Health Promotion: Obesity among Adults in Wales
According to the World Health Organization (2017), obesity is a global public health concern. Statistical research data indicates that 63% of adults in England are overweight or obese (Duncan, et al., 2012). Therefore, obesity is an epidemic that must be addressed through effective public health programs and initiatives. Failure to address the problem will ultimately lead to significant straining of NHS resources (Flint, Hudson, & Lavallee, 2015). Serrano & Cardoso (2014) reveal that the NHS spent £6.1 billion between 2014 and 2015 on obesity-related health problems in England. Expenditure on illnesses related to obesity will increase if the epidemic is not effectively addressed (Hamer, Weiler, & Stamatakis, 2014). According to Lang & Heasman (2015), obesity is a complex issue due to its many drivers, including behavioral, biological, environmental, cultural, and physiological factors. The purpose of public health programs on obesity is to address its drivers or determinants and its negative implications on the health of the population (Patterson, Kee, Hughes, & O'Reilly, 2014).
In the context of obesity, public health is defined as programs and initiatives that work towards preventing weight gain and minimizing the burden of obesity on the community (Dare, Mackay, & Pell, 2015). Public health programs on obesity also seek to reduce the burden of the disease on healthcare resources (Well et al., 2014). Dowdle (2016) asserts that public health professionals play an important role in empowering individuals at risk of obesity by encouraging them to adopt active lifestyles and to take healthy diets. Kmietowicz (2013) adds that public health initiatives help people overcome the struggles they face in dealing with weight gain (Dare, Mackay, & Pell, 2017). Public health practitioners create awareness of the problem of obesity, its causes, and effective prevention strategies (Hale, Phillips, & Jewell, 2012). Wunsch (2014) illustrates that public health professionals enable members of the community to make healthier choices among the available options with the purpose of preventing weight gain and obesity. Public health practitioners also advocate for the needs of the community through campaigns that influence local food businesses and outlets to provide consumers with healthier meals (Phillips, Wood, & Kinnersley, 2013). Briggs et al. (2013) show that public health practice also influences policy frameworks related to the health of the population.
Nurses also work towards the prevention of obesity through strategies such as providing nutritional advice and supporting patients with weight management programs (Flint et al., 2015). Swift, Choi, Puhl & Glazebrook (2013) demonstrate that nurses work with professionals in multidisciplinary teams, including public health practitioners and nutritionists, in the design and implementation of strategies for reducing caloric intake and increasing physical activity of individuals who are at an increased risk of obesity (Dare et al., 2017). Health surveys in Wales indicate that 57% of Welsh adults are either overweight or obese (Wills, Evans, & Hopfer, 2017). This essay presents a detailed discussion of obesity, including its main determinants and underlying theories, with the goal of influencing effective health promotion strategies and initiatives for the mitigation of weight gain among adults in Wales. The concerning epidemiological data on the increasing problem of obesity in Wales justifies the discussion in this essay. The essay aims to discuss obesity as a significant public health problem affecting the adult population of Wales and to demonstrate why public promotion programs should be focused on dealing with the problem. The essay begins with a discussion of socioeconomic and environmental factors contributing to the high prevalence of obesity in Wales. Public health policy for addressing obesity in Wales is also part of the essay. The role of a nurse in addressing the problem of obesity is also discussed in this essay.
Overview of the Public Health Issue
There is clear evidence to indicate that obesity is a big problem in Wales. Yogev & Sheiner (2013) demonstrate that obesity is a significant determinant of morbidity and mortality among adults in Wales. Notably, individuals with BMI ≥ 30kg/m2 are categorized as obese (Tampubolon, Subramanian, & Kawachi, 2013). Wunsch (2014) reports qualitative research data indicating that the prevalence of obesity in Wales increases by an average of 3% annually. Hadgraft et al. (2015) affirm that gender and household income are notable determinants of obesity. For instance, Welsh males are affected more by obesity than their female counterparts (Munir, Clemes, Houdmont, & Randall, 2012). McPherson (2014) reveals that obesity affects 51% of women and 62% of men in Wales. However, females from low-income groups have an increased risk of being overweight or obese (Patterson et al., 2014). Chaput et al. (2015) reveal that the prevalence of obesity in Wales is 2.9% higher than the national average. However, there are specific methodological limitations in research that should be considered in the interpretation of data on the prevalence of obesity in Wales and the rest of England (Bullock, Griffiths, Sherar, & Clemes, 2017). For instance, Akin & Nienaber (2015) reveal inconsistencies in research data on the prevalence of obesity in Wales in the context of social variables, such as level of education, ethnicity, gender, and household income. Nonetheless, researchers agree that the high proportion of the Welsh population affected by obesity is a public health concern that needs immediate action.
