Leadership and Professional Image: Population: Adult Obesity
Task 1: Leadership Experience
Introduction:
Nursing is a practice discipline that includes direct and indirect care activities that affect health outcomes. As a baccalaureate nursing student, you are developing new competencies in leadership, and in order to achieve mastery, you must apply those competencies to live practice experiences and situations. This Leadership Learning Experience (LLE) is designed to allow you to choose a clinical focus (e.g., practice, policy, education, population) in which you apply your leadership problem–solving skills. The LLE requires engagement with other people within the setting to complete.
You will develop a project within a practice setting that allows you to develop these leadership skills. You will identify a problem area in a practice setting that you specifically want to address (e.g., practice, policy, population, education) that aligns with organizational priorities. Example sources for the problem area may include the following:
� Practice: joint commission standards, core measures as quality indicators, other data
� Policy: legislation, staffing ratio, regulations from state boards
� Population: children with diabetes, adult obesity
� Education: future of nursing, Benner’s recommendations about nursing education
You will focus on a real-life solution for the problem. You should choose a topic that is timely, manageable, and realistic to the current healthcare environment. An external resource person (i.e., manager, clinical leader, clinical educator, policy expert, or population expert) must confirm the relevance of the selected project and your engagement in the setting as part of project completion. As with all projects, you should think how you, as a nurse, function in the following roles: detective, scientist, and manager of the healing environment.
Leadership and Professional Image
Problem Identification
The identified problem is the near epidemic prevalence levels of adult obesity in the United States.
- Problem Discussion & Relevance/Applicability to Healthcare Environment
Problem Statement: The statistics of adult obesity in the United States have reached epidemic level where 2/3 American adults have been reported to be obese largely occasioned by unhealthy diets, sedentary lifestyles, lack of physical exercises and the fact that over half of American adults lack the recommended level of physical activities necessary for a healthy body (NCHS, 2015) .
According to CDC, a third of American adults are overweight, while another third have a BMI that exceeds 30. The problem of adult obesity is related to my area of study given that adult obesity has been linked to numerous health complications that include heart diseases, high blood pressure, stroke, diabetes, high cholesterol, apnea, diverse types of cancer among other health conditions (NCHS CDC, 2015).
Obesity can be defined as a condition where the body weight is disproportionate to the body height, even though a more etiological definition is that it is a sophisticated phenotype that is largely linked to surplus adiposity or excess body fat and is linked to increased risks for chronic illness morbidity. The problem of adult obesity is relevant because obesity is associated with increased disease morbidity that encompasses diabetes mellitus, depression, different types of cancers, host of cardiovascular complications and disease mortality. While adult obesity prevalence levels are worrying, it remains a complex though preventable disease. The diseases affect 1/3 of the world adult population and will affect up to 38% of the world‘s adult population 2030. Still, further statistical projections suggest that more than 85% of the U.S adult population will be either obese or overweight (NCHS, 2015). Morbid obesity is emerging as the leading trend in developed countries even though the prevalence levels in developing nations is also on an upward trend. A separate study conducted by CDC in 2015-2016 indicated that 39.6% of American Adults are aged above 20 were obese with women and men constituting 41.1% and 37.9% respectively (NCHS, 2016).
- Applicability and relevance of the problem
Adult obesity applies to my area of practice since it can be linked to many of the health conditions that patients are diagnosed with. Most adult patients are diagnosed with health conditions that have a direct link with obesity. Given that obesity accounts for over 40% of the adult health care costs, a proposed solution would help decrease these statistics and ease the pressure that the disease exerts on healthcare facilities (CDCP, 2015). Still, it is relevant since the researcher deals with all types of adult patients most of whom are either overweight or obese. The proposed solution will be recommended to adult obese patients diagnosed with obesity. Adult obesity is relevant to the selected healthcare environment where the researcher practices since there is a special healthcare unit for adult obesity patients, as they constitute a large percentage of the patient population.
