c155:Assignment on Obesity

Introduction

Obesity is usually defined by the individual's Body Mass Index (BMI) that is often calculated by dividing the weight by the square of the person’s height.  It is estimated that around 600 million adults are obese. This also shows that an elevated body mass index accounts for around 4 million deaths around the world.  According to the center for disease control, by 2018, the age-adjusted prevalence of obesity in American adults stood at 42.4% and there were no significant differences between women and men in all adults by age group (Center for Disease Control, 2020).  The age-adjusted prevalence regarding severe obesity among adults was 9.2% was also higher in women in comparison to men. Also regarding age, the prevalence was high among adults of ages 40-59 when compared to other age groups (Center for Disease Control, 2020). 

Pathophysiology

The pathophysiology of obesity is usually complex with a social-cultural, environmental, physiological, behavioral, medical, genetic, and epigenetic factor that leads to the course. An individual is reported as being obese when their BMI is 25 to 29.9 kg/ Msq, or more which indicates that the individual has obesity.  People that report a BMI of more than 40 kg/meter sq.  are considered as suffering from stage 3 obesity, which is at times referred to as the morbid type of obesity (Ettinger, 2017).  However, in some cases the individual BMI may not be a perfect measurement for obesity, it may not be able to distinguish the lean mass from the fat mass, or can be able to account for other factors like the ethnic and racial differences (Heymsfield & Wadden, 2017).  When discussing obesity, it is also important to consider other factors such as the neck and waist circumferences, lifestyle, and overall fitness.  Often obesity will occur when there is an imbalance between energy expenditure and the intake of calories ("Correction to 2019 AHA/ACC/Hrs focused update of the 2014 AHA/ACC/Hrs guideline for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the heart rhythm society," 2019).  These types of imbalances are often thought to be under environmental or genetic influences.   

Standards of Practice

Evidence-based pharmacological treatments and how they affect the management of diabetes

As much as there are various anti-obesity agencies in the United States, most of them do not qualify due to safety concerns. In the United States, five are now available and they include lorcaserin, orlistat, Topiramate, bupropion, and lariglatude 3.0 mg. all these drugs are reported to produce positive results regarding the management of weight (Gadde et al., 2011).  One of them is a combination of phentermine and Topiramate, this is a norepinephrine and dopamine releasing agent which also has a lower impact concerning dopamine vs. norepinephrine that are usually approved as being short term treatment for obesity.  In my state, Topiramate is a registered antiepileptic drug, which has various pharmacological mechanisms of action.

The effect lays on the major mechanisms through which the combination of  phentermine in addition to Topiramate will produce weight loss.  According to one case of  phase 3 studies of the drug, it looked at the efficacy of the combination of phentermine 7.5 mg/Topiramate 46.0 mg also phentermine 15.0 mg/Topiramate  92.0 mg impacted on weight loss after 56 weeks (Gadde et al., 2011). The study shows that those patients who completed a 1 year of treatment reporting a significantly (p<0.0001) with a high and absolute body weight change of -9.9 kg (-9.6%) in addition to phentermine 7.5 mg plus Topiramate 46.0 mg vs. -12.9kg with phentermine 15.0 mg added to Topiramate 92.0mg as compared to -1.8 kg (1.6%) in reference to the placebo group (Wilson & McAlpine, 2006).  Based on the study, those patients who had type 2 diabetes (388 subjects) were able to report weight reduction of -6.8% to -8.8% with phentermine 7.5 mg/Topiramate 46.0 mg plus phentermine 15.0 mg/Topiramate 92.0 mg.  The drug was well tolerated, even though there were impacts like paraesthesia, constipation, and dry mouth as being the commonly reported form of treatment-emergent (Apovian et al., 2015).  Often there has been a requirement for the risk evaluation and mitigation by the United States food and drug administration (FDA) when it comes to pharmacological treatment of obesity (Gadde et al., 2011). Other factors that are looked in to are pregnancy and chronic conditions. 

