Community Project Obesity in the homeless

1. Oh the Irony … Community ProjectObesity in the homeless Sania A. Beckford Boston College: William F. Connell School of Nursing Keys to Inclusive Leadership in Nursing (KILN) Wednesday April 20, 2011

2. Objectives By the end of this presentation, you will… • Discuss the effects of nutrition on long-term health in the population served at the Barbara McInnis House • Identify social disparities that places the population served at the Barbara McInnis at risk for obesity • Describe nursing roles and interventions to promote healthy weight & maintain good nutrition habits in the population served at the Barbara McInnis House

3. The Barbara McInnis HouseBoston healthcare for the homeless program (BHCHP) Boston.com; www.bhchp.org Location: South End of Boston Established: 1984 as a pilot program funded by The Robert Wood Johnson Foundation (RWJ) & the Pew Charitable Trusts (PCT) Mission: to provide or assure access to the highest quality health care for all homeless men, women and children in the greater Boston area Specialized Services: clinics (suboxone, outpatient, transgender), dental, pharmacy, respite, diabetes collaborative, outreach (HIV team, Street team, family team, racetrack)

4. Mentorship PoojaBhalla • Registered Nurse (RN) • Associate director of Clinical Operations • 13 years at the Barbara McInnis House • Multiple roles • Student nurse • Clinical resource nurse • Case manager Community Project Topic Background • Discussion •  initiatives to control obesity of patients •  obesity was an issue in this population • lack of education, resources, finances • Plan •  list of preventative steps • promote/ maintain healthy weight & nutrition habits • cost-effective & practical nfdl.k12.wi.us

5. Public health issue: Obesity Past Present • Food insecurity • linked to poverty • Nutritional deficiencies • Malnutrition • Obesity epidemic in USA • Results from the 2007–2008 National Health and Nutrition Examination Survey (NHANES) • 34.2% of U.S. adults aged 20 years and over are overweight • 33.8% are obese • 5.7% are extremely obese (Ogden & Carroll, 2010) • “the nature of nutritional risk faced by low-income families in the US appears to be shifting from food insecurity to obesity” (Surgeon Call, 2001; Schwarz et al.,2007) www.cdc.gov

6. Facts & Figures Risk Factors Implications • Poverty • Homeless • Low education level • Underemployed/ Unemployed • Family Structure • Single female head of household • Multiple morbidities • Cardiovascular • Hypertension • Foot ulcers • Amputations • Diabetes Mellitus • Mental Illness • Substance Abuse • Nutritional deficiencies • Malnutrition =↓ health • Illiteracy • Poor management of illness/ disease status • ↑ use of Emergency Room • ↑ healthcare costs • Accessibility • Homeless = No means for preparing or storing food • No $ = Binge on junk food • Limited hours & funding of food banks • Morbidity = ↓ activity level • no job

7. Nursing Role  PREVENTION • Primary Prevention • Educate • Cultural & Developmentally appropriate • Learning Styles  auditory, visual, kinesthetic • Assess • Barriers  language, access, literacy rate • Secondary Prevention • Health Screenings • BMI < 24 • Blood Pressure • Glucose • Hemoglobin A 1 C < 7% • Tertiary Prevention • Rehabilitation • Long-term medication

8. Community Health Project • GOAL: • To control obesity in the population served by the Barbara McInnis House. • Population: low-income and homeless individuals with co-morbidities who utilizes services at the Barbara McInnis House • Task 1: • Create a library of resources to inform the community about signs/symptoms of illnesses • Influenza • Noravirus • Task 2: • Create a brochure/ pamphlet educating about cost-effective ways to control weight • translated in various languages (e.g. Spanish, etc). 

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10. Community Health Project (CONT’D) Weight Management Tips • Be Active • Use the stairs • Go for a walk, run, etc • Be active for at least • 30 to 60 minutes per day • 60 minutes/ 3-5x per week • Do passive range-of-motion • Choose healthy options • Avoid fried food • Avoid alcoholic beverages • Limit sugar and salt intake • Choose a variety of whole grain products • Choose foods from the Food Pyramid • Choose FRUITS & VEGETABLES • Stay hydrated  DRINK WATER • Portion control • Small, frequent meals • Meals should be size of fist Normal Ranges Blood Pressure: 120/80 mm Hg Blood Glucose: 70-110 mg/dl Cholesterol levels: <200 mg/dl Body Mass Index (BMI) Normal: 19-24.9 Overweight: 25.0- 29.9 Obese: >30 www.harvardpilgrim.org KNOW YOURNUMBERS

11. References • Boston Health Care for the Homeless Program. (2010). Barbara McInnis House- Boston Health Care for the Homeless Program. Retrieved from www.bhchp.org • Ogden, C., & Carroll, M. (2010). Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1976–1980 Through 2007–2008. Retrieved from http://www.cdc.gov/nchs/fastats/overwt.htm • Schwarz, K., Garrett, B., Hampsey, J. & Thompson, D. (2007). High Prevalence of Overweight and Obesity in Homeless Baltimore Children and Their Caregivers: A Pilot Study. Medscape General Medicine, 9(1): 48. Retrieved from http://www.medscape.com/viewarticle/551711 • Stanhope, M., & Lancaster, J. (2010) Foundations of nursing in the community: Community-oriented practice, (3rd e.d.). St: Louis, MO: Mosby Elsevier. • Surgeon General. (2001). The Surgeon General's Call to Action To Prevent and Decrease Overweigth and Obesity. US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, Rockville, MD.