Welsh health surveys indicate that obesity is associated with material deprivation (Gillman, & Poston, 2012). Notably, people from deprived areas in Wales have an increased risk of being overweight or obese (Mackintosh & Crosbie, 2013). Obesity is increasingly a public health problem in Wales that affects both adults and children. In 2015, the Child Measurement Program reported that 11.6% of Welsh children between the ages of 4 and 5 are obese (NHS Wales, 2017). Adams & White (2015) demonstrate that obesity predisposes adults to a wide range of health problems, including coronary heart disease, hypertension, deep vein thrombosis, menstrual abnormalities, lower back pain, joint problems, and type II diabetes. The many health effects associated with obesity make it an important topic of discussion.
Reducing obesity and increasing physical activity are top priority areas in the design and implementation of public health action plans, strategies, and policies in Wales (Brown, Hole, & Roberts, 2014). Public Health Wales (2017) indicates that by 2050, 60% of the UK population will suffer from obesity. The increasing prevalence of obesity and its negative effects on the physical and psychological well-being of affected populations justifies the discussion in this essay. Obesity is specifically associated with depression and psychological problems, such as low confidence, poor self-image,, low self-esteem (Hale et al., 2012). Therefore, obesity impairs the quality of life of affected populations. Serrano & Cardoso (2014) illustrate that treating obesity is also attributed to a significant increase in healthcare costs in the UK. Public Health Wales (2017) reveals that obesity costs NHS Wales more than £73 million a year. The high cost of obesity necessitates the use of evidence to provide an understanding of socioeconomic and environmental issues related to its prevalence to inform public health programs for its mitigation.
Environmental and Socioeconomic Factors
Economic development, globalization of societies, marketing, and the media are notable forces that influence behaviors and the health of populations (Shelton & Knott, 2014). Obesity is linked to socioeconomic inequalities and complex interactions of macro and micro-environmental determinants. For example, dietary choices are influenced by interrelated socioeconomic and environmental factors, such as personal beliefs, cultural environment, education level, income, and marketing of food products (Tigbe, Briggs, & Lean, 2013). Munir et al. (2012) reveal that individuals at the lower levels of the socioeconomic ladder have increased exposure to an environment of limited access to healthcare, physical inactivity, poor diet, and limited social support. Swift et al. (2013) argue that the relationship between lack of food, poverty, and obesity is complicated. This is because obesity is commonly associated with increased food intake. Researchers focus on explaining how poverty and restricted household budget contributes to an increased risk of obesity. Kmietowicz (2013) demonstrates that there is a strong relationship between obesity, nutrition insecurity, and poverty. Notably, the risk of obesity among people who are food insecure has increased by between 20% and 40% (Wunsch, 2014). A review of literature on the topic reveals that the correlation between food insecurity and obesity has not been comprehensively explained by researchers (Hamer et al., 2014).
A wide range of theories has been put forth to demonstrate why food-insecure people are predisposed to obesity. For example, Kmietowicz (2013) suggests that becoming overweight or obese is relatively inexpensive. Wunsch (2014) explains that in food markets across the UK, sugars and fats are cheap food sources that increase the risk of obesity as they only gratify the physiological demand for energy and provide little nutritional value. Lang & Heasman (2015) theorized that cultural attitudes about food intake and physical activity are influenced by the socioeconomic status of a specific population. Studies from the UK indicate that people who receive welfare benefits have a 40% increase in the risk of developing obesity (Tampubolon et al., 2013). Education is another socioeconomic determinant of obesity. Less educated individuals have limited access to well-paying employment. Akin & Nienaber (2015) illustrate that low earnings negatively impact one's ability of households to afford nutritious foods and increase the risk of obesity.
