Subject: Obesity

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Subject Obesity
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• Group of Budapest
• ICHCI
• Date 10-09-2007
• Location Brugge

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Structure of the presentation

• Group introduction
• Introducing the subject obesity
• Some facts on obesity
• Definition of the WHO
• Ethiologie
• Consequenses (individual and sociaty)
• Prevalance and Incidence each country
• Statistics
• Health Care Programs on obesity
• Reflection on obesity and our professions
• Discussion with the audience
• Feedback
• Summary
• References

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Introduction of our group
Desi Netherlands- Nursing Willem-Jan
Netherlands- Nursing Louise Denmark-
Occupational Therapist Rikke Denmark-
Occupational Therapist Zeza Portugal- Speech
therapist Our Tutor Erszebeth (dietisian)
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Introducing the subject
The proces of finding the subject Obesity
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Definition of Obesity according to World Health
Organization (WHO)
Chronic disease as a result of excessive grease
storage on the body over a timespan.
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Definition of Obesity according to World Health
Organization (WHO)
Is evaluated through the Body Mass Index
(BMI) This formula will not regard to pregnant
women, children and athletes.

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Ethiologie

• Interplay among genetic, biochemical, hormonal,
  cultural and behavioural factors.

- Thus, it is a disease complex with several
dimensions, like social and psychological,
affecting people from every age and socioeconomic
group
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Contributing Factors

• - Increasing the sedentary works
• Little time for eat or preparing the food ? poor
  dietary habits
• Fast food abounding
• Society and technological development (i.e.
  remote control, computer games).

Life Styles Changes
People eat more and more and move less and less.
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Obesity is a risk factor to many diseases or
problems.
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Consequenses

• Individual Consequenses
• High risc of diseases like
• Diabetes
• Cardiovascular disease
• Musculoskeletal disorders
• Gallbladder diseases
• Some cancers (endometrial, breast, and colon).
• Osteopereuse
• Psychologich consequenses
• Fear of rejection from the society which could
  cause social isolation.
• Also social discriminiation through the sociaty
  that obese people experience.
• Because of the high risc of diseases or already
  having some of them, obese people have a lower
  life-expectancy.

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Consequenses

• Consequenses for the society
• WHO estimates that 60 - 70 of all europeans
  will be overweight by 2030!!
• Costs a lot for the society, think about
• cost for hospitalcare
• medication for the diseases
• prevention-programs
• incapacity (for working)
• Medical expenses for the society (insurance)

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In the Netherlands

• Prevalence Incidence
• In 1989 among the Dutch population
• 34 of men and 24 of women were overweight.
• 4 of men and 6 of women were obese.
• In 2005
• was 51 of the males overweight, 10 were obese.
  
• Of the women 42 were overweight, 12 were obese.

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Estimations for the Netherlands 2015
Males 13,2 - Females 14,3
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Statistics Netherlands

• The prevalence of obesity is negatively related
  with social class.

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Statistics Netherlands

• The prevalence of obesity increases by age.

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Obesity in Denmark
From 1987 to 2003 the incidence of obesity in
Denmark increased to 14

• Prevalence of obesity in the Danish population in
  2003
• 30-40 1,3 mil. were overweight
• 10-13 app. 400.000 were obese
• And almost 100.000 were severely obese

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Estimations for Denmark 2015
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Prevalence and Incidence (Portugal)

• Prevalence
• Percentage (2004)
• Male Obesity 14,5 Male
  Overweight 44,1
• Female Obesity 14,6 Female
  Overweight 31,9
• Incidence
• Along the last years obesity has increased,
  especially among children.
• Percentage
• 31,56 Children

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BMI Class Prevalence in Portugal
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Overweight and Obesity Prevalence in Portugal by
gender and age group
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Overweight and Obesity Percentage in Portuguese
Population by Level of Education
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Danish health-care program
Made by the Department of Health Healthy all
life 2002
Goals Everyone has to work together connection
between the primary prevention, personal effort,
patients counsel, support, habilitation,
rehabilitation and other with relation to public
health. Equal health opportunities in society
for everyone therefore special effort towards
some risk factors.
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Danish health-care program
Healthy all life - risk factors

• smoking
• alcohol
• nutrition
• physical activity
• severe overweight
• accidents
• work environment
• factors of the environment

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National Action Plan against Obesity-
Recommendations and Perspectives

• Danish National Board of Health, Centre for
  Health Promotion and Prevention, 2003
• Documentation-basis of the action plan
• A Danish Nutrition Council Report
• Contents of the Plan
• Proposals of action
• Objectives
• Target groups
• Recommendations
• Types of initiatives
• Levels of proposed action