Clinical guidelines for assessment, diagnosis, and patient education for obesity

When it comes to obesity the first step is to screen the individual BMI which should also be measured and recorded at each visit, in addition to looking at other vital signs. Even though the BMI could also correlate with the amount of the individual body fat, it should be noted that the BMI may not be able to measure the patient's fat from muscle. Meaning that the accuracy of BMI in the diagnosis of obesity could be limited, especially in the intermediate range, concerning older adults and men in general. A BMI cut-off of 30 kg/Msq provides a good specificity however will miss out on the issue of excessive body fat. Also, BMI is usually recommended for use when it comes to clinical practice as a manner of identifying overweight or obese individuals (Kushner, 2010).  The other assessment is on the weight circumference which needs to be looked in to frequently since the increase evidently means that there could be an imbalance of the BMI, and the patient is likely to be obese (Gadde et al., 2011). The other productive assessment for patients that have a BMI of 25 kg/ Msq or higher,  or a patient with a circumference that is greater than 35 in women or 40 in men could also mean that they are in the risk. Another assessment is the level of blood pressure, including the fasting glucose and lipid levels. The presence of other diseases like type 2 diabetes, cardiovascular condition care other complications that should be assessed as they can lead to mortality. 

Standards of Practice

In comparison to other states, the standards of practice are often the same and most will be focussed on lifestyle modification as being the foundation of weight loss.  Even though the intensive lifestyle interventions might lead to clinical benefit regarding weight loss for most patients, there must be the consideration of intensive lifestyle intervention.  This is often difficult to achieve or maintain on a long term basis for most patients.  Also when looking at the optima clinical trial setting, a third of most patients may not succeed in achieving the required percentage of weight loss.  In most cases, individuals tend to lose weight over a period of about 6 months. Most will also report losing around 10% of the baseline weight before a recognizable amount of weight loss, which could easily be followed by the regaining of weight (Ettinger, 2017). Also losing weight in the long term is regarded as maintenance of about 75% of the initial weight loss, which in most cases it is difficult to achieve, calling for additional options like pharmacotherapy and using a very low-calorie diet. 

Other studies indicate that few other chronic public health conditions are parallel the prevalence regarding obesity and overweight. They usually seem to affect two-thirds of adults in addition to one-third of adolescents and children in the country. The ethnic and minority racial groups are the ones often affected, nearly 76.6% of the black Americans and 80% of the Mexican Americans are found to be obese or overweight. Per capita medical expenditure also look at the issue like presenteeism and absenteeism where workers are at work however because they are having a medical condition they may not be as productive. Aspect attributable to obesity also ranges from 1000 – 7000 USD among obesity III women (Kushner, 2010). 

From the clinical perspective, the determination of weight and height function functions are also as simple and inexpensive surrogate measures when it comes to establishing measures for the body fat percent when the values are also entered into the quelled index weight commonly referred to as the BMI. The patient categorization by the BMI will also work as a useful link to risk assessment for mortality and morbidity which is also supported by various population studies (Haire-Joshu & Klein, 2011). The relationship is also related to striking for the development of type II diabetes mellitus. Also, the BMI tables are conveniently used in the facilitation of patient evaluation.   

The relevance of detection was also impacted when the 2009 healthcare effectiveness data and information was used in setting the measure included assessment regarding the adult level of BMI for the initial time; in addition to the centers for Medicare and Medicaid services that are mandated in a manner which electronic medical records could be capable of calculating the Individual BMI as being part of the major measures of the vitals. Also, when looking at the issue of treatment, it is often more difficult when it comes to implementation and ways of sustaining the provided limited resources and the available time regarding primary care settings (Haire-Joshu & Klein, 2011).  Besides, the United States preventive services task force continues to indicate that the behavior-based treatments are effective and safe for the aspect of weight loss and maintenance. As a result, the center for Medicare and the center for Medicaid services have also been able to approve the coverage for intensive behavior therapy in the state for obesity and Medicare beneficiaries regarding the primary care settings. This is based on the fact that whether the caring initiative is going to reduce the clinical inertia which surrounds the care of obesity or not or is less certain. 

Identification and Evaluation of Obesity Patients.

