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Obesity, Community Health and Social Care in Scotland

Introduction

World Health Organisation (2011) (WHO) defines someone that is obese as someone who has a Body Mass Index (BMI) of greater than 30. “BMI is measured by a person’s weight in kilograms divided by the square of the person’s height in meters (Kg/M2)” (WHO, 2011). This assignment will look at obesity and how it affects community health and social care; this will be done by looking at local and national policies and guidelines, influences across the lifespan, services and agencies available to help with obesity, and the relevance to nursing practice.

Policies and Guidelines (Local and National)

The Scottish Government has set out a strategy to help prevent obesity; Healthy Eating, Active Living: An action plan to improve diet, increase physical activity and tackle obesity (2008-2011) is a strategy that aims to explain how the Scottish Government will improve Scotland’s diet, and encourage greater exercise in order to establish a base to tackle obesity, and support people to achieve and maintain a healthy weight are targeted mainly towards those at greatest risk of health inequalities (Scottish Government, 2008). A main objective of the strategy is to improve and maintain natural and built environments to encourage a more active lifestyle, providing opportunities for activities like walking, cycling, and swimming with the aim of preventing obesity in Scotland. (Scottish Government, 2008) with in the strategy it also states it aims to “Promote healthy food choices, meal preparation and eating habits by communicating practical achievable steps towards the consumption of a healthier diet.” (Scottish Government, 2008 p.19). Specific action plans will be put into place to support people to make healthier choices including: introducing a cooking bus that will highlight the importance of food and nutrition for schools and communities, It will allow people to develop a better understanding on how to eat healthier and what food can do to your health. (Scottish Government, 2008)

Hungry for Success was developed by the Scottish Government (2003) and introduced nutritional guidelines for school meals. The Scottish Standards indicate that oily fish should be served at least once a week and processed meat products only once a week; Brown bread should always be on offer; and there should be at least two helpings of vegetables and two of fruit on every menu each day (Scottish Government 2003).

The Scottish Intercollegiate Guidelines Network (SIGN, 2010) have released guidelines called: Management of Obesity: A National Clinical Guideline (SIGN 2010). This is after realising that “obesity in Scotland has reached epidemic proportions and its prevalence is increasing. The impact on physical and mental well-being is now recognised at a national level” (SIGN, 2010 P.1) The guideline aims to provide evidence based advice for the prevention and treatment of obesity in the clinical area (SIGN, 2010) It does this by looking at targets as and evidence based recommendations. Some recommendations include: weight loss targets should be based on the individual’s comorbidities and risks, rather than their weight alone, and weight management programmes should not exclude patients with binge-eating disorder. (SIGN, 2010)

Within Dumfries and Galloway a strategy has been developed by a multi-agency working group, with the help and support of local communities to help reduce and prevent obesity. The main aim of the Physical Activity Strategy (2008 – 2011) (Dumfries and Galloway Council, 2008) is to improve the health and wellbeing of the local community through the promotion, provision and support of various physical activity initiatives (Dumfries and Galloway Council, 2008). Within the policy it made clear that obesity levels in Dumfries and Galloway are alarming as the level of obesity and overweight in Dumfries and Galloway has increased from 10% in 1995 to 20.3% in 2007, meaning it has the highest percentage in Scotland (Dumfries and Galloway Council, 2008). The policy states that the rise of obesity means that other diseases such as diabetes are becoming increasingly common, this has a detrimental effect on the economics of the healthcare system; it estimated that Dumfries and Galloway alone spend £5.2 million a year to treat obesity (Dumfries and Galloway Council, 2008).

Influences across lifespan

When hoping to conceive, being obese can cause complications and reduce the chances of conception by 50% (Ward, 2012). Brewer & Balen (2010) showed how weight loss can lead to a higher chance of conception and that 67 out 87 obese women who lost weight managed to conceive previously they were infertile.

