Morbid Obesity

1. Morbid Obesity Katie Romo, Nina Pena, Regina Eason, Jeffrey Moore, Rosario Alvarez, Kelly Squire-Hamblet & Carly Marre

2. Introduction • The National Institutes of Health (NIH) defines morbid obesity as: • Being 100 pounds or more above your ideal body weight • Body Mass Index (BMI) of 40 or greater • BMI of 35 or greater and one or more co-morbid condition • According for the Centers of Disease Control and Prevention, more than one-third of the adult population is obese (CDC, 2012). • The disease of morbid obesity interferes with basic physical functions and can lead to: • Breathing difficulties • Functional mobility • Shorter life expectancy • Type 2 diabetes • Heart disease

3. Sociocultural • Societies altered eating habits • Restaurants vs. Home cooked meals • Portions Control • Culture • “Fast food nation” • Social impact • Emotional Outlet • Most individuals described themselves as “chubby” kids and identified and associated with similar peers.

4. Socioeconomic • Cost of living • Lack of access • Lack of resources • Losing weight costs money

5. Diversity Factors • Morbid Obesity does not discriminate against race, gender, sexual orientation, SES, or any other pertinent factor. • According to the Centers for Disease Control and Prevention (2012), some populations have a higher prevalence to obesity: • Ethnicity • Non Hispanic Black (49.5) • Mexican American (40.4%) • Income (High vs Low) • Education “Not really because it depends on who you associate with and I associate with people of my own kind, I guess you can say that.”

6. Lifestyle choices • Decreased physical activity • Unwillingness to participate in social events or activities “It’s uncomfortable to sit in a chair, it’s uncomfortable to stand. And everything is just so awkward and tiring, and you just don’t want to do it.” “Shopping for clothing is probably the most difficult task; the stares, laughter and disgust on people’s faces are more than I can stand.”

7. Oppressed and/or Marginalized • Social stigma • If your overweight, you are seen as “lazy”, “unattractive” and “unlovable” • Social isolation • Unable or frightened to find meaningful relationships “I was overweight as child and excluded from athletic and social groups growing up. I also felt that dating was not possible for me due to my appearance.” • Unable to gain employment • Physical limitations due to weight • Discrimination based on their physical appearance • Judgment and scrutiny from healthcare providers • Suffer feelings of depression, anxiety and low self-worth “I currently attend appointments with a psychologist because there was a point in my life where I had considered suicide. I started visiting a psychologist as a way to get help and I feel this is my only current form of support.”

8. SOCIAL JUSTICE

9. Social Justice “I have been discriminated in so many ways I don’t know where to begin” • Overeating • Morbid Obesity • Discrimination/Exclusion • Chronic Stress • Increased cortisol levels, high blood pressure, diabetes • Depression • Overeating

10. Occupational Deprivation “Been called hippo, whale, elephant, gorilla, butterball. This constantly happens, even as an adult.” • Social exclusion and isolation • The occupation of childhood • Adult occupations of leisure/social participation

11. Occupational Deprivation “One day I was pulled aside by two of my [beauty college] tutors and told I was in the beauty industry and I had to go on a diet…I was humiliated once again and not accepted.” – Sandra • Limited access to nutritious food and safe play areas • Limited access to services based on funds or physical size • Limited job opportunities

12. Health Disparities “I had a back issue and went to the emergency room. And the doctor just said I was too fat and to lose weight and that will help my back. Didn’t do any exams, or X-rays, or anything else.” • Not getting equal time or treatment from providers • Being viewed as stupid or less intelligent • Instead of treating the root cause, the doctors try to solve the symptoms • Low self-esteem

13. Occupational Therapy Role “I think just to not judge a book by its cover.  Whether a person is overweight, or really underweight, or really shy, there’s usually a back story.  There’s usually reasons why someone is the way that they are.” • Therapeutic rapport • Client-centered • Holistic interventions

14. Occupational Therapy Role “I would love the support, it helps me stay motivated, though at this moment I am not sure where else to turn that doesn't cost anything. I don't want to give up, but after years of trying to find help, it gets emotionally and mentally exhausting.” • Education • Advocacy • Community Resources

15. Beliefs Values Customary Practices

16. Beliefs • Right to participate in life • Right to work • They are more than their weight. • Outings and social events can be physically and mentally exhausting • Losing weight is easier said than done • Food is sometimes used to provide comfort and support that people do (will) not provide them.

