Obesity in Mecosta County

1. Obesity in Mecosta County KettieChapeyama, Amanda Labarge, ChinyerePortee, Kelly Pasch, and Debra Weaver

2. Analysis • HOST: Risk factors include having parents who also were obese, low socioeconimic status, and unemployment • AGENT: Genetics, and foods with chemicals and sugars are argued to be agents of obesity in adults. • ENVIRONMENT: Unemployment rate in Mecosta county is 11% and estimated median household income in 2009 was $26,395. Acccess to healthcare is limited by income and health insurance coverage. There is a large amount of available providers in Mecosta County.

3. Analysis Cont. • The obesity rate of Mecosta County is 5% higher then the benchmark • Others factors contributing to an increase in obesity include low household income levels ,use of expensive, unhealthy convenience foods, lack of organized recreation for adults, and lack of obesity prevention programs. • This problem effects all ages in Mecosta County, however our data focuses on adults. Source: County Health Rankings (2011).

4. Analysis Cont. • The obesity rate of 30% in Mecosta County shows a need to address the obesity epidemic. • Community Nurses need to focus on primary prevention, secondary prevention and teritiary prevention of this problem. However, educating and implementing startgeies to increase healthier eating and exercsie would be the most beneficial. • The local health department, park and recreation, service groups, and Ferris State Univeristy are all groups that should get involved in the obesity problem in Mecosta County. This collaboration would be very beneficial to the obese and potential obese.

5. 2011 Mecosta County, Adult Obesity • Summary Data- Range in Michigan(Min-Max): 26-36% Overall in Michigan: 31% National Benchmark: 25% (90th percentile) Mecosta County Percent obese-30% Ages-25 yrs.-35yrs Source: County Health Rankings (2011).

6. Source: County Health Rankings (2011).

7. Defining Overweight and Obesity • Overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. Source: Centers for Disease Control and Prevention (CDC) (2010).

8. Definitions for Adults • For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the "body mass index" (BMI). BMI is used because, for most people, it correlates with their amount of body fat. • An adult who has a BMI between 25 and 29.9 is considered overweight. • An adult who has a BMI of 30 or higher is considered obese. Source: Centers for Disease Control and Prevention (CDC) (2010).

9. Health Effects of Overweight and Obesity • Research has show that as a person’s weight increases to the levels of “overweight” and “obese” the risks for the following increase: • Coronary heart disease • Type 2 diabetes • Cancers (endometrial, breast, and colon) • Hypertension (high blood pressure) • Dyslipidemia (for example, high total cholesterol or high levels of triglycerides) • Stroke • Liver and Gallbladder disease • Sleep apnea and respiratory problems • Osteoarthritis (a degeneration of cartilage and its underlying bone within a joint) • Gynecological problems (abnormal menses, infertility) Source: Centers for Disease Control and Prevention (CDC) (2011).

10. 2010 Adult obesity

11. 2008 Age-Adjusted Estimates of the Percentage of Adults Who Are Obese in Michigan Source: Centers for Disease Control and Prevention (CDC) (2008).

12. Risk Factors for Premature Death: Mecosta County, MI nrf No report, survey sample less than 50 Source: Community Health Status Indicators (CHSI) (2009).

13. Michigan 2010 Critical Health Indicator-Obesity Source: Michigan Department of Community Health (MDCH) (2010).

14. Michigan 2010 Critical Health Indicator-Obesity Source: Michigan Department of Community Health (MDCH) (2010).

15. Self-reported prevalence of obesity* among adults --- Behavioral Risk Factor Surveillance System, United States, 2000, 2005, and 2009

16. The Caloric Balance Equation • Overweight and obesity result from an energy imbalance. This involves eating too many calories and not getting enough physical activity. • Body weight is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status. • Behavior and environment play a large role causing people to be overweight and obese. These are the greatest area for prevention and treatment actions. Source: U.S. Department of Health & Human Services (2001).

17. Contributing factors to Obesity • Genetics • Environment • Choices in Eating and Physical Activity • Diseases and Drugs Source: Centers for Disease Control and Prevention (CDC) (2009).

