Obesity in America
Another Lancet reference suggests that "Expert panels and research funders increasingly call for interdisciplinary, even trans-disciplinary, research that uses multiple theories and methods to discover new knowledge that can be rapidly translated into clinical or public health practice.” (Freudenberg, 2011)
In 2011, The Lancet did a four-part series on Obesity—as obesity has become "Pandemic" on this planet, due to a variety of factors and a multi-factorial epidemiology. This series included commentaries, papers, and, of course, research studies. Obesity has become pandemic in both Western & non-Western nations due to a variety of health-related factors, including the following: (1) Industrialization and Mass Food Processing (2) Preservatives and Artificial Sweeteners being placed in foods (3) An increased Incidence of Sedentary Lifestyles (4) The high costs associated with healthier alternatives and organic foods (5) The prevalence and relatively low cost of Fast Foods (6) Busy Lifestyles (7) Insomnia (8) Lack of Consistent Aerobic, Cardiovascular Exercise (9) Prescription Medications (10) Social Customs & Conventions.
Clearly many factors affect the development and persistence of obesity in Western societies. And, many pharmaceutical companies, insurance companies, federal and local governments, public health agencies, and community groups have been attempting to define and address some of the variables that contribute to this pandemic. Pharmaceutical companies have been conducting trials and developing diabetes agents with novel mechanisms of action to limit the degree that type 2 diabetics gain more weight. Insurance companies have attempted to catalog and address the issue by allowing consistently obese and morbidly obese individuals to have operations such as gastric bypasses, "Lap Band" surgery, and other non-traditional therapies aimed at reducing co-morbidities associated with obesity. Public health agencies, governments, and community groups have tried to address the problem by advocating that citizens get regular exercise and make healthier, more balance food selections. However, even if improper dietary habits are the fundamental reason for a patient’s obesity, it is highly unlikely that social and psychological factors have played no role in the person’s dietary habit formation and overall lifestyle choices. To ignore the social and psychological factors in obesity is to fail to address the true problem illustrated by the symptom of obesity. Obesity is a symptom as well as a disease process… In fact, one author suggests that we live in an "Obesogenic" Environment, coining a new term for the relationship between our environment and pandemic of obesity (The Lancet, 2011).
Many definitions of "Public Health" recognize the fact that social and economic factors play a mammoth role in public health—perhaps even the greatest role. I truly believe that “Social Machinery” plays just as great a role in public health as does clinical medicine. Perhaps the most important concept, regardless of the definition that you choose to embrace, is that the definition recognizes that "Public Health" is a 'Multi-Disciplinary Subject Matter' that needs a collective, embracing, and collaborative approach in order to make positive public health a reality." (Turnock, 2009) (WHO, 2011)
The three core functions of public health are: (1) Assessment (2) Policy Development (3) Assurance. These core functions require that public health-related federal and state agencies gather data. They must then use that data to: (1) Discover diseases and factors that affect health (2) Develop policies to combat these diseases, considering the factors that favor disease development (3) Assure the public that these diseases are being prevented and/or managed effectively by monitoring the effects of policies and procedures. These processes should begin with “Data Acquisition.” Even this beginning step is no easy feat since it involves multiple processes aimed at finding out information about all citizens in the country.
In addressing a problem or dilemma, you must: (1) Accurately determine the present circumstance (2) Determine whether or not you want to address it (3) Determine how to address it (4) Institute programs (and accompanying processes and activities) to address the dilemma (5) Judge how sufficiently you have met your goals of addressing the issue or circumstance using the best available data sets. So, many steps are involved once you find a dilemma to address. The "Processes" of a program are the activities and elements of the program that allow it to carry out its defined functions. The outcomes are the measured results of those activities and elements. The impact is an appraisal of the outcomes in terms of the following: (1) Expectations of the groups being serviced (2) Expectations of the whole community, (3) Expectations of those who designed, carried out, and instituted the processes. They contribute to program evaluation by helping to justify resource allocation to a program and to address shortcomings and successes.
The focus of healthcare products and services in the United States should be “Prevention”, not treatment. However, because a “Treatment Focus” in healthcare preceded a “Preventive Focus”, many capitalistic interests in the US are firmly rooted in a “Treatment Model.” And, those interests would have to spend considerable degrees of capital in order to transition to a “Preventative Model.” Unfortunately, as long as corporations (who may heavily invested in a “Treatment Model&rdquo have the ability to significantly influence elements of the political process in this country, I think that it will be a long time coming before the focus switches. Obvious losers in such a switch would be the following interests: (1) Insurance companies (2) Pharmaceutical companies (3) Treatment providers (4) Healthcare organizations. Therefore, the question of prevention vs. treatment in healthcare is similar to the one of crime vs. “no crime” civilly. While it would be socially desirable to have a society devoid of crime (if it were even possible to create and sustain such a system), it will most likely never happen because such a circumstance would eliminate to many jobs—including those of judges, police officers, prison guards, bail bonds persons, and lawyers. (Turnock, 2009)
In summary, U.S. public health agencies, and insurance companies, for that matter, have identified obesity as a chronic, Western, preventable condition that is associated with a number of causal morbidities. Moreover, obesity and the comorbidities with which it has become associated are very costly to Americans—both individually and collectively. In order to address and solve this dilemma, we must gather data and create research to identify why we are seeing increases in the incidence and prevalence of obesity. Once data is gathered, then we can use that data to examine whether or not existing strategies to combat this pandemic are successful. This requires a multi-disciplinary approach. Unfortunately, the pandemic of obesity in Western nations is not due to diet alone. The pathogenesis of obesity cannot be separated from the socio-economic factors that have helped to foster its epic rise over the past few decades. In addition, political factors must be considered since a great number of groups stand to lose capital if the problem of obesity were solved in this country. Of note, food producers, manufacturers, and retailers might loss economically if consumers began to make more health-conscious choices. Finally, insurance companies, pharmaceutical, treatment providers, and healthcare organizations stand to lose much if obesity is prevented and/or curtailed in The United States. Clearly, the pandemic of obesity must be addressed in a multi-disciplinary way so that solving the problem of pandemic obesity does not negatively influence multiple economic industries. This will require time, talent, creativity, significant resources, money, cooperation, and compromise. And, much like healthcare reform, it will likely not happen expeditiously.
Crawley, J., ED. The Oxford Handbook of the Social Science of Obesity. Oxford University Press, Pp 912, 2011. ISBN 0199736367.
Freudenberg, N. The Social Science of Obesity, Perspectives. The Lancet, Volume 378, August 27th 2011. Retrieved on September 15th 2011.
The Lancet. Obesity. Published on August 26th 2011. Retrieved on August 30th 2011. http://www.thelancet.com/series/obesity#
Turnock, B.J. Public Health: What It is and How It Works, 4th Edition. Jones and Bartlett Publishers, 2009.
Wang, Y.C., MD, McPherson, K., PhD, Marsh, PG Dip, Gortmaker, S.L., PhD, & Brown, M., PhD. Health and economic burden of the projected obesity trends in the USA and the UK. The Lancet, Volume 378, Issue 9793, Pages 815 - 825, 27 August 2011, doi:10.1016/S0140-6736(11)60814-3. Retrieved on Friday, September 30th 2011 from http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2960814-3/fulltext?_eventId=login
WHO (World Health Organization). Health Promotion Glossary, Page 3, 1998. Retrieved on Tuesday, August 30th 2011 from www.who.int/hpr/NPH/docs/hp_glossary_en.pdf