Obesity in Kentucky
Introduction
Health professionals have been issuing warnings of an obesity crisis in the USA. People with Body Mass Index (BMI) scores of 30 or over are obese (Suwanski, 2010). Trust for America’s health indicates that 64.5 percent of American adults are either obese or overweight (Lambert & Min, 2010). In 2009, Kentucky was ranked the fourth highest in obesity rate at 31.5, after Mississippi with 34.4, Louisiana with 33 and Tennessee at 32.3 percent (Suwanski, 2010). A study done in 2012 revealed that Kentucky ranked 10th in the United States for having the worst rates of obesity (Berkshire, 2012). According to a study on Obesity and cardiovascular disease among manufacturing companies workers in Kentucky, more than 77% of the participants were either overweight or obese. Females had an increased prevalence of at risk waist circumference and this was associated with unhealthy dietary practices (Berehm, Gates, Singler, Poeppelman, Succop, & Alessio, 2007). If the numbers keep escalating, more people will be at risk of complications of obesity such as heart disease, stroke, diabetes and cancer.
Health care in Kentucky, population’s health and preparedness
Health and wellness dieticians indicate the people in the state do not get the recommended activity because they have busy schedules. Most of them are in a habit of consuming convenience foods, which tend to be higher in fat and calories (Suwanski, 2010). Additionally, it is reported that selling snack foods in schools in Kentucky had been compromising elementary school children nutrition status. This is because such schools’ nutrition environment exposes the children to risks of obesity.
It is reported that 35.3 % of children below 4 years and almost 40% of 10-17 years children in Kentucky are overweight or obese. They are less likely to be physically active for at least 4 days per week and more likely to spend two or more hours watching television or in front of a computer screen than any other children population group nationwide. Additionally, 50% of children in poor households in the state are overweight or obese according to Pediatric Nutrition Surveillance System (PedNSS).
Kentucky is ranked seven for diabetes prevalence. Patricia Barnstable Brown a resident at Louisville hosts the Barnstable Brown Gala, which brings several celebrities from Hollywood, sports and the world of politics. In 2008, the proceeds from the sale of the gala tickets were devoted to the development of the Barnstable Brown Kentucky Diabetes and Obesity Center at the University of Kentucky. This healthcare facility is devoted to providing the best research, education and clinical assistance focused on diabetes and obesity (Anonymous, 2008).
Obama created a task force on childhood obesity issuing a national obesity strategy with concrete measures for every agency in the federal government. Kentucky has established nutritional standards for school lunches, breakfast, snacks, and nutritional standards for competitive foods sold in schools in vending machines, school stores or through bake sales. However, it requires enforcing the requirement for BMI screening of children and adolescents (Goldman, 2010).
Childcare centers in Kentucky are also yet to implement licensing regulations that dictate that meals and snacks to be consistent with dietary guidelines for Americans and to have vigorous or moderate physical activity in their schedules. They are also yet to establish policies prohibiting foods having low nutritional value and policies on vending machines (Child Health Data, 2013).
Kentucky is unprepared to implement anti-obesity health promotion interventions. This is because the institutions bearing the highest responsibility for children’s nutrition and physical activity have failed to implement the minimum standards for preventing obesity. This indicates that schools and childcare centers need obesity education to emphasize the importance of physical activity. This is because both institutions can implement physical activity at minimal cost. Additionally, children are malleable and thus it is easy to change their perceptions about good nutrition choices.
Sociopolitical, economic, and ethnic characteristics affecting the health
The largest ethnic group in Kentucky is the whites at 86.3%, then blacks at 7.7% percent and Hispanics at 3.1% (Demographics, 2010). The state’s median income is at $41,576 but 17.7% of the Kentucky residents are poor. 66%, 76% and 59% of Whites, Blacks and Hispanics adults in Kentucky are obese (Kaiser Family Foundation, 2011). The Black ethic group has the highest rate and this may be because of their cooking culture. Southerner’s cooking style is characterized by adding bacon and fat. They tend to use more fat in their cooking which equals more calories. Advertising is another factor affecting Kentucky’s health. Mega burgers and tasty ice cream treats are high in fat and calories and look very inviting in ads. The state does not have a culture of physical activity unlike Colorado. It is reported that Colorado seems to have a culture of physical activity as it spent money from a state lottery on biking and walking trails (Suwanski, 2010).
