This is a seconday dataset analysis on my Obesity topic. Please read the Instructions carefully and please address all the points requested in Assignment: you write the point requested in Assignm and

Description of The Health Problem Identified

Obesity and overweight are evaluated as an epidemic that has been increasing over the past years in the United States. 17% of the US citizens, almost 50 millions citizens, live in rural areas where Healthy People 2020 emphasizes social environments that can create a change in behaviors and overall health in these rural communities. Health promotion programs focused on prevention, lifestyle modification and health behaviors can especially enhance health in rural communities (Cromartie et al., 2015).

70% of the population in the United States are overweight and more than 35% are obese (CDC, 2018). The most useful gadget to determine and evaluate overweight and obesity in primary care setting is body mass index (BMI). Obesity has been correlated with poor life standards, poor mental health, and with the major causes of death in United States such as heart disease, stroke, certain forms of cancer, therefore it represents a major problem (CDC, 2018).

A higher BMI is correlated with high blood pressure, cardiovascular disease, stroke, type 2 diabetes and some forms of cancer and these are the major causes of death in the United States that we should be able to prevent. Studies concluded that when BMI improves, these comorbidities risks ameliorate (Post et al., 2015).

Overweight and Obesity are associated with an increased health care costs and higher mortality rates and according to CDC, the evaluated annual medical cost of obesity in 2008 in the United States was $147 billion dollars and the medical expenses for obese patients were $1,429 higher than those with normal weight. Mortality estimates show that at least 300 000 excess deaths in US are correlated with obesity, and the majority occur in individuals with a BMI of at least 35.

(CDC, 2018).

West Virginia was classified among first four states with the highest prevalence rate of obesity over the last 10 years, and in 8 out of the last 10 years had the highest obesity rates in the entire United States. West Virginia has seen consistently increasing obesity rates since 2002, achieving 37,7% in 2016, the highest in the Unites States (West Virginia BRFSS, 2016). According to the same source the biggest changes were seen in the prevalence of underweight, with an estimated annual decrease of 3,3% and in obesity, with an estimated annual increase of 4,8%.

According to BRFSS, West Virginia adults falling into each BMI category weight class is as following: about one third of adults follow in the normal range, with the remaining two-thirds being overweight or obese (West Virginia BRFSS, 2016).

Is clear that rural West Virginia requires an intervention and I chose to focus on McDowel County, for the following reasons: McDowell County in West Virginia has also seen an epidemic of obesity and in 2016 and 2017 was recorded with the highest rates of obesity in the entire state, with the highest rates found among adults population. Adults in the County were found to have significantly higher level of physical inactivity; approximately one in 5 adults in the County doesn’t have a healthcare provider, and more than one in five adults did not have primary care physician checkup in the last 24 months; more than 39% of adults ingest soda or a sugar added refreshment drink every day (West Virginia BRFSS, 2016).

Only 62,9% of West Virginia adults have had a diabetes test in the last 3 years. West Virginia classifies as highest in the country for heart attack rates (7,5%) and coronary heart disease and occupies the highest 7th position in the country in the stroke rates (4,4%). According to BRFSS, McDowell County has the highest rates of cardiovascular diseases in the entire State and also the rates of diabetes are higher in McDowell County when compared to other Counties in West Virginia (West Virginia BRFSS, 2016).

My Health Promotion Program will address the following research question: how does a 12 weeks long health promotion program will influence BMI, weight, physical activity, and nutritional choices after the completion of the program, in adults in McDowell County rural West Virginia area that have a BMI at least 25? We will contrast the BMI, weight, physical activity and nutritional choices after the completion of the program and before the initiation of the program, using adults volunteers from rural West Virginia with a BMI of at minimum 25.