According to practices in Jacksonville, they have been able to show that counseling for obese patient rates continues to be at a low level among healthcare professionals.  The reasons also continue to vary and will include the constraints of time during the time of a busy practice, and the lack of effective options for treatment or the use of different practical tools, insufficient training and low confidence in the management of weight and skill and counseling in addition to concerns that raising the topic is going to be interpreted by the patient as a show of insensitivity.  Also, there are other few conditions when it comes to medical practice and in the society where patients are stigmatized and feel rejected for being obese (Kushner, 2010).  In reality, the issue of obesity is often complex and is usually caused by biological, genetic, economic, environmental, psychosocial, and behavioral determinants. Instead of blaming the patients due to their weight, acknowledging the aspect of obesity as being a medical condition will provide a way that can promote respectful dialogue. 

Also in Jacksonville, there is no clear established way of telling patients that they are obese or overweight. However by ensuring that discussions have been initiated regarding weight and the interactive process with the sharing of information between the physician and the patient.  When the issue of body weight was raised in the first place, words are very important.  Also when it comes to approaching that are used by the physicians to broach the sensitive topic and potentiality it could also be able to influence the ways that patients cognitively and emotionally react to the discussion and advice provided.  The language that physicians also use will set the stage for interaction (Haire-Joshu & Klein, 2011). The reason that this concern is established is that the aspects of obesity are highly emotive and well charged.  It provides a very significant pejorative meaning when it comes to many patients, leaving them feeling as if they are being blamed or judged when they are seen as obese and not individual.  The basic perspective is that the patient and the physician need to use shared terminology that is not offensive, agreeable, and understandable concerning both individuals. 

The history of physical activity and dietary history also needs to be assessed by looking at all patients before counseling has been initiated.  In modern society, walking to and from the car, using a train and bus, or ensuring that one has kept the home clean usually provides representation on the extend of the physical or daily activity for the most individual. The assessment concerning psychological health and the psychiatric history of the individual needs to also be routinely done during history (Haire-Joshu & Klein, 2011). Particular consideration should be given to the existence of mood and anxiety disorders, which are the most common disorders in the general population and occur at high levels in people with obesity. Screening for disordered eating conditions such as binge eating disorder, bulimia or night-eating syndrome or other psychological problems that may hinder care. For example,  attention deficit disorders which are the experience of a major depressive episode, eating disorder or extreme psychological illness will cause a referral to a provider of mental health (Wilson & McAlpine, 2006).

The assurance of a patient's ability to lose weight is an integral part of the initial evaluation. The National Heart, Lung, and Blood Institute's Practical Guide on Adult Diagnosis, Evaluation, and Treatment of Overweight and Obesity recommends that physicians evaluate patient motivation and encouragement, stressful life events, psychological status, time availability and constraints, and appropriateness of goals and expectations to help determine the probability of improvement in lifestyle. Motivational interviewing is an especially useful technique for addressing ambivalence and has been shown to modestly improve weight loss in obese patients (Wilson & McAlpine, 2006). The technique can be implemented in a time-efficient manner once a healthcare professional is qualified and experienced in motivational interviews.

Physical Examination of the Obese Patient

According to the National Heart, Lung and Blood Institute's Clinical Guidelines for the Detection, Evaluation, and Treatment of Overweight and Obesity in Adults, the Practical Guide for the Detection, Assessment, and Treatment of Overweight and Obesity in Adults, and the World Health Organization, the risk assessment arising from overweight or obesity is focused on the patient's status. A desirable or healthy BMI is 18.5 to 24.9 kg/m2; overweight is 25 to 29.9 kg/m2, and obesity is ≥30 kg/m2. Obesity is further sub defined into class I (30.0–34.9 kg/m2), class II (35.0–39.9 kg/m2), and class III (≥40 kg/m2), although lower cut-points have been suggested for the Asian population. While BMI does not explicitly quantify body fat, its usefulness as a risk estimate has been demonstrated in several population studies. However, in some cases, the use of height and weight alone to determine BMI as a surrogate measure of body fat may result in an incorrect risk estimate. Patients with uncommon body habitus, bodybuilders with increased muscularity, or e-fat patients with increased body fat (Wilson & McAlpine, 2006). While there are accurate methods for measuring body fat, such as dual-energy x-ray absorptiometry or plethysmography of air displacement, they are inefficient and too costly for regular clinical use. The inherent problems with using BMI alone to estimate risk are exemplified by the paradox of obesity, the observed inverse correlation between BMI and mortality in patients with existing chronic heart failure, coronary heart disease, and chronic kidney disease. Although the reasons for the obesity paradox remain uncertain, the confounding factors proposed include the poor sensitivity of BMI to detect various aspects of fitness.