2.1 Discussion of the Problem Investigation
The researcher’s investigations have suggested that adult obesity is the most significant etiological cause of adult healthcare complications in the healthcare environment where she practices. The researcher’s investigations have established that adult obesity-related health complications account for more than 40% of the adult health care costs in the healthcare facility. Still, the investigations have established that 2 out of 5 adult patients are diagnosed with a health condition that is associated with overweight or obesity. These statistics are consistent with the national and global statistics discussed in the preceding section. If the problem is left unchecked, adult obese patients will soon exceed the designated healthcare facility. Rather than focusing on the effects of obesity, this paper proposes an integrated, holistic solution that is the best fit for addressing the etiological factors.
3.1 Substantiating Problem Evidence
There is substantive evidence to support the investigation results as they were obtained from scrutiny and analysis of medical records at the researcher’s workplace. The researcher obtained permission from the management to investigate the problem of adult obesity to establish its impact on the healthcare delivery quality and capacity. The information was extracted from the hospital’s inpatient and outpatient health records. Therefore it’s credible, authoritative and reliable. On the other hand, the national and global adult obesity statistics were obtained from credible national source documents accessed from The Center for Disease Control (CDC) and National Center for Health Statistics (NCHS). The researcher also interviewed the hospital management staff whose views have been incorporated in the report. The researcher also conducted a preliminary investigation in the bariatric surgery department where permission was sought to review the department’s records. A letter seeking permission from the relevant hospital departments has been attached in Appendix 1 as proof that different stakeholders were involved in the departmental investigations.
4. Situational Analysis Using Current Data
The problem of adult obesity has reached epidemic levels. According to CDC National Center for Health Statistics (NCHS), the U.S adult obesity rates hit 35% in 2017 and is currently estimated at 36.5% of the U.S adult population, constituting well over 1/3 of the total U.S adult population (NCHS, 2016; NCHS 2017). Still, the NCHS statistics indicate that adult obesity rates have recently surpassed the national rates in at least five of the U.S states, remained constant at 30% in 25 states and it is 25% in 46 states. Virginia is the leading state with an adult obesity rate estimated at 37.7, while Colorado recorded the lowest rate at 22.3% (NCHS, 2015). In a glance, CDC statistics showed a decline in Kansas, an increase in four states that includes West Virginia while the rest of the states did not report any significant change. Regarding cost, NCHS reports an estimated annual cost of obesity to have been $147 Billion according to a 2008 report. The report further suggested a surge in medical cost for obese adult Americans, which were estimated to have exceeded that of normal weight by $1,429 (NCHS, 2014; CDCP, 2015).
Current statistics indicate that Non-Hispanic blacks reported the highest rates at 48.1% while Hispanics ranked closely at 42.5% (NCHS, 2015). Non-Hispanic whites and their Non-Hispanic Asian counterparts followed in the third and fourth position respectively. Still, obesity is ranked high in middle-aged U.S adults comprising 40.2% while the older obese adults were 37.0%; while young adults aged 20-39 comprised 32.3% of the total adult obesity cases (NCHS, 2015). The largest determinant was social, an economic status where non-Hispanic blacks were at high risk closely followed by Mexican American men. Furthermore, the risk increased proportionately to increase in income. However, while higher income men were at high risk, the opposite was true for women where lower women were the most at risk as compared to their higher income counterparts. Still, women with a college degree had lower exposure risks as compared to those without (CDCP, 2015).
4.1 Analysis of Areas contributing to the Problem
There is growing evidence that adult obesity could be caused by environmental pathogens (Nelson et al., 2016). Although not substantiated, there is evidence that obesity can be contagion and that it could result from microbiota that is found in the human gut. Ad-36, a virus that is largely associated with adiposity in animals is the single most studied environmental pathogen (Al-Saud et al., 2014). High viral loads of Ad-36 pathogens have been linked to obesity in both children and adults.
