As you build your project/presentation, be sure to provide the evidence/research in the literature that supports your evidence based PRIMARY LEVEL OF PREVENTION intervention. Provide the citation on the slide of your interventions that demonstrates the evidence. For example, education is not a solution unless you have research evidence that demonstrates that it solves your identified problem.  I look forward to all the great ideas you each have for solutions to your topics.

Tips for creating the powerpoint:

1.  Bullet points only, no complete sentences

2.  Do not use first person or vague pronouns

3.  Goals need to be outcomes focused on a pre/post measure of change related to your interventions

4.  Use pictures on the slides

You all have clearly discussed interventions at the community and system levels. How does this presentation on the web of causation help to expand on the complexity of your population? 

THIS IS VERY IMPORTANT

Answer the following questions as you develop your evidence-based, culturally appropriate intervention for your community:

What health issue, problem, or disparity in health outcomes is of concern to you as a scholar practitioner in your community? What gaps in knowledge and care do you see as possible causes for the health issue? What does the health data tell you about the health issue? What does the literature tell you about the health issue? How can you learn about the health issue and about possible solutions from the viewpoint of families, community as a whole, and health professionals in your community? What evidence is there to support your proposal? What is one avenue you could advocate for improved health outcomes and know when a change has taken place?

Suggestions for the Project

Each week’s activities are geared to help you move along with your proposal. Use this time well and utilize some aspect of discussion and assignments in this course (e.g. windshield survey) to support your proposal as well. Read about the whole project before you start. 

Week 1: Identification of a Population in Your Community

Week 2: Practicum: Epidemiology: Define Your Population and Selected Problem

Week 3: Practicum: Population Cultural Considerations and Genetic Predisposition

Week 4: Evidence-Based Practice and Evaluation of the Project Through Measureable Goals

[Presentation Title Goes Here]
[Your Name Here]
Walden University

[Heading Goes Here]
Go to the Home tab at the top and click the New Slide or Layout button to access different formatting for your slides.
Choose formatting that presents your information in the most logical way.
Use consistent, grammatically parallel format for bulleted lists (for example, on this slide, each element begins with an imperative verb).

[Heading Goes Here]
Keep font of text consistent.
Be sure headings are consistent in their spacing, placement, size, etc.

Consider using the slide after the title slide to summarize your presentation’s points (like an abstract for a paper).

Your slides can also contain entire paragraphs, like this one does. Citation rules apply to presentations just as they do to papers—when using or referencing another author’s ideas, you must cite that source. When incorporating a citation in a slide, do so just as you would in a traditional paper (Smith, 2010). According to Jones (2007), presentations aren’t very different from papers!
[Heading Goes Here]

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Use APA style rules to format any tables and figures in your presentation:
Figure 1. Bar graph showing useful information. From “Utilizing bar graphs,” by A. Jones, 2011, Journal of Handy Graphs, 76(2), p. 3. Reprinted with permission.

Chart1

Category 1 Category 1 Category 1

Category 2 Category 2 Category 2

Category 3 Category 3 Category 3

Category 4 Category 4 Category 4

Series 1
Series 2
Series 3
4.3
2.4
2
2.5
4.4
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3.5
1.8
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Sheet1

Series 1 Series 2 Series 3

Category 1 4.3 2.4 2

Category 2 2.5 4.4 2

Category 3 3.5 1.8 3

Category 4 4.5 2.8 5

To resize chart data range, drag lower right corner of range.

Remember to adhere to any assignment guidelines regarding presentation format. This template contains suggestions only.
Keep in mind that there is no such thing as an “APA standard PowerPoint.” Review http://blog.apastyle.org/apastyle/2010/09/dear-professor.html for more information!
[Heading Goes Here]

References
Always include a reference list at the end of your presentation, just like you would in a paper. Reference list entries take the same format they would in a paper:
Jones, P. (2004). This great book. New York, NY: Publisher.
Smith, W., & Cat, D. (2010). How to make a good presentation
great. Presentations Quarterly, 45(4), 56-59.
doi:10.123.45/abc

Community assessment power point
NURS 4210 Week 6 Assignment

*

Section 1 of the rubric
Use the Slide Headings from the grading rubric/criteria as written
Describe Population
Describe Population’s Health Problem
(This section is worth 20 points)

*

Section 2 of the rubric
Describe Results Comprehensive Assessment (including collaboration
with health care team, etc.
(This section will be worth 30 points)

*

Section 3 of the rubric
Evidence-based culturally competent nursing interventions
(Must be referenced in the slide)
Interventions need to include some at the primary prevention level
(This section is worth 30 points)

*

Section 4 of the rubric
Short term & Long term goals with Evaluation
(This section is worth 20 points)

*

Section 5 of the rubric
Presented to Professional
Present ideas to at least one professional
Include professionals name, credentials, and agency
Include feedback from professional and lessons learned
(This section is worth 15 points)

*

Section 6 of the rubric
Role Health Care Leader in Community
Describe role as health care leader
Note how this will promote social change

(This section is worth 20 points)

Remember to adhere to any assignment guidelines regarding presentation format. This template contains suggestions only.
Keep in mind that there is no such thing as an “APA standard PowerPoint.” Review http://blog.apastyle.org/apastyle/2010/09/dear-professor.html for more information!
[Heading Goes Here]

Section 7 of the rubric
APA/Format
Points will be deducted when:
Bullets are not used on slide
There are more than seven lines per slide
There are more than seven words per sentence
All capital letters are used
A background does not enhance the quality of the information being presented
Reference list as final slide is not included

Minimum 7, maximum 18 slides – this includes the title slide and reference list
(This section is worth 15 points)

(Total Points for Power Point: 150)

