Understanding Obesity: Diet, Exercise, and Genetics

Chapter One

Introduction

Obesity has been described as a complex disease that involves excessive fat in the body that increases the risk of health problems such as heart diseases, diabetes, high blood pressure and different types of cancer (Berthoud & Klein, 2017). Obesity is directly related to Body Mass Index (BMI). Individuals with a BMI of 30 or more are likely to suffer from the disorder. Obesity can occur as a result of personal diet, exercise choices and genetics. Physical activity and exercise have helped to burn excess calories, the amount burned depends type of exercise undertaken and the duration. (Bernhardsen et al, 2019). It is only applied to patients that have health risks that are related to the disorder, such as blood pressure, diabetes and high blood cholesterol which increases their risks of contracting heart diseases. Individuals with a BMI of 30 or those greater than have existing medical conditions and are advised to undertake exercise in order to reduce body fats. Unhealthy lifestyle choices such as unhealthy diet such as fast foods and inactivity routinely can cause obesity. Consumption of high amounts of energy from fats and sugars without regular exercise generally contributes to obesity (Muntaner-Mas, 2017). High value energy foods are measured in terms of calories. Average physical by a man in a day burns 2,500 calories while for a woman its 2,000 calories. Consuming large amounts of processed fast food, drinking too much alcohol and comfort eating comprises of a poor diet that leads to obesity. This medical condition can also be inherited, genes are hereditary and usually affect the amount of fats stored and distributed in one’s body. How your body regulates appetite and burns calories during exercise is greatly influenced by genetics. This condition normally runs in family not only because of genes by the common eating habits these members share (VanStrien, 2018). Chronic imbalance in a person can result into obesity it occurs in families as a result of clear inheritance patterns of a single gene. Since 2006 studies from the genome-wide association found out that more than 50 genes were associated with the disorder, hence monogenic obesity. Social and economic factors have been linked to obesity, having safe areas to walk and exercise reduces the body fat accumulation. Healthy cooking ways and having access to healthy foods such as fruits and vegetables reduces obesity syndrome (Ateschrang et al, 2018). Social groups and friend one keep normally influence the risk of occurrence of obesity as friends are relatives with obesity are likely to be sticking factor for obesity. In United States, studies conducted on obesity were able to deduce that poverty was the main socio-economic factor shown to increase obesity (Muntaner et al, 2017). Consumption of low quality foods due to economic status leads to an energy imbalance in the human body hence obesity.

Obesity is not age determined and can occur at any age even in younger children; however research has been able to prove that risk factors of obesity increases with age, hormonal changes and lifestyle activities (Uzogara, 2017). Other factors that have increased the risk of obesity include; pregnancy, quitting smoking, lack of sleep, stress, previous attempts to lose weight and stress. This condition is more prevalent in the United States as their dietary composition contains too high calories (Meldrum, Morris & Gambone, 2017). Obesity can diminish the overall quality of life, as one may not be able to do activities they used tengaged in due to the fear of the public and their opinions. These people are normally discriminated and end up isolating themselves from the real world (Uzogara, 2017). The shame and guilt these individual experience leads to depression and lower work achievement. However, there are various preventive measures that have been put in place to reduce the risk, daily exercise, healthy diet and dietary plans and use of medication have reduced excessive weight gain in individuals.

