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Adolescent Obesity: Theories and Interventions

Introduction

The problem of adolescent obesity is gaining more and more attention as the adverse impact of the health condition affects millions worldwide and in the United States in particular. The obesity epidemic is associated not only with the decreased quality of life of those diagnosed with the condition but also with the serious public health hazard around the world. As mentioned in the National Health and Nutrition Examination Survey, one out of five children (aged between six and nineteen years old) are obese or overweight (Stanford Children’s Health, 2017). In the past thirty years, the problem has tripled in its prevalence, which means that there is no better time than now to address the issue through education, nursing advocacy, and clinical expertise.

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This assignment will focus on exploring the issue of adolescent obesity from the theoretical perspective as well as providing a cohesive action plan to propose how to remedy inefficiencies, gaps, and other problems that limited the success of implemented interventions. Also, a case summary will be provided to offer a comprehensive look at the components of the problem. Lastly, the assignment will identify an appropriate research instrument for evaluating the efficacy of the proposed adolescent obesity solutions.

Literature Review

Due to the wide popularity of obesity as an overarching health issue, its coverage in the research literature is vast. Del Mar Bibiloni, Pons, and Tur (2013) conducted a systematic review of the occurrence of obesity in adolescents (10 – 19-year-olds). The researchers found that obesity in adolescents of this age was more prevalent “in males than females, with the International Obesity Task Force (IOTF) criterion being the most frequently used tool to identify the condition in public health research” (p. 2). It should be mentioned that gender differences in the occurrence of obesity among individuals aged between ten and nineteen years old were attributed to cultural and geopolitical circumstances, which means that different countries will exhibit different prevalence rates of the condition (Del Mar Bibiloni et al., 2013). Furthermore, the occurrence of obesity in the United States increased as time went by. For instance, in 2003 it increased by 4% compared to previous measurements while in 2007 it rose by 10% (Del Mar Bibiloni et al., 2013). It must be noted that the United States is among the leading countries to have the highest adolescent obesity rates.

Kramer, Raskind, Van Dyke, Matthews, and Cook-Smith (2016) studied the problem of adolescent obesity with the US-specific context and examined the condition’s geography. Territorial prevalence of adolescent obesity was seen in the Deep South and Southern Appalachian regions. The disparities are associated with the activity and nutritional environment variables as well as crime rates and the high density of recreational facilities (Kramer et al., 2016). These findings show that the contextual measures that characterize different regions across the United States contribute to either lower or higher rates of adolescent obesity.

The article by Sousa (2013) mentioned that the existing procedures targeted at addressing the problem of adolescent obesity were insufficient enough to provide any effective results. The author wrote, “the standard nursing approach – assessment, diagnosis, planning, implementation, and evaluation – does very little to integrate family members and the patient into the plan of care, and it can be patronizing” (Sousa, 2013, p. 12). This points to the fact that teens diagnosed with obesity struggle with getting inspiration to become healthier and make changes when in general, nurses only mention things that they do wrong, thus placing blame and disregarding the unique needs of each patient. Thus, in terms of managing adolescent obesity as a pandemic, standardized procedures and instruction are not enough to make sure that patients are dedicated to solving their health problems.

Steinbeck, Lister, Gow, and Baur (2018) focused on the need for the effective treatment of adolescent obesity. The researchers underlined the importance of behavior management and adjunctive therapies that address multiple barriers that prevent interventions from being truly effective. According to the proposed approach, the effective treatment principle implies long-term behavioral improvements (changes in diet, increased physical activity, work on sleeping patterns, the removal of frequent instances of low activity) accompanied by long-term strategies associated with the management of weight. Importantly, obesity-oriented interventions that deal with adolescents require more engagement and participation than those targeting children.

Theoretical Description

From the theoretical standpoint, obesity is defined as a condition characterized by the excessive or abnormal presence of body fat that presents some health risks to patients who were diagnosed with it. The body mass index (BMI) is the most frequently used method for determining whether an individual is obese; it is calculated by diving a person weight by the square of his or her height (in kilograms and meters respectively). An individual whose BMI is 30, and higher is considered obese. Throughout decades of research, multiple theoretical models and frameworks were developed to explain the occurrence of the condition among the public.

