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Big Issue of Obesity in United States

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    1. How common is obesity in this age group (26-50) in the U.S.?

    Obesity is a persistent problem in the United States. It affects one-third of adults in the United States and characterized as an epidemic that is ongoing. Obesity can be the factor in many diseases such as diabetes, heart disease, cancer, depression and death. The causes of obesity can range from environment, family history, poverty, dietary intake, and physical activity (Gray, Messer, Rapazzo, Jagai, Grabich & Lobdell, 2018).

    According to the Centers for Disease Control and Prevention (CDC) 39.8% of United States adults are prevalent to obesity and affected about 93.3 million of United States adults in 2015-2016. Obesity affects some groups more than others, like Hispanics at 47%, and non-Hispanic blacks at 46.8%. Followed by non-Hispanic whites at 37.9% and non-Hispanic Asians at 12.7%. Income and educational level in relation to obesity is complex and it differs by sex and race/ethnicity. Another area that obesity is affecting the United States is in direct and indirect medical costs. The difference in medical cost for people that were obese compared to normal weight was $1429 higher. In 2008, the estimated annual medical cost for obesity in the United States was $147 billion (Adult Obesity Facts, n.d.).

    Obesity has contributed to an estimate of 300,000 deaths per year in the United States. In the process of designing and implementing prevention measures data collected needs to be classified accurately, by population level. There are discrepancies between two national surveys (2010 Behavioral Risk Factor Surveillance System (BRFSS) and Centers for Disease Control and Prevention (CDC, 2016), they vary across gender and ethnicity. This could be due to the different methods of data collection in both surveys. Measuring body mass index (BMI), which is a ratio of height and weight is usually how they determine obesity (Mozumdar & Liguori, 2016).

    2. What are the current goals and focus for nutritional treatment of adulthood obesity?

    Intentional weight loss of at least 3 to 5% can improve some clinical parameters. In order to do this the degree of weight loss needs to be maintained. There is no standard as to how long do you maintain the weight loss to be considered successful, but 1 year is usually used. Long term weight loss maintenance is one of the challenges for those that are obese, but it is possible (Raynor & Champayne, 2016). Action for Health in Diabetes (AHEAD) ran a random controlled trial (RCT) with 5,000 adults with type 2 diabetes they reported 39.3% of the 825 participants that received a lifestyle intervention and lost 10% of their body weight the first year maintained the loss at year 8.

    A lifestyle intervention is needed to help adults with obesity. This consists of a reduced-energy dietary and physical activity prescription and a cognitive behavioral intervention. The diet should be altered to each person, so that reduction in excessive energy intake and dietary quality occurs in order to achieve recommendation made by 2010 Dietary Guidelines for Americans (DGA). Along with the dietary intake obesity treatments should implement physical activities (Raynor & Champayne, 2016). In 2008 Physical Activity Guidelines for Americans the recommendation is to do 150 minutes per week of moderate-intensity, or 75 minutes per week of vigorous-intensity physical activity as a minimum. For weight-loss maintenance the American College of Sports Medicine recommends 250 minutes per week of moderate-intensity of physical activity and enhance cardiovascular fitness. Changes in lifestyle behaviors are required to successfully achieve weight-loss goals (Raynor & Champayne, 2016).

    In addition, focus on some kind of behavioral interaction to help motivate, accept and commit to therapy. There are many types of therapy, finding the one that works for you is a challenge. Talk with your doctor, discuss how to change your way of thinking in order to impact health outcomes. Two widely recognized programs to help with obesity are: The Diabetes Prevention Program (DPP) and the Look AHEAD, these two are examples of cognitive behavioral therapy help assist with changing eating and activity behaviors (Raynor & Champayne, 2016).

