By Stephanie Levin-Gervasi
November 29, 1999
Photo: Eyewire

Obesity in the United States has reached epidemic proportions: One out of five American adults is overweight, and the obesity rate has surged from 12 percent in 1991 to 17.9 percent in 1998. The grim numbers, recently reported in a collection of national Centers for Disease Control and Prevention (CDC) studies, have prompted concern among healthcare professionals, whose patients suffer from obesity’s chronic and deadly effects.

Barbara A. Bowman, PhD, co-author of one of the studies, said that being overweight and inactive accounts for more than 300,000 premature deaths each year in the United States, second only to tobacco-related deaths. “Only one-third of overweight patients ask for advice from healthcare professionals on weight loss—even though statistics show that individuals are three times more likely to heed a word from a nurse or doctor than articles written about weight loss,” she said.

Professional intervention

Nurses have one of the best opportunities to make a difference in the quality of care by helping to get the message across, Bowman said. “They are in a position to reach the underserved part of our population, particularly African American and Hispanic populations.”

Nurses are also able to assess obesity and educate patients, said RoAnne Dahlen-Hartfield, DNSc, RN, administrator of the department of continuing education at the American Nurses Association. Questions about diet, weight, and exercise are routinely asked during patient assessment. But even though obesity should be addressed, Hartfield said it isn’t always a priority. “When there are other critical problems that need immediate attention, obesity might not be at the top of the list.”

Registered dietitian Susan Bowerman, MS, executive assistant director at the UCLA Center for Human Nutrition, said there are a host of complex reasons why nurses and physicians are reluctant to intervene with their patients where obesity is concerned. “Some physicians don’t want to deal with the problem; others may make suggestions and get no response. Patients demur broaching the subject and so do physicians. The standard [practice] is a referral to a dietitian,” she said. In fact, much of the responsibility for educating patients falls on dietitians, who sit patients down and help them work out a plan to lose weight.

The youngest victims

Morgan Downey, executive director of the American Obesity Association, warns this epidemic is of particular concern for children. Indeed, the CDC studies found that 60 percent of overweight 5- to 10-year-olds already have at least one risk factor for heart disease, including hyperlipidemia and elevated blood pressure or insulin levels.

Both Downey and Dolores Jones, EdD, PNP, RN, director of education for the National Association of Pediatric Nurse Associates and Practitioners, agree that the most efficient plan for combating obesity requires a team effort. “Schools have nurses on-site that counsel and help implement nutrition and health curriculum, but the biggest problem is poor diet and lack of physical activity,” Jones said.

Downey feels a concerted effort will be required to overcome these problems. Healthcare professionals must continue to educate children about diet and exercise in schools, and urban policymakers can play a pivotal role by providing parks or paths for walking or biking. “But the best place to start obesity prevention is at home—parents need to reduce their children’s TV and computer time and encourage more physical activity,” he said.

How can a culture that appears to focus on fitness and has carte blanche access to healthy foods do so poorly in curbing weight gain? The culprit, according to the experts, is lifestyle. We live in an automated society, and people rely on conveniences. Add a diet of fast food and snacks, as well as a lack of exercise, and maintaining a healthy weight becomes a challenge for even those with the best of intentions, Jones said.

“There has been little public attention, prevention, or government research directed toward obesity,” Downey said. “We are in dire need of evaluations in order to implement programs. We hope the studies provoke an all-out effort on the part of government, community, and healthcare professionals.”

Trouble in Texas

No part of the country has escaped the epidemic, including Texas. Among the 45 states with complete data, Texas has the eighth highest obesity rate. Registered dietitian Sherry Clark, MPH, public health nutrition coordinator of the Texas Department of Health Bureau of Nutrition Services, said combating obesity, particularly among children, is a top priority, and the agency is trying to establish programs to address the problem. “We need funding to collect more data on children in order to implement prevention programs. The Diabetes Council has funded CATCH, a program to promote better cardiovascular health for children in schools through more physical activity and a healthy-meal programs in 600 schools across Texas,” Clark said.

Research from the CDC also found that more than two-thirds of American adults are trying to lose or keep from gaining weight. With obesity becoming one of the nation’s greatest health concerns, there is an increasing opportunity for healthcare professionals—nurses in particular—to take action. “Nurses have a critical role in this epidemic,” Bowman said. “They have the potential and are in the position to challenge people’s behavior.”