Background of study

Currently in the world of epidemics, obesity has been considered as a public health crisis that is a few years old. Rapid technological advancements in the 18th century led to increase in food supply with different varieties with different calorific content (Qasim et al, 2018). The abundance of the readily available accessible food, with reduced physical activity have accounted for the recent spring of the condition. Food scarcity thought time, led to the idea that being fat was a good thing and increased flesh signified the health of an individual (Hamer et al, 2020). By mid of the 19th century, being fat led to stigmatization and was considered anaesthetically. Later in the 20th century obesity became a clear cause of death and other increased health risks such as diabetes and heart diseases. Chronic nephritis was a major risk factor of obesity and resulted in mortality (Echouffo-Tcheugui et al, 2019). More subsequent recognitions of the risk factors of obesity altered the previous listing and perception on obesity leading to more concern being shifted to individuals with obese conditions. In the past decade, a body of evidence was established and as at now the direct association of obesity and chronic kidney diseases and the resultant effects have been identified (Saldana-Tejeda & Wade, 2018). The impact of obesity on the quality of life in the 21st century led to the World Health Organization recognising it as a global epidemic and an issue of public concern. The pathogenesis of obesity is more complex any other simple paradigm of availability of food and the effort spent to obtain it. There are other factors beyond food and limited exercise that have caused obesity in individuals, which have made the consequence of obesity even more severe (Bentley Ormerod & Ruck, 2018). Cultural aspects have played a critical role in shaping gross obesity over time. A good example is the idea that beautiful and healthy women were perceived to be those rounded and fatty, nut latter in the 20th century fat girls were viewed as ugly and unwanted.

Service improvement plan

Obesity is has been considered a very significant cause of chronic diseases in the UK. More than 147 billion is used every year to treat obesity and the related chronic illness. A service improvement has been set forward to ensure that there are effective strategies to address the barriers that have inhibited primary care to patients suffering from obesity (King et al, 2015). Obesity is a complex problem and there is no single or simple solution to this pandemic. Policy makers, local organizations and health care professions have come together to create a healthy environment with use of several multifaceted approaches to promote healthy living for these patients. To improve service delivery to obesity patients, family based care multicomponent behavioural therapy is advocated. According to Doctor Hollie Raynor experts in behavioural change play a very significant role in designing, testing and delivering of obesity treatment measures (Bird et al., 2015). In treatment and prevention of obesity in children people who are highly trained in behavioural change and principles and can understand how to engage in parents or guardians training skills. This service improvement model encourages the entire family to engage in healthier behaviours. These skills are typically taught in both family sessions with the kids and guardians attending together. Another service improvement delivery model is the integrated care model, currently there is deficiency in knowledge, organization and structure in the health care systems which has become a major risk for obesity (McCombie et al, 2019). There is need to strengthen integrated care systems in place for both primary and secondary care to improve service delivery. In 2010, educational training programs have been in place opting for improved care for patients with obesity. These programs were tailored with a sole purpose of offering training practice to large numbers of care givers. Multidisciplinary care team is another service improvement model that includes physicians with expertise in pharmacotherapy, a nurse and medical practitioners (Ralston et al, 2018). These experts can provide guidance on weight loss programs by bringing together effective interventions from different disciplines that cut across medical practice. Weight loss goals and plans are identical to plans for people suffering from diabetes. These clinics both aim for realistic, modest weight loss targets where they both view weight gain as an indicator of metabolic diseases in individuals. Patient centred care is also advocated as a service improvement model. A lot of the patients are found in these multidisciplinary obesity and diabetes clinics. These patients are considered to be the epicentre of both teams who receive help from primary physicians (Watanabe et al, 2020). Pharmacists and case managers can complement this group and mainly focuses on patient participation, goal setting and patient self- management. It begins with screening and diagnosis to identify their body mass index.

With the rising rates of obesity in Canada, recent discussions have been held to promote healthier lifestyles. The idea of paying people so that they can adopt healthy living behaviours has attracted studies and debates and has already been adopted by some governments and companies. Target incentives for specific risk groups have yielded more results (Kasture et al., 2019). The use of financial incentives for weight loss has been useful in promoting health policies. This idea is now attracting attention and has gained popularity in Canada as a variety of interventions have allowed individuals to join these reward programs. The state and local programs have made resources available to help in the dissemination of evidence based practices to the state, local grantee and practitioners (king et al, 2015). In order to combat obesity, knowing your body mass index, maintaining a healthy diet and regularly exercising are important factors to consider. To reverse the effects of obesity, communities have shifted more focus on supporting healthy diet and improved living standards. A healthy living is key to achieving and maintaining weight which should go hand in hand with regular physical exercise.