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A setting-based theoretical framework implies that people may get obese because of the specific environmental conditions in which they live (Panter, Andersen, Aro, & Samara, 2018). For instance, the wide availability of fast food restaurants in the area increases the chances of poor dietary choices while a sedentary lifestyle contributes to the decreased physical activity. From the genetic theoretical framework, obesity can be an inherited condition, and, in combination with environmental factors, can develop in people whose parents are obese (Hebebrand et al., 2017). Moreover, the cultural theoretical framework points to the links between a person’s culture and his or her likelihood to become obese. The cultural context is especially important to note in the discussion about obesity because any changes in the usual patterns can encourage the development of the condition (Sahoo et al., 2015). For instance, in Mexican immigrants who moved to the United States, obesity can become an issue because of the lifestyle changes, social isolation, stress, and anxiety.

Discussion

Based on the findings from the research literature, adolescent obesity is a product of many factors, the combination of which increases the likelihood of the condition’s development. The case of adolescent patients is especially complex because, unlike children-patients, they experience a wider range of emotional issues, most of which can be linked to puberty as well as individual psychological characteristics. This leads to the finding that traditional and standardized methods of dealing with adolescent obesity are not effective enough to consider the unique needs of each patient. Furthermore, there is an issue of nurses blaming patients for getting obese without providing a constructive framework they could follow to become healthier. Thus, there is a serious need for developing solutions that will remedy this gap in the treatment and prevention of adolescent obesity.

Another important finding that must be mentioned in the discussion about adolescent obesity is that effective intervention programs require greater participation and engagement of both patients and their relatives. In childhood obesity prevention, the development of an action plan that parents could enforce upon their children was enough. However, with the added emotional aspect of adolescent obesity, nurses have to dedicate more time and efforts to make sure that their adolescent patients are engaged and will comply with the treatment. This point is important because, without a patient’s participation, interventions are unlikely to be effective. The emotional changes that adolescents go through is a variable that should never be overlooked when developing obesity management interventions.

Summary of the Case

Adolescent obesity presents both physical and emotional challenges for patients, especially because of their aged and the vulnerability toward different external factors. From the standpoint of nursing ethics, adolescent obesity is a problem that requires the application of multiple provisions of the Code of Ethics. The first five provisions are especially instrumental to the problem because they are associated with patient advocacy and responsibility for achieving any improvements in a patient’s health. This means that in the case of a nurse managing the treatment and recovery of an adolescent patient, he or she should proceed with work by showing compassion and attention for the unique qualities of the patient, be committed to doing the work successfully, protect the individual rights along with health and safety. The case of obesity is sensitive, and the adherence to the ethical standards of nursing will safeguard professionals from making mistakes that will prevent any interventions from being successful.

In addition, it is imperative for a nurse who manages a specific condition or illness to show high levels of responsibility, authority, and accountability, which means that he or she should make decisions and take actions consistent with the duty to provide optimal care (American Nurses Association, 2015). In the context of adolescent obesity management, a nurse is also required to maintain competence and the integrity of character regardless of how complicated the work with the patient may be. It is highly likely that working with an obese adolescent patient will be complicated due to the emotional struggles that come with such age. In some instances, obesity may be linked to emotional trauma that the patient has experienced in the past, which means that poor lifestyle choices can be perceived as a solution to the psychological distress. Therefore, the preservation of nursing ethics in the case is the most important aspect of care to ensure the adherence of a patient to treatment.

Solutions

Adolescent obesity is a problem that develops as a result of multiple reasons and because of this, standardized approaches are not enough to address it completely. Due to the adverse impact of the condition on both physical and psychological health of patients, there is a need for addressing the issue from multiple perspectives. The first gap to be addressed refers to the lack of nurses’ knowledge on being sensitive to the unique needs of each adolescent patient. As mentioned by Sousa (2013), an action plan that describes the details of nutritional changes is not enough; nurses should offer empathy and acknowledge that losing weight is a complicated task for which patients should not be left unsupervised. Motivation and support can be provided through strengthening collaboration between patients and their health providers. For instance, some nurses have used the motivational interviewing approach to connect with their patients and identify the main challenges that prevent them from making healthy lifestyle choices.