According to a study by Toschke, Montgomery, Pfeiffer et al (2003) smoking while pregnant increases the risk of being obese later in life. Women who are obese during pregnancy increase their risk of disorders that affect the pregnancy outcome, these include: “Early miscarriage, Gestational diabetes, and pregnancy hypertension” (Robson, Waugh, 2009 p165). (Basso, 2004) cited in Arendas, Qiu, Greusling (2008) showed that being pregnant when obese also increases the risk of having twins. This was said to be because the “relationship between increased BMI and the incidence of twinning are related to increased levels of FSH in obese women” Arendas, Qiu, Greusling (2008 p.5)

Exposing infants and toddlers to food insecurity are putting them at risk of becoming overweight or obese later in life. “Food insecurity is defined as limited or uncertain access to enough nutritious food” (Cook et al, 2004 p.1) this does not mean there is a reduction in food quantity. Research suggests food insecurity can trigger health conditions such as obesity and overweight Cook et al (2004). Parents are buying unhealthy meals more often because of barriers such as fatty foods are cheaper than fruit and vegetables (Dwyer et al 2008). If a child is brought up with healthy foods he or she is unlikely to eat healthy later in life increasing obesity risk. A HEAT target is set out to help reduce child obesity and aims to achieve agreed completion rates for child healthy weight intervention (NHS Scotland 2010)

The number of early deaths in people of healthy weight, who smoked more than ten cigarettes a day was found to be the same as non-smokers who were obese, (Smith 2009) The study was carried out on 45,000 people who were conscripted for military service at age 16 to 19 when their BMI and smoking habits were noted. They were followed up for an average of 38 years and during that time 2,897 of them died (Smith 2009). The study found that being overweight as a teenager increases the risk of dying within a 38 year period by a third, and the chance of dying in obese teenagers is doubled (Smith 2009).

Obesity in adulthood causes disorders such as cardiovascular diseases, strokes, diabetes, and some cancers (Alexander, Fawcett, Runciman, 2006) thus life expectancy will be decreased, as well as quality of life in some instances which has a prolonged effect on the health of the obese person

Although obesity is an ever growing epidemic obesity in the elderly population it is a rare occurrence as many people who are obese die younger (Elia 2001). After a peak in body and BMI at the age of 60, there is a rapid decline of weight of 0.65kg per year (Elia 2001).

Services and Agencies

Weight Watchers is an agency that helps people lose weight and, maintain a healthier life style. Weight Watchers is “Based on up-to-date science and tried and tested over the years by real people, the Weight Watchers programme comes from the experts at the weight loss game. It’s designed for living and losing weight” (Weight Watchers, 2011). This service is available to everyone but does have a cost that comes along with it, with memberships starting at “£10.95 per month” (Weight Watchers, 2012).

Weight Watchers have over 6000 classes all over the UK including five in the Dumfries area. (Weight Watchers, 2012(B)) Weight Watchers claim so many people join there club because you can still eat the food you love. “We’ll empower you to make informed choices to continue to lose weight and not lose out on a social life” (Weight Watchers, 2012). Although Weight Watchers is not free it proves to be popular with the public after more than 35 years of service and helping millions of people lose weight (Weight Watchers 2012).

Dumfries and Galloway has services such as SONAS, which is a public health service that works with health partnerships to “raise awareness, educate and build capacity in health improvement in the locality” (NHS, Dumfries and Galloway, 2012 p1) SONAS aims to provide information to the public about health issues and reduce health inequalities within Dumfries and Galloway (NHS, Dumfries and Galloway 2012) including obesity and overweight.

SONAS support evidence based projects such as the Dumfries and Galloway Physical Activity strategy, and Healthy eating, Active living improvement plan (NHS, Dumfries and Galloway, 2011), all of the current policies are available at sonas based in Annan, Dumfries and Galloway. If anyone has any queries the friendly staff members are there to help, and support to allow an overall health gain. SONAS has a library in which anyone can use to research any health information, and access to all the resources needed to have a healthy life (NHS, Dumfries and Galloway, 2012).

Within Dumfries and Galloway and Scotland primary care services such as GP’s will be able to help with weight problems. “GPs believe it is part of their role to advise obese patients on the health risks of obesity” (Epstein 2005 p1).

School nurses are able to send letters home following a health screening which includes taking a BMI (Brunner, Suddarth 2010) the letters inform parents their child has a high BMI, and offer advice and support to help the child reduce the BMI. Some parents see this as the school nurse saying their child is overweight or even obese.