In addition to BMI, excess abdominal fat and exercise levels are separately correlated with the risk of overweight and obesity. Clinical studies have found that individuals with large waist circumferences have an elevated health-related risk of obesity relative to those with small waist circumferences and within specific categories of BMI. The criterion for excess abdominal fat tends to differ between racial and ethnic groups. The International Diabetes Federation has suggested cut-points. Fitness level identification is another component of the risk evaluation associated with BMI. Longitudinal studies have shown that cardiorespiratory activity (as calculated by a cumulative check for aerobic exercise) is a significant predictor of all-cause mortality, independent of BMI and body composition. More precisely, healthy obese men had a lower risk of all-cause mortality and CVD mortality that made lean men unfit for it. Similarly, cardiorespiratory fitness was a more significant predictor of all-cause mortality among women than was the baseline BMI.

Identifying the High-Risk Obese Patient

With the high incidence of obesity and the imprecise BMI and waist circumference alone to measure individual risk, a significant clinical decision is to determine the patient to treat. Among All adults, 51.3 percent of overweight adults and 31.7 percent of obese adults are metabolically stable, described as having 0 or 1 cardiometabolic abnormality. Obesity primarily raises the risk of CVD through its effects on other risk factors. The adverse effects of overweight on blood pressure and cholesterol levels account for as much as 45 percent of the increased risk of coronary heart disease, according to a meta-analysis of 21 longitudinal studies involving > 300 000 individuals (Kushner, 2010). There are conflicting data on whether BMI or waist circumference contributes independently to cardiovascular outcomes, in addition to the forecast Framingham Risk Score. It is proposed that overweight patients with clinical insulin resistance markers will most benefit from weight loss.

Specific markers include elevated triglyceride concentration, low concentration of lipoprotein cholesterol, high ratio of triglycerides to high-density lipoprotein cholesterol, or a combination of an enlarged waist and elevated concentration of triglycerides. According to the realistic guide. Patients at very high absolute risk that cause the need to adjust and treat an extreme risk factor include those with proven atherosclerotic diseases, type 2 diabetes mellitus, and sleep apnea (Kushner, 2010). Only immediate care should be prompt for the involvement of metabolic syndrome. Obesity is connected to > 60 medical conditions, whose incidence and prevalence differ by BMI class, gender, and age. Especially for diabetes mellitus, hypertension, and dyslipidemia, a direct association with rising categories of BMI is observed. Special aspects of physical examination have recently been evaluated for patients with obesity (Haire-Joshu & Klein, 2011). No standard laboratory test or diagnostic assessment is recommended for all patients with obesity, although a fasting glucose and lipid profile is consistent with existing guidelines. The clinical diagnosis should be focused on symptom presentation, risk factors, suspicion index. 

Jacksonville, Daytona Beach or Orlando  is one of the example  that shows how demonstrates that people with obesity are disadvantaged in all aspects of social and economic life, and societal perceptions can be believed to play a role in causing and perpetuating disadvantage. In Orlando, there are very few structures that do protect societal attitudes to the illness, however. Given that the measures in this survey focus on the existence and severity of the impairment and its relationship to outcomes such as education and jobs, it is not possible to gauge the degree or depth of feeling among the general population, rather than the relationship between attitudes (especially those without impairment) and outcomes.