Objectives of study

The main objective of this study is to ascertain the effectiveness of regular exercise, dietary plans and use of medication in treatment of obesity in individuals. This will be able to produce an understanding of the mechanism that causes obesity and how it is linked to other illnesses. These insights have been used to develop effective prevention and treatment conditions. Activities of this research have been based on the causes of obesity, how it influences the occurrence of other diseases and effective treatment by use of approaches physiology and epidemiology.

Chapter Two

Search Strategy

The topic on exercise, diet and dedication to reduce obesity, is abroad one and a lot of research pertaining it. Journals and articles from CINAHL and medical databases as they relate to health care provision to patient with different pathological conditions were used (Ali & Usman, 2028). Other used materials include the multiple database approach that informed the literature reviews. Specific database searches were obtained from PubMed. The use of keywords such as obesity, risk factors of obesity and use of specific medication in treatment of obesity were used to locate these research papers (Aveyard & Bradbury‐Jones 2021). To ensure accuracy, other search features such as obesity were used to narrow down the research. There were restrictions that were centred on the geography, publications dates’ language and full texts. Most of the information obtained from these search strategy were outdated and could not be used (Maurao et al, 2017). Geographically it was a limitation as there is little research that has been done on these topics in England and Asia. Boolean operators such as “and”, “or”, and “not” were used in advanced search strategies. These operators when used ensure that the title, author and the dates are accurately explored (Mendes et al., 2019). Electronic databases were chosen as they allow for search of academic literature that is relevant to the main topic of study. International searches were filtered with regard to location in order to exclude data was not relevant to obesity and treatment procedures. However, valuable information from older sources may have been missed due to the filtering and hence creating biasness within the collected information.

Critiquing tool

Critique tools were identified in order to appraise the chosen research literature. The Critical Appraisal Skill Programme (CASP) allowed a deeper insight into the reliability and validity of the data collected during research. Data that has been proven useful by the quantitative and qualitative search studies is considered useful in answering the research question (Larsen et al, 2019). If the research is new to the research process, the critiquing tool is recommended. All papers that have been chosen for review by a researcher have to be evaluated by the same tool to avoid using irrelevant data (Long et al, 2020). Use of tools has proven to be advantageous to research as questions asked were relevant in the design. There is no standard tool that has been recommended for critiquing research as different tools used to critique the same paper may yield different results (Imam et al, 2017). However similarities have been established after critiquing these papers using different tools which have been able to prove that there is some degree of validity in using these tools. The results of the appendix have been able to deduce that literature has been structured comprehensively using the CASP tool. To ensure accuracy and quality assessment in each piece of research, individual tools that were specific to the research were used (Claydon, 2015). Explanations of varied results between different studies have been explained which have highlighted different methodologies and data presentation techniques that were used in conducting research. Although the CASP tool is not ideal for all literature search as it does not a checklist for all types of literature used.