References
Always include a reference list at the end of your presentation, just like you would in a paper. Reference list entries take the same format they would in a paper:
Jones, P. (2004). This great book. New York, NY: Publisher.
Smith, W., & Cat, D. (2010). How to make a good presentation
great. Presentations Quarterly, 45(4), 56-59.
doi:10.123.45/abc

*
*
*
*
*
*

Running head:

HEALTHCARE 2

HEALTHCARE 2

Healthcare

Student’s Name

Institutional Affiliation

Healthcare

In the United States, the healthcare system is unique compared to other developed states across the world. Different states in the U.S. have different health systems, universal healthcare coverages, and healthcare policies. Generally, the United States healthcare system is hybrid. Some healthcare determinants have led to poor healthcare outcomes in areas such as quality and service delivery. As a result, social determinants such as race, education, poverty, income, housing, and rural-urban residence have contributed to what kind of healthcare a citizen receives. Disparities in income distribution is a challenge in improving the healthcare outcomes for children and adults living with obesity (population at risk) in Wayne County, Michigan.

In Michigan, children between 10 to 17 years old and adults with 20 years old and above make 21.8% of the population with obesity (Koh, 2018). Michigan ranks number five out of all states as a vulnerable state to obesity. This state statistics involves data on childhood and adult obesity, health issues linked to obesity, and prevention measures taken by Michigan to lower obesity. In Wayne County, healthy lifestyle indicators to those of the whole Michigan state reveals existing disparities in the distribution of income whereby those children and adults with obesity come from low-income populations in Wayne County. The county only has 33% of adults obese, while 12.9% is a low-income child obese.

Determinants of Health in Wayne County

In my community, social determinants influence healthcare outcomes and consist of all that makes people healthy and others unhealthy. They are conditions in which individuals are born, grow, work, and live. In Wayne county, education, housing, income, and discrimination determine people’s health conditions (King et al., 2019). The interaction between Wayne people and their environment worsens undesirable health outcomes. For instance, in Wayne County, people have no access to clean water and live in areas where air pollution is prevalent due to poverty. Their poverty cannot enable them to maintain a good dietary pattern, thus worsen obesity, especially among adults and children.

Prevalent Health Problems in Wayne County

In Wayne County, Wayne Metropolitan Community Action empowers low-income citizens and strengthen communities to access quality healthcare. The most prevalent issue identified is the lack of health insurance coverage. This insurance coverage is a critical component in having quality healthcare among all people, both low-income and high-income populations. It tries to bridge the gap between poor and wealthy families in accessing healthcare (Friedman et al., 2017). For instance, insured teenagers in Wayne County are likely to be healthier and have low rates of avoidable hospitalizations and childhood deaths than their uninsured children. Also, about 17% of adults in Wayne County do not have health insurance, and approximately 4% of young adults do not have as well.

Another prevalent health issue is disparities. It begins at birth and continues into adulthood. Thousands of citizens of Wayne County face inequalities in accessing healthcare in public care facilities. Blacks have poorer health status than whites. These backs survive with chronic illnesses such as hypertension, diabetes, cancer, and heart diseases. They skip follow-up care and do not have opportunities to access online health care services to manage their health conditions. Also, care disparities have led to difficulties in the provision of adequate home and community-related alternatives for backs and disabled people. Almost 68.2% of people from low-income populations do not have an interest in using telehealth to connect with nurses due to poverty.

Obesity Rates Among Children and Adults in Michigan, Wayne County

Michigan faces weight issues among children and adults. 31.1% of Michigan citizens have a weight problem (obese). In Wayne County, the obesity rate is 23.3% of its adult citizens. Children between the age of 10 and 17 and adults above 20 years old are obese (Kan et al., 2017). People with obesity in Wayne County, according to health reports, take a higher amount of energy than they do physical activities. Also, societal values and norms influence obesity among this population. It is through a culture that determines what this population feed and how it views body weight. How much a person thinks. Both culture and religion influence dietary preferences that are the critical cause of obesity.

Concussively, obesity among children and adults in Michigan, Wayne County, is a public health issue. The healthcare outcomes for this population at risk are undesirable, and the critical health determinants contributing to the problem are income disparities, poverty, education, and housing. The prevalent health issues in Wayne County are ack of health insurance cover and healthcare disparities. Healthcare outcomes for the c community can be improved through solving the current health problems and finding a long-term solution to obesity among children and adults. The care sector needs enough funding to ensure equality and quality services to all people regardless of their income level.

References

Friedman, M. F., Fangmeier, J., Baum, N., & Udow-Phillips, M. (2017). A STUDY OF AFFORDABLE CARE ACT COMPETITIVENESS IN MICHIGAN.

Kan, K., Lichtenstein, R., Famulare, M., Jensen, A., Kowalski-Dobson, T., Pettway, J., … & Patel, M. (2017). Health Insurance Enrollment of Children and Young Adults in Wayne County, Michigan: A Qualitative Evaluation. Journal of Health Disparities Research and Practice, 10(4), 9.

King, A., Foley, D., Arfken, C., Aaron, C., Sung, L., & Hlavaty, L. (2019). Carfentanil-Associated Mortality in Wayne County, Michigan, 2015–2017. American journal of public health, 109(2), 300-302.

Koh, K., Elder, T. E., Grady, S. C., Darden, J. T., & Vojnovic, I. (2018). Explained and unexplained racial and regional inequality in obesity prevalence in the United States. Ethnicity & health, 1-14.

Running head:

EPIDEMIOLOGY
2

EPIDEMIOLOGY
2

Epidemiology

Student’s Name

Institutional Affiliation

Epidemiology

The rate at which children and adults with obesity in Michigan state have dramatically increased. Both children and adults are classified as at-risk populations by public health agencies. Recent research by the Michigan Department of Community Health (MDCH) shows that approximately 2.5 million adults and more than 400 children in Michigan State are obese. This health problem, obesity, is attributed to heart attack, stroke, and type 2 diabetes. The problem is at a high rate and is costing the state billions of dollars in unnecessary health care expenditures to take care of the at-risk obese population. Michigan is obese, unhealthy, and dying young despite the state having beaches, hiking trails, bike paths, and locally grown fruits and vegetables that make a healthy and fit state.

