Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Application of the Epidemiological Model: Community-Based Interventions for the Management of Obesity in Children and Young Adults

Academic journal article Forum on Public Policy: A Journal of the Oxford Round Table

Application of the Epidemiological Model: Community-Based Interventions for the Management of Obesity in Children and Young Adults

Article excerpt

Abstract

Healthy People 2010 identifies that one of the ten leading health indicators representative of the relative state of health of Americans is overweight and obesity (www.healthypeople.gov). The Institute for Medicine (IOM, 2005) has identified obesity in children and young adults as having reached epidemic proportions in the United States. This problem is noted nationally throughout the United States and is evidenced on individual state (i.e. Virginia), regional (i.e. the Hampton Roads area of Virginia) and local levels (i.e. Norfolk and Virginia Beach). The epidemic proportions of the obesity in children and young adults require interventions beyond that of the traditional one-to-one intervention format. A community focused intervention strategy must be employed to target aggregate level health promotion. This community-based format supports approaches aimed at intervention at points in the natural history of obesity in the prepathogenic stages; this primary prevention can be planned and implemented with focus on modification of agent, host or environmental factors that are significant in the presence of obesity in children and young adults in a particular community. Obesity prevention strategies such as nutritional intervention following an epidemiologic model can be implemented on the local and regional levels to address the health problems related to obesity. Integration of the epidemiologic model within community-based programs provides the format for focusing on the obesity epidemic. Selected exemplars will be presented to illustrate these approaches.

Introduction

Obesity has been transformed from being considered the result of an individual's lack of self-control to being identified as a dilemma in relation to global wellbeing. A dilemma in which obesity serves as the source of a myriad of health concerns (Eberwine 2002 ). Specifically, obesity is identified as an epidemic in the United States (Dietz and Gortmaker 2001) and concern is mounting in other countries and cultures (Haslan and James 2005). The concomitant health risks and costs associated with obesity are a major focus of health promotion and wellness agendas.

Obesity may be defined in terms of Body Mass Index (BMI) [greater than or equal to] 95th percentile (Dietz and Gortmaker 2001), and although this is a valid definition, it excludes the complexity of obesity as a bio-psycho-social disease process. Obesity, as a physical, social and environmental disease is a prime example of the holistic nature of an illness process. The three key determinants of the expression of obesity are genetic predisposition, dietary intake, and energy expenditure. Obesity has become a significant public heath problem (Haslan and James 2005). Results of the 1980 National Health Examination II and the 1994 National Health Examination Survey III support the determination that while the genetic base of the population did not substantially change over that period of time, the environmental variables of calorie intake and energy expenditure accounted for the 100% increase in number of children and adolescents determined to be obese. This increase correlates with an accounting of 10-15% of children and adolescents in the United States as being obese (Dietz and Gortmaker 2001).

A component of the obesity epidemic which is of particular concern is the rise in obesity rates among children and adolescents (Mercer 2005). The physical costs alone of obesity are well known and evident in the medical community. Complications of adult obesity include cardiovascular disease, stroke, diabetes and hypertension (Ignatavicius and Workman 2006). In accordance with the explosion in childhood obesity, it is projected that the expression of these obesity-related health outcomes will be evidenced by an earlier onset and perhaps an accelerated severity. In addition to the physical consequences of childhood obesity, psychosocial and economic consequences abound. …

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