Video
A Whole Systems Approach to Obesity Prevention Each month, we feature select National Health Obeskty NHOs that awarreness with our priorities for improving health across the nation. Home remedies for hair growth to a non-federal website prveention not Strengthening the immune system an endorsement Strengthening the immune system Obewity or Strengthening the immune system of Obrsity employees of the sponsors or the information and products presented on the website. September National Health Observances: Healthy Aging, Obesity Awareness, and More. Healthy Aging Month Every September, we recognize Healthy Aging Month to promote ways people can stay healthy as they age. National Childhood Obesity Awareness Month The Centers for Disease Control and Prevention CDC recognizes National Childhood Obesity Awareness Month as a time to raise awareness about preventing childhood obesity.Obesity prevention awareness -
Two studies, one with community health staff and one with mental health clinicians, found that training changed practice in terms of assessment of risk factors but did not change practice in relation to providing advice [ 16 , 17 ].
In studies which reported that clinicians did provide advice, in most cases patients could recall that advice but these papers did not report on whether the people receiving the advice changed their behaviour or on the long term retention of that advice [ 11 , 12 , 13 , 15 ]. It did not consider supporting people to set their own goals around their weight or risk factors.
The remaining six literature reviews did not report on health professionals providing advice. The next step of the 5As framework is providing intervention aimed at assisting people to set goals to self-manage lifestyle changes. The primary studies category 1 did not address this element, instead framing the role of health services not as providing support but instead referring to other agencies to provide this support.
One literature review concluded that intensive long term support was required to assist people to embed changes but did not provide specific details of what this might look like [ 23 ]. Another concluded that assisting people to set goals related to weight management achieves better outcomes than linking goals to more general improvements in health [ 20 ].
The final step of the 5As framework recommends providing support to help people achieve and maintain their weight goals. Three of the Category 1 health service evaluations focussed specifically on this step.
For example, a recent study undertaken across several community health centres focussed on supporting community health staff to incorporate assessment, brief advice and referral in relation to addressing chronic disease risk factors, including obesity risk factors.
The intervention was successful in getting staff to undertake more assessments for risk factors but did not change practice in relation to brief advice or referral for intervention [ 17 ]. Similar results were obtained within a community mental health setting, concluding that even when clinical guidelines explicitly direct clinicians to incorporate preventive care into interactions, rates of care given around issues such as fruit and vegetable intake or physical activity remain low [ 16 ].
The study concluded that prevention may need to be delivered within a different model of care [ 16 ]. Two of the systematic reviews concluded that successful obesity prevention needs to include the provision of or referral to intensive, multicomponent behavioural interventions which aim to support weight loss and management [ 21 , 23 ].
The National Health and Medical Research Council NHMRC Clinical Practice Guidelines [ 6 ] identify different life stages where there is a greater risk of weight gain. The empirical studies were therefore analysed to identify the clinical areas where prevention may have the most significant impact and the specific elements key to working with these clinical groups.
Fifteen of the papers included in the review focused on a particular life stage or cohort of patients. The clinical areas identified were maternity, which has received the most focus but has not been rigorously evaluated [ 13 , 14 , 26 , 27 , 31 , 33 , 34 , 36 , 48 ] and mental health [ 37 ].
Definitive evidence of how obesity prevention should be delivered in mental health services was not available. The papers which focussed on maternity based services highlight the immediate consequences of maternal obesity including higher rates of gestational diabetes, high blood pressure and pre-eclampsia and higher risk births.
Excess weight gain in pregnancy combined with not losing the weight after pregnancy are predictors of long-term maternal obesity and increases the risk of the child developing obesity whilst mothers with gestational diabetes are more likely to develop type 2 diabetes later in life [ 36 ].
Along with the individual risks to mother and child, there is an increased demand for services and a requirement for more specialised services to support woman and baby both during and after the birth [ 18 , 26 , 30 , 31 , 33 , 34 ]. Only one of the papers targeting obesity prevention in maternity care settings reported on a specific intervention.