Michigan is ranked 18th as a country with the highest rate of obesity in the world. The problem has risen by 21.8% among adults from 2001 to 2008. In the United States, it comes to number 8 as a state with the highest prevalence rate of obesity. In 2008, 65.3% of adult citizens in Michigan were reported to be either obese or overweight (Tholen et al., 2019). 35.2% were overweight, while 30.1% were obese. Obese children between 2 to 10 years old make 18.9% and rank Michigan position 5 out of 51 states in the U.S. that are vulnerable to obesity. Adult obesity is 33.0% and lists Michigan number 19 out of 51 countries in the U.S.

The poor diet, poverty, and lack of physical exercises among the people Michigan are the leading causes of obesity among children and adults. Physical exercises help in maintaining body weight; thus, continued physical exercises lower the risk of having other problems such as osteoporosis and cancer, which are linked to obesity (Perez-Sanz, 2019). Unhealthy eating is another leading factor in obesity in Michigan. Due to high levels of poverty, healthy weight is not attained through good eating habits. 78.3% and 78.3% of Michigan adults and children do not consume adequate vegetables and fruits, respectively.

The State of Childhood Obesity website provides the above information and data on the prevalence of obesity in Michigan state. It is a public health-based organization that aims at helping all children to grow up healthy. Another useful website that assisted in locating obesity prevalence in Michigan is Bridge, Michigan Health Watch. Its website presents obesity epidemiology in Michigan state. Additionally, scholarly articles by Perez-Sanz and Tholen et al., played a role in explaining epidemiologic information on obesity.

References

Perez-Sanz, S. (2019). The problem of obesity among high school students in Michigan State House District 101. Public Health Review, 2(1).

Tholen, S., Kovary, K., Rabiee, A., Bielczyk-Maczyńska, E., Yang, W., & Teruel, M. N. (2020). Flattened circadian glucocorticoid oscillations cause obesity due to increased lipid turnover and lipid uptake. bioRxiv.

Website links:

https://www.bridgemi.com/michigan-health-watch/michigan-obese-unhealthy-and-dying-young-and-thats-costing-billions

https://stateofchildhoodobesity.org/states/mi/

Running head:

OBESITY

2

OBESITY 2

Obesity

Student’s Name

Institutional Affiliation

Obesity

In current healthcare settings, community health nurses need to understand some critical cultural and genetic factors that influence the persistent disease and how a particular population responds to such illnesses. Genetics are linked to a patient’s background and may determine how a patient is prone to a specific disease such as obesity or cancer. In Michigan state, obesity remains a prevalent health issue among children and adults, in which the persistence of the problem connects to cultural and genetic factors; thus, community health nurses in Michigan must study and understand the necessary resources for treating obesity among children and the adult population.

In Michigan State, community resources can play a vital role in helping obese children and the adult population to resolve their control and treatment needs. Community resources such as Early Care and Education facilities, Salad Bars to Schools, Community Healthy Food Environments. Under Early Care and Education, a community can set up many facilities in which children can start earning healthy dietary at an early stage; thus, they grow with a strong foundation of healthy habits for life (Nagelkerk et al., 2018). Salad Bars to Schools is where a community can collaborate with the private sector to create awareness and engage parties in all counties of Michigan in promoting and sponsoring salad bars in schools. This community program helps children and adults in these schools enhance eating habits throughout their lives.

However, there exists a health care service gap in treating obesity among children and adults in Michigan state. In Michigan healthcare facilities, obesity data and information are not collected regularly despite high rates of obesity. This irregular data collection means the available data is several years old and cannot capture the current obesity condition that is prevalent among children and adults. My cultural beliefs greatly influence my approach as a community health nurse in caring for obese children and adults on obesity. Religious differences, language barriers, and a patient’s belief in alternative medication are cultural considerations likely to shape and influence my caring approach to obese children and adults. Nurses can recommend physical activity as an evidence-based approach to promote the health of the obese population since this approach contributes to weight loss. This approach is a comprehensive weight loss therapy applicable to all cultures.

Most obese children and adults in Michigan, their medical records reveal a genetic predisposition trend. The significant percentage of children with obesity have at least one member of their children who had obesity (Koh et al., 2018). These trends have increased the likelihood of having obesity based on their genetic makeup that links with their obesity-prone backgrounds. As a result, they have high chances of having obesity either in their early childhood or adulthood. Similarly, genetic variations have substantial effects on the chances of developing obesity among adults, especially those who come from backgrounds with no obesity record. The treatment of obesity in this population is, most of the time, ineffective because the cause of health issues is biologically-based rather than poor diets and lack of physical activity.

Conclusively, obesity among children and adults in Michigan state links to various modifiers. A community health nurse needs to study and know the effective approaches of caring for obese children and adults, especially in Michigan state, where there are different races, varying cultures, and people have different ethnic grounds. Similarly, a nurse’s perceptions of obesity influence the used approach. Bias in treating the obese population results from the norms and practices of such a particular care provider. So, community health nurses must consider the culture and genetic predispositions that determine the outcome of the treatment approach used.

References

Koh, K., Grady, S. C., Vojnovic, I., & Darden, J. T. (2018). Impacts of Federally Funded State Obesity Programs on Adult Obesity Prevalence in the United States, 1998-2010. Public Health Reports, 133(2), 169-176.

