Influences across lifespan
When hoping to conceive, being obese can cause complications and reduce the chances of conception by 50% (Ward, 2012). Brewer & Balen (2010) showed how weight loss can lead to a higher chance of conception and that 67 out 87 obese women who lost weight managed to conceive previously they were infertile.
According to a study by Toschke, Montgomery, Pfeiffer et al (2003) smoking while pregnant increases the risk of being obese later in life. Women who are obese during pregnancy increase their risk of disorders that affect the pregnancy outcome, these include: “Early miscarriage, Gestational diabetes, and pregnancy hypertension” (Robson, Waugh, 2009 p165). (Basso, 2004) cited in Arendas, Qiu, Greusling (2008) showed that being pregnant when obese also increases the risk of having twins. This was said to be because the “relationship between increased BMI and the incidence of twinning are related to increased levels of FSH in obese women” Arendas, Qiu, Greusling (2008 p.5)
Exposing infants and toddlers to food insecurity are putting them at risk of becoming overweight or obese later in life. “Food insecurity is defined as limited or uncertain access to enough nutritious food” (Cook et al, 2004 p.1) this does not mean there is a reduction in food quantity. Research suggests food insecurity can trigger health conditions such as obesity and overweight Cook et al (2004). Parents are buying unhealthy meals more often because of barriers such as fatty foods are cheaper than fruit and vegetables (Dwyer et al 2008). If a child is brought up with healthy foods he or she is unlikely to eat healthy later in life increasing obesity risk. A HEAT target is set out to help reduce child obesity and aims to achieve agreed completion rates for child healthy weight intervention (NHS Scotland 2010)
The number of early deaths in people of healthy weight, who smoked more than ten cigarettes a day was found to be the same as non-smokers who were obese, (Smith 2009) The study was carried out on 45,000 people who were conscripted for military service at age 16 to 19 when their BMI and smoking habits were noted. They were followed up for an average of 38 years and during that time 2,897 of them died (Smith 2009). The study found that being overweight as a teenager increases the risk of dying within a 38 year period by a third, and the chance of dying in obese teenagers is doubled (Smith 2009).
Obesity in adulthood causes disorders such as cardiovascular diseases, strokes, diabetes, and some cancers (Alexander, Fawcett, Runciman, 2006) thus life expectancy will be decreased, as well as quality of life in some instances which has a prolonged effect on the health of the obese person
Although obesity is an ever growing epidemic obesity in the elderly population it is a rare occurrence as many people who are obese die younger (Elia 2001). After a peak in body and BMI at the age of 60, there is a rapid decline of weight of 0.65kg per year (Elia 2001).
Services and Agencies
Weight Watchers is an agency that helps people lose weight and, maintain a healthier life style. Weight Watchers is “Based on up-to-date science and tried and tested over the years by real people, the Weight Watchers programme comes from the experts at the weight loss game. It’s designed for living and losing weight” (Weight Watchers, 2011). This service is available to everyone but does have a cost that comes along with it, with memberships starting at “£10.95 per month” (Weight Watchers, 2012).
Weight Watchers have over 6000 classes all over the UK including five in the Dumfries area. (Weight Watchers, 2012(B)) Weight Watchers claim so many people join there club because you can still eat the food you love. “We'll empower you to make informed choices to continue to lose weight and not lose out on a social life” (Weight Watchers, 2012). Although Weight Watchers is not free it proves to be popular with the public after more than 35 years of service and helping millions of people lose weight (Weight Watchers 2012).
Dumfries and Galloway has services such as SONAS, which is a public health service that works with health partnerships to “raise awareness, educate and build capacity in health improvement in the locality” (NHS, Dumfries and Galloway, 2012 p1) SONAS aims to provide information to the public about health issues and reduce health inequalities within Dumfries and Galloway (NHS, Dumfries and Galloway 2012) including obesity and overweight.