Access to Healthy Food

In a study done in Jacksonville, Daytona Beach or Orlando it was found that having a food or grocery store in the immediate neighborhood would often affect the individual diet where people that live in low-income areas or those living in minority communities will have limited access to full service of a food store that sells health foods. The same studies have also been done in Philadelphia, Detroit, and New Orleans (Drewnowski et al., 2016): these are areas that are often characterized by poor housing, racial differences, and inadequate food supply.  According to the study carried out in Jacksonville, Daytona Beach, or Orlando regarding obesity and access to healthy foods, there is very limited data regarding were individuals go shopping for food and in most cases, it is assumed that the food shopping is often done within the immediate neighborhood. A lot of studies regarding the food environment health can also be able to link the density of supermarkets and fast-food restaurants in a given area with the measure of different forms of diet and the health of the people living in the said area. According to a study done among the Jacksonville, Daytona Beach, or Orlando food outlets, it is evident that the density of fast-food restaurants or supermarkets in a provided area is also related to the type of diet and health in the same area.

In this study, using a street network the researcher, the study was able to calculate the distance between the nearest supermarkets and the homes of participants.  It was found that the physical distance between the people’s residence and the nearest grocery store, fast food, or supermarket was also related to healthy eating and lower body mass index which also translated to lower cases of obesity in the region.  In these investigations, it was established that there is a lot of local food sourcing done with neighborhoods and this could affect the eating behaviors of individuals who may not get access to healthy food (Haire-Joshu & Klein, 2011).  This also means that the nearest food outlet is the main determinant of healthy food intake.  For example in this research, it was found that groceries offered healthy foods that include fresh farm produce at affordable prices. However, the prices in the supermarkets would vary regarding different store chains, including demographics and quality of food.

The distance from food outlets affected health food intake. The study was carried in Jacksonville, Daytona Beach, or Orlando also reveals that the physical proximity to food outlets is a major determinant of healthy food intake and obesity. In most cases also found that people usually shop by car, meaning they would prefer fast food stores more than walking in the grocery to fetch healthy food.  One study was done in a Local food Mart which is a food store known to sell food items in addition to different varieties of soft drinks, chips, and many non-healthy foods (Haire-Joshu & Klein, 2011). According to the study, about 50% of the people who enter the food store would come out with foods that they had not intended to pick themselves.  Also in a study done in  a neighbouring store,  it was found that 60% of the customers would order hot grilled food, and around 50% of these customers would also go for two soft drinks after that.  

For most people, they look at the convenience of the food and not the health aspects. For some of the respondents, they often find bringing lunch from home as being time-consuming and are tied to cook from home at the end of the day. However in a study done in other vegeterian marts, the situation was different as many people who visited the area bought fresh produce, also bought beans, lentils, and more. In this regard, most of them tend to make healthy choices including a selection of various Asian food items.  Also, when it comes to the purchase of sale of fresh produce in addition to frozen items , a discussion with the store employees indicates that there is very little traffic of people visiting to access health farm produce. Other groceries like around the city have a mixture of a deli, bakery, and fresh and frozen organic foods. Liquor is also sold, including an assortment of meat and seafood in addition to offering sushi.  There is also a department of fresh vegetables and fruits. When it comes to affordable prices, there are those stores that have affordable and reliable food selection. It also has a selection of meat products and vegetables as there is a diversity of the population that visits the store (Haire-Joshu & Klein, 2011).   Regarding healthy diet consultations, there is free service for people in need of preventive care in Jacksonville, Daytona Beach, or Orlando and obese patients like heart disease, PT, and overweight management.  

Discussion

The above study indicates that the quality of diet is determined by both the social, cultural, and economic behaviors of the people living in the area.  What was also found in the  study, wealthier consumers often have a healthier, high quality, and more varied diet. There is a low population of individual’s healthy meat diets like seafood, quality meat, fruits, and vegetables. Also in many cases, people tend to select diet regarding convenience that is why there is a high population of individuals taking fast food and food with added sugar and fats.  This is evident from the finding where the social economic and cultural aspects were represented by different food and retail store including food composition and prices. The monetary value of the residents was also estimated using the price tag on each food item where a column of food and prices were analyzed (Haire-Joshu & Hill-Briggs, 2018).  The underlying aspect in this area is that the diet intake of food was not determined by health but by convenience and price. This means that for the prevention of diabetes to be realized in the area, there is a need for the food department to ensure that diet food is sold in at affordable prices. The public health department needs to discuss the cost of a healthy food diet and make it affordable for the higher population. 