Nagelkerk, J., Benkert, R., Pawl, B., Myers, A., Baer, L. J., Rayford, A., … & Murray, D. (2018). Test of an interprofessional collaborative practice model to improve obesity-related health outcomes in Michigan. Journal of Interprofessional Education & Practice, 11, 43-50.

Running head:

MEASURABLE INTERVENTIONS

2

MEASURABLE INTERVENTIONS 2

Measurable Interventions

Student’s Name

Institutional Affiliation

Measurable Interventions

Obesity is a severe healthcare problem among the Michigan’s communities. As a result, there is a need for measurable interventions and evaluation of these interventions through evidence-based practice to have a long-term solution for obesity. Healthcare providers can cite various evidence about obesity among adults in Allen Village, Hillsdale County about the work they do and the results they achieve. These care workers accumulate evidence of their impacts of programs such as narratives about obesity among communities, challenges that the community face in dealing with obesity, and necessary interventions. However, these interventions must be measurable and pave the way for evaluation based on collected data and information from the community to determine their effectiveness in resolving obesity among people.

In my last Allen Village community assessment and windshield survey within Allen Village, the data and information revealed that a quarter of adults in Allen Village are obese. For every five members of the community assessed, one is overweight. Overweight is a primary measure of obesity since individuals who are overweight are regarded to have obesity (Teixeira et al., 2015). Diet was another factor evaluated. The data reveals that most of the families depend on pro-obesity foods such as fast food that have substantial content of fat and are sugar-sweetened. Also, Allen Village community enjoys good infrastructure such as railways and tarmacked roads; thus, residents cannot walk or cycle, they drive. Driving undermines physical activity hence make them prone to obesity.

In response to the collected data and information from the community on the obesity prevalence, there is a need for evidence-based behavior change to improve and promote health among adults in the Allen Village community. The behavior change develops an obesity-free community. Overweight and obese adults should engage in daily physical activity (a gym and regular walk) and avoid the use of public service vehicles and cars for short distances. The community should, therefore, use this behavior change as a self-regulation skill as a promising individual-level mediator of positive weight outcomes. The community should set gym centers to help adults reduce weight and overcome the obesity issue.

Obesity impacts both adults and children, hence a culturally sensitive, evidence-based Vida Saludable intervention to address the obesity issue. The community is engaged in developing this intervention, which is a two-phase-based program (Salerno et al., 2018). The first phase involves four biweekly interactive group lessons for obese adults to emphasize healthy foods such as fruits and vegetables, and the second phase focuses on healthy drinks approaches to reducing juice, soda, and sugary drinks. The nutritional perspective is equally prevalent in public health with cultural dimensions of nutrition as protective of obesity is interesting. Traditional foods lack chemical constituents that may have putative impacts on human health. The prevalence of medical sciences into the food’s field contributes to the exclusion of social and cultural functions of the meal.

Once these interventions are implemented, expectations are increased walking and cycling to and from workplaces in the morning and evening as well as morning-run before. This walk to work increases the levels of daily physical activity and makes commuting culture look like a health hazard. The perception will then develop among people that regular commuting is a risk factor to obesity and compel many people to walk to work in at least two days a week. These changes are a result of self-regulation skills for preventing and controlling obesity and have a significant influence in addressing community prevalent health problems, obesity being one of them.

Measurable interventions and evaluations based on evidence-based practices in the community rely on collected data and information from community assessment and windshield surveys. The collected data on the obesity issue in the community reveal many underlying issues on the obesity prevalence among adults in the Allen Village community in Hillsdale, Michigan. Measurable interventions such as daily walking and cycling to and from work can help in changing the dominance of obesity within the community (Teixeira et al., 2015). Further, Vida Saludable intervention addresses the issue by engaging members of the community where they learn healthy lifestyles in terms of diet. So, all other communities in Hillsdale County and State of Michigan in general, should try these measurable interventions to address the obesity problem.

References

Salerno, J. P., McEwing, E., Matsuda, Y., Gonzalez‐Guarda, R. M., Ogunrinde, O., Azaiza, M., & Williams, J. R. (2018). Evaluation of a nursing student health fair program: Meeting curricular standards and improving community members’ health. Public Health Nursing, 35(5), 450-457.

Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I., … & Brug, J. (2015). Successful behavior changes in obesity interventions in adults: a systematic review of self-regulation mediators. BMC medicine, 13(1), 84.

PERIE Model: Obesity

1

Introduction
At their most basic, the words “overweight” and “obesity” are ways to describe having too much body fat.
What’s the best way to determine whether a body is fat or fit? Body fat can be measured in several ways, with each body fat assessment method having pros and cons.
As in adults, obesity is also a growing problem in children and adolescents. Because children grow at different rates, depending on their age and gender, the definitions of overweight and obesity in children and adolescents differ from those in adults.

Obesity
Excessive amount of body fat
Increases your risk of diseases and health problems
Increases your risk for heart disease, diabetes, and high blood pressure
Factors that can make you gain weight

According to www.mayoclinic.org obesity is “A complex disorder involving an excessive amount of body fat (“Obesity”, 2018). First, obesity can cause a major increase of diseases and heart problems. It can cause major fat in your heart and have a higher risk of a heart attack. Next, with obesity you have a higher risk for heart disease, diabetes, and high blood pressure. Finally, obesity and staying obese can cause you to gain more weight and just be miserable.
3

Overweight or Underweight?
Your body mass index is 30 or higher
How do you know if you’re overweight or obese?
Does it matter where on my body I carry weight?