Annotated Bibliography:

Menez S, Cheskin L, Geller G. Perspectives on obesity and its treatment: health care providers and the general public in rural West Virginia and urban Baltimore. Health Educ Behav. 2013; 40(6):663-672. doi:10.1177/1090198112473101

This primary article is 5 years old. It looks at health care providers' and general population's attitude on Obesity and its treatment in rural West Virginia. The study conducted a 206 statement paper surveys among the random people in WV, as well as among health care providers (HCPs). A total of 200 people from the general public were surveyed, with 47% having BMI of 30 or more than 30 and majority of responders having high school education or less. The study found that the solid firm view that Obesity has a genetic basis were associated with BMI (with Obese patients more reasonably believing into the genetic basis of the Obesity) and also with the education level (more education was associated with believing into the genetic basis of the Obesity). Therefore, a patient's insights on the genetic basis of the Obesity in general and more specifically within their family, can advantage the long term management of the Obesity, since it can have a strong impact on the health behavior and the adherence to the treatment.

BMI (body mass index) over 30 was linked with the solid firm view that Obesity has genetic basis and that it can be managed by controlling food choices. Citizens with less education (high school diploma) were unlikely to view Obesity as a problem in their community and also were unlikely to view the healthy, nutritious diet and consistent physical activity as part of the solution, when compared with those with the higher education. HCP views significantly contradicted with the general public views.

Patient's awareness into the understanding of the Obesity should be the main focus of HCP, when considering the conversation and counseling on the long term management and complications of the Obesity. The study found that spending significantly more time with the patients who are less aware about the Obesity burden, could enhance the adherence with the lifestyle modifications and the entire patient’s outcome.

There were certain limitations in this study that affected the analyses that could be performed and the conclusions that were drawn. Although survey items were reviewed for clarity and “face validity” by coauthors and other medical colleagues, no formal internal validation or psychometric analyses were performed. In addition, the study was not piloted with members of the general public, and therefore, the final survey questions may not have been as clear to the general public as anticipated. There may be potential benefit or value in conducting psychometric analyses of the data, including reliability and factor analysis, particularly once more HCP views can be elicited, in order to develop a validated scale of the attitudes of both the general public and HCPs. Furthermore, the small sample size limits the power to compare HCPs in the two locations. Also, although the survey was available to physicians, nurse practitioners, and physician assistants, all HCPs who completed the survey were physicians. Nurse practitioners and physicians assistants, especially, would be important future survey participants as they have increasing roles in the care of patients, particularly in rural settings. In addition, since the majority of the general public surveyed were in medical offices, the results of this study may not be widely generalizable, and may be more representative of only those seeking medical care. Finally, the discrepancy in location of survey distribution to the general public, only in physician offices in WV but in physician offices and a local food market in Baltimore, may have biased the study.

In both rural and urban areas, differences in BMI and education were associated with differences in how certain subgroups of the general public perceive obesity. Those with higher education were more aware of the medical consequences of obesity, regardless of place of residence. Also, those who were obese were more likely to view obesity as a genetic problem and more likely to be concerned about potential health problems in the future.

The perspectives of HCPs differed significantly from the general public in terms of the causes, treatment, importance, and effects of obesity on the community. We believe that HCPs can assist their obese patients better by recognizing and inquiring about their patients’ views on the causes, importance, and treatment of obesity. More research is needed to confirm our findings and gain further insight into perspectives on obesity, its causes, and its treatment in various geographic areas and demographic groups. A better understanding of HCPs’ views on obesity and how they differ from patients’ views may help HCPs provide better care for this growing segment of the population.

Practical Implications: given the very limited time with patients during typical clinic visits, it is imperative for clinicians to optimize obesity management counseling. Health care providers must consider patients’ education level and level of understanding when discussing management of or risk of developing obesity. Certain patients may benefit from health care providers who are very explicit in discussing the health risks associated with obesity. More time spent discussing the consequences and management of obesity in patients who do not have great insight into their disease may improve patient adherence with treatment and overall health outcomes. Therefore, clinicians need to establish with patients early on the most helpful ways to counsel regarding obesity and do so on an individualized basis. Whether through education, motivational counseling, or other techniques, health care providers must adapt the content and delivery of information to effect the greatest change for each patient in obesity management.

