The purpose of this assignment is to analyse how an individual’s lifestyle and cultural influences has been an underlining factor in causing their medical condition. I will be looking at their lifestyle and the environment in which they live in, how statistically trends have influenced the healthcare provision, the structure in healthcare systems involved and their contribution. I will be looking specifically at Childhood Obesity.
Obesity is a condition in which excess fat has accumulated in the body and an individual has a Body Mass Index of over 30 in adults (Oxford, 2008). The World Health Organisation (2007) defines Body Mass Index (BMI) as a simple index of weight-height ratio that is commonly used to classify underweight, overweight and obesity in adults. However, in children over the age of 5 this is adjusted to take into account their age and gender and healthcare professionals now more commonly use the term percentile which uses a percentage of the overall BMI. The categories are set out are overweight being over the 85th percentile and obese being over 95th percentile.
Nursing and Midwifery Council (NMC) have set out a code of conduct on how to maintain confidentiality within a healthcare setting and state that we must treat information about patients and clients as confidential and use it only for the purpose in which it was given (NMC Code of Conduct, 2008a). Throughout this piece of work I will be maintaining confidentiality at all times by not mentioning the real name of the client, or the trust that they live in therefore I will name him Lewis.
Childhood obesity is the most widespread and preventable nutritional disorder of the twenty first century (Caprio & Genel, 2005). According to Ogden, Flegal & Carroll (2002) there are many factors linked to obesity in children including poor eating habits, excessive calorific intake and lack of physical activities or exercise that are linked to obesity in children.
Lewis is a 12 year old boy and lives with his mother who is an unemployed single mother and has had problems with his weight from the age of 8. His mother is of average weight. She has struggled over the years to financially to support them both therefore both Lewis’ health and weight have suffered dramatically as he now has a BMI of 30.
Over the years Lewis has developed poor eating habits by mainly eating processed and unhealthy food at home and refuses to eat fruit and vegetables. However at school he does eat healthy meals due to strategies already in place which I will look at later.
According to Adair (2005) home and family environments are essential in the development of food preferences and consumption habits, and families represent a promising avenue toward improvement of children’s eating habits and prevention of obesity, so in the case of Lewis it can be said that his upbringing by his mother has played a fundamental role in his eating habits. As suggested in Ebbeling, Garcia-Lago, Leidig (2007) nutritional factors in fast food, such as low levels of dietary fibre, high palatability, high energy density, high fat content, and high content of sugar in liquid form, may promote excess energy intake.
As I mentioned earlier another fundamental aspect in obesity is the lack of physical activities and exercise also contributes to obesity. Children are similar to adults in that regular exercise provides additional health benefits for overweight individuals and therefore physical activity is critical for the prevention of abnormal weight gain and weight maintenance. Lewis attends school which is situated two miles from where he lives. Also Lewis doesn’t participate in any sport or activities at school and he would much sooner watch television or play games consoles and according to Ritchie, Welk & Styne (2005) television viewing is generally higher among lower socio-economic populations and as a result low income children are subjected to 40,000 commercials on television per year.
Poor eating habits that lead to obesity contribute to health problems and conditions that will develop in adulthood including high blood pressure, type 2 diabetes and problems breathing whilst asleep, cardiovascular disease and certain cancers (Daniels, 2006).
According to Health Survey for England (HSE) (2008) the prevalence of obesity of children aged 2 years to 15 years has increased from 25% in 1995 compared to 30.3% in 2008. It also showed that levels of obesity increased greater in boys compared to girls, with boys increasing from 11.1% in 1995 compared to 16.8% in 2008 with girls increasing from 12.2% in 1995 compared to 15.2% in 2008.
Over the years there have been many Government initiatives and campaigns to reduce obesity in children which aims to help the public increase their awareness of the dangers of obesity especially in children. Many people associate obesity with consuming an unhealthy diet but as I pointed out earlier it is a combination of an unhealthy diet and lack of exercise.
One of the new Government campaigns is titled ‘Change 4 Life’ and its goals are simply ‘Eat well’ ‘Move more’ and ‘Live longer’. The campaign is to improve our children’s diets and levels of activity therefore reducing the threat to their future health (National Health Service (NHS), 2010a). The campaign appears to be very clear and concise in what it is trying to portray and has television adverts that it will be broadcasting that will appeal to children, with their aim of ‘make getting fit fun’.
Another policy that is relevant to preventing and managing obesity in children is ‘Sure Start’ with is a Government programme that aims to achieve better outcomes for children, parents and communities by: improving health and emotional development for young children. Most of the centre’s include integrated early education and childcare, support for parents which includes advice on parenting; child and family health services that includes health screening, health visitor services to breast-feeding support; helping parents into work – with links to the helping parents back to work and training. The scheme funds a variety of community-based projects, from cooking clubs to community cafes. These are set up in disadvantaged areas to promote healthy eating and cooking (Sure Start, 1995).
A further intervention is the Department of Health’s 5 a day scheme which is to encourage individuals to eat more fruit and vegetables. The School Fruit and Vegetable Scheme is part of the 5 a day programme to increase fruit and vegetable consumption in children. Under the Scheme, all four to six year old children in infant, primary and special schools will be entitled to a free piece of fruit or vegetable each school day. Teachers found that distributing the fruit in schools helped encourage a sharing, calm, social time. Fruit and vegetables are important in achieving a healthier lifestyle and research has shown that on average, children in England eat only two portions a day, with many eating fewer than that (NHS, 2005).
Healthy Start is another initiative which is a voucher scheme that can be exchanged for fresh fruit and vegetables as well as milk and infant formula. It will also ensure that pregnant women and families quality help and advice about living and maintaining a healthy family life (NHS, 2010b).