Hadgraft et al. (2015) indicate that many determinants of obesity have a socioeconomic gradient. For example, medical conditions that are linked to obesity, such as poor dental health, disproportionately affect people from low-income households. Healthy gums and teeth enable people to consume a healthy diet that contains vegetables and fruits. Therefore, poor dental health negatively impacts people from low-income families and increases their risk of obesity (Well et al., 2014). Specific patterns in the intake of food and beverages are also influenced by the socioeconomic status of individuals. For instance, higher consumption of soft drinks and fast food is reported in low-income households (Ntuk et al., 2014). In addition, low-income families have an increased vulnerability to the marketing of unhealthy food products, especially fast food brands (Wills et al., 2017). Furthermore, people from low-income groups are more likely to miss breakfast when compared to high-income earners (Millar, Perry, Broeck, & Phillips, 2015).
Keaver & Webber (2016) reveal that there are more fast food outlets in the UK’s economically deprived neighborhoods than in other areas. This affirms that the intake of healthy foods, such as high-fiber bread, vegetables, and fruit, is directly linked to the socioeconomic status of members of a population. Munir et al. (2012) assert that people from low-income groups have an increased tendency to eat less healthy food products, such as potatoes, meats, and full-fat milk. Additionally, low-income households have limited access to a variety of food products (Wohland, Rees, Nazroo, & Jagger, 2015). Therefore, low-income earners are less likely to change or improve their diets. Financial constraints specifically influence the food consumption behaviors of members of the community (Twaij et al., 2013).
The built environment of a community determines the nature of the physical activity of its members (Swift et al., 2013). The work and school environments specifically influence physical activity and the predisposition of a population to obesity. McPherson (2014) demonstrates that urban design and transport systems are other notable aspects of the built environment that influence the physical activity of members of a population and their health. Frayling (2012) asserts that low-income groups have less access to green spaces and exercise facilities. Additionally, economically deprived areas have fewer areas that encourage people to adopt healthy lifestyles (Ziauddeen, Farooqi, & Fletcher, 2012). Briggs et al. (2013) demonstrate that poor neighborhoods in London have a limited number of safe parks, community gardens, paths, pavements, and streets. Notably, the unsafe built environment discourages healthy lifestyles, such as cycling and jogging (Phillips et al., 2013).
Yogev & Sheiner (2013) assert that levels of physical activity in the UK are generally low. Adams & White (2015) report findings of Eurobarometer surveys indicating that 21% of respondents do not walk for more than 10 minutes a day. Sedentary lifestyles limit the ability of community members to engage in active physical activities (Brown et al., 2014). Chaput et al. (2015) explain that sedentary activities, such as excessive watching of television, limit the time spent in active physical activities, which results in an increased predisposition to overweight and obesity. Many workers in the UK also engage in little or no physical activity at work (Munir et al., 2012). Fitness centers and sports clubs are also not adequately used by low-income groups in the UK (Ntuk et al., 2014). Therefore, it is the prevalent physical inactivity of populations in the UK that increases their risk of obesity.
Underlying Theory
The health belief model is used to describe both the socioeconomic and behavioral factors that contribute to the increased risk of obesity. According to the health belief model, social, behavioral, and psychological factors influence the perceptions of individuals regarding the threat of a specific health problem (Campbell, 2014). For instance, perceptions of individuals regarding the threat of obesity influence their behaviors and actions that increase their susceptibility (Gillman, & Poston, 2012). Socioeconomic status, ethnicity, gender, knowledge, and age are some of the modifying factors that influence the perceptions of individuals on the susceptibility and severity of a health condition (Wills et al., 2017). Socioeconomic status influences perceptions related to barriers to action for the mitigation of obesity (Shelton & Knott, 2014). According to Keaver & Webber (2016), barriers, such as unemployment and low income, influence people’s perceptions of healthy eating. Individuals from low-income households take little action to mitigate obesity, such as eating healthy foods, because of perceived socioeconomic barriers (Ziauddeen et al., 2012).
Marketing of unhealthy food products influences the perceptions of consumers and their purchase decisions (Summer, 2013). The health belief model postulates that it is the level of perceived severity that influences actions individuals take to prevent illness (Tigbe et al., 2013). The cost-effectiveness, availability, and positive marketing of fast food products specifically influence the perceptions of consumers in Wales (Gillman & Poston, 2012). Therefore, the high incidence of obesity in Wales can be attributed to inadequate knowledge of the severity of obesity and the role of unhealthy foods in weight gain. Lack of education also limits the knowledge of individuals about healthy eating and physical activity and increases their risk of obesity (Duncan et al., 2012). The health belief model also states that specific cues of action influence people’s health behaviors (Summer, 2013). Lack of cues of action, such as built environments that encourage participation in physical activity, is attributed to the high incidence of obesity in Wales (Swift et al., 2013). Dowdle (2016) shows that low-income families do not engage in adequate leisure and physical activities due to socioeconomic constraints and lack of cues of action, such as accessible sports clubs and fitness centers (Bullock et al., 2017).