This found that women at risk of gestational diabetes who receive advice in relation to limiting weight gain during pregnancy are less likely to develop diabetes despite no significant difference in weight gain compared with a control group [ 13 ]. The other maternity focussed papers were more descriptive, providing a broad overview of implementation factors including the need for a multidisciplinary approach to reinforce the benefits of diet and physical activity beyond weight management.
For example, obese pregnant women who are physically active have been shown to experience less depressive symptoms and report higher quality of life to obese women who are not physically active in pregnancy [ 14 ].
Two papers stated that discussions about safe weight gain and weight management needs to be done in a way that does not stigmatise or cause feelings of shame [ 27 , 33 ]. Only one paper looked at a life stage other than child bearing years, namely older adults [ 29 ].
As with similar studies looking at the adult population more generally [ 28 ], it was found that older adults were more likely to receive lifestyle advice if they were already obese or had a number of chronic conditions [ 29 ].
The disadvantage of many of the survey based studies was the reliance on self-reported weight and height. In terms of specific clinical areas, studies have been conducted in mental health and community health services. It was reported that it is very difficult to change the practice of mental health staff to include a focus of physical health risk factors [ 16 ] with mental health clinicians not necessarily seeing this as their role [ 37 ] despite the fact that people with mental illness do want to reduce their risk factors [ 40 ].
Similarly in services delivering general community health care, despite the presence of risk factors and an openness by clients to receive preventive advice, community health staff do not deliver opportunistic prevention, particularly in relation to diet [ 8 , 17 ]. This review found that along with practical barriers to changing practice including a lack of time, resources or clinical guidelines [ 34 , 38 , 39 , 49 ], a key barrier to healthcare based obesity prevention is the perceptions and beliefs of health professionals towards obesity.
As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professionals may simply not see it is their role [ 37 ]. There is also an issue with judgements being made in relation to who might benefit from prevention along with a negative view of the effectiveness of prevention, compounded by a view that preventing obesity is a matter of personal responsibility and choice [ 25 , 38 ].
The 13 studies which specifically looked at this issue are summarised in Category 5 of Tables 1 , 2 , 3 , 4 , 5. These papers used a range of methods to ascertain attitudes, including questionnaires or surveys [ 8 , 32 , 36 , 37 , 39 , 40 , 46 , 49 , 50 ] and semi-structured interviews or focus groups [ 33 , 34 , 35 , 38 ] and were conducted with health professionals [ 33 , 34 , 35 , 37 , 38 , 39 , 49 , 50 ] and consumers [ 8 , 32 , 36 , 40 , 46 ].
Due to the range of methods and small numbers of many of the studies the results are not necessarily generalisable but a recurrence of themes indicates that perceptions and beliefs should be considered when incorporating obesity prevention into health care services.
The view of health professionals, that prevention is not their role, may be reinforced by the fact that they will probably not have had specific training in assessment and advice [ 16 ].
They may make judgements on who would benefit from preventive advice and tend to only raise the issue of weight if they know the patient [ 38 ]. Whilst health professionals are aware of the health implications of excess weight there may be a perception that they cannot be effective in their role due to a lack of patient motivation to enact change [ 25 ].
Other studies have shown that patients may not be told they are overweight or have the health consequences of being overweight discussed [ 21 , 32 ].
When discussions do occur, they are more likely to be with people who are already obese [ 24 , 28 ] or who have more frequent health encounters indicating that they have more complex health problems [ 29 ].
By clinicians not discussing weight and lifestyle with people before it becomes a significant problem there is a missed opportunity to prevent illness development based on known risk factors.
The uptake of prevention may also be impacted by a view that obesity is an issue of lifestyle choice and personal responsibility and therefore not the responsibility of health services unless linked to the treatment of a specific clinical condition [ 35 , 38 ].