Literature Review

This research surveys similar scholarly articles on the same topic of discussion. Identification of theories, methods and gaps existing within research is derived from the overview of the current knowledge (Snyder, 2020). It involves finding the relevant publications such as books and magazines, and analysing the critically to explain the findings. It involves five key steps of search, evaluate, identify, outline and writing a review. The core priority of this literature review has been identified by the National Institute for Health and care excellence (The National Institute for Health and Care Excellence, 2015). Commutation was faint between nurses and patients. According to Selman in 2017, he carried out interviews with patients, caregivers and clinicians in the United Kingdom. Phenomenology approach was used to analyse the results. The findings suggested that poor communication was identified as inadequate skills which affected care provision to patients with obesity (Selman, 2017). On a similar study conducted by the royal college of physicians’ audit, an incidence of communication between caregivers and patients was reported. This made the patients feel more empowered which later proved to be of significance to the overall performance and experience of healthcare providers. Obesity has been linked to more than 25% increase in moods and anxiety disorders which greatly inhibit the mental health of an individual. Studies conducted have been able to prove that obesity is directly related to depression (Hamilton & Pearce, 2028). In a study conducted with 9,125 participants on psychiatric disorder and weight, the response rate was 71% which was able to suggest that mental health is directly proportional to weight gain in individuals. An in-person interview including the assessment of a range of mental disorders as well as weight of individuals was used in this study. It was deduced that obesity may be significantly associated with mood disorders which may lead to depression. In a similar study conducted in the US, survey suggests that there is a stronger association between obesity and mental health among those patients under the age of 65 (Bennell et al, 2019). The Caucasian samples obtained in the US and Canada suggests that there is a stronger association between depression and obesity however these findings may not extend to other cultural or ethnic groups. Longitudinal studies have been able to prove that than onset of obesity is subsequently predicted by depression (weight loss is associated with decreased depression). Anxiety disorders, substance abuse and obesity are greatly interconnected. Professional non clinician interviews from the institute of social research in ye university of Michigan conducted different assessments (Benzerouk et al, 2028). Mental disorders were assed with more than 300 interviewers which lasted for more than 7 days. Laptops were used in administering these interviews and a random 10% was used for randomized control experiments. Age, sex and race were used in assessment of the participants. Previous research suggests that self-reported height and weight were directly proportional to the weight.

Obesity is considered a significant health issue for different health policies as it affects millions of individuals in the world and because of its risk of complications (Karami et al, 2018). Findings from DEGS Have been able to prove that a research carried out between 2008 and 2011 by Robert Koch institute in representative populations 23% of men and 23.9% of women were found to have obese conditions (Abel-Fattah & Mazen, 2019). The condition is more prevalent and increases with increase in age within the given population. Obesity is directly proportional to age and gender does not play a significant role in the prevalence of the disorder. In the year 1999 to 2009 prevalence of persons with a body mass index of more than 35kg/m2 indicates that the body mass index is directly proportional to obesity. The German Federal Court together with the WHO organization was able to deduce that is a chronic disease that that occurs as a result of complex interruptions between environmental factors and genetic factors (Chooi, Ding &Magkos, 2019). These combined increases the body mass index in an individual and may cause mortality and morbidity which have called for treatment and preventive measure for obesity. It heterogeneous nature has called for individualised assessment practices and risk stratification. Given the prevalence of the disorder and the difficult nature of treatment, prevention procedure is required. Consumption of food and drinks should be according to the nutritional requirement of these individuals (Jumbe, Hamlet & Meyrick, 2017). Regular exercise and constant body checks are important to prevent over weight and obesity in individuals. This means that people should consume less food with energy densities and more food with low energy densities. Research from the German College of General Practitioners and Family Physicians suggests that people with a body mass index of 25 should avoid consuming foods that have high energy densities (VanStrien, 2018). The Mediterranean diet has also been considered as one that prevents the prevalence of overweight and obesity in people. Consumption of alcohol, fast food and sugary drinks should be reduced to prevent accumulation of fats in the body. These foods are considered to be energy dense as they contain very high proportions of sugar and fats that are fatal when ingested (O'Donoghue et al, 2020). According to research conducted by Rosenheck of the effects of fast food consumption and effect of its calorific value, not only drinks sweetened with sugar but fruit juice too has a high sugar content are dangerous when consumed. Inactive lifestyles that involve doing little to nothing also promote weight gain in individuals. The intensity and type of exercise conducted by an individual determine the amount of calories that will be burnt (Reid, Thivel & Mathieu, 2019). Research conducted by Donnelley et al in 2009 on American college of sports medicine position stand has pointed out that endurance to these physical activities serves as the best goal to achieve when fighting obesity, which should be done more than 2 hours a week. On the question of who should lose weight depends on the body mass index recorded and the fat distribution. High psychosocial distress, abdominal overweight, hypertension related to obesity and a BMI related to 30kg/m2 or more require argent medical attention (Barrow et al, 2019). However pregnant women and individuals with waiting diseases that do not allow them to exercise are exempted from the list requiring medical attention.