Another contributing factor to the problem is environmental factors, and particularly the built environment (Nelson et al., 2016). However, the role of build characteristics in causing adult obesity is still unclear. There is evidence that the built environment and more specifically, the diet have a greater causal role as compared to physical activity. Although the availability of physical activity facilities in the residential neighborhoods has been linked to a higher level of physical activity, and hence energy utilization, availability of fast food restaurant has been proved to have a greater causal role (Van Wye et al., 2017).
A key-contributing factor to adult obesity is social-economic risk factors such as poverty and income (Al-Saud et al., 2014). Studies have shown a consistent relationship between income and educational level and adult obesity. It has been established that wealth or income is inversely related to adult obesity. Hence obesity is prevalent among populations that live below the poverty level. Similarly, there is an inverse correlation between adult obesity and education, showing that low education is associated with a higher a risk. Another key contributing factor to the problem is lack of physical, activity or prevalence of sedentary lifestyles, and excess or lack of sleep (Al-Saud et al., 2014). These factors have a direct causal relationship with weight gain in adults, especially when combined with unhealthy dieting. Other individual behaviors such as poor diets and physical inactivity have been linked to the problem. High caloric intake more than the body requirements and physical inactivity are all critical causal factors. Other contributing factors include genetics, psychological conditions, and use of certain drugs such as steroids as well as perinatal exposure (Van Wye et al., 2017).
4.2 Proposed Innovation/Solution to the Problem
The proposed solution to the problem of adult obesity will comprise of diverse strategies. Firstly, it will involve supporting families in an endeavor to provide them with healthier food and drinks, and further promote increased physical activity and discourage largely sedentary lifestyle (Al-Saud et al., 2014). The second strategy would be to confront the environmental factors by ensuring availability of healthy food and beverages are readily available in the neighborhood. This will involve the adoption of healthy food financing strategy and nutritional assistance initiatives as well as educational education. The third strategy will be to offer healthcare coverage for adult obesity-related counseling and further strengthen prevention efforts targeted at children since childhood obesity is the largest contributor to adult obesity (Nelson et al., 2016). The fourth strategy will be to incorporate and engage healthcare providers in supporting and providing services that exceed medical appointments. The program will encourage healthy living by support community-based programs as this can significantly reduce healthcare costs and hence better results. The solution shall also promote and encourage the smart community development approach (Van Wye et al., 2017). These will involve proper utilization of land through green spaces and parks among other initiatives geared toward the promotion of active lifestyles. The solution shall also encompass supporting the initiative to produce healthy food and beverages. Lastly, the solution will comprise a strategy for promoting workplace wellness initiatives and corporate participation in health improvement programs (Nelson et al., 2016).
5.1 Solution Justification based on Investigations
The proposed solution is an integrated approach that incorporates components to address all risk factors. It’s justified, as it does not focus on addressing a single risk factor, but rather provides a holistic and proactive approach toward solving the problem (Nelson et al., 2016). The strategies in the solution are based on scientifically proven solutions based on evidence-based research findings. It addresses health education and family support in the area of food and nutrition. Numerous studies have shown that healthy dieting can significantly reduce the risk of adult obesity (Van Wye et al., 2017). Secondly, it discourages sedentary lifestyles while promoting increased physical activity among adults. This strategy has the potential of reducing adult obesity.
6. Recommended resources & Cost-Benefit Analysis
The recommended resources will include financing to help support the family nutrition and education program. The solution will target high-risk regions based on the national statistics for maximum impact, while still helping families in nutritional planning. Parents and caregivers will be educated on the importance of a healthy diet. To cut down cost, the initiative will be accomplished through partnership and collaboration with healthcare providers and private organizations. To address the second component, gyms and recreational centers such as parks will have to be provided. The concerned state departments will provide this. Families will be educated on cheap options for healthy living such as going for walks, jogging, biking and maintaining healthy nutritional choices. A cost-benefit analysis suggests that the cost of implementing the solution is