Health Visitors use Hall 4 as baseline of practice (Hall, Elliman 2006).They have a vital part to play in obesity prevention as they can recommend breast feeding which is shown to reduce obesity later in life, (Armstrong 2003). They can also tutor the new parents about healthy food choices and support the parents throughout the child’s infancy

Relevance to nursing

Nurses need to be aware of a disorder known as Binge Eating Disorder (BED) is a common form of obesity where patients usually have difficulty losing and maintain weight loss, and BED patients should not be excluded from any weight loss programs (SIGN, 2010). This disorder is one that nurses should be aware of particularly if the patient is struggling to lose weight. Nurses should also be aware that if the patient is trying to stop smoking a weight loss intervention should be put in place, as the risk of having further health problem due to the weight gain is substantial (Martin, 2011)

Obesity in Scotland cost the NHS £171 million and only a small portion of this money was used for weight loss intervention (SIGN, 2010), this led to need for a guideline. The rise in obesity has a major impact and burden on all aspects of health and social care, financially and in terms of waiting times, (Bell, Crystal, Detsky, et al, 2006).

Nurses should also be aware of weight loss management by medications as it costs NHS Scotland £4.5 million a year (Scottish Government 2010) and it is compulsory for nurses to have knowledge of the effect the drugs may have. For example Sibutamine HCl (Meridia) decreases appetite and may cause hypertension and should not be considered for patients with a history of Coronary heart disease, angina, dysrhythmias, or people on antidepressants (Brunner, Suddarth 2010). Nurses should use the British National Formulary (BNF) to look up and find all information about the drug before administration.

Moving and handling is difficult when dealing with obese patients as specialist bariatric equipment is needed (Hignett, Griffiths 2009). A study in England showed that 150 trusts were spending £60,000 per year on specialist equipment such as larger hospital beds, chairs, surgical equipment and delivery beds (Scottish Government 2010). Recently The Scottish Ambulance Service adapted 63 vehicles to allow anchoring of the trolley in the middle if the ambulance to manage obese patients this cost £189,000 (Scottish Government 2010). In the South of Scotland obese patients have to be transferred to Aberdeen in order to use the bariatric MRI scanner (Scottish Government 2010) costing money and increasing waiting times.

Nurses should be aware of the HEAT Targets like breast feeding which aims to encourage more mothers to breastfeed after recent studies show it is more beneficial (NHS Scotland 2010). HEAT Targets such as Child Health Weight, and Alcohol, as well as Smoking Cessation are all Targets nurses should be aware of when dealing with obesity.

Conclusion

Obesity is a national epidemic and is a main cause of poor health in Scotland such as cancers, strokes, and coronary heart disease. It is also apparent that the overall objective is to reduce obesity in all age groups, to the standard where a person’s health risks are reduced to a minimum whether this is through exercise or healthy eating. Reports read throughout this assignment all agree more education is needed to reduce obesity, and cost to the NHS. Objectives can be achieved with advice from local or national services and agencies, and by educating people from a young age in schools.

References

Alexander, F., Fawcett, N., Runciman, J. (2006) Nursing Practice Hospital and Home. 3rd ed. London: Elsevier.

Armstrong, J, (2003) Breastfeeding and lowering the risk of childhood obesity. The Lancet. [Online] Vol.359(9), pp.2003-2004 Available:http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(02)08837-2/fulltext. [Accessed: 09 June 2012]

Arendas, K., Qiu, Q., Greusling, A. (2008) Obesity in Pregnancy: Pre-Conceptional to Postpartum Consequences. Obstetrics, [Online] Available:http://www.jogc.com/abstracts/full/200806_Obstertrics_1.pdf. [Accessed: 17th June 2012].

Basso, O. (2004) Risk of twinning as a function of maternal height and body mass index. JAMA Vol:291(3), pp. 1564-6.

Bell, C., Crystal, M., Detsky, A., Redelmeier, A. (2006) Shopping around for hospital services. The Journal of the American Medical Association. [ONLINE] Vol. 279 (13), p1015 – 1017 Available: http://jama.ama-assn.org/content/279/13/1015.short [Accessed: 23rd March 2012].

Brewer, C., Balen, A. (2010) The adverse effects of obesity on conception, and implantation. The Journal of the Society for Reproduction and Fertility. [Online] Available: http://www.reproduction-online.org/content/140/3/347.full.pdf+html. [Accessed: 16th June 2012].

Brunner, I., Suddarth, S. (2010) Textbook of Medical-Surgical Nursing. 12th ed. Tokyo: Lippincott, Williams, and Wilkins.