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Objectives of the Action Plan
to contribute to producing awareness and
cultural norms in the Danish population that
promote normal weight development to
counteract habits that lead to overweight to
contribute to reducing bodyweight for persons who
already suffer from or have a special risk of
developing obesity especially persons with type
2 diabetes and cardiovascular disease

• By
• Maintaining existing initiatives
• Supporting new initiatives
• Evaluating new initiatives

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• Categories of initiative
• Structural eg. legislation
• Normative eg. guidelines
• Informational eg. campaigns
• Research Development of Methods
• Levels of action
• Private individual/family
• Community eg. trade industry, day-care
  centres, schools etc.
• Public sector state, regions and municipalities

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Health Care Programs (Portugal)

• National Fight Program to Obesity 2004-2010
• Objectives
• - contribute for reduction of weight
• - contradict determinants habits of overweight.

in obese people and in people that would have a
particular risk of develop obesity
(diabetes/obese class II and cardiovascular
disease)
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Health Care Programs (Portugal)
National Fight Program to Obesity 2004-2010
- This process involves cooperation and
partnership between public, private and non
governmental sectors
That act in health area
With local and regional responsibilities
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Health Care Programs (Portugal)
National Fight Program to Obesity
2004-2010 Target Groups - Underweight or
overweight at birth - Obesity familiar
antecedents - With some alimentary disease in
the past - Women with multiples pregnancies -
Women in menopause period and post-menopause -
Recent Ex-smokers.
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Health Care Programs (Portugal)
National Fight Program to Obesity
2004-2010 Strategies 1. Intervention
Strategies 2. Educational Strategies 3.
Collecting and Information Analyse Strategies.
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Health Care Programs (Portugal)
National Fight Program to Obesity
2004-2010 1. Intervention Strategies -
Improving all identification and attendance
process of people with risk factors - Improving
the patients diagnosis, treatment, recuperation
and control.
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Health Care Programs (Portugal)
National Fight Program to Obesity 2004-2010 2.
Educational Strategies - Involve actions with
informative, pedagogic and formative aspects.
Direct to health professionals and to population
in general, almost obese, obese or ex-obese,
including specific groups that promote a big
habilitation and capacity at health management.
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Health Care Programs (Portugal)
National Fight Program to Obesity
2004-2010 3. Collecting and Information Analyse
Strategies - Involves actions that improve the
epidemiological knowledge of obesity and make
possible get information about obesity impact in
individual health.
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• Health Care Program Netherlands
• Preventive Program Nederland in balans 2005-2010
• Taking care of persons with healthy weight dont
  come above a BMI of 25.
• Taking care of persons with overweight (bmi of 25
  or more) become more overweight.
• Goals
• Stimulate the knowledge en allerting about
  healthy weight.
• 2. Explain the rol of the energybalans.
• 3. Stimulate knowledge about the riscs of
  overweight.
• 4. Give options of how you can change your
  behavior which are practical usefull.

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Activity program

• Give information about healthy food, excersicing
  and energybalans by television, magazines and
  internet.
• Make healthy food easy en good looking!! Helping
  choosing healty food.(marks, reciepts)
• Changing product, assortiments in cantines,
  sportcantines Connection NOC NSF.
  (sportasociation)
• Promote activities which are directed to
  excercing.
• Treath overweight quick and soon as possible.
• Activities at school (see next slide)
• Investigations about overweight.
• Handle Overweight International
• Harmony betweem WHO and EU

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Healthcareprogram Youth till 19 years.

• Started the project Youth and overweight.
• Goals
• Promotion of expertise
• Distribution of materials about overweight
• Campagne of Healthy food and excersice.
• How
• Information for primary school, meterials and
  cooperation with Teleac (childeren television
  compagny)
• Healty food in schoolcantines.
• Promotion excersice in schooltime and in
  sportclubs.
• Much cooperation with child welfare, schools and
  intermadairy of childeren en youth. (Internet
  use, magazines)
• Inform en reach parents (magazines parents)

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Obesity Occupational Therapy (OT)

• OT not among the disciplines mentioned in the
  Danish National Action Plan against Obesity (!)
• OT expertice is relevant and unique as part of a
  diverse interdisciplinary effort in both
• health promotion,
• disease-prevention and
• treatment of obesity
• Obese people gradually deprived of occupations
• OT not care-oriented focus Activity perspective
  for lifestyle-change

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A holistic and activity-oriented paradigm