Engagement and active participation of patients within the context of obesity management programs have often been overlooked (Oh et al., 2018). In contrast with interventions that involve children, adolescent-oriented obesity treatment cannot rely only on the commitment of nurses and patients’ parents. Thus, an important solution to this gap is the introduction of programs that have a place for health consultations with patients. For instance, in their research, Oh et al. (2018) conducted an intervention where a group of patients received health consultations throughout the 24-week period of weight loss. When compared with the non-intervention group that did not receive any consultations, it was found that patients, whose engagement was boosted through continuous communication with their providers, showed better results in terms of healthy lifestyle and dietary choices.

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In order to evaluate the efficacy of the solutions for overcoming treatment gaps, it is imperative to define a research instrument that nurses could use. Since engagement is an issue that plays a significant role in guaranteeing the effectiveness of obesity treatments, interviews will be the most suitable research instrument. For collecting data on the positive or negative effect of solutions targeted at addressing the emotional needs of patients as well as engaging them in the plan of obesity management. Interviews represent a systematic way of talking and listening to patients and are effective for collecting information from patients on the basis of their personal reflections and nurses’ observations. Open questions can be used during interviews to go in-depth with the collected data and account for any feedback that patients have in regards to the improvement of their dietary and activity choices.

The usefulness of interviews as research instruments will be evaluated based on their outcomes as well as the attitudes of patients toward their implementation. If adolescent patients show excitement and are eager to share their experiences on the journey to overcoming obesity, then the interviews should be considered effective. A quick survey to collect patients’ feedback will be a suitable evaluation strategy. Measuring the impact of health consultations reflects the provisions of the nursing code of ethics as it is associated with showing respect and compassion for patients’ unique needs.

Conclusion

In the exploration of the problem of adolescent obesity, it was discovered that regardless of the wide availability of solutions and interventions, many health care providers overlook the importance of emotional support and the engagement of patients in the plan of care. The report identified that the lack of respect, compassion, and sympathy for the unique needs of adolescent patients with obesity, which aligns with the provisions outlined in the Code of Ethics for Nurses. Overcoming the identified gaps can be done by implementing engagement-driven interventions such as motivational interviewing to determine health constraints and encourage patients to make healthy lifestyle choices. In terms of future research directions, studies of adolescent obesity should focus on connections between the emotional wellbeing of patients of that age and the poor choices they make thus deteriorating their physical condition.

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Web.

Del Mar Bibiloni, M., Pons, A., & Tur, J. A. (2013). Prevalence of overweight and obesity in adolescents: A systematic review. ISRN Obesity, 2013, 1-10.

Hebebrand, J., Holm, J-C., Woodward, E., Baker, J. L., Blaak, E., Schutz, D., … Yumuk, V. (2017). A proposal of the European Association for the study of obesity to improve the ICD-11 diagnostic criteria for obesity based on the three dimensions etiology, degree of adiposity and health risk. Obesity Facts, 10(4), 284-307.

Kramer, M. R., Raskind, I. G., Van Dyke, M. E., Matthews, S. A., & Cook-Smith, J. N. (2016). Geography of adolescent obesity in the U.S., 2007-2011. American Journal of Preventive Medicine, 51(6), 898-909.

Oh, B., Yi, G. H., Han, M. K., Kim, J. S., Lee, C. H., Cho, B., & Kang, H.C. (2018). Importance of active participation in obesity management through mobile health care programs: Substudy of a randomized controlled trial. JMIR mHealth and uHealth, 6(1), 2.

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Panter, J., Andersen, T. A., Aro, A. R., & Samara, A. (2018). Obesity prevention: A systematic review of setting-based interventions from Nordic countries and the Netherlands. Journal of Obesity, 2018, 1-34.

Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: Causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187-192.

Sousa, A. M. (2013). Adolescent obesity. American Journal of Nursing, 113(5), 12.

Stanford Children’s Health. (2017). Obesity in adolescents. Web.

Steinbeck, K. S., Lister, N. B., Gow, M. L., & Baur, L. A. (2018). Treatment of adolescent obesity. Nature Reviews Endocrinology, 14, 331-344.

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