Post RE, Mendiratta M, Haggerty T, Bozek A, Doyle G, Xiang J, King DE. Patient Understanding of Body Mass Index (BMI) in Primary Care Practices: A Two-State Practice-based Research (PBR) Collaboration. J Am Board Fam Med. 2015 Jul-Aug;

28(4):475-80. doi:10.3122/jabfm.2015.04.140279.

This 3 years old peer-reviewed research article highlights the fact that there is little to know understanding of BMI, its relationship to the Obesity and the chronic diseases among the surveyed patients in the West Virginia. The participants were recruited from the different primary care physicians' offices in the West Virginia. The participants were approached in the waiting room and proposed with the chance to be part of the survey. The survey had 13 questions, 8 related to BMI knowledge such as, “What does BMI stand for”, “A BMI of 30 or greater means”, “have you heard of BMI before” and 5 demographic questions that gathered information such as age, sex, height and weight. Every patient’s chronic condition associated with high BMI such as Diabetes, Hypertension, and Hyperlipidemia was evaluated. The study concluded that half of the participants were not aware of the medical conditions associated with BMI and were unable to state their own BMI level. The majority of the participants did not remember having conversations about their BMI level with their nurses or their doctors. These data support the idea that citizens are not well informed on their own BMI status. The patient’s awareness into their overweight status has been linked with higher inclination to lose weight. Thus, patient’s low level of education about BMI, including their own BMI status is highly alarming, considering that patients feeling motivated to lose weight highly depends on this awareness. The primary care providers should take the first step which is discussing the meaning of BMI and its cutoff, to open a conversation regarding Obesity and the risks. After that healthcare professionals can educate the patients about their own BMI status and how this correlates with Overweight, Obesity and the medical complications.

This article’s findings allow for a different approaches to overcome the Obesity, especially involving the primary care providers participating in the education of BMI, co-morbidities relationships and most importantly the individual's own BMI level. Therefore education and a clear correlation between the individual's own BMI and the possible related comorbidities, could be the greatest motivation for the patients to take action and address the weight.

Spurrier A, Suttle C, Matheson L, Baker-Watson A. The Effects of a Health Promotion Program on Rural, West Virginia Adults. Fam Community Health. 2018 Apr/Jun; 41(2):95-104.

doi: 10.1097/FCH.0000000000000179

This is a recent peer-reviewed article that discusses that how a 12-week long health promotion program, that focuses on providing the education and learning material about healthy nutrition diet, healthy eating habits and consistent physical activity, created sustainable changes among the participants. The members applied the knowledge from the program into their lives consistently and the results showed a decrease in weight and BMI, as well as an increase in physical activity and better nutritional choices.

At the end of the program, the overall weight was decreased by -140 lb and the BMI also decreased overall by -28.8 kg/m2. One-month follow up showed an additional decrease of 25.2 lb and BMI showed an additional decrease of -4.3 kg/m2. Throughout the 12-week, The Godin Leisure-Time Exercises Questionnaire showed an increase in the exercise and also an increase in the physical activity habits after the program; The PACE: Healthy Eating survey showed better eating habits among the participants, as well as less negative eating habits after the program.

Though this program has some limitations, such as smaller size (18 adult participants whose BMI was at least 25 or greater and who resided in the West Virginia community, started the program and only 15 finished it) it represents an evidence base for future expansion and implementation on larger scale.

O’Brien K, Hutchesson M, Jensen M, Morgan P, Callister R, Collins C. Participants in an online weight loss program can improve diet quality during weight loss: randomized controlled trial. J Nutr. 2014; 13(82):1-8.

This intervention program was coordinated on a sample of 192 adults with a MBI between 25 and 40. The study concluded that a 12 weeks long program with weekly modules was sufficient to advance better diet approaches and decrease BMI among participants. The intervention was based on Social Cognitive theory, goal setting, self-efficacy. Survey questions on dietary intake, weight, and physical activity were completed preprogram and at the end. The results revealed a mean decrease in weight of 3.3 kg ± 4.0 kg over 12 weeks. This intervention will serve me as evidence to implement my health promotion program.