    3. Identify specific physical activity recommendations for Maria.

    Exercise training and physical activity have been instrumental in the prevention and treatment of type 2 diabetes mellitus along with glycemic control. There are a number of benefits that are associated with exercise, like decreasing your insulin resistance and improving aerobic capacity, muscular strength and endothelial functions. Exercise is effective in improving glycemic control and other outcomes but the different types of exercise and its effects are less known (Kumar, Maiya, Shastry, Vaishali, Ravishankar, Hazari & Jadhav, 2019). Aerobic exercise is the most known and most studied. Some of the exercise associated with aerobic exercise is walking, cycling, swimming and jogging.

    Type 2 diabetes mellitus people tend to be overweight or obese, and have issues with mobility, peripheral neuropathy, visual impairment or cardiovascular disease. This population does not find aerobic exercise easy and resistance training may be more efficient. Exercise training is known as a non-pharmacological tool for treatment of diabetes. This along with lifestyle modifications can reduce the progression of insulin resistance (Kumar, Maiya, Shastry, Vaishali, Ravishankar, Hazari & Jadhav, 2019). When exercising take precautions, make sure medicine is applied as directed, that you are hydrated, start with a controlled environment until you know what your body can or cannot do and how the exercise is effecting you.

    4. Can individuals on high insulin doses successfully lose weight?

    Losing weight is associated with a decrease of antidiabetic medications. However, not everyone that loses weight is able to reduce their medication. Scientifically, intentional weight loss has the potential to see reduction in dose of anti-diabetes medications. This is a strong motivational factor for a diabetic patient to lose weight. According to an article from the Biomedical Journal, a study was conducted to try to predict dose reductions of anti-diabetes medications with intentional weight loss. Two clinics were used in this study that were similar (Shantha, Kumar, Ravi Khanna, Kahan & Cheskin, 2016). In this study they had physician visits twice a month for follow up. Patients were evaluated in all areas from blood tests, detailed dietary, physical examinations, behavioral and treatment was individualized for each patient. This typically consisted of 1000 kcal/day energy deficit, many times using meal replacements, a behavioral modification plan and increasing physical activity using both aerobic and strength training (Shantha, Kumar, Ravi Khanna, Kahan & Cheskin, 2016). The treating physicians were the only ones able to alter the dose or discontinue antidiabetic medicine. Factors considered was the amount of weight loss, glycemic control, hypoglycemic symptoms and if patients were following the weight management protocol.

    The result of this study showed that out of 121 diagnosed with DM, 81 achieved at least one dose reduction of any anti-diabetes medication. The other 40 failed to achieve even one dose reduction of their medication. Participants showed 40% maintained the weight loss, 36% reported weight gain and 24% lost further body weight after first dose reduction. In this study even those that gained weight did not have to the dose increased (Shantha, Kumar, Ravi Khanna, Kahan & Cheskin, 2016).

    5. How does fear of hypoglycemia contribute to uncontrolled diabetes?

    Hypoglycemia is defined by those with diabetes as a blood glucose (BG) that is less or equal to 70mg/dL that may or may not have hypoglycemia symptoms. Another definition is a drop in BG that can cause harm to a person. Even with effective management and treatment hypoglycemia is still a risk for injury. The symptoms can by uncomfortable and it contributes to an inability of achieving diabetes BG goals (Brackney, 2018). This happens when the peripheral receptors in the hepatic vein and the central receptors in the hindbrain and hypothalamus respond to changes in BG. It then cause release of counter regulatory hormones and neurotransmitters (Brackney, 2018). Together they produce the physical symptoms of hypoglycemia, decrease glucose uptake from peripheral tissues and activates hepatic glucose production.

    Diabetics should have accurate knowledge and document any episodes they might encounter. This way the severity and frequency of hypoglycemia can be reported and analyzed by physician and insurance companies (Brackney, 2018). This could also support the need for an insulin pump. Some of the symptoms of hypoglycemia include rapid heartbeat, anxiety, tremors, perspiration and hunger. Some symptom that area little more serious are tiredness, dizziness, weakness, inappropriate behavior, unable to concentrate, confused, blurred vision and in extreme case coma and death. Many times these symptoms can be mistaken for being under the influence. Those with diabetes should wear medical alert information to avoid mistreatment (Brackney, 2018).