Also when comes to the decision to prescribe bariatric surgery, it will be largely based on the BMI of the patient and the existence of comorbid conditions likely to be susceptible to weight loss. Many factors specific to the patient, such as psychosocial wellbeing, commitment, aspirations, and previous attempts at weight loss, are taken into account. There is insufficient statistical information available for an individual patient to differentially choose one treatment over another. Restrictive-malabsorptive procedures, however, tend to lead to a greater weight loss and increase in comorbid conditions than restrictive procedures. It also considers the expertise of the surgeon and the risk-to-benefit ratio (Haire-Joshu & Hill-Briggs, 2018). Contraindications include an exceedingly high operating risk, the misuse of active drugs, or a major psychotic or untreated psychopathological illness such as clinical depression, schizophrenia, or bulimia. All patients seeking weight loss surgery will receive a thorough review by an interdisciplinary approach of health care providers that includes a doctor, registered dietitian, and mental healthcare provider. During the preoperative cycle, patients are usually advised on habits of healthy eating and physical activity, coping approaches to incorporate improvements in lifestyle, and the value of stress management and long-term positive social support. Lately, evidence-based guidelines have been released on health care best practices.

3. Characteristics and resources

Access to primary care is one of the major components when it comes to the treatment and management of obesity in the country.  In the country, primary practitioners are the main determinants of medical care which include prevention and treatment of obesity. It is recommended that the physician offers an intensive multicomponent behavioral form of intervention when it comes to obesity treatment (Ettinger, 2017). Also, the center for Medicaid services is required to provide the coverage for intensive behavioral therapy when it comes to obesity by a qualified PCP. Previous studies have also shown that the treatment options for obesity in the country often have limited access leading to a very limited level of weight loss in the first 6-24 months of intervention.  Due to limited levels of interventions, lead to low levels of weight loss, thus affecting obesity prevention and care. It is also evident that obesity will affect people of low social and economic status, most of whom receive care in public hospitals and primary care clinics. Patient education is also a very important aspect of improving care in a clinical setting, thus the need to identify the patient’s knowledge and attitudes regarding weight loss, and determining the approaches to weight loss for healthcare providers. 

ORDER CUSTOM NURSING ASSIGNMENT PAPER FROM EXPERTS

4. Factors Affecting management and treatment of Obesity

Financial Resources- Financial resources can work on the positive or the negative aspect when it comes to the management and treatment of diabetes. People who have access to financial surplus are likely to suffer from diabetes based on the fact that they can afford to buy food in surplus as well (Saghafi-Asl et al., 2020). Also, the lack of financial resources may mean that they can afford the cost of medicine and physical therapy, which could lead to more complications.

Access to care - access to care is a very important fact when it comes to diabetes management. This includes being able to meet doctors’ appointments, accessibility to the hospital and is provided with the required level of care by nurses and doctors during treatment (Saghafi-Asl et al., 2020).  Obesity is mostly viewed as a lifestyle disease, which means most people would not find it serious enough to visit the hospital whenever they are affected.

Insured and Uninsured -  Medical insurance is also another phenomenon in the treatment and management of obesity, and this will often affect people coming from poor communities and those that do not show interest in their health (Saghafi-Asl et al., 2020).  The uninsured individual often finds a problem when it comes to emergency treatment, accessing medication, and continued treatment or therapy when they get ill.  This could affect their treatment process when they are not able to continue due to financial challenges. 

Financial costs related to diabetes will including having to keep up with the patient's ever-demanding diet which might affect the family budget.  Also, extremely obese people need constant care and support in performing household chores which brings about more burden for the family members.  Due to the cost of medication, families may not be able to sustain the patient diet requirement which could easily see them slide back to obesity. 