“Your obesity is diagnosed when your body mass index (BMI) is 30 or higher” (“Obesity”, 2018). You can calculate your BMI when you divide your weight in kilograms by your height in meters squared. Here are a few examples of BMI and how you can tell if you are overweight or not. If your BMI is below 18.5 then you are underweight. For normal BMI it’s 18.5 to 24.9. Anything over 25.0 then you are overweight and higher than 30.0 than you are obese. According to www.womenhealth.gov another way that you can tell if you are obese is to measure around your waist (“Weight and Obesity”, 2018). If your waist is larger than 35 inches you are at risk of being overweight or obese. Does it matter where on my body I carry my weight? The answer is yes because if you carry all of your fat in your belly you are at higher risk than carrying your fat in other places.
4

Causes of Obesity
Inactivity
Unhealthy diet and eating habits
Genetics
Medical Problems
Social and economic issues
Lack of sleep
Pregnancy

Did you know that if you don’t exercise and burn calories you are inactive? Being inactive can cause more heart problems and could cause obesity. Another cause for obesity is unhealthy diet and eating habits. If you plan on eating fast food every day and not exercise, it could cause you to gain more weight. “Most Americans’ diets have too many calories that are full of fast food and high-calorie beverages” (“Obesity”, 2018). Genetics are another cause of obesity. Genetics may cause the amount of fat that your body stores and where it’s distributed. Next, is medical problems. Medical problems and obesity can be traced because of medical issues. Issues include crushing syndrome, arthritis, and decreases activity can cause weight gain. Social and economic issues are next. The family and friends that you hang out with can either help you or cause you to become obese by the way that you eat and cook. Next, lack of sleep can cause obesity. When you are awake and don’t get enough sleep you want to eat and it can cause weight. Lack of sleep can cause you to eat more high calories and carbohydrates. Finally, the last cause that can cause obesity is pregnancy. According to women’s studies, “women gain weight during pregnancy and then some women find it difficult to lose the weight after they have the baby” (“Weight and Obesity”, 2018).
5

Demographics + Effects of Obesity

The poor are more likely to be overweight or obese than the rich. Studies suggest lower-income individuals consume higher amounts of calories through fast foods and sodas that are high in sugar, fat, and calories. Quite simply, in the United States today, eating healthy food can cost more than eating junk.
Obesity of all types is related to higher levels of chronic conditions such as high blood pressure and diabetes as well as a lower quality of life.
6

The U.S. Centers for Disease Control and Prevention also previously found that women are more likely than men to fall into obese class III, based on data from the 2007-2008 National Health and Nutrition Examination.
Raised BMI is a major risk factor for noncommunicable diseases such as:
Cardiovascular diseases ( heart disease and stroke, diabetes, musculoskeletal disorders especially osteoarthritis, some cancers (including endometrial, breast, ovarian, prostate, liver, gallbladder, kidney, and colon).
(Mendes, Newport, & McGeeney, 2012).
7

Key Facts of Obesity + Overweight
Worldwide obesity has nearly tripled since 1975.
In 2016, more than 1.9 billion adults, 18 years and older, were overweight. Of these over 650 million were obese.
39% of adults aged 18 years and over were overweight in 2016, and 13% were obese.
Most of the world’s population live in countries where overweight and obesity kills more people than underweight.
41 million children under the age of 5 were overweight or obese in 2016.
Over 340 million children and adolescents aged 5-19 were overweight or obese in 2016.
Obesity is preventable.
(“World Health Organization”, 2017).

– The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.
– Changes in dietary and physical activity patterns are often the result of environmental and societal changes associated with development and lack of supportive policies in sectors such as health, agriculture, transport, urban planning, environment, food processing, distribution, marketing, and education.
8

Obesity Effects
Everyone
Community Effects
National Effects
Global Effects

On a national level, obesity is second leading cause of death. Not to mention the individual and national cost associated with health care and medicine to treat the disease. Obesity and other disease take a toll on the health care system. According to Centers for Disease Control and Prevention (2017),  “The medical care costs of obesity in the United States are high. In 2008 dollars, these costs were estimated to be $147 billion.” The contribution of cost ranges from repeat doctor visits, prescription drugs, ER and hospital visits, etc. This translates to higher premiums, again loss of days at work and low income or job loss.
Obesity on a global level is being witnessed as a epidemic. Countries that were once concerned with eating off the land are welcoming the processed food and cheaper convenient meals. This combined with lack of exercise causes weight gain over time and are risk factors of obesity. This is normal information you hear about effecting the United States. But obesity is taking world by storm and isn’t going away anytime soon. According to World Economic Forum (2015),  “seven out of 10 women and four out of 10 men are overweight or obese in South Africa” Obesity is a public health issue effecting everyone from local communities to communities and countries around the world.

9

Obesity Solution “Prevention”

The Best solution for the obesity and overweight problem in our communities is to create a support environment where individuals have the tools necessary to make better choices and create a healthier life style.
Education is a KEY for communities to understand the consequences of bad eating habits and the lack of physical activity.
It is crucial for the government to establish policies to ensure healthy foods are affordable and easily accessible to everyone, particularly to the poorest individuals which are the ones with a higher rate of obesity.
Engaging in regular physical activity 60 minutes a day for children and 150 minutes spread through the week for adults.
Since the food industry plays a great influence in this issue, it is important that the government enforces polices to promote:
reducing the fat, sugar and salt content of processed foods
ensuring that healthy and nutritious choices are available and affordable to all consumers
restricting marketing of foods high in sugars, salt and fats, especially those foods aimed at children and teenagers
ensuring the availability of healthy food choices and supporting regular physical activity practice in the workplace.
planning and land use decisions create built environments that support walking and biking and increase access to better food choices and limit exposure to unhealthful foods
schools provide better food choices and more opportunities for physical activity
organizations provide and support community programs designed to increase physical activity
local governments, organizations, and institutions adopt comprehensive strategies to reduce overconsumption of sugar-sweetened beverages and to implement nutritional standards for foods and beverages available at government and public sites
health care providers improve practices for prevention, screening, diagnosis, and treatment of overweight and obesity
employers encourage active living and healthful eating at work
(“Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress.,” 2013).

