Essay On Obesity In Australia

Obesity is a general heath issue, a condition where fat is accumulated in body due to increased energy production from consumption of food and drinks which is greater than the energy utilized by the body. The ongoing frequency of Obesity epidemic in Australia is leading public health challenges confronted by all healthcare professionals with compel to come up with strategies towards its prevention and control.

Over the last 30 years, overweight and obesity prevalence has stirred up in Australia. The condition is not just bound among men and women but child obesity cases are rising too. The factors influencing the rise in the condition are unhealthy food habits & lifestyle, rise in fast food junctions, socioeconomic status, education, race/ethnicity, and inherited hunger gene, lack of exercise and immigrant population. Data from Australian Bureau of Statistics (based on self-reported height and weight) from the 2011–12 Australian Health Survey to calculate BMI reported nearly 63% of Australian adults are overweight or obese (1), which was 61% in the year 2007-08 (2). This means 2 out of 3 were obese or overweight. Former chair of the National Preventative Health Taskforce, Professor Rob Moodie has stated that obesity rates in Australia will dramatically worsen as other health priority

areas improve (3). Obesity prevalence is estimated to rise over 70% by the year 2025 that is approximately one third of the Australian adults will be overweight or obese.

Obesity may lead to increased risk of several chronic and impending dangerous diseases.

Study conducted by the Burden of Disease and Injury in Australia (BoD) in 2003 indicated that in Australia 7.5% of the total burden of disease and injury was due to obesity. Around 55% of the burden related to diabetes, 21.3% of cardiovascular disease, 24.5% of osteoarthritis, 20.5% colorectal, breast, uterine and kidney cancers is due to obesity (4) (5). Other obesity related conditions are obesity hypoventilation syndrome (OHS), sleep apnea, gout, gall bladder disease & gallstones, back, mental and reproductive issues, depression, loss of self-esteem and weakening peer-group

relationships.
Obesity was the primary cause of 169 deaths in 2007 and total 869 deaths where obesity was either principal or an associated cause of death as recorded by Australian Bureau of Statistics (2). AIHW reported in 2007–08, about 69% of adults with severe or profound disability in the age group 18-64 years were overweight or obese, compared with 58% of with no disability (5).

Obesity in Australian adults with disability or suffering from mental health disorders is causing a profound public health burden globally. Obesity & overweight affects women more than men. The intervention is planned considering the physical and mental stability, health and response level of the patients. This approach intends to create awareness of obesity/overweight in patients at aged homes, disability care, mental health service homes and families. The aim is to enable early detection of obesity symptoms in these individuals, prevent the condition, achieve lifestyle and behavioral change ultimately reduces the disease burden. The strategy will focus on both obesity related mental health disorders and mental disorders caused due to obesity.

• Body Mass Index measurements, height, dietary intake, diabetes status and other physical and mental health status of the patients along with other intervening factors must be collected prior to implementing this plan.
• A piloted innovation with education, training, guidelines and assistance provided to all care takers of the disabled, mental health service centers, health care professionals, doctors and nurses to improve and train patients in maintain their physical health, diet, prevent being in the condition in the first step.
• Constant support will be provided with standard monitoring and surveillance conducted at regular intervals.
• Periodic evaluation of this intervention will be carried out to analyze the progress and update any required amendments in terms of new creative ideas to lose weight, develop the patient mentally for the changes to remain fit.
• Continuous assistance to the participants takes part in required therapies that will help in this intervention.

- Dietary intake records, food habits, self determination and physical fitness levels have to be evaluated.
- Customary validation of standardized equipments used for measurements and diagnostic tests.
- Regular training, update and review of the staff and any activities introduced in this introduction.
- Supervising the participants progress with the past & present intervention and improve or modify the future actions.

Data will be collected and recorded of all participants from the service homes, disability care centers and families concerning the body measurements, general health, mental health, psychological status, history of any pre-existing conditions, socio-economic status, qualification, demographic details and stress level. The data and measurements collected must be validated using standardized instruments. Provision will be made to maintain these records electronically.