45%, 33% and 33% of Non-Hispanic whites, Black and Hispanic respectively living in Kentucky in 2000 had attained a bachelor’s degree and higher (Diversity Data, 2010). By 2011 53.6%, 73.9% and 69.8% of white, Black and Hispanic children were attending K-12 schools with a poverty rate where they are eligible for free or reduced lunch (Diversity Data, 2010). This indicates that over half of Kentucky’s children come from middle income and low income households, which are at risk for obesity. Additionally, children from white households have a lower risk for obesity because most households are headed by individuals with a bachelor’s degree or higher and thus have more income than their Black and Hispanic counterparts.
Researchers indicate that housing density is a primary variable that is linked to an area’s level of physical activity observing a positive correlation between density and physical activity. According to a study in Louisville, Kentucky area, greater sprawl indexes drawn from data of sparsely settled neighbor hoods with newer expensive homes with high rates of home ownership and longer blocks sizes indicated lower average BMI and lower obesity rate. This is because a more sprawled area is likely to have more whites, upper income and college educated residents and not because of the built environment. The study concluded that a larger percent of those who walk or bike to work seems to be more a function of living in non-sprawled, low income neighborhoods and having to walk or bike to work perhaps out of necessity and not necessarily for exercise (Lambert & Min, 2010).
This study reveals that demographic and income factors in Kentucky seem to play the largest role in influencing BMI. Higher income and people that are more educated put premium on taking care of their health. This is because in Louisville, people who are generally healthier tend to be located in the more sprawled neighborhoods. Census data indicates that the highest rates of homeowners moving into them have the lowest levels of average BMI and obesity. People in these neighborhoods make up for the negative consequences of sprawl by exercising and dieting (Lambert & Min, 2010). Additionally, a lifestyle of poverty in Kentucky is a primary factor for obesity (Talbert, Wackerbarth, & Hattman, 2002). PedNSS indicates that 32.3% of low-income children between 2-3 years are overweight or obese in Kentucky (Child Health Data, 2013).
Nature of values and value systems in the community
The values about health care different depending on income and education level of the different ethnic groups represented in Kentucky. However, because Kentucky is a predominantly White state, most of the population is generally open to health care interventions. They are more likely to pass these values to their children. This is because households with higher incomes are more likely to be health conscious and open to learning. The black and Hispanic ethnic groups may be more reluctant to learning how to alter their health habits as compared to their white counterparts.
Effects of hazards in the community on people’s health
Nutrition and lack of physical exercise are the health hazards that cause childhood obesity in Kentucky. Childhood obesity has immediate and long-term effects. Obese youth are more at risk for cardiovascular disease. Obese children also face great risk for bone and joint problems and sleep apnea. They also suffer social and psychological problems such as stigmatization and low self-esteem, which may subsequently result in clinical depression. Additionally, it is reported that obese young people are more likely than children of normal weight to become obese adults. This makes the children to be more at risk of acquiring adult health problems such as type II diabetes, stroke, osteoarthritis and cancer ( US Surgeon General, 2001).
Obesity has costly impacts on the health care system. This is because obesity related diseases such as cardiovascular diseases are expensive and have a significant economic impact. For instance, in 2004, the direct costs and indirect costs associated with obesity in the US were $98 billion. In the same year, Obesity health care costs were at $1.2 billion (Swartz & Puhl, 2003).
Intervention
Different settings and populations often require specific tailoring of interventions to achieve actual reductions in weight status or changes in health behavior that can lead to obesity. Race and ethnicity, family income, family structure and health behavior such as screen time and physical activity and neighborhood safety and amenities are the primary factors that would affect the intervention on childhood and adult obesity in Kentucky (Bethell, Simpson, Stumbo, Carle, & Gombojav, 2010).