10

Obesity Solution Outcomes

There are a few solutions to help with the obesity epidemic. First individuals can get moving. Getting off the couch and going outside is the first step. Parents can have their kids turn the video games off and go play outside. Partnered with eating right, getting enough sleep and managing stress will help to prevent obesity. In a effort to make sure kids are eating better or healthier school lunches have changed what they serve. Incorporating whole wheat and eliminating vending machines. The government is even getting involved by creating programs and regulations to help assist with exposure and education on prevention of obesity. An example of this is the “Let’s Move” program initiated by First Lady Michelle Obama. This initiative is to stock and supply healthier foods and drink in underserved cities(Martinac, 2017). And also provide playground and outside play areas for the underserved population. There is no magic cure for obesity. Getting active and eating healthy are the first steps for prevention of obesity. Breaking bad habits and creating healthy habits takes time and doesn’t happen overnight. Its especially hard to do on low income and fast food on every corner.
11

Get moving

Healthier meals at school

Government involvement

Alternative Solutions
for Children
Breastfeeding
Practice Healthy Eating in Early Childhood Stages
Refrain from Using Food as a Reward or Punishment Tool

Obesity is a condition that presents it origins early on in life. A parent has the opportunity to give their child an advantage in combating obesity by implementing healthy habits at birth. Although all mothers are not capable, breast milk offers great benefits for the baby. Breast milk is natural, unlike manufactured formulas, offers many nutrients and is easily digested. According to “Stanford Health Care” (2018), “A primary reason that prevention of obesity is so vital in children is because the likelihood of obese becoming obese adults is thought to increase from about 20 percent at four years of age to 80 percent by adolescence.” (Obesity Prevention). Another strategy to combat obesity is to make healthy options available. We have an the option to purchase sugary, high fat foods or to buy vegetables and natural juices. Its okay to have foods that will be considered as snacks, but the most important thing is to have portion control. The percentage of sweets should be significantly less than the nutritional items. Lastly, the sweet items cannot be used as a bargaining tool. It may cause a childe to develop an unhealthy relationship with food.

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Bariatric Surgery

As mentioned before in a earlier slide, the severity of obesity is determined by ones’ body mass index. You can be defined as having normal weight, overweight, obese, or morbidly obese. For the individuals considered morbidly obese, the physical ability can be severely limited due to other co-morbidity diseases. Arthritis, lymphedema and respiratory issues are common reasons why an individual can struggle with weight loss. Advances in medicine have introduced medical procedures that assist with weight loss in qualifying individuals. A physician will approve the patients’ need for the surgery. As pictured above, laparoscopic bypass is the use of lasers to make small incisions, create a small pouch and redirection of the intestines to encourage eating smaller portions to be broken down. Next, the gastric sleeve is the creation of the pouch in the stomach and removal of the remainder; unlike the other options, this procedure is not reversible. A tertiary method would us a silicone band, adjusted over time, at the opening of the stomach to restrict the amount of food the stomach can hold. Other weight loss procedures are available, but the above mentioned tend to result in a greater weight loss percentage (“Bariatric Surgery Procedures”, 2018).
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The Center of Diseased Control utilizes the P.E.R.I.E model as they identify obesity as a health concern affecting a large part of the population. The etiology of obesity is discussed in length due to the varying causes for individuals to practice unheathy behaviors. Data indicates the best approach to combating the disease is prevention rather than reaction. Early childhood education, placing healthy food options in schools and the establishment of community programs are a few of the initiatives encouraged by the national organization. Also, the website provides information targeting the different groups likely to experience obesity. Recommendations are categorized by the specific group with website links noted under each header and the implementation of numerous programs are highlighted in these areas. Lastly, data is collected using surveillance systems receiving statistical data from providers ande health organizations. One of the most recognizable programs is the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). WIC serves families from the mother’s pregnancy until the child is of school age. This allows a clear view into their participant’s state of health. Questionnaires are conducted with these low-income families so there is an educated understanding of where we can best intervene to endorse healthy behavior.
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Conclusion
Effects of obesity on society include low quality of life, mental illness, high blood pressure, difficulty with day to day functionality, and even days lost at work. These effects of obesity reach across the community, and even across the globe. At the local and community levels, childhood obesity is impacting neighborhood across the country. Obesity in childhood from poor diet and lack of exercise can cause health issues at an early age and causes severe issues into adulthood. Community environment and lifestyle are contributing factors in obesity.

References
Bariatric Surgery Procedures. (2018). Retrieved from https://asmbs.org/patients/bariatric-surgery-procedures
Benefits of Bariatric Surgery. (2018). Retrieved from https://asmbs.org/patients/benefits-of-bariatric-surgery
Centers for Disease Control and Prevention . (2017). Adult Obesity Causes & Consequences. Retrieved from https://www.cdc.gov/obesity/adult/causes.html
Institute of Medicine. 2013 7. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress. Washington, DC: The National Academies Press. 7. https://doi.org/10.17226/18334.
Martinac, P. (2017). Solutions for Obesity. Retrieved from https://www.livestrong.com/article/342134-solutions-for-obesity-in-america/
Mendes, E., Newport, F., & McGeeney, K. (2012, July). In U.S., Blacks Most Likely to Be Very Obese, Asians Least. Gallup, (), . Retrieved from http://news.gallup.com/poll/155735/blacks-likely-obese-asians-least.aspx
Overweight and Obesity. (2018). Retrieved from https://www.cdc.gov/obesity/index.html
Obesity. (2018). Mayo Foundation for Medical Education and Research, Retrieved from http://www.mayoclinic.org
Stanford Health Care. (2018). Retrieved from https://stanfordhealthcare.org/medical-conditions/healthy-living/obesity/prevention.html
Weight and Obesity. (2018, March 13). Retrieved from http://www.womenshealth.gov
World Economic Forum. (2015). What is the global impact of obesity. Retrieved from https://www.weforum.org/agenda/2015/10/what-is-the-global-impact-of-obesity/
World Health Organization. (2017). Retrieved from http://www.who.int/news-room/fact- sheets/detail/obesity-and-overweight