Research on dietary therapy suggests that obese people should receive personalised recommendations of on their nutrition which should be adopted to the goals of therapy and the risk profile of these people (Petridou, Siopi & Mougios, 2019). There are different therapeutic goals and risk factors in patients, and assigning these individuals the same dietary regulation is risky. No valid studies have been published on these recommendations and can only be successful over long term if these patients agree to change their initial lifestyle and adopt the outlined dietary recommendations. In groups that require therapy and nutritional counselling, programs within medical management should be adopted to enhance efficiency. Therapeutic forms that are effective when undertaken in long time to enhance energy deficit should be recommended to patients for weight reduction. According to Bennell et al in 20019, a research conducted on the importance of reducing weight through exercise, increased exercise of 150 minutes per week with a lower energy consumption leads to effective weight loss (Bennell, et al., 2019). Strength training alone is not considered effective as it requires one to reduce the sugar and fatty intake. Studies and Meta-analysis from well controlled studies show a weight reduction of about 2kgs and 6% loss of abdominal fat for more than six months (Ekkekakis, Zenko & Werstein, 2018). These studies among multiple researchers have been able to prove that effective physical activities result in body weight loss and abdominal fat. Mental disorder has also been directly linked to obesity in adults more than 65 years of age. These individuals are prone to stress and exercise less and hence accumulating excess body fats that lead to obesity. Weight loss and requires regular exercise as well as a healthy diet, however in certain conditions, prescription of weight loss drugs may help. These medications are to be used along with a healthy diet to enhance efficiency. There are several anti-obese medications helps one to stick to a low diet as they inhibit appetite. Individuals who have not shown any improvement in dietary regulations and regular exercise are prescribed these medications (Chooi, Ding & Magkos, 2019). Doctors consider patients history before prescribing weight loss drugs for them. Pregnant women and individual with other chronic illnesses cannot be prescribed these medications. Medical monitoring is required to individuals taking these drugs as weight loss may not work for everyone and may have medical complications overtime. Obesity and depression have indicated a higher probability of association, prevalence of depression is 10% and overweight is 65% the moderator distinction approach was used to conduct this study (Vittengl et al, 2018). Depression gender and gene by environment were used as the main moderators in this study, major depression was observed among the adolescents who had a higher body mass index which was higher than 27. It was deduce that obesity was related to major depression and anxiety disorders. Diverse childhood experienced also contributed to obesity in individuals.

Chapter Three

Change management

Change management has been referred to as the methods which a company describes and implements changes within its process. These changes can either be internal or internal depending on the problems or issues at hand. Necessary steps are required to successfully implement changes in an organization (Zaman et al, 2020). The National Health Service (NHS) has developed a structured approach to ensure a beneficial transition within the health sector. Implementation of the NHS goals for a long time involves a great deal of changes for all issues of concern. The process of change in the NHS involves a series of steps which are followed effectively (Ferrel & Sood, 2020). Research over time has been able to prove that most effective changes applied in NHS have three distinct phases which include; preparing for change, change management (which involved a detailed plan and implementation process) and the reinforcement of change which involved data collection, data manipulation and analysis of the results. The main element of change management described by the NHS is the readiness assessment. Change management leaders have used this tool for a long time to evaluate their readiness and efforts to implement the anticipated change (Zamani et al, 2020). Service improvement models such as integrated care model which involves strengthening the readily available structures. This ensures that primary and secondary care is effectively delivered to patients with obesity. Providing the teams in charge of project administration with insights into potential opportunities and enlightens them with the future challenges they are likely to face during this process of change ensures that change is effectively implemented. Communication and planning is another key component of change management, managers are required to clearly communicate with the rest of the employees to ensure that the job is done clearly (Ferrell & Sood, 2020). Effective communication within health care improves the delivery of service by minimising the occurrence of errors and room for mistakes from the previous studies on obesity it is evident that there has been a service delivery gap poised by communication. In order for the service delivery model of multi disciplinary model to work efficiently, effective communication should be adopted. This will ensure physicians, pharmacotherapists; nurses and medical practitioners need to maintain communication. Effective communication considers these three components such as audience, the message and when it was said (Aiello, 2020). In order to create awareness within an organization, initial communication is typical it involves a thorough analysis of the audience, key messages and the timing. These communication plans should be well designed by the change management team to ensure each audient has the specific requirements.