SONAS support evidence based projects such as the Dumfries and Galloway Physical Activity strategy, and Healthy eating, Active living improvement plan (NHS, Dumfries and Galloway, 2011), all of the current policies are available at sonas based in Annan, Dumfries and Galloway. If anyone has any queries the friendly staff members are there to help, and support to allow an overall health gain. SONAS has a library in which anyone can use to research any health information, and access to all the resources needed to have a healthy life (NHS, Dumfries and Galloway, 2012).
Within Dumfries and Galloway and Scotland primary care services such as GP’s will be able to help with weight problems. “GPs believe it is part of their role to advise obese patients on the health risks of obesity” (Epstein 2005 p1).
School nurses are able to send letters home following a health screening which includes taking a BMI (Brunner, Suddarth 2010) the letters inform parents their child has a high BMI, and offer advice and support to help the child reduce the BMI. Some parents see this as the school nurse saying their child is overweight or even obese.
Health Visitors use Hall 4 as baseline of practice (Hall, Elliman 2006).They have a vital part to play in obesity prevention as they can recommend breast feeding which is shown to reduce obesity later in life, (Armstrong 2003). They can also tutor the new parents about healthy food choices and support the parents throughout the child’s infancy
Relevance to nursing
Nurses need to be aware of a disorder known as Binge Eating Disorder (BED) is a common form of obesity where patients usually have difficulty losing and maintain weight loss, and BED patients should not be excluded from any weight loss programs (SIGN, 2010). This disorder is one that nurses should be aware of particularly if the patient is struggling to lose weight. Nurses should also be aware that if the patient is trying to stop smoking a weight loss intervention should be put in place, as the risk of having further health problem due to the weight gain is substantial (Martin, 2011)
Obesity in Scotland cost the NHS £171 million and only a small portion of this money was used for weight loss intervention (SIGN, 2010), this led to need for a guideline. The rise in obesity has a major impact and burden on all aspects of health and social care, financially and in terms of waiting times, (Bell, Crystal, Detsky, et al, 2006).
Nurses should also be aware of weight loss management by medications as it costs NHS Scotland £4.5 million a year (Scottish Government 2010) and it is compulsory for nurses to have knowledge of the effect the drugs may have. For example Sibutamine HCl (Meridia) decreases appetite and may cause hypertension and should not be considered for patients with a history of Coronary heart disease, angina, dysrhythmias, or people on antidepressants (Brunner, Suddarth 2010). Nurses should use the British National Formulary (BNF) to look up and find all information about the drug before administration.
Moving and handling is difficult when dealing with obese patients as specialist bariatric equipment is needed (Hignett, Griffiths 2009). A study in England showed that 150 trusts were spending £60,000 per year on specialist equipment such as larger hospital beds, chairs, surgical equipment and delivery beds (Scottish Government 2010). Recently The Scottish Ambulance Service adapted 63 vehicles to allow anchoring of the trolley in the middle if the ambulance to manage obese patients this cost £189,000 (Scottish Government 2010). In the South of Scotland obese patients have to be transferred to Aberdeen in order to use the bariatric MRI scanner (Scottish Government 2010) costing money and increasing waiting times.
Nurses should be aware of the HEAT Targets like breast feeding which aims to encourage more mothers to breastfeed after recent studies show it is more beneficial (NHS Scotland 2010). HEAT Targets such as Child Health Weight, and Alcohol, as well as Smoking Cessation are all Targets nurses should be aware of when dealing with obesity.
Conclusion
Obesity is a national epidemic and is a main cause of poor health in Scotland such as cancers, strokes, and coronary heart disease. It is also apparent that the overall objective is to reduce obesity in all age groups, to the standard where a person’s health risks are reduced to a minimum whether this is through exercise or healthy eating. Reports read throughout this assignment all agree more education is needed to reduce obesity, and cost to the NHS. Objectives can be achieved with advice from local or national services and agencies, and by educating people from a young age in schools.
References
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, C., , M.,, A., , A. (2006) Shopping around for hospital services. The Journal of the American Medical Association. [ONLINE] Vol. 279 (13), p1015 – 1017 Available: http://jama.ama-assn.org/content/279/13/1015.short [Accessed: 23rd March 2012].
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