The intervention will focus on educating Kentucky children, teachers and caregivers on how to use physical activity as a primary method of combating obesity in the schools and care centers. It shall have a training dedicated to children and adolescents in a school setting. Increasing children’s and adolescents’ physical activity in schools and care centers is effective because this is where they spend most of their time (Kentucky Health Issues Poll, 2009). It will challenge teachers to prioritize physical education classes and encourage students and children to attend. It is based on the belief that it is easier to mold children behavior than it is adults. In order to combat childhood obesity there will be need to liaise with health systems, and schools. (Bethell, Simpson, Stumbo, Carle, & Gombojav, 2010).
This health promotion intervention will engage several health care experts such as physicians, dieticians, community health nurses and health psychologists. The objectives of the intervention are to reduce to reduce the proportion of children and adolescents who are obese to 5%, to empower teachers to provide more efficient health education and to ensure schools provide at least 30 minutes of physical education to students each day.
This is an intervention with six weeks of learning sessions about balanced nutrition choices, increased activity and lifestyle improvement tracking. The children learn principles of weight management for two 30 minutes session per week at school and have take-home assignments to complete together with their parents. This is so that the child and parent participate together and so that the parent can support the child that may be struggling with extra weight (Business Wire, 2012).
The first week shall be an introduction to obesity where teachers, caregivers and children shall learn about the causes and effects of obesity. On the first day, a health psychologist shall introduce the topic using short video clips of childhood obesity. She will seek to show how lifestyle and other unhealthy health habits contribute to obesity. She will let the children explore the unhealthy habits that they may be practicing at a personal level in school and at home. They will write down the unhealthy choices they make while at school and take an assignment to complete with their parents about the types of unhealthy choices they make at home. The teachers and caregivers will explore about their institutional choices that increase the risk of childhood diabetes. The next learning session shall resume after one day and they shall review the take home assignment together. This is because it is important for the children to be aware of the personal and institutional choices that are risk factors for obesity.
On the second week, a physician shall conduct a session about effects of obesity. He shall age appropriate video clips to show the health effects of the obesity. Elementary and kindergarten students will see clips involving popular cartoon characters that are suffering from obesity related diseases. Grade school and High school students will be shown real life visual scenarios of the disease. The physician will emphasize on the fact that obese children are more likely to become obese adults. Children will receive an assignment to reflect on together with their parents about people in their households or families that may be suffering from the effects of obesity. After one day, both the physician and health psychologists will review children’s reflections. The health psychologists will emphasize that the children, teachers and caregivers can become the change agents and avert some of those effects with simple lifestyle changes.
On the third week, a dietician shall conduct a session about healthy and unhealthy eating habits. She shall introduce all the unhealthy foods and eating habits that the participants engage in. She shall also ask them to reflect about the unhealthy foods that they take while at school from the vending machines and as part of the school lunch. Children shall take an assignment to complete with their parents about the unhealthy foods present in their household that week. Teachers and caregivers shall explore the unhealthy foods in the school or care Centre’s menu, store and vending machine. After one day, the dieticians shall review their feedback and ask them to suggest the healthy alternatives to the unhealthy foods. She will also guide them on how to determine healthy foods from unhealthy ones.
On the fourth week, the dietician and a community health nurse shall teach the participants about how to measure calorie intake. Children will explore with their parents about stores that sell healthy food or develop strategies of accessing if there are no stores that sell healthy foods. The children will also teach their parents how to measure calories in different servings.
The fifth week will include fitness experts and dance instructors. They inform the participants about the importance of physical activity in combating obesity. The schools have already allocated fitness and dance instructors in coordination with the federal department of education and the local education school board. Children shall be allowed to choose the type of physical activity that they may be interested in. Teachers in different grades shall allocate sessions to the different physical activities and issue basic guidelines for the different sorting activities and dance. While not at school, children will be encouraged to discuss with their parents about safe neighborhoods where they can exercise.
In the sixth week, the health psychologists shall counsel the participants about health behavior. She shall emphasize that health behaviors are as a result of individual values, feelings and belief system. She shall encourage participants to engage in healthy behavior and inform them about relapse into unhealthy habits and what to do when it happens. This way they are aware of their power and coping mechanisms. She will inform them to take their own personal decision to change their unhealthy behavior in nutrition and physical exercise both at school and at home. She shall offer a humanistic group counseling approach which enables assessment of the social, environmental and psychological rationale behind behavior. This enables advocacy and ensuring access to the relevant health promotional services and helping to prevent inequalities (Balsdon, 2009).
