Approaches to obesity: Behavioural measures

Issue for reflection: Can obesity be controlled through behavioral measures?

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One of the global concern that we are facing now is obesity, not only has it increase, the prevalence rate has also doubled since 1980 (Anderson, Quinn & Glanz et al., 2009). Behavioral theories suggest the increase in obesity is link with decrease physical activity and unhealthy dietary behavior and thereby altering our behavior would help to decrease risk of obesity (Heather, 2004). However, despite enormous research and interventions, the prevalence rates are still on the climb. Thus, casting doubts on behavioral approaches. This paper shall reflect on the issues on controlling obesity and practical implication in workplace setting.

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Inter-relationship between theory, research and practice

Theory and research

In the basis of behavioural approaches, it is assumed that there is two main reasons that results in obesity epidemic, firstly, there is an imbalance in energy intake (excess) and energy output (inadequate). Secondly, these actions that contributed to the energy imbalance are learned behaviour (Jeffery et al., 2000). For example, we observe the purchase of fast food from others or advertisement, it increases our chances of buying it. If it was a learned behaviour then in order to decrease obesity rates, we should be able to acquire new behaviour to make better decisions that promote our health and well-being.

It is also argued that when we engage in physical activity we are using our energy from food, however, the improvements in transportation and technological advancement has greatly reduce our level of physical activity, accounting at least 30% of the worldwide population and half of the adults in United States did not meet the recommended level of physical activity (CDC, 2007;WHO, 2009). Studies have collected epidemiological data that compared activity levels and found two associated variables with increasing trend namely, car ownership, and time spend in television viewing with obesity (Prentice & Jebb, 1995).

Other than the drop in energy output, it can be seen that our energy intake has increased significantly together with obesity rates. Studies show that calorie intake of food increased from of 335 calories per day for females and 168 calories for males from 1971 to 2004 (Wright et al., 2004). Moreover, within this time frame it was the bloom of economics for processed food accompanied by the increase portion size and fast-food trends, which leads to excess calorie intake, resulting in rapid weight gain (Rolls, 2007). Thus, the extra calories input might be from food choices that consist of high energy density.

Practice

As of workplace environment, these research has helped in developing behavioural modification program in treating obesity. Reports show that companies that adopted obesity interventions have significant improvements for the employees, and also helped the employers in decreasing absenteeism rate, job stress experience, workplace injuries and increase in work productivity in workers (Jensen, 2011; Mhurchu, Aston & Jebb, 2010). These health outcomes has been revealed to be commonly experienced with obese workers (Bungum et al., 2003; Nishitani & Sakakibara, 2005; Poston et al., 2011).

These behavioural programs often includes the combination of self-monitoring measures such as monitoring dietary intake (e.g. diary), cues and encouragement for appropriate behaviour (e.g. extrinsic incentives) (Stuart & Davis, 1972), group exercise and providing healthy meal options, as well as, equipping workers with nutritional knowledge. Moreover, employees who had adhere to the program has considerably increase their daily intake of fruits and vegetables, and reduce their fat intake from food, along with improvements in mental and physical health (Maes, Cauwenberghe & Lippevelde, 2012; Hutchinson, 2011). Therefore, with a better health profile, it could help in issue of absenteeism, productivity and benefited both employers and employees.

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Personal reflection

For: Behavioural theories could help in controlling Obesity

The Contribution of extensive research

Firstly, research on behavioural approaches could aid in implementation of interventions and modification of existed programs in the workplace environment. Perhaps, we could develop a framework that identify the contributing factors of obesity in the workplace setting. Then, analysing the trend between the contributing factors and workers through survey data and using statistical methods to samples different groups (e.g. normal weight, overweight and obese employees). Next, we could design the program making sure to modify the contributing work system parameters (e.g. providing healthy food options) to create behavioural changes (e.g. ordering healthy meal) that could improve health conditions.

