequences for Asia-Pacific individuals appear to be more intense at an absolute BMI value when compared to their European descendant counterparts. A suggested method that is possibly a more accurate assessment is a waist-to-height ratio [10]. This method was used by Hsieh and colleagues[10] to determine the metabolic risk of Japanese men and women. They discovered that nearly all of the “overweight” subjects had high metabolic risk value and that 45.5% of men and 28.3% of women of “normal weight” status also had high metabolic risk values when using the waist-to-height ratio method. Collectively, these findings indicate that obesity is not only a problem in the United States but is also a major health concern in Europe and other regions of the world.
Future Directions
In 2004, the Department of Health and Human Services (DHHS) in collaboration with the National Institutes of Health (NIH) created a program announcement to outline the type of obesity/weight loss research that is needed. As previously mentioned and outlined through meta-analysis, weight loss research has been narrowly focused on the population and time frame. With this in mind, the DHHS and NIH have outlined ten areas that should be the focus of future research as follows:
1) Studies that investigate biological mechanisms underlying weight regain after intentional weight loss (neuroendocrine, endocrine, and gastrointestinal function, muscle and adipocyte biology, etc);
2) Investigations of appetite and food intake during weight maintenance and regain periods (including energy intake, macronutrient preference, micronutrient intake from foods and supplements, eating behaviors, and binge eating);
3) Studies to elucidate the role of energy expenditure during the weight regain after intentional weight loss (including voluntary physical activity, thermic effect of feeding, nonexercise-activity thermogenesis, and sympathetic/parasympathetic nervous system function);
4) Studies of the effects of age-related changes on responses to weight maintenance interventions, including effects on body composition, metabolic regulation, and other physiologic responses;
5) Clinical studies that evaluate the impact of behavioral interventions such as extended or more frequent patient contact, use of technology to enhance self-monitoring behaviors, social supports, motivational interviewing, etc. on improved weight maintenance;
6) Studies of dietary strategies to enhance long-term weight maintenance (such as meal replacements, alterations in nutrient density, or macronutrient composition);
7) Studies using approved or investigational weight loss agents to enhance weight maintenance or prevent regain after weight loss;
8) Clinical studies evaluating the impact of differing types, intensity, and frequency of physical activity on long-term weight maintenance;
9) Innovative interventions that incorporate the sociodemographic and cultural factors thought to influence weight maintenance;
10) Innovative methods to promote long-term weight maintenance in persons with mobility-limiting conditions.
Conclusion
The prevalence of morbidly obese Americans is estimated to have increased three-fold from 1990 to 2000. Obesity is not only a problem in the United States but is also a major health concern in Europe and other regions of the world. The associated effect of obesity on type 2 diabetes, hypertension, coronary heart disease (CHD), gallbladder disease, osteoarthritis, and certain cancers gives rise to the increasing economic costs of obesity. The total annual medical expenditure cost for the United States has been estimated to be 5–7% of total healthcare costs or about 75 billion dollars a year.
Thus, the need for preventative techniques, as well as, treatment has never been greater. Historically, obesity has been thought to simply be related to an imbalance between energy intake and expenditure. However, more recent research has suggested that genetic, physiological, and behavioral factors also play a significant role in the etiology of obesity. There are many ways to treat and prevent obesity. Today’s market is flooded with weight loss drugs, surgeries, and fad diets.
However, eating a proper diet and maintaining a relatively active lifestyle is the most effective means to prevent and treat obesity. Although it seems simple enough, there is still a need for research in this area. There needs to be further research on the genetic and hormonal aspects of obesity such as CCK, ghrelin, leptin, and cortisol. There is also a strong need for long-term weight maintenance studies. Commonly research focuses on short-term weight loss, but not on maintaining the weight loss. Finally, there is a need to study the effects of obesity in sports. In recent weeks, some questions have been raised about the health of professional athletes who carry 300+ pounds. While most are athletically talented, they are still clinically obese. Thus, there is a growing need to evaluate the physical stress associated with obesity in athletes.