Whisenant D, Cortes C, Hill J. Is faith-based health promotion effective? Results from two programs. J Christ Nurs. 2014;31(3):188-193

This article investigated 2 rural community churches accomplishing a health promotion program at the church. The program had 6 months weekly exercise sessions and 3 learning and studying sessions. Their first session centered the attention on honoring the body as a temple, the second session centered on eating habits and how to make better nutritional approaches; the third session centered on the importance of being active consistently and the different levels of physical activity we need to engage in. After 3 months the program concluded that Weight and had decreased with 112 lb, among the 35 participants and there was a significant increase in physical activity. At 6 months Weight was decreased with over 200 lb and there was further improved physical activity and better nutritional approaches. The participants were recruited from 2 local community churches. This article concluded that faith-based organization health promotion programs will have positive effects on Weight, BMI and lifestyle approaches.

Findlay S, Davidson H, Smith S, Jones J. A 12-week activity point system achieves weight loss in sedentary overweight and obese women: a pilot study. Proc Nutr Soc. 2012;71:E17.

This study centered on increasing physical activity in a 12 weeks intervention program. The sample contained adult females with BMI of at least 25 or higher who participated in weekly modules educating about weight and medical implications of weight gain and the importance of consistent exercise. The participants were asked to perform 30 minutes of daily exercise and the results showed a mean decrease in BMI of 8.7 kg/m2 at the end of the program. All the enrollees were surveyed and had Height and Weight measured at the beginning, 6 weeks into the program and at the end. Preprogram and post program values were contrasted.

Nordtvedt M, Chapman L. Health promotion in faith-based institutions and communities. Am J Health Promot. 2011;25(4):1-8.

This health promotion program was a partnership with faith-based organization and was centered on weight diet and exercise education. The sample consisted of 41 participants who were overweight or obese, recruited from faith-based organizations in the community. The researchers centered their attention on diabetes and metabolic syndrome and concluded that all the participants showed decrease weight with dietary changes and increase physical activity on a consistent base. The intervention showed the positive effect lifestyle modification approaches can have on the Weight, BMI and the associated chronic diseases.

Duru O, Sarkisian C, Leng M, Mangione C. Sisters in motion: a randomized controlled trial of a faith-based physical activity intervention. J Am Geriatr Soc. 2010; 58(10):1863-1869

This is a trial study that looked at the faith-based partnership walking program effect on the blood pressure in adult women. The 62 participants described being active less 3 times per week, and walking less than 35 000 steps in a week. The program placed goals, strategy, direction and counseling, walking sessions and Bible readings sessions. This faith-based walking program was successful, because it showed an increase in weekly walking activity and it proved to decrease the blood pressure among all the participants. I will use this article as evidence for faith-based health promotion programs success.

Herath J, Brown C. Obesity in WV: control and costs. Am J Public Health. 2013;1(8):203-280.

This article highlights the fact that West Virginia is the only state entirely in the Appalachian region and the rural communities that exist in West Virginia; rural communities can impact the daily physical activity such as walking to and from a store, as there is an increase dependence on vehicles. The article also highlights the fact that West Virginia rates among top 5 in low income, lack of education and obesity, among all the states in US. Statistics show that 2/3 of adults in West Virginia are overweight or obese; the larger part of the population live below the poverty rate; 25% of the population doesn’t have a high school diploma. The insufficient education is linked to a major influence on health promotion and disease prevention, as the education will enhance the way we conduct and approach health.

This will be used to support evidence for my intervention.

References:

Center for Disease Control and Prevention. (2018). Adult Obesity Causes and Consequences. Retrieved from https://www.cdc.gov/obesity/adult/causes.html

Cromartie J, Parker T, Breneman V, Nulph D. Mapping population and economic trends in rural and small-town America. http://www.ers.usda.gov

28(4):475-80. doi:10.3122/jabfm.2015.04.140279

West Virginia Behavioral Risk Factor Surveillance System Report. 2016. Retrieved from http://www.wvdhhr.org/bph/hsc/pubs/brfss/2016/BRFSS2016.pdf