Most employers and employees acknowledge the impact of obesity

Secondly, studies have found that both employers and employees has consider weight management program at work settings to be appropriate and effective in controlling obesity (Gabel et al., 2009). These shows that employers might be concern about the rising medical cost, expenses incurred due to the loss of productivity and an increase in work injuries. Employers understand the impact of obesity that imply health cost towards employees and indirectly affecting the company as well, as such they are more willing to provide cooperate health benefits to reduce obesity. However, the employees must also have personal responsibility and discipline to attend the welfares provided. Thus, when both parties work together the chances of reducing obesity would be possible in workplace.

Against: Behavioural theories does not help in controlling Obesity

Obesity is genetically inherited

Firstly, in contrast to the behavioural theories, researchers have also investigate the genetic approaches towards obesity epidemic. Studies have explored the chances of inheriting obesity by looking at samples of first-degree relatives, which indicated moderate association (0.20 to 0.30). In addition, they looked into samples of monozygotic twins, which results in a higher heritability rate (0.60 to 0.70), indicating that genetics have contributed approximately 25% to 40% of the variance in BMI (Price, 2002). Furthermore, early research has also discovered that the distribution of fat in body parts and individual’s metabolic rate are also genetically predisposed (Levine, Eberhardt & Jensen, 1999). This might support the notion that obesity could not be reduce.

The complexity of contributing factors to obesity

Secondly, with the vast variety of potential factors that could contribute to obesity, it would be challenging to target all factors. Workplace influencers include, high job demand, insufficient sleep, lack of physical activity, stress, low job control (Parhizi, Pasupathy & Steege, 2012). Likewise, while considering the workplace effects, there are additional domain such as individual difference, psychosocial factors and genetics factors that could cause further complexity to provide solution to reduce obesity rate. Additionally, there may be multiple association between factors creating the difficulties in providing optimal levels of treatment for each individual.

Inconsistent interventions results

Thirdly, considering most of the research being done has a significant outcome improvement in health related issues (Hutchinson, 2012). Nonetheless, when evaluating the results of interventions that included promotion of physical activity and nutritional programs in accordance to the obesity measures of BMI, fat percentage and body weight, there were inconclusive evidence of the efficacy of reduction in these areas (Vuillemin, 2011).

Similarly, such studies does not identify which of the interventions are effective for specific types of employee population. For example, is there a need for two different programs for office-based workers and retail-based workers? Additionally, most of the programs does not measure its long-term effects on weight maintenance which could provide overestimation of the positive outcomes from intervention and employees might actually gained weight in the long run. Thus, the inconsistency and methodological flaws of these studies might have an impact on its efficacy level.

Conclusion

Obesity is drawing massive attention and growing as a health problem that consisted undesirable consequences on individual’s health measures such as heart diseases, diabetes and cancers. To add on, obesity also greatly influences our workplace productivity, absenteeism, work injuries and job stress. These not only have negative effects on individual level but also pressures the employers with rising healthcare cost and expenses incurred from obese employees.

As a result, vast majority of studies has examine the cause of obesity, in which, the most common approach was applying behavioural modification methods such as increasing physical activity and changing dietary intake. Yet, with great effort being place in weight management programs, obesity rate is still up-trending. This provides doubts and challenge to conventional methods in combating obesity. Such that, explanation of genetics, complexity of the contributing factors, flaws and inconsistent results of interventions from studies have come to doubt the effectiveness of these methods.

Final Word

Overall, obesity is a health problem that has variety of contribution factors that are complex and there is no definite model or program that cater to majority of the obese community. Nevertheless, it might be possible to be able to start from the workplace setting of individual and creating little changes that hopefully decrease obesity rate overtime.

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References

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Centers for Disease Control and Prevention. (2007). Prevalence of regular physical activity among adults. United States. MMWR 56:1209.C1212

Gabel, Jon R, Whitmore, Heidi,Pickreign, Jeremy Pickreign, Ferguson, Christine C, Anjall Jain, Hilary Scherer. (2009). Obesity and the Workplace: Current Programs and Attitudes among Employers and Employees. Health Affairs. 28, 1. ProQuest pp. 46

Heather O. Chambliss. Behavioral Approaches to Obesity Treatment. (2004) QUEST, 56. pp.142-149

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Price RA. (2002). Genetics and common obesities: Background, current status, strategies, and future prospects. Wadden TA,Stunkard AJ (eds) Handbook of obesity treatment. New York: The Guilford Press

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