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Community Assessment
Maria Pribe
Walden University

Obesity in Wayne County, Michigan
children and adults are vulnerable populations
obese children and adults have low-income
45.9% of Wayne County population is obese (Teixeira et al., 2015)
obesity is linked to overweight, heart disease
Figure 1.0. Bar graph showing income distribution of counties
Source: https://www.pittcountync.gov/Archive/ViewFile/Item/140

Obesity in Wayne Count is a public health problem, especially among children and adults. Children aged 10 to 17 and adults with over 20 years are vulnerable to obesity. Children and adults with obesity make 45.9% of the total population, and most of them come from low-income populations where health disparity is a prevalent issue. Health determinants in Wayne County include education, poverty, income, housing, and discrimination (Teixeira et al., 2015). The obese population does not have access to clean water and live in slums, where air pollution is dominant. More than 17% of adults in Wayne County lack health insurance coverage. Blacks are poorer compared to their white counterparts and have increased chances of having obesity.
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Results comprehensive assessment
poor diet, lack of physical activity
Wayne County ranks position 5th in Michigan (Tholen et al., 2019)
beaches, hiking trails, bike paths remain underutilized
obesity leading factor is unhealthy eating habit
the Michigan Department of Community Health (MDCH)

Obesity is prevalent as a result of poor eating habits and lack of physical activity such as walking, soccer-playing, climbing the stairs, and gardening. Most of the roads are tarmacked, and residents of Wayne Count prefer driving than walking. These residents deny themselves an opportunity for physical activity, thus becoming vulnerable to overweight. Wayne County is among the topmost counties of Michigan where obesity among children and adults is a health problem; it is ranked 5th position (Tholen et al., 2019). Wayne County is a healthy county, but most of the resources for improving physical fitness, such as hike trails, bike paths, and beaches, remain unutilized. The primary obesity leading factor is unhealthy eating, where people do not take fruits and vegetables to control obesity. Collaboration with MDCH aids the approximation of the number of obese children and adults in Wayne County.
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(continued)
the State of Childhood Obesity website
the Bridge Michigan Health Watch
Physical activity (PA) assessment
Wayne Metropolitan Community Action (WMCA)

The State of Childhood Obesity website provides information and data on the prevalence of obesity in Michigan state. It is a public health-based organization that aims at helping all children to grow up healthy. Another useful website that assisted in locating obesity prevalence in Michigan is Bridge Michigan Health Watch. The website presents obesity epidemiology in Michigan state. Approximately 2.5 million adults and more than 400 children in Michigan State are obese (Tholen et al., 2019). Physical activity assessment involves the measure of movement intensity, type, and duration. An assessment in people without obesity is critical for early diagnosis of disease and influences weight management and related interventions. Marginalized races such as blacks are the at-high population to obesity as WMCA empowers low-income citizens and strengthen communities to access quality healthcare.
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Evidence-based nursing interventions
Vida Saludable intervention:
The community is engaged in developing this intervention, which is a two-phase-based program (Salerno et al., 2018).
The nutritional perspective is equally prevalent in public health with cultural dimensions of nutrition as protective of obesity is interesting (Salerno et al., 2018).
Windshield survey
Daily physical activity Measurable interventions such as daily walking and cycling to and from work can help in changing the dominance of obesity within the community (Teixeira et al., 2015).

Vida Saludable is a culturally-based intervention for obesity in Wayne County. The first phase is biweekly interactive group lessons for obese adults. The theme of the lesson is based on the emphasis on healthy eating, such as fruits and vegetables. The second phase is based on healthy drinking strategies to reduce juice, soda, and sugary drinks. Windshield survey reveals data and information on population at-risk (children and adults) and ways to combat the prevalence (Perez-Sanz, 2019). On the other hand, daily physical activity involves a regular walk and gym, which discourages the use of cars for short distances. Children who walk to school daily have reduced chances of having obesity, while adults walking to and from the workplaces remain healthy since daily walking helping in reducing weight.
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Assessment and windshield survey within Allen community
number of obese adults within the village
overweight individuals
obesity causing factors in Allen Village community
approach for addressing obesity prevalent

A quarter of adults in Allen Village are obese. For every five members of the community assessed, one is overweight. Overweight is a primary measure of obesity since individuals who are overweight are regarded to have obesity (Teixeira et al., 2015). Diet is obesity, causing factors for obesity evaluated, and families depend on pro-obesity foods such as fast food. Allen Village community enjoys good infrastructure such as railways and tarmacked roads.
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(continued)
health’s determinants in Wayne County
prevalent health problems in Wayne County

Social determinants influence healthcare outcomes and consist of all that makes people healthy and others unhealthy. These determinants are conditions in which individuals are born, grow, work, and live. The interaction between Wayne people and their environment worsens undesirable health outcomes. Poverty cannot enable people to maintain a good dietary pattern, thus worsen obesity, especially among adults and children from marginalized groups (Koh et al., 2018). The most prevalent issue identified is the lack of health insurance coverage. The healthcare outcomes for the community is improved through solving the current health problems and finding a long-term solution to obesity. Insured teenagers in Wayne County are likely to be healthier and have low rates of avoidable hospitalizations and childhood deaths than their uninsured children.
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Short term and long term goals with evaluation
Short-term goals
mobilize and educate residents twice a week
advocate for implementation of nutrition rules
advocate for physical education in schools