The theory of reasoned action is also applicable to understanding the increasing incidence of obesity in Wales. The theory states that intention is the main key to change in behavior and healthy living (Ntuk et al., 2014). The theory of reasoned action indicates that an individual’s intention to live a healthy lifestyle is influenced by beliefs and attitudes (Millar et al., 2015). Notably, people’s socioeconomic conditions and environments influence their beliefs and attitudes regarding food consumption and physical activity. Therefore, determinants of socioeconomic status, such as education, employment, household income, welfare benefits, and social isolation, determine people’s intentions to live healthy lifestyles and to prevent obesity (Twaij et al., 2013). Tigbe et al. (2013) illustrate that social isolation limits the physical activities of the affected population and predisposes them to the risk of gaining weight and becoming overweight. Researchers relate abuse of alcohol and smoking with low socioeconomic status (Twaij et al., 2013). According to Mackintosh & Crosbie (2013), the negative social experiences of people from low socioeconomic groups, such as poverty and household conflicts, increase their risk of alcoholism and smoking. Keaver & Webber (2016) report valid exploratory studies showing that alcoholism and smoking are among the main determinants of obesity.
According to the theory of reasoned action, a subjective norm often limits the intention of people to engage in positive health behaviors (Wohland et al., 2015). The social environment is attributed to subjective norms related to eating behaviors and physical activity. For example, people who live in a community in which eating cheap fast food is normal are less likely to opt for healthier options (Yogev & Sheiner, 2013). Therefore, the social environment and cultural norms subject people to specific health habits that increase their risk of being overweight or obese.
The social cognitive theory states that health behaviors are effectively described in the context of environmental influences and personal factors (Tigbe et al., 2013). Therefore, this theory is useful in understanding specific environmental and personal influences of unhealthy behaviors and associated increased risk of obesity. The concepts of the social cognitive theory that are applicable in explaining the high incidence of obesity in Wales include observational learning, reinforcement, behavioral capability, expectations, and self-efficacy (Gillman & Poston, 2012). Observational learning is the process of watching others engage in specific health behaviors. A social environment that does not provide opportunities for observational learning from people who eat healthy increases the risk of a population to obesity (Brown et al., 2014). Reinforcement refers to the use of rewards to promote desired behavior (Dare et al., 2015). Lack of adequate reinforcements, such as health education campaigns would be attributed to the high prevalence of obesity among adults in Wales.
Behavioral capability refers to the skills and understanding of individuals that influence their ability to engage in desired health behaviors (Twaij et al., 2013). Lack of understanding of the importance of physical activity is associated with weight problems within a population (Frayling, 2012). Expectations are the outcomes of health behavior. Members of a population assume positive health behaviors when the expected benefits are worthwhile (Tigbe et al., 2013). Mackintosh & Crosbie (2013) assert that poor eating habits among obese people are attributed to a limited understanding of the long-term benefits of healthy lifestyles. Self-efficacy is the ability of a person to take control over behavior for desired health outcomes (Campbell, 2014). Summer (2013) demonstrates that obese people lack the self-efficacy to engage in positive behaviors and actions, such as exercising and increasing the intake of fruits and vegetables.
Impact of the Welsh Government Policy
The Welsh government's public health policy on obesity is understood under eight main themes: health service interventions, food poverty, weight management programs, awareness raising, food in schools, planning and transport, sports and physical activity, and taxes on unhealthy foods (Goodman, 2013). The health service interventions of the Welsh government on obesity are implemented at four levels. The first level includes community-based early interventions, such as self-care and behavior change (Tampubolon et al., 2013). Programs that implement first-level interventions focus on providing members of the community with advice on physical activity and proper nutrition (Dowdle, 2016). Second-level interventions are implemented through weight management programs that target families and children at high risk of obesity (Goodman, 2013). The third level interventions are specialist weight management services offered to obese adults, young people, and children. The fourth level of interventions includes surgical services and specialist medical services (Tampubolon et al., 2013). The health service interventions of the Welsh government are aligned with the “Our Future Health” framework. Public Health Wales (2017) reveals that the “Our Future Health” framework is based on six key areas: reduced health inequalities, early intervention,n and prevention, promotion of health and wellbeing, building healthy and sustainable communities, strengthening evidence and monitoring, control, and addressing health as a shared goal.