17. Values • Family (especially their children) • Being independent • Being a part of society • Mental and physical health

18. Customary Practices • Food often utilized for comfort or support. • Childhood factors play a role • May have developed their own compensatory strategies for dressing and bathing • May avoid social events due to exhaustion, pain, and social discrimination • Often are secluded in their homes for multiple reasons • Struggle to manage their health-care

19. Informative Sources

20. Book: Underneath the Fleshby Alexandra Gallagher Mearns • Autobiography • Child Abuse • Compulsive eating • Discrimination • Psychosocial issues • Health issues • Difficulty with: • Functional mobility • ADLs • IADLs

21. Book: Underneath the Flesh

22. Scholarly Articles Sources: • Obesity Research • Canadian Journal of Occupational Therapy • Social Science & Medicine • American Journal of Occupational Therapy • Journal of American Bioethics • Critical Care Nursing Quarterly

23. Public Press Articles Sources: • New York Times • Health Day Website • Huffington Post • Atlantic Magazine • Glamour Magazine

24. Interviews • Individuals who are morbidly obese • Individual who have been morbidly obese

25. Group Time

26. Case Study • Alexandra or “Sandra” is 29 years old and weighs 392 lbs. She is a single mother with two young children. Sandra has reported that she is unable to bend or kneel. Sandra would like to make some major changes in her life, but does not know where to start. A local hospital referred an occupational therapist to her home in order to assess her current living situation.. • Besides the information in the case study, what other information do you think would be good to gain from talking to Sandra? • If you were the therapist, what do you think would be a good recommendation for Sandra? • Please utilize the OTPF….

27. Class Discussion

29. References • Ambinder, M. (2010). Beating obesity. Atlantic Magazine. Retrieved from http://www.theatlantic.com/magazine/archive/2010/05/beating obesity/308017 • Brown, Harriet. (2010, March 15). “For Obese People, Prejudice in Plain Sight.” The New York Times. Retrieved from http://www.nytimes.com/2010/03/16/health/16essa.html?_r=0. • Cahill, S. M., & Suarez-Balcazar, Y. (2009). The issue is- Promoting children’s nutrition and fitness in the urban context. American Journal of Occupational Therapy, 63, 113-116. • Centers for Disease Control and Prevention. (2012). Adult obesity facts. Retrieved from http://www.cdc.gov/obesity/data/adult.html • Clementson, J.A. (2003). Improving Rehabilitation of Severely Obese Patients. Rehabilitation Nursing, 28 (6), pp. 171, 191. • Forhan, M.A.,Law, M.C.,Taylor, V.H., Vrkljan, B.H.(2010). The experience of participation in everyday occupations for adults with obesity. Canadian Journal of Occupational Therapy, 77, 210-218. • Gardner, A. (2013, February 26) Many obese Americans struggle with stigma, discrimination, poll finds. Retrieved from http://consumer.healthday.com/Article.asp?AID=667697 • Golomb, B., & Koperski, S. (2010). Pondering the ponderous: are the 'moral challenges' of bariatric surgery morally challenged?. American Journal Of Bioethics, 10(12), 24-26.

30. References Gordon, S. (2002, May 3). Bullies Target Obese Kids. Retrieved from http://health.usnews.com/health-news/family-health/brain-and- behavior/articles/2010/05/03/bullies-target-obese-kids Mearns, A.G.(2007). Underneath the Flesh. Brentwood, United Kingdom: Chipmunkapublishing. Palermo, T. M. and Dowd, J. B. (2012). Childhood obesity and human capital accumulation. Social Science & Medicine, 75. Retrieved from http:// http://www.sciencedirect.com.lb- proxy2.touro.edu/science/article/pii/S0277953612005989. Petronis, L. (2012, October 3). Body image: Check out this anchor’s amazing on-air response to a viewer who called her “obese”. Glamour, 169-171. Puhl, R. & Brownell, K. (2012). Bias, discrimination, and obesity. Obesity Research, (9)12, 788- 805. Retrieved from EBSCOhost Sorensen, R. (2003). A personal perspective on the needs of the weight loss surgery patient. Critical Care Nursing Quarterly, 26(2), 150-157. Wilkie, C. (2012, October 4). Obesity discrimination on the job provokes dispute over best remedy. Retrieved from http://www.huffingtonpost.com/2012/10/04/obesity discrimination_n_1939385.htm