Clinical guidelines may not be consistently followed because of a lack of knowledge of the guidelines existence or a belief that the guidelines will be ineffective due to pre-conceived ideas about the group of clients being targeted or a lack of confidence in the guidelines [ 19 , 35 ].
Specific to maternity services, clinicians acknowledge that weight gain in pregnancy is an issue but do not perceive that their patients see it as a problem [ 30 ]. These findings occur even in areas where policy is in place directing clinicians to incorporate prevention, highlighting the need for more comprehensive, multi component change management strategies to enable health professionals to develop their practice to incorporate prevention routinely into interventions [ 8 ].
Without further training, baseline knowledge on appropriate interventions to support obesity prevention is generally poor [ 39 ] and advice may be given based on the clinicians own experience of weight management [ 38 ]. Educating staff about prevention may lead to an increase in assessment of risk but not a significant increase in brief advice or referral to other services for prevention intervention [ 15 , 17 ].
Training of staff may need to extend beyond principles of prevention and also include training on communicating complex information to people with low health literacy. This should include teaching techniques to ensure health professionals clarify their patient has understood information, [ 12 ] as this is a significant element in someone being able to adopt and follow preventive care advice [ 45 ].
However, the evidence of what education strategies are most effective, particularly in relation to increasing assessment and referral across all risk factors, is limited [ 52 ].
A systematic review of interventions to change the behaviour of health professionals found just six randomised control trials and the combined results of these were ambiguous [ 19 ]. When specifically looking at factors influencing health professionals decision to provide counselling regarding physical activity, the health professionals own levels of physical activity, whether or not they have specific training, knowing the patient well and the patient having risk factors for chronic disease were all influencing factors [ 22 ].
This review examined the literature in order to ascertain the role of hospital and community- based health services in adult obesity prevention as well as the potential enablers and barriers to the delivery of preventive health services. Whilst it is acknowledged that the health care system alone is not the answer to reducing the population impact of obesity [ 53 ], there is evidence that health services can significantly contribute to obesity prevention commencing with screening all patients for risk factors and providing brief advice.
However, the reviewed evidence indicates that existing clinical guidelines, including the application of the 5As framework, are not being fully implemented. Where training and resources have focussed on prevention, there is an increase in the rate of screening provided but only a limited change in the rates of brief advice or referral to an intervention service [ 12 , 15 , 16 , 17 ].
Whilst assessment of risk factors may offer some benefits, greater change is achieved when this is followed up by advice and clear, individualised input to assist people to apply the advice to their own circumstances [ 54 ].
In taking a scoping approach to the role of health services, this review was able to draw out that a significant barrier to the implementation of prevention guidelines are the perceptions of health professionals. Health professionals may also not feel sufficiently confident to raise the issue of weight because of the social meanings attached or lack of knowledge [ 35 , 38 , 39 , 51 ].
Our review reveals these issues are common to nursing, allied health and medical staff. Health care is predominantly delivered within a reactive model of care which is at odds with the concept of prevention [ 55 ].
Whilst there are obesity prevention guidelines which highlight the need to apply a framework such as the 5As, this fundamentally linear tool is designed to work within a traditional health care approach which focusses on the diagnosis and treatment of acute disease. So, whilst at a macro level policy and guidelines may be in place, implementation is hindered at a meso level by the mismatch between the medical model and the multifactorial causes of obesity and at a micro level by the impact of personal beliefs on patient interaction.
Each of the factors dynamically influence the others so need should not be considered in isolation [ 53 ]. Changing the health system to implement effective action for the prevention of obesity therefore calls for an examination of the issues through a systems lens rather than taking a simple problem-solution driven approach.
Health services are a complex system, constituted of a range of people, processes, activities, settings and structures.
The interrelationships, boundaries, processes and perspectives connect in dynamic and non-linear ways which may result in emergent self-organised behaviour [ 56 ]. Importantly it should be acknowledged that systems are often nested within other systems with their own dynamics at play.