    6. Maria asked you about using over-the-counter diet aids, specifically Alli (orlistat). What would you tell her?

    Over the counter diet aids are usually added when the person with type 2 diabetes fails to achieve lifestyle and behavioral modifications for the management of obesity. Their BMI has to be greater or equal to 30 or if BMI is greater or equal to 27 and has at least one cardiovascular factor, like hypertension or hyperlipidemia, the physician will suggest over the counter diet aids (Pilitsi, Farr, Perakakis, Nolen-Doerr, Papathansiov & Mantzoros, 2019). Orlistat is the only FDA approved medication for long term management of obesity that a physician can prescribe to an adolescent. Adolescent should be greater than 12 years old.

    When FDA administers certain studies and trials relating to obesity there are three things they look at to make them FDA medical approved: does it decrease appetite and caloric intake, does it increase energy expenditure and does it decrease fat absorption. Orlistat 120 (Xenical) mg has been approved in the United States since 1999, while orlistat 60mg (Alli) is an over-the counter medication available in the United States since 2007 (Pilitsi, Farr, Perakakis, Nolen-Doerr, Papathansiov & Mantzoros, 2019). Long term safety of orlistat was evaluated and there was significant weight reduction, in addition it demonstrated a 41% risk reduction in overall incidence of T2D (type 2 diabetes). Obesity is multifactorial disease, combination treatment may be necessary to manage T2D (Pilitsi et al., 2019).

    7. Maria asked you about gastric bypass surgery. What are the recommendations regarding gastric bypass surgery for patients with Type 2 diabetes?

    Gastric bypass surgery in the United States has been one of the most common weight loss surgeries done. If you are looking at long-term and sustained weight loss it’s an excellent option. Some of the areas where there were significant improvements were in hypertension, high cholesterol, osteoarthritis, and diabetes. Studies show that remission or resolution of diabetes was higher with the gastric bypass than it was with the sleeve gastrectomy at a rate of 80% for diabetes remission. The studies also showed improvements in the quality of life and decrease in mortality rate (Stevens & Sterns, 2019).

    Surgery is usually performed with minimally invasive techniques, to remove 60% to 80% of the stomach. The left over stomach is made into a small pouch that is approximately the size of a lemon and attached to the distant part of the intestine. This is where the term “bypassing” comes from the surgery bypasses part of the intestine. Reason for doing this is food will have a shorter distance to travel through the digestive tract. This will cause the food to not be fully absorbed (Stevens & Sterns, 2019). Surgery leads to changes in their hunger hormone and causing a decrease in appetite. Recovery time is usually 2 to 4 weeks and they can get released to go back to work but no heavy lifting. It will take 4 to 6 weeks before heavy lifting is allowed. Mortality rate is low with this procedure. Complications that can occur are leaks, bleeding, bowel obstruction deep vein thrombosis and pulmonary embolism. Long time side effects not getting enough nutrition, like protein, multiple vitamins and minerals. Weight loss after 10 to 15 years was at 67.9% and a resolution of type 2 diabetes of 87.5% (Stevens & Sterns, 2019).

    8. What support groups are available for obese patients and their family members? National? Local?

    A local group helping millions to take off pounds sensibly is TOPS Club Inc. This group does not pay celebrities to endorse and do not promise quick fix they focus on health (Advanced Solutions International, Inc., n.d.). This group does not guarantee weight loss by just going to the meetings they encourage support through all the states to receive desired goal weight. A hands on and pounds off approach that starts with meetings to support and educate not judged. This program offers positive support for those living in Southwest Florida that want to lose weight. It is a non-profit group and only cost $32 a year to join (Frampton, 2018).

    There are over 35 leading healthcare organizations that are launching campaigns to improve obesity here in the United States. These organizations join together to form National Obesity Care Week (NOCW) an annual campaigns that promotes comprehensive, compassionate and personalized ways to treat obesity as a disease. In addition, they know that no one organization is capable of reaching everyone that is obese. It takes a village, by working together NOCW collective voice is stronger and can achieve great things.