18. Public Policy • In 2009, the CDC initiated the Common Community Measures for Obesity Project (the Measures Project) to assess the implementation of policy and environmental changes at the community level. • The goal of this project was to identify and recommend a set of obesity prevention strategies and suggested measurements that the local governments and communities can use to plan, implement, and monitor initiatives to prevent obesity. • In 2004, the Healthy Lifestyles and Prevention American Act or HeLP America Act was introduced into Congress. The purpose of the bill is to improve the health of Americans and minimize health care by restructuring the Nation’s healthcare system towards prevention, wellness, and self care • Also in 2004, the Healthy Lifestyles Act of 2004 was introduced. Its purpose was to provide for the implementation of physical activity and nutrition in schools, worksites, and communities to help in the prevention of obesity for all Americans. Source: Centers for Disease Control and Prevention (CDC) (2009).

19. Public policy cont. • The Labeling Education and Nutrition Act (LEAN) of 2009-amends the Federal Food, Drug, and Cosmetic Act to authorize a food service establishment to provide nutrition on a food item: 1. providing calories and nutrient information required for food for human consumption. • In 2006, the Food and Drug Administration (FDA) required food manufacturers to list trans fat on Nutrition Facts with saturated fat, and cholesterol (1993). (Congressional Research Service Summary, 2009). • The Michigan Department of Community Health developed the Nutrition, Physical Activity and Obesity Program. Its goal is to prevent and control obesity and other chronic diseases through healthy eating and physical activity. The program has 6 principle targets: Increase physical activity     ·         Increase the consumption of fruits and vegetables       ·         Decrease the consumption of sugar-sweetened beverages     ·         Increase breastfeeding initiation, duration and exclusivity      ·         Reduce the consumption of high-energy-dense foods       ·         Decrease television viewing (Michigan Department of Community Health (MDCH), 2010).

20. Public policy cont. • The Local Advisory Group Project is a project within Building Healthy Communities Program that provides funding to local health departments to incorporate nutrition education and physical activity promotion (MI Healthy Communities, 2010).

21. o Source: Centers for Disease Control and Prevention (CDC) (2010).

22. Nursing Diagnosis Risk of Obesity among adults in Mecosta County related to lack of knowledge.

23. Plan • Partner with local community-based organizations such as the Hospital, businesses, Ferris State University, and government agencies to hold a health fair that offers obesity prevention, BMI screening, nutrition information and physical activity education.

24. Interventions

25. Hospital • The Community Health/public Nurse is to meet with the administration of the hospital to develop obesity education brochures emphasizing nutrition and physical activities. These should be posted in common areas and patients rooms. • Educate the nurses on supporting the community by encouraging patients to eat the right diet provided in the hospital. This can be evaluated according to the menus ordered from the hospital kitchen at the end of the year. • Use of educative channels or videos on diseases that are a result of obesity on prevention and promotion. Nurses to evaluate the patients after hospital stay to monitor response. • Encourage and educate patients the importance of exercises such as walking for 30-60 minutes a day, working in the yard, or doing chores in the house.

26. Food Pyramid Source: United States Department of Agriculture (USDA) (2010).

27. Businesses • The Community/Public Health Nurse in collaboration with the Bureau of Food Safety and Community Sanitation who are responsible to monitor the food handlers should work together to implement and educate food handlers in Restaurants to incorporate healthy nutrition by providing health menus of low in fat, cholesterol and calorie. This should be evaluated at the period of one year for effectiveness of the menu change • Advertising by menu labels, server pins, window decals, posters, and comment cards will enhance customers to order the right menus and discourage them from fast food once reasons are stated on the advertising labels. • Grocery stores and food markets can post brochures about nutritious foods such as fruits, vegetables, calories, and cholesterol.

28. Ferris State University, Community Health Department and the community. • Collaborating in organizing a fair with schools and the community within Mecosta county to focus on the prevention and management of obesity. • Include education about the Food Pyramid and healthy foods such as locally grown vegetables and fruits,. • Education about free physical activities. Examples include walking the dog, running, playing sports, and swimming, with a goal of increasing the amount and duration of exercise. These activities promote long-term weight loss in adults. Source: New York State Department of Health (2011).

29. The information about screening places, such as the Dept. of Health to know whether one is overweight or obese by using Body Mass Index • School, parents, community and government agencies work together, with schools to see that students are provided with the right nutrition and that school activities are maintained and after school activities are initiated. • There should be follow up after a year at the next county fair. • Provide education on building, strengthening, and maintaining supportive social network. • education on increasing physical activity and availability of places where people can safely walk for leisure such as work, schools, and shopping malls. • Source: New York State Department of Health (2011).

30. EVALUATIONS • The brochures will be given out to the community and the patients will then be asked about the brochures and if they where informative and helpful and then the nurse can evaluate with the patient by evaluating their knowledge of diets and obesity. • Patients in the hospitals should watch a video on obesity and then answer a few questions related to obesity and the nurse can review and go over the questions to assist the patient in further understanding; repetitiveness helps people retain the information a little more.