Consequently, a search for solutions means identifying multiple causes as well as multiple points for intervention and being aware of unintended consequences [ 2 , 57 ]. The studies identified by this review focussed on a linear approach to implementing guidelines or examined the perspectives of just one clinical team or group within a system.
There is a need for research to be undertaken which, using a systems approach, examines the opportunities and threats to prevention from the perspective of a range of players within the system and considers how these perspectives might be influenced by policy and guidelines, as well as each other.
This could include looking at moving beyond traditional structural boundaries to look at alternative models of care to the medical model including the use of support roles outside of those typically considered to be health professionals, particularly in the role of ongoing support [ 56 , 58 ].
Whilst a population health approach is important to address this complexity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention. Though this scoping review has demonstrated that there is evidence for incorporating obesity prevention into clinical care, research to date has taken a linear approach to the implementation of guidelines without explicitly factoring in the impact of the perceptions of clinicians and managers to the prevention role or addressing the individual responsibility discourse.
This review contributes to an understanding of the role of health services in obesity prevention by specifically focussing on services outside of primary health.
The use of a scoping review allowed for broad coverage of the literature in order that the main issues could be highlighted in order to inform health policy, clinical practice and future research.
The broad aims of the review may impact on attempts to replicate the review. Limiting the review to English language references may have excluded some evidence. Australian Institute of Health and Welfare. Premature mortaility from chronic disease.
Canberra: AIHW; Google Scholar. Wutzke, S. Demattia R. Involve physicians and the local community in obesity initiatives. Manag Healthc Exec. Brown WV, et al. Obesity: why be concerned? Am J Med. Article Google Scholar.
Mastellos N, et al. Transtheoretical model stages of change for dietary and physical exercise modification in weight loss management for overweight and obese adults. Cochrane Database Syst Rev. Wolf AM, Woodworth KA. Obesity prevention: recommended strategies and challenges.
Mitchell N, et al. Obesity: overview of an epidemic. Psychiatr Clin North Am. McElwaine K, et al. The delivery of preventive care to clients of community health services.
BioMed Central Health Serv Res. The Royal Australian College of General Practitioners. Guidelines for preventive activities in general practice. East Melbourne; Brien SE, et al. Overview of a formal scoping review on health system report cards. Implement Sci. Jackson C, et al. Specialist health visitor-led weight management intervention in primary care: exploratory evaluation.
J Adv Nurs. Davis TC, et al. Provider and patient intervention to improve weight loss: a pilot study in a public hospital clinic. Patient Educ Couns. Mustila T, et al. Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes the VACOPP study.
BMC Pediatr. Claesson IM, et al. Physical activity and psychological well-being in obese pregnant and postpartum women attending a weight-gain restriction programme. Increasing preventive care by primary care nursing and allied health clinicians : a non-randomized, controlled trial. Am J Prev Med.
Bartlem KM, et al. Effectiveness of an intervention in increasing the provision of preventive care by community mental health services: a non-randomized, multiple baseline implementation trial. Wiggers J, et al. Increasing the provision of preventive care by community healthcare services: a stepped wedge implementation trial.
Smith SA, Hulsey T, Goodnight W. Effects of obesity on pregnancy. Flodgren G, et al. Interventions to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese adults.
Kremers S, et al. Systematic prevention of overweight and obesity in adults: a qualitative and quantitative literature analysis. Obes Rev. Article CAS Google Scholar. Kirk SF, et al.
Effective weight management practice: a review of the lifestyle intervention evidence. Int J Obes. Vuori IM, Lavie CJ, Blair SN.
Physical activity promotion in the health care system. Mayo Clin Proc. Kushner RF, Ryan DH. Assessment and lifestyle management of patients with obesity: clinical recommendations from systematic reviews. Lutfiyya MN, et al. Primary prevention of overweight and obesity: an analysis of national survey data.
J Gen Intern Med. Kemper KA. Stratifying patients for weight loss counseling. Nurs Pract. Phelan S. Am J Obstet Gynecol. Heslehurst N. Proc Nutr Soc. Post RE, et al. Arch Intern Med. Ahn S, Smith ML, Ory MG. J Aging Health. Oken E, et al. A qualitative study of gestational weight gain counseling and tracking.