As the Olympic Games are fast approaching the Government have introduced a very clever initiative called ‘Be Active, Be Healthy’ which instantly promotes that in order to be healthy you need to keep active. This is an ideal time for such a campaign as the Olympics is going to be on the forefront of everyone’s minds over the next couple of years including children so this will stand in good stead to promote exercise and physical activities (Department of Health (DH), 2009).
For many years now, the Government, DH (2010a) has spent huge sums of money in promoting healthy eating and keeping active to prevent obesity, this is solely because if obesity continues to rise at the rate it has done over the past 10 years it will place a significant burden on the NHS as they have their is health is at risk of developing life-threatening conditions such as type 2 diabetes, some cancers, and heart and liver disease.
The World Health Organisation (WHO), WHO (2009), has identified that by the end of 2010 an estimated 43 million children will be overweight which is extremely worrying. I am now going to look at the structure and functioning of the healthcare system and their involvement and responsibilities in the care that Lewis has received.
Lewis is seen by the school nurse on a regular basis who checks his weight and BMI, and also talks to him about healthy living, therefore she has a pivotal role to play. She also checks Lewis blood pressure to ensure that it is of a normal level. The school in which Lewis attends supports the Governments initiatives and children are weighed in Reception class and again in Year 6, however if any children are overweight or obese then they will be checked on a more regular basis which is all part of the National Child Measurement Programme (NCMP) (DH, 2010b).
As the school nurse has identified issues with Lewis’ weight she referred him to a dietician to look at his eating habits. The dietician will see Lewis along with his mother as in keeping with a family-based approach for treatment, programs usually target both parents and children. Registered dieticians are able to assess, diagnose and treat diet and nutrition problems. Dieticians use the most up to date evidence based research on food, health and disease and are able to help and guide children and parents in making appropriate choices in their dietary and lifestyle decisions. Not all dieticians are regulated, it is only the registered dieticians that are governed and regulated by an ethical code that ensure they work to the highest of standards (The British Dietetic Association, 2010).
As school nurses are community based they are registered by the NMC under specialist community public health nurses to ensure safe and effective practice. They have professional responsibilities as part of the code. Under their code of practice it is imperative that each school nurse adheres to the code of practice which includes evidence based practice and learning so they are kept up to date with the rapidly changing environment in which we live in. This is especially important in dealing with obesity as it is on the rise. Also the code states management of community public health practice which means that school nurses need to accept responsibility for the effectiveness of their provision in what they are dealing with as they have to make their own judgement on risk assessments. As I have identified individuals have different lifestyles and different ways of living, therefore school nurses do have to provide their service with openness and not be judgemental about the families in which they are caring for. The code also wants community based nurses to be the forefront of clinical effectiveness within healthcare with the ultimate aim of achieving high quality healthcare and improving the quality of community public health nursing practice (NMC, 2008b).
The Health Professions Council (HPC) is also regulator designed to protect the public similar to NMC however they regulate 15 different professions including dieticians. The HPC keeps a register of health professionals that meet their standards and it is an offence for a professional to practice if they are not on the register. The HPC will operate under six guiding principles which are: to protect the public; have a transparent complaints procedure; communicate and be responsive; provide a high quality service; value for money service; and work collaboratively on best practice (HPC, 2010). The Standards of Proficiency set out by the HPC are the standards which every professional that is registered must meet in order to practice, and must continue to meet in order to maintain their registration. The code also monitors and ensures that professional practitioners are adhering to standards of conduct, performance and are practicing ethically. It also sets standards on continuing professional development to ensure practitioners are kept up to date with latest research and information, as well as setting standards on education and training programmes.
Both the NMC and HPC are in place to ensure that all individuals on a national scale have the best care available with the confidence that the healthcare professional has the appropriate training and knowledge needed in their particular area. As in the case of Lewis the school nurse and dietician will both be regulated and will both be adhering to their regulator.
In summary, as I highlighted earlier unfortunately childhood obesity is on the rise in the United Kingdom. The main factor in this is due to children’s lifestyles and the environment in which they live in. There are games consoles, television programmes, advertising, computers and an easy access to fast food with children often preferring sugary treats rather than a piece of fruit. With more parents able to drive the impact is that children then do less walking and physical activity outdoors which all contributes to an unhealthy lifestyle which subsequently leads to obesity if not acted upon before it gets out of control.
There are massive government initiatives and campaigns that will hopefully increase awareness of the importance of maintaining a healthy balance diet, keeping active and also the dangers of obesity with the health implications it can cause. It is important for health professionals and schools to promote this and encourage children and their families to adapt their lifestyles accordingly in order for obesity levels to be controlled, as obesity is extremely hard to treat and much easier to prevent.
Lewis eventually received professional help and advice which has enabled him and his mother to treat his obesity. However if his mother had more awareness then Lewis’ obesity could have been prevented.
Adair, L.S., Popkin, B.M. (2005) Are child eating patterns being transformed globally? Obes Res July Vol.13, pp. 1281-1299
British Dietetic Association (2010) dietician? nutritionist? nutrition expert? diet specialist? (online) last accessed 2 January 2011 at URL http://www.bda.uk.com/publications/dietitian-nutritionist2010.pdf
Caprio, S. & Genel, M. (2005). Confronting the epidemic of childhood obesity Paediatrics, vol. 115, No. 2, pp. 494-495
Daniels, S.R. (2006) The consequences of childhood overweight and obesity Future Child Spring Vol. 16, No. 1, pp. 47-67
Department of Health (DH) (2009) be active be happy (online) last accessed 2 January 2011 at URL http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_094359.pdf
Department of Health (DH) (2010a) obesity general information (online) last accessed 2 January 2011 at URL http://www.dh.gov.uk/en/Publichealth/Obesity/DH_078098