31. Evaluations The fast foods restaurants should have surveys completed after this information is posted to check their sales of certain foods that are high in calories or is there and overall decrease in sales. This should be done at 3 months to see initial shock then at 6 months then 1 year. With grocery stores they make it hard for people to afford healthy foods and with this they should reduce the prices of healthy foods or have an increase in sales in these foods to make them more accessible to people. This should be passed to the manufacture to promote them to reduce the prices. This could be evaluated by the increase in sales and surveys that the grocery store can give on receipts like business’s do.

32. Evaluations • If companies made the labels a little easier for a normal person to understand then maybe people could adjust their diet plans a little better and accordingly. When companies do this and people actually are able to understand what they are eating, we then survey those manufactures about their sales if there are increases in sales or decrease’s. • With the schools having health fairs they can have volunteers doing surveys which ask questions on things that where helpful and also getting personal information and asking if they can follow up in 3 months to see if progress was made with information that was gain from the health fair. Also the health fair could have free gym membership as door prizes to get people motivated if they win to put them on the right track.

33. References Centers for Disease Control and Prevention (CDC). (2011). Healthy weight-it’s not a diet, it’s a lifestyle! Retrieved from http://www.cdc.gov/healthyweight/effects/index.html. Centers for Disease Control and Prevention (CDC). (2010). Overweight and obesity. Retrieved from http://www.cdc.gov/obesity/defining.html. Centers for Disease Control and Prevention (CDC).(2009). Causes and consequences. Retrieved from http://www.cdc.gov/obesity/causes/index.html. Centers for Disease Control and Prevention (CDC). (2009). Morbidity and mortality weekly report. Retrieved from cdc obesity.pdf. Centers for Disease Control and Prevention (CDC). (2008). National Diabetes Surveillance System. Retrieved from http://apps.nccd.cdc.gov/DDTSTRS/default.aspx. Centers for Disease Control and Prevention (CDC). (2004). Federal Obesity-related legislation. Retrieved from http://www2a.cdc.gov/phlp/Federal_obesity.asp. Community Health Status Indicators (CHSI). (2009). Risk factors for premature death: Mecosta County, MI. Retrieved from http://www.communityhealth.hhs.gov/RiskFactorsForPrematureDeath.aspx?GeogCD=26107&PeerStrat=32&state=Michigan&county=Mecosta.

34. References cont. Congressional Research Service Summary (2009) H.R. 1398 Labeling Education and Nutrition Act (Lean). Retrieved from http://www.govtrack.us/congress/bill.xpd?bill=h111-1398&tab=summary. County Health Rankings. (2011). 2011 Health outcomes-Michigan. Retrieved from http://www.countyhealthrankings.org/sites/default/files/state/downloads/2011%20Health%20Outcomes%20-%20Michigan.png County Health Rankings. (2011). 2011 Mecosta, Michigan Adult Obesity. Retrieved from http://www.countyhealthrankings.org/michigan/mecosta/11. Food and Drug Administration (FDA). (2006). Trans fat now listed with saturated fat and cholesterol on the nutrition facts label. Retrieved from http://www.fda.gov/Food/LabelingNutrition/ConsumerInformation/ucm109832.htm Michigan Department of Community Health (MDCH). (2010). Michigan critical health indicators. Retrieved from http://michigan.gov/mdch/0,1607,7-132-2946_5093-17501--,00.html. Michigan Department of Community Health (MDCH). Nutrition, physical activity and obesity program. Retrieved from http://michigan.gov/mdch/0,1607,7-132-2940_2955_2959_3208-148846--,00.html.

35. References cont. MI Healthy Communities. (2010). Michigan Nutrition Network. Retrieved from http://mihealthtools.org/mihc/MichiganNutritionNetwork.asp. New York State Department of Health. (2011). New York Strategic Plan for Overweight and Obesity Prevention. Retrieved from http://www.health.state.ny.us/prevention/obesity/strategic_plan/docs/strategic_plan.pdf. New York State Department of Health. (2011). Obesity prevention. Retrieved from http://www.health.state.ny.us/prevention/obesity/. United States Department of Agriculture (USDA). (2010). Food guide pyramid. Retrieved from http://www.the-food-guide.com. United States Department of Health & Human Services. (2001). The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Retrieved from http://www.surgeongeneral.gov/topics/obesity/.