• Human activity as
• a result of physical, cognitive, affective and
  spiritual processes interplaying with
  environmental factors and circumstances of given
  activities
• the individual,
• the occupation
• the environment
• Both individual and group-level OT.
• OT tools help clients identify occupational
  problems, and to clarify the reasons for them
• Client-centeredness
• OCCUPATIONAL perspective disease is not
  determinant for outcome of OT.
• OT can support a client with obesity in
• defining what is MEANINGFUL in sense of his or
  her daily activities, and
• in achieving a meaningful occupational life

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Examples of relevant OT competences

• Anatomy
• Physiology
• Pathology
• Cardiovascular disase
• Diabetes 2
• Psychology
• Motivational volitional factors
• Roles habits
• Activity-analysis and adaptation to clients
  needs.
• Bottom-up perspective the clients ambassador,
  not the systems.

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• Resources over weaknesses
• OT goal To enable occupation by means of
  empowerment
• OTs strive to secure and endorse the vital human
  needs of
• BEING
• the need and right to be acknowledged as an
  equal existence, unconditionally
• DOING
• the need and right to live an active life
• and BECOMING
• the need ad right to develop and grow at all
  times

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Reflections Speech Therapy
The prevention of this disease is very important
to avoid future problems in several areas,
include the speech therapy, like apoplexy and
aphasia
In spite of the obesity isnt directly connected
to speech therapy
In this cases the speech therapy besides his
regular intervention should be attend to physical
condition of his patient and give some advices
about alimentation with the coordination of the
nutritionist or dietician. In another situations
the speech therapist can intervene in the obesity
prevention in schools at several levels with
other professionals.
Importance of the professional decentralization
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Obesity and Nursing

• Mostly First disease ? hospitalcare ? treating
  obesity and stimulate information about healty
  weight, excercising.
• Important Focus on preventive function of
  nursing!
• Childhood and Youthcare
• Give attention to healthy food weight by
  patients before getting diseases (weighing
  patient, look at intake daily food drinks)
• Give attation to psychological factors of eating
  behavior
• Stimulate excercising in hospital, at home, work
  and in daily life.
• Help making solutions for changing habits

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Discussion

• Not getting obese is a individual responsibility
  and not society?
• The health care professions can not do everything
  to prevent the epidemic of obesity?

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References

• World Health Organisation. (2006) Factsheet
  Obesity and overweight. online Retrieved from
  the web 30-07-2007 http//www.who.int/mediacentr
  e/factsheets/fs311/en/index.html
• Branca, F., Wijnhoven,T. Mantingh, F. (2007)
  Obesity in Europe. World Health Organisation.
  online Retrieved from the web at 30-8-2007
  http//www.euro.who.int/obesity/import/20060217_1
• World Health Organisation. (2007) Overweight and
  obesity. WHO Global Infobase. online Retrieved
  from the web 31-08-2007 http//www.who.int/ncd_
  surveillance/infobase/web/InfoBasePolicyMaker/repo
  rts/Reporter.aspx?id1
• Schokker, D.F., Visscher, T.L.S., Nooyens,
  A.C.J., Baak, van, M.A. Seidell, J.C. (2007).
  Prevalence of overweight and obesity in The
  Netherlands. Obesity Reviews, 8(2), 101-107 (voor
  prevalentie, etniciteit)
• Seidell, J.C., Visscher, T.L. (2003) Nutrition en
  Health Obesity.online Nederlands tijdschrift
  geneeskunde, 147(7), 281-286. Abstract from
  Pudmed http//www.ncbi.nlm.nih.gov/sites/entrez?D
  bpubmedCmdShowDetailViewTermToSearch12622004
  ordinalpos53itoolEntrezSystem2.PEntrez.Pubmed.P
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• Visscher T.L.S. (2007)Zijn er verschillen naar
  sociaal-economische status en etniciteit?Volksgezo
  ndheid Toekomst Verkenning online, version
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• Voedingcentrum. (2005) Nederland in balans
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  the web op 05-09-2007 http//64.233.183.104/searc
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  asnederlandhlnlctclnkcd2glnl

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References

• National Board of Health Center for Health
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• Lander Svendsen et al (2001). Fedme i Danmark
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  http//www.ugeskriftet.dk/portal/page/portal/LAEGE
  RDK/UGESKRIFT_FOR_LAEGER/KLINISKE_VAERKTOEJER/KLAR
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• OECD Health Data 2007 How does Denmark compare?
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  http//www.oecd.org/dataoecd/46/32/38979778.pdf

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References

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  l
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