Management training and coaching for is effective for change management. Managers and supervisors have more influence on employees for motivation and readiness for change. Training this management team will ultimately ensure that change is enacted (Hutchinson, 2020). However, gaining the trust and support of the supervisors and managers in building changes in leadership and care administration is hard. But once they are on board change management team must prepare strategies and training for them. Multidisciplinary care model will work effectively in service improvement when integrated with this model of change management. This will equip them with the knowledge and skills they require to effectively implement changes in an effort to improve care provision to patients (Selman, 2017). Training is a foundation of building knowledge about change, which makes it possible for project teams to develop the necessary requirements in terms of knowledge and skills to implement change. All these requirements inform the starting point of training programmes and the development team. Sponsor activities and sponsor roadmaps are another element of change management process. In an effort to manage change, executive, business and organization leaders play a crucial. It encompasses the idea of change management teams consequently developing sponsor activities plans and assists these leaders in executing their plans (Aiello, 2020). The NHS guideline of service improvement that focuses on the availability of resources from state and local programs clearly fits in this element of change. These resources are helpful in an effort to administer change, by enabling the dissemination of evidence based practise. Sponsorship also involves senior leaders to be visible and actively participates thought the whole process of change. The roles of these change project leaders include assisting senior leaders in implementing change management. Another aspect of change in health care provision is the resistance management. In an effort to implement change in care systems, it is normal to encounter resistance from top management. Most projects are at risk if this resistance persists (McShane & Kirkham, 2020). Identification and understanding of this reasons for resistance across all levels of an organization is important for change management teams. Implemented plans such as family based care and patient cantered care are important guidelines of NHS that can be effectively implement for change by project teams assisting executive managers. It is important to include the whole management in implementing change as employee feedback is an important factor.

Conclusion

Obesity is a medical disorder that involves an excessive amount of body fat that is caused by lack of exercise, poor diet, genetics and other factors such as socio economic factors, pregnancy, age and hormones. Consuming foods those higher sugary and fatty contents increases the amount of calories in the human body. Lack of exercise to burn the excessive fats accumulated by poor diet increases the body mass index of a person leading to obesity. Genetics also plays a critical role in contributing to obesity; studies done previously suggested that more than 50 single genes inherited by offspring from their parents contributed to a type of obesity known as monogenic obesity. Obesity is more prevalent in the united stated with chronic food shortage and malnutrition cases among the black Americans. Currently it has been recognised as a world health crisis that is barely years old with its emergence in the mid-18th century as food supply gradually increased. Since the inception of the Second World War, there has been food abundance which was accompanied with reduced physical activities. Initially increased flesh was viewed as healthy but later in the late 19th century there was stigmatization which was linked to beauty and aesthetic with the condition becoming serious in the 20th century with increased rates of mortality. Reviews from different scholars on impacts of exercise, diet and medication on obesity has been able to prove that regular physical exercise with improved dietary concerns have greatly reduced the prevalence of obesity in the modern world. Medication is not commonly used in treatment of obesity except for the case of patients with severe cases. Another finding was that obesity contributes to other chronic diseases such as coronary diseases, diabetes and mental illness. however there have been gaps identified from previous studies conducted on obesity and it has been proven that these is need for service improvement plans and change management guidelines from NHs to ensure that there is effectiveness in service delivery. Family based care; integrated care models, multidisciplinary approach and patient cantered control are advocated for improvement of health care services to patients with obesity.

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