The promotion of best practice would include educating the community regarding healthy lifestyles (Saghafi-Asl et al., 2020). Also, another strategy will be the promotion of a healthy diet within families and encouraging physical exercise to be put in the school schedules. It will also be important to advocate for physical exercise and non-medical interventions when the individual is in the initial stages of obesity. 

The best method of evaluation of the suggested strategies will be establishing a new food roaster for schools, a reduced number of patients reported as having a BMI over 30 while also more people reporting changes in lifestyle and diet. Obesity is a serious disease that is highly prevalent, associated with increased morbidity and mortality. Health care providers must play an active role in finding, evaluating, and treating patients at high risk. Both doctors need to include broaching the subject of weight and undertaking an obesity-focused history. Concerning pharmacotherapy and bariatric surgery, all patients should be given lifestyle therapy when indicated. Primary care will be targeted at avoiding more weight gain for patients with overweight and achieving a moderate weight loss of 10 percent for obese patients.

Food Outlets 

From the above findings, it is evident that people prefer buying food from convenience stores than looking for health foods stores. This also contributes to the high obesity rates in Jacksonville, Daytona Beach or Orlando and not shopping at the high priced areas.  The supermarkets appear to be the most significant for people of different social and economic status. The selection of foods is not only driven by food prices by convenience. This means that convenient food stores contribute a lot when it comes to the selection of diet quality and health. This shows that most people always shop closer to where they are and that proximity is an index to exposure of good of poor diet. Also, people may look for food items that have good bargains, however, the wealthy will go for food that promotes healthy outcomes. This study was done in Jacksonville, Daytona Beach, or Orlando which shows the different food patterns and how this affects the health of these populations.  It also means that the choice of food and selection of food outlets could be the reason populations are vulnerable to chronic diseases that include obesity become the choice of food is not always about health but convenience.  

Conclusion

In conclusion, this report shows that obesity is beyond poverty and other factors like access to healthy food items. There is a lot of influence of the neighborhood type regarding the choice of food outlets, supermarket outlets, property values, and the body mass index of the participants.  This could also be related to the social and economic aspects that are strongly linked with diet-related variables.  This means that the rates of obesity are related to the choice of food intake that the composition of the diet. If the population has access to healthy food, this may lead to a reduction in the number of people with obesity or likely to develop obesity. The prevention of obesity strategies in Jacksonville, Daytona Beach, or Orlando currently seems not to recognize the cost of healthier diets as it only looks at income and no other factors related to healthy diets like the convenience and easy access to unhealthy food items in supermarkets and grocery stores.

References

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Gadde, K. M., Allison, D. B., Ryan, D. H., Peterson, C. A., Troupin, B., Schwiers, M. L., & Day, W. W. (2011). Effects of low-dose, controlled-release, phentermine plus topiramate combination on weight and associated comorbidities in overweight and obese adults (Conquer): A randomized, placebo-controlled, phase 3 trial. The Lancet, 377(9774), 1341-1352. https://doi.org/10.1016/s0140-6736(11)60205-5

Heymsfield, S. B., & Wadden, T. A. (2017). Mechanisms, pathophysiology, and management of obesity. New England Journal of Medicine, 376(3), 254-266. https://doi.org/10.1056/nejmra1514009

References

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Haire-Joshu, D., & Klein, S. (2011). Is primary care practice equipped to deal with obesity? Archives of Internal Medicine, 171(4). https://doi.org/10.1001/archinternmed.2011.3

Kushner, R. F. (2010). Tackling obesity. Archives of Internal Medicine, 170(2), 121. https://doi.org/10.1001/archinternmed.2009.479

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Saghafi-Asl, M., Aliasgharzadeh, S., & Asghari-Jafarabadi, M. (2020). Factors influencing weight management behavior among college students: An application of the health belief model. PLOS ONE, 15(2), e0228058. https://doi.org/10.1371/journal.pone.0228058

Warner, E. T. (2012). Obesity treatment for socioeconomically disadvantaged patients in primary care practice. Archives of Internal Medicine, 172(7), 565. https://doi.org/10.1001/archinternmed.2012.1

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