Several communication tools will be utilized to spread information, fact-sheets and guidelines about this program.
• Use of social media, Power Point presentations, video clips, posters and slides.
• Involve volunteers and residents to draw, make collage and paint their ideas and understanding about the intervention and display it in the centre.
• Organize group sessions with acts and activities related to the intervention.
• Depending on the abilities of the concerned patient groups use of gestures, objects, picture cards, small acts, dance or songs can be used to communicate (6).
• Message can be passed on to the subjects by involving local community’s personnel, health ambassadors, local business, patients and family members.

The data collected is gauged and a guideline is designed deliver the required information on the basis of the recorded data. The information pamphlets and sessions will be planned in a way to avoid repetition of information but gradually bring about behavioral change.
Training, educating and guiding the residents, care takers, health care workers, physicians and nurses to develop a healthy lifestyle culture, that will support the disabled and mentally ill individuals to stay fit, active, be wise and assist in prevention of the condition by improving the quality of life.

INPUTS
• Physically Disabled Patients
• Mentally Ill Patients
• Mental Health and Disabled Services
• Funding
• Share/Stakeholders
• Famers & Food Suppliers
• Agriculture Sector
• Transportation, Land and Recreational Area
• Local Community
• Ground Staff, Administrators, Healthcare Professionals
• Family/Guardians/Caretakers
• Timeline
•

OUTPUTS (Activities)
OUTPUTS (Participants)
• Informed and Written Consent
• Implementation of rule/guidelines
• Distribution of resources
• Mass Media Press Releases
• Staff Training & Education
• Physical Fitness Activities
• Awareness involving patients and caretakers
• Workshop for Behavioral and lifestyle change of patients
• Communication training or staff to interact with mentally unstable patients
• Planning and implementation of new, fun and innovative physical fitness activities
• Incentives • Farmers, Dieticians, Chef, cooking staff and food suppliers to promote healthy eating and educate about healthy affordable food.
• Patients, healthcare staff, caretakers, family, guardians and community members to establish new ideas for physical fitness using available resources.
• Organize workshops to create and design fitness activities and games at various locations like schools, community hall, parks etc
• Administrators, NGO’s, Local community, council members, volunteers, Health department, Public Health Sectors, Legislative bodies, Nonprofit organizations and Healthcare industry
• Fund Collection to run the intervention

IMPACT (Short Term)

IMPACT (Intermediate Term)
IMPACT (Long Term)
• Awareness towards physical fitness
• Develop daily routine and knowledge of healthy eating & lifestyle
• Increase self confidence
• Raised enthusiasm, motivation and energy
• Improvement in health
• Information Sharing
• New ideas developed to stay fit and physically active
• Change in diet and food habits
• Behavioral change
• Overall reduction body mass index (BMI) and significant weight loss
• Reduced obesity and healthier patients
• Confidence level of staff, caretakers, family and guardians increases
• Increase in self assessment, self-control and self competence level
• Time save and revenue generated

• Reduction in Obesity, Diabetes and other obesity related risk factors.
• Reduced morbidity and mortality rates
• Structural and organizational level practice change
• Established confidence, behavioral and lifestyle change
• Improved mental and physical health.
• New ideas developed for staying fit and fine
• Establish positive attitude, ability, control and competence
• Changes in policy

• Communication Barrier: Since the intervention is aimed for physically disabled and mentally ill patients, chances of message not being delivered effectively.
• Staff and material shortage.
• Availability of funds and resources.
• The type of physical limitations that may confine certain patients from taking part in certain activities.
• We may also face barriers from certain mentally ill patients to get them readily participate in the physical training.
• Unable to adapt or change to healthy lifestyle or health diet due to cultural beliefs.
• Use of non standardized equipments and non-clear guidelines to handle and implement the program.
• Lack of space.
• Issues with continuity due to lack of interest and participation.
• Food retailers and some stakeholders may oppose the health diet ideas.
• Lack of interest, minimal participation and initiation.