    One national organization is About the Obesity Society (TOS). This organization is dedicated to better understand, prevent and treat obesity. TOS through research, education and advocacy is committed to improving lives of those with the disease. For more information you can visit www.Obesity.org, or connect on social media like Facebook, Twitter and Linkedin (“More than 35 Leading U.S. Health Organizations Launch Campaign to Improve Obesity Care – STOP Obesity Alliance”, n.d.).

    References

    1. Adult Obesity Facts | Overweight & Obesity | CDC. (n.d.). Retrieved from https://www.cdc.gov/obesity/data/adult.html
    2. Advanced Solutions International, Inc. (n.d.). Real People. Real Weight Loss.®. Retrieved from https://www.tops.org/tops/TOPS/FindAMeeting.aspx
    3. Brackney, D. E. (2018). Hypoglycemia: An unwelcome companion to effective diabetes management: Tailor your assessment, prevention, and treatment to individual patient needs and risks. American Nurse Today, 13(8), 6+. Retrieved from http://link.galegroup.com.ezproxy.fgcu.edu/apps/doc/A557304054/AONE?u=gale15690&sid=AONE&xid=656d4fde
    4. Frampton, C. (2018, July 20). Program offers positive support for Southwest Floridians wanting to lose weight. Retrieved from https://www.winknews.com/2018/07/20/program-offers-positive-support-for-southwest-floridians-wanting-to-lose-weight/
    5. Gray, C. L., Messer, L. C., Rappazzo, K. M., Jagai, J. S., Grabich, S. C., & Lobdell, D. T. (2018). The association between physical inactivity and obesity is modified by five domains of environmental quality in U.S. adults: A cross-sectional study. PloS one, 13(8), e0203301. doi:10.1371/journal.pone.0203301
    6. Kumar, A. S., Maiya, A. G., Shastry, B. A., Vaishali, K., Ravishankar, N., Hazari, A. & Jadhav, R. (2019). Exercise and insulin resistance in type 2 diabetes mellitus: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine, 62(2), 98-103. doi:10.1016/j.rehab.2018.11.001
    7. More than 35 Leading U.S. Health Organizations Launch Campaign to Improve Obesity Care – STOP Obesity Alliance. (n.d.). Retrieved from http://stopobesityalliance.org/uncategorized/more-than-35-leading-u-s-health-organizations-launch-campaign-to-improve-obesity-care/
    8. Mozumdar, A., & Liguori, G. (2016). Corrective equations to self-reported height and weight for obesity estimates among U.S. adults: NHANES 1999-2008. Research Quarterly for Exercise and Sport, 87(1), 47-58. doi:http://dx.doi.org.ezproxy.fgcu.edu/10.1080/02701367.2015.1124971
    9. Pilitsi, E., Farr, O. M., Polyzos, S. A., Perakakis, N., Nolen-Doerr, E., Papathanasiou, A., & Mantzoros, C. S. (2019). Pharmacotherapy of obesity: Available medications and drugs under investigation. Metabolism, 92, 170-192. doi:10.1016/j.metabol.2018.10.010
    10. Raynor, H. A., & Champagne, C. M. (2016). Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults. Journal of the Academy of Nutrition and Dietetics, 116(1), 129-147. doi:10.1016/j.jand.2015.10.031
    11. Shantha, G. P., Kumar, A. A., Ravi, V., Khanna, R. C., Kahan, S., & Cheskin, L. J. (2016). A clinical score to predict dose reductions of antidiabetes medications with intentional weight loss: A retrospective cohort study. Biomedical Journal, 39(3), 188-194. doi:10.1016/j.bj.2016.06.002
    12. Stevens, J. R., & Stern, T. A. (2019). Facing Overweight and Obesity: A Guide for Mental Health Professionals. Psychiatric Annals, 49(2), 65-77. doi:10.3928/00485713-20190109-02

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