Creating awareness to educate citizens of Wayne County facilitates a better understanding of the obesity issue. Most of the people are not aware of the healthy practices for maintaining and controlling obesity. In most households, the families use fast-foods that contain large content of fat and sugar. The families have abandoned fruits and vegetables that help in preventing obesity (Koh et al., 2018). There is a need to champion the implementation of nutrition roles at healthcare facilities to educate patients on healthy eating habits. In schools, children spent their free time in classes rather than physical education. The school timetables lack physical education lessons. There is a need to push for the introduction of such lessons to help children engage in physical activity to minimize their chances of obesity.
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(continued)
long-term goals
weight maintenance during an adult age
opening of community-based gym facilities

Obesity prevention among children and adults in Wayne County involves weight maintenance. During adulthood, community members should practice weight maintenance. The weight maintenance is achieved through avoiding gradual, incremental weight gain with increasing age (Perez-Sanz, 2019). Adults are advised to avoid fat accumulation around the abdomen. Weight increase with an increase in the number of years is a risk factor to obesity. At the community level, there should be the opening of pubic gym facilities that are accessible to all members of the public. This goal aims at promoting physical activity among the people. Gym activities maintain a healthy community since people who cannot afford to pay for the gym have free access to community gym. It also helps in bridging healthcare disparity between low-income populations and the high-income population.
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(continued)
obesity is linked to chronic diseases
older women are more vulnerable to obese than older men
genetics also lead to obesity
high cost for obesity treatment

Obesity is associated with more than 60 chronic diseases. Most of the people in Wayne County with obesity have the risk for dozens of diseases and conditions. some of the evident chronic diseases are stroke, cancer, and heart disease. The diseases make obesity costly, and citizens of Wayne County cannot afford expensive medical costs. Obese children and adults pay more out of pocket than people who do not have obesity (Kan et al., 2017). Genes play a significant role in the prevalence of obesity and influence intervention approaches. Obesity is inherited and cannot be controlled through healthy eating habits such as the introduction of salad bars in schools. Only traditional forms of treatment can cure inherited obesity among children and adults, but not medical sciences.
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Ideas presentation
Doctor Rebecca Craig, MBA, Wayne Memorial Hospital
obesity prevention needs social change
applicable strategies require broad actions
social systems influence obesity interventions

The control and prevention of obesity in Wayne County require a clear framework that addresses complex health issues. Developed multifaceted strategies should promote public health by providing care alternatives to communities. Alternatives may include integration across all levels, such as policy and legislative levels. These levels should ensure care policies and laws match with changes in fostering effective interventions such as eating styles in healthcare settings. Broad actions such as community-based obesity prevention aim at restricting or limiting the availability of fast-foods and high-calorie in schools, restaurants, and homes. social structures or systems such as universal, indicated, and selectively determine the effectiveness of the intervention at different levels of the community. Intervention at the universal system targets the entire population, at the selective level, it is directed toward the population’s sub-group and indicated system target at-risk population.
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Role healthcare leader in the community
ensuring the provision of community-centered healthcare services

Healthcare leader operates in a modern playing field that needs changing the models by having community-based care. A care provider ensures that health issues that target the community are identified and understood. Effective interventions for improving community health are found. Social changes under effective interventions are possible. A leader maintains that community healthcare system has adaptive response through the clear defined challenges. The promotion of a healthy population is integrated with the health care leader’s role in building community-based care services (Tholen et al., 2020). The role involves medical education given to all patients and management of care facilities as well as patients at all interdisciplinary levels. A healthcare leader exercises honesty and observes ethical considerations while discharging the duty to meet the broader needs of the people.
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Obesity statistics
the overall ranking of the State of Michigan
reported percentage of obese people
percentage of obese adults in State of Michigan
percentage of obese children in the State of Michigan
Figure 1.2. A graph showing obesity prevalent by age and percentage

Michigan is ranked 18th as a country with the highest rate of obesity in the world. The problem has risen by 21.8% among adults from 2001 to 2008. In the United States, it comes to number 8 as a state with the highest prevalence rate of obesity. In 2008, 65.3% of adult citizens in Michigan are either obese or overweight (Tholen et al., 2019). Approximately 35.2% are overweight, while 30.1% are obese (Kan et al., 2017). Obese children between 10 to 17 years old make 18.9% and rank Michigan position 5 out of 51 states in the U.S. Adult obesity is 33.0% and lists Michigan number 19 out of 51 countries in the U.S. At least 78.3% and 78.3% of Michigan adults and children do not consume adequate vegetables and fruits, respectively.
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References
Tholen, S., Kovary, K., Rabiee, A., Bielczyk-Maczyńska, E., Yang, W., & Teruel, M. N. (2020). Flattened circadian glucocorticoid oscillations cause obesity due to increased lipid turnover and lipid uptake. bioRxiv.
Perez-Sanz, S. (2019). The problem of obesity among high school students in Michigan State House District 101. Public Health Review, 2(1).
Koh, K., Grady, S. C., Vojnovic, I., & Darden, J. T. (2018). Impacts of Federally Funded State Obesity Programs on Adult Obesity Prevalence in the United States, 1998-2010. Public Health Reports, 133(2), 169-176.
Kan, K., Lichtenstein, R., Famulare, M., Jensen, A., Kowalski-Dobson, T., Pettway, J., … & Patel, M. (2017). Health Insurance Enrollment of Children and Young Adults in Wayne County, Michigan: A Qualitative Evaluation. Journal of Health Disparities Research and Practice, 10(4), 9.
Teixeira, P. J., Carraça, E. V., Marques, M. M., Rutter, H., Oppert, J. M., De Bourdeaudhuij, I.,… & Brug, J. (2015). Successful behavior changes in obesity interventions in adults: a systematic review of self-regulation mediators. BMC medicine, 13(1), 84.

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