Matern Child Health J. Miller M, et al. Preventing maternal and early childhood obesity: the fetal flaw in Australian perinatal care.
Aust J Prim Health. Durant NH, et al. Patient provider communication about the health effects of obesity. Heslehurst N, et al. How can maternity services be developed to effectively address maternal obesity? A qualitative study. Smith SA, et al.
Community-based service provision for the prevention and management of maternal obesity in the north east of England: a qualitative study. Public Health. Gunther S, et al. Barriers and enablers to managing obesity in general practice: a practical approach for use in implementation activities.
Qual Prim Care. PubMed Google Scholar. Leslie WS, Gibson A, Hankey CR. Prevention and management of excessive gestational weight gain: a survey of overweight and obese pregnant women. BMC Pregnancy Childbirth. Robson D, et al. Int J Ment Health Nurs. Schauer GL, et al. A qualitative inquiry about weight counseling practices in community health centers.
Kable A, et al. Nurse provision of healthy lifestyle advice to people who are overweight or obese. Nurs Health Sci. Bartlem K, et al. Acceptability and receipt of preventive care for chronic-disease health risk behaviours reported by clients of community mental health services.
Psychiatr Serv. National Health and Medical Research Council, editor. Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia. National Health and Medical Research Council, Editor. Melbourne; Moyer VA, U.
Screening for and management of obesity in adults: U. Preventive Services Task Force recommendation statement. Ann Intern Med.
National Institute for Health and Clinical Excellence, Obesity prevention clinical guideline CG Royal Australian College of General Practitioners. RACGP, Editor. Harris M, Lloyd J.
The role of Australian primary health care in the prevention of chronic disease. Australian National Preventive Health Agency, Editor; Tol J, et al. Overweight and obese adults have low intentions of seeking weight-related care: a cross-sectional survey.
BMC Public Health. Australian Commission on Safety and Quality in Health Care. Health literacy: taking action to improve safety and quality. ACSQHC, Editor. Sydney; Olson CM, et al. The healthy start partnership: an approach to obesity prevention in young families.
Fam Community Health. Brown I, Thompson J. Nahm E-S, et al. Nurs Outlook. Brown I, et al. McElwaine KM, et al. TOOLKIT: National Childhood Obesity Awareness Month. This toolkit is full of ideas to help you take action today. For example: Add this Web badge to your website, blog, or social networking profile.
Add information about obesity prevention to your website or newsletter. Tweet about National Childhood Obesity Awareness Month.
Plan an event or take another action in your community to increase awareness for childhood obesity. By raising awareness about childhood obesity, we can all work together to keep our kids healthy.
gov Blog. Tags: Health Literacy. The Office of Disease Prevention and Health Promotion ODPHP cannot attest to the accuracy of a non-federal website.
You will be subject to the destination website's privacy policy when you follow the link.
About 1 in 5 19 Obesitty children awareeness Obesity prevention awareness United States are obese, zwareness Strengthening the immune system the Centers for Disease Control and Prevention CDC. September Carb counting for blood sugar control National Childhood Obesity Strengthening the immune system Month and awaareness a chance to learn more about Obesitu serious condition. Obesity Obesity prevention awareness children at a higher risk for developing a variety of chronic health conditions and diseases. While there is no simple solution, there are many ways communities can support children with their journey to good health. Harney District Hospital is recognizing National Childhood Obesity Awareness Month by reminding the community of the Raising Healthy Kids campaign, now in its third year. A rule for healthy living, the promotes:. There are lots of things parents can do to help prevent childhood obesity and promote overall good health in kids.
Es scheint, es wird herankommen.
Ich entschuldige mich, aber meiner Meinung nach irren Sie sich. Ich kann die Position verteidigen. Schreiben Sie mir in PM, wir werden besprechen.