• Funds can be generated by increasing the costs of junk & unhealthy food (tax), fund-raising events, and handmade crafts done by the patient’s etcetera can be used towards this cause.
• Resources for the fitness activities can be inventive ideas that would not need many reserves.
• Involving the families, friends, communication specialists, behavioral therapist and community in communicating with the patients in a non-judgmental clear receptive way.
• Understand the behavior, learning and grasping ability of the patient and deliver the message using creative comfortable ways like singing, art, painting or signs.
• All the equipments used for measuring purpose must be regularly validated and standardized.
• Local parks, picnic spots areas, indoor/outdoor recreational areas within the health service centers can be used for the purpose exercising and other fitness activities. Organize health fairs/workshops, nutrition training which can be family oriented too.
• Paralympics or companies manufacturing fitness equipments for disabled can be approached to donate or loan instruments.
• Involve staff, caretakers, families and patients to grow or farm healthy food within the organization, service centre or homes.
• Organizing simple games, walking groups, yoga sessions or activities shaped bearing in mind of the limits of patients that will encourage, initiate and get patients remain active.
• Arranging fun competitions, providing incentives and fairs can keep the patients remain interested.

The intervention ‘Obesity awareness in physically disabled and mentally ill’ will be evaluated using the Focus group qualitative analysis. This qualitative research being flexible will provide insight into the awareness and mind-set of physically disabled and mentally ill patients along with the healthcare professionals and care-takers, family or guardians assisting the patients. This qualitative research will also use the cross-case analysis (7) with thematic networking to identify the difficulties patients with disabilities or mental illness would face in the course of this intervention.
Participants were recruited into 6 focus groups randomly. Healthcare professionals and service centre staff in one group, family/guardians and caretakers in second group, mentally ill and physically disabled patients were divided into 2 groups -obese and normal weight respectively.
The focus groups were interviewed by 2 researchers, one organizing the study and an external facilitator to ensure equal participation, enrollment and discussion.
The interview questions were framed aiming to understand participant’s awareness, knowledge and approaches to staying physically active, healthy lifestyle and obesity. The questionnaire will be semi structured open and close ended with allotment for feedbacks and ideas from participant’s perspectives of obesity and improvised physical fitness activities.
Validation of scales and measures in the questions will be done on the basis of previous research questions. Each group is allocated 2hours for the interview; patients requiring assistance to communicate were accompanied by their care-givers.

Perception of Obesity:
Participants of all focus groups will be asked to define obesity, their insights to staying physically fit, dietary requirements, difficulties faced in staying active and swaying factors limiting them from performing fitness activities.
The information received from participants in the different groups will assist the researchers to understand the degree of awareness, experiences of the participants to perform physical activities or obstacles they face due to their condition. This information helps researchers to make any changes to the intervention plan.

Initiation for Behavioral & Lifestyle Change:
Interviews conducted within focus groups both on individual level and in groups will give the researchers an idea on the confidence level, ability or willingness to participate, and their understanding of the intervention. The care-takers and healthcare professionals who have close link with the patients will be able to give more insights on the capability, grasping ability of the patients and types of communication to be used with the patients to achieve the intended outcome of the intervention.

Healthy Food Habits, knowledge and Ideas:
Participants will be asked for information regarding their current dietary intake, knowledge about healthy food, habits and interest to change. The researchers will also collect data from the health service center records regarding the diet, food consumed and provided at the center. Information on special requirements, consent to grow or promote healthy food at the center involving the patients will also be collected.

Pre-existing and Obesity Related Diseases:
Health records of all patients will be assessed for pre-existing diseases that may influence the patients from taking part in the intervention and also benefit from it. Conditions like Diabetes, Cardiovascular diseases, gout or other obesity related diseases will be measured during follow-up to evaluate the progress and improvement.