Public Health Wales (2017) provides evidence of food poverty by demonstrating that people from deprived communities in Wales are less likely to keep healthy diets. However, there are no specific policy interventions for addressing food poverty in Wales (Goodman, 2013). The planning policies of the Welsh government are not informed by the fact that planning and policymaking have a direct impact on the health of the population (Keaver & Webber, 2016). Tampubolon et al. (2013) suggest that the planning policies of the Welsh government should provide for walking and cycling routes, safe play areas, cycle parking, congestion charging, and traffic calming to ensure that spaces and infrastructure encourage physical activities and work towards the prevention of obesity. The UK government encourages voluntary action by stakeholders of the food industry, such as manufacturers and retailers, rather than an increase in regulations (Dowdle, 2016). The stand of the UK government has influenced the Welsh policy on the regulation of the food industry. This is because there are no strict regulatory frameworks in Wales, such as increased taxation of unhealthy foods (Keaver & Webber, 2016). Tampubolon et al. (2013) recommend that the Welsh government should increase taxes on unhealthy foods by 20% to cut their consumption and reduce obesity. Goodman (2013) adds that healthy foods, especially vegetables nd fruits, should be subsidized to encourage changes in dietary habits in Wales. Taxation of unhealthy foods will influence the perceptions of members of Welsh society on the severity of unhealthy diets, as postulated by the Health Belief Model (Keaver & Webber, 2016).
Role of a Nurse
Nurses play an important role in promoting the health of individuals and populations. Zhu, Norman & While (2013) demonstrate that nurses assess the health needs of individual patients, families, and sub-populations to identify health promotion strategies that would effectively prevent illness, disability, injury, and premature death (Kemppainen, Tossavainen, & Turunen, 2013). This includes the determination of the BMI of patients and establishing their risk of developing obesity or its complications. Nurses also participate in the planning of public health interventions that are aligned with the identified health needs of the population (Phillips, Wood, & Kinnersley, 2013). In the context of obesity, nurses participate in the implementation of population-based interventions for the mitigation of weight gain (Kemppainen et al., 2013). Zhu et al. (2013) suggest that nurses should play active roles within multidisciplinary teams, which include public health professionals, social workers, and clinicians, in the implementation of multifaceted strategies for the prevention of obesity at the family and population levels. Notably, nurses educate patients and provide them with nutrition advice with a vietoof encouraging lifestyle changes and preventing obesity (Phillips et al., 2013).
Public health nursing is an important practice that contributes to health promotion programs and the implementation of initiatives that protect the health of at-risk populations (Kemppainen et al., 2013). For example, public health nurses work with social workers, volunteers, and public health professionals in engaging at-risk groups and populations for the successful implementation of screening, health education, and treatment interventions (Zhu et al., 2013). Nurses also participate in the evaluation of public health interventions for the prevention of obesity. Phillips et al. (2013) indicate that nurses should apply the findings of the evaluation of health promotion programs to inform the delivery of care at the community level. In addition, nurses act as advocates for their patients by pushing for changes in health policy through their professional organizations (Kemppainen et al., 2013). More importantly, nurses support evidence-based practice in public health by engaging in research processes, such as on the prevention of obesity among at-high-risk groups.
Conclusion
Statistical evidence on the prevalence of obesity indicates that it affects 60% of the UK population. Obesity is also a public health concern in Wales because 57% of Welsh adults are either overweight or obese. Analysis of research literature reveals that obesity is a complex problem because it is influenced by a wide range of factors, including behavioral, biological, environmental, cultural, and physiological determinants. Empirical research shows that obesity predisposes adults to a wide range of health problems, including coronary heart disease, hypertension, deep vein thrombosis, menstrual abnormalities, lower back pain, joint problems, and type II diabetes. Therefore, it is a serious problem that should be addressed immediately through multifaceted approaches, which include public health policy interventions, changes in regulatory frameworks, and effective planning of public services, such as transportation, sports, and public spaces. Healthcare providers, including public health professionals, clinicians, nurses, and social workers, should work collaboratively in the planning and implementation of evidence-based interventions for the prevention and mitigation of obesity and its complications. Nurses play an important role in assessing the health needs of individuals, families, and sub-populations. Healthcare practices in nursing should be aligned with public health objectives and interventions for the alleviation of obesity.
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