Evaluation
Effectiveness, efficiency and equity are the factors of evaluation. In terms of effectiveness, it shall evaluate the objectives such as reducing the proportion of children and adolescents who are obese to 5%, empowering teachers providing more efficient health education and ensuring schools provide at least 30 minutes of physical education to students each day. It shall be effective if teachers will commit to teaching health education, the number of obese children in each school shall go below 5% and if each school will commit at least 30 minutes to physical education. The implementation will be evaluated as efficient if the children use the resources dedicated to physical activity in the school by the federal department of education and allocated by the school board to pay instructors salaries. It shall also be evaluated in terms of whether all the students are able to access the physical activity facilities and resources equitably in all public schools.
References
US Surgeon General. (2001). Overweight and Obesity: Health Consequences. Retrieved August 5, 2013, from Rockville MD: http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_consequences.htm.
Anonymous. (2008, November 10). Celebrities Help Fund Kentucky Diabetes and Obesity Center. PR Newswire Association LLC, n.p.
Balsdon, L. (2009). Tackling Overweight and Obesity Using Public Health Promotion. Public Health Care, 19(10), 33-35.
Berehm, B., Gates, D., Singler, M., Poeppelman, A., Succop, P., & Alessio, D. (2007). Prevalence of obesity and cardiovascular risk factors among manufacturing company employees in Kentucky. AAOHN Journal: Official Journal Of The American Association Of Occupational Health Nurses, 55(10), 397-406.
Berkshire, F. (2012, August 23). Kentucky ranks as one of most obese states; Local health officials say fight against obesity involves fighting traditions, lifestyles. Kentucky Standard, The Bardstown KY, 3.
Bethell, C., Simpson, L., Stumbo, S., Carle, A. C., & Gombojav, N. (2010). National, State, and Local Disparities In Childhood Obesity. Health Affairs, 29(3), 347-356.
Business Wire. (2012, September 17). Research Published in Peer-Reviewed Journal Pediatrics Demonstrates Effectiveness of “JOIN for MESM” Program to Treat Childhood Obesity. Business Wire, n.p.
Child Health Data. (2013). Kentucky State Fact Sheet. Retrieved August 5, 2013, from Child Health Data: http://www.childhealthdata.org/docs/nsch-docs/kentucky-pdf.pdf
Demographics, K. (2010). Get Kentucky Demographics. Retrieved August 5, 2013, from Census 2010 SF1 & 2006-2010 American Community Survey 5 year estimates: http://www.kentucky-demographics.com/
Diversity Data. (2010). Louisville, KY-IN. Retrieved August 5, 2013, from Diversity Data: http://diversitydata.sph.harvard.edu/Data/Profiles/Show.aspx?loc=848
Goldman, S. (2010, July 6). States with 30 Percent Obesity Rate Doubles. Penton Business Media, Inc. and Penton Media Inc., n.p.
Kaiser Family Foundation. (2011). Overweight and Obesity Rates for Adults by Race/Ethnicity. Retrieved August 5, 2013, from Kaiser Family Foundation: http://kff.org/other/state-indicator/adult-overweightobesity-rate-by-re/
Kentucky Health Issues Poll. (2009). What Kentuckians Think About Childhood Obesity. Retrieved August 5, 2013, from Kentucky Health Issues Poll: http://www.healthy-ky.org/sites/default/files/docs/KHIP09%20-%20Childhood%20Obesity.pdf
Lambert, T. E., & Min, H. (2010). Neighborhood environment and obesity in the Louisville, Kentucky area. International Journal of Housing Markets and Analysis, 3(2), 163-174.
Suwanski, R. (2010, August 16). Kentucky obesity rate 4th-highest in U.S. McClatchy – Tribune Information Services, n.p.
Swartz, M. B., & Puhl, R. (2003). Childhood Obesity: A Societal Problem to Solve. Obesity Review, 4(1), 57-71.
Talbert, J., Wackerbarth, S., & Hattman, K. (2002). Charting the Type II Diabetes Epidemic: Trends Among Children Recieving Medicaid in Kentucky. Abstr Acad Health Serv Res Health Policy, 19-40.
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