Utilization of Local materials and resources:
Participants will be asked for information on the use of available facility for taking part in physical fitness (gym, walking trails, treadmills, cycling, parks, and indoor games/activities). Researchers will also get ideas from participants about new ways to carry out physical exercise adding fun to it.
Interests and suggestions on usage of available resources towards this intervention, like physical activities or games to keep patients fit, using the garden space to grow healthy food.

Information collected during the qualitative research and follow-ups (one month interval for first 3 months and then quarterly follow-ups for 5 years) throughout the intervention process to assess the progress of the patients will evaluate the impact of this intervention.
For first 3 months – every month participants (patients and care-givers, health professionals and guardians) will be assessed for their degree of awareness via interviews, diagnostic tests and body measurements.
The short and intermediate outcomes awareness, information share, and utilization of materials available, confidence built, saved time, change in practice at organizational level, behavioral and thus lifestyle change will all contribute towards control, reduction and prevention of obesity in the targeted patients. Part of the funding for this intervention can also be generated for the time saved, sales from game events, exhibitions, local produce by the participating organizations and service centers which not only serve the objective of the intervention but also spread the wisdom to others.

Several articles related to obesity awareness in mentally ill and physically disabled were reviewed to provide evidence based dissemination on the system level (health care organizations and government) and individual level (patients, families, healthcare providers, community partners, stakeholders). This intervention and the studies reviewed used strategies that aimed to motivate, create awareness, reach out the targeted population, make changes in organizational practices and enhance knowledge about healthy eating and physical fitness.
Progress and evidence on obesity awareness and staying physically fit in mentally ill and physically disabled are too low, contradictory and not statistically important. Studies by James L. Megna et al. 2011 (10), James H Rimmer et al. 2009 (11), Masaru Teramoto et al. 2015 (12) and National Institute on Disability and Rehabilitation Research (13) have demonstrated evidence and their findings have shown multi-component behavioral and lifestyle changes.
Active Dissemination strategy will be used to spread the evidence-based information. Video records demonstrating the progress and results achieved during the intervention, publishing articles on health organizational websites, written reports, oral presentations, publishing articles in academic journals, mailing information in newsletters or on websites, health magazines, local and state news bulletin, social networks, conducting workshops and conferences can be used to disseminate the evidence based reports of the intervention.
The facts and information collected during the intervention are reviewed and evaluated to make any changes towards obesity in the targeted population. Sharing and spreading this information should first be aimed at local community level which can be attained by conducting workshops, conferences, publishing articles on health magazines and community websites, news, presentation of videos/audio recorded during the intervention of patient behaviors, progress, structural and organizational changes achieved during the intervention process.
Based on the reviewed results of the intervention training packages can be organized at provided at multidisciplinary levels to bring about changes in policy, structural or organizational changes (9).
To efficiently communicate or convey the information and bring about required changes in the policy or organizational practices a systematic market research and classification of target audience, stakeholders, healthcare professional, policymakers, decision makers, community awareness level, misperceptions about the condition and physical fitness have to be evaluated. Obesity awareness in physically disabled and mentally ill intervention results dissemination will recognize the importance of systematically integrating change in practices which is both responsive to and inclusive of family/guardians, caretakers, healthcare service providers, psychiatrists, clinicians, administrators, nurses and community members perception on treatment, awareness to services provided.
The evidence of results like innovative physical fitness activities, utilization of available resources this generating funds and saving time, changes in behavior and lifestyle, reduction in the condition, reduced morbidity and mortality rates due to increased awareness and knowledge of healthy eating and staying fit will assist researchers, practitioners and service centers of the targeted patients to meet demands for a systematic advance to public health problem solving that yields measurable outcomes.
Other strategies that could be used to disseminate the outcomes would be organizing sport events, having healthy eating and lifestyle awareness day at workplaces, conducting special events like game and activities at zoo, museums, schools, healthcare centers, hospitals, libraries and parks. Information booklets, display of slides, videos and website information will be shared at these events which will target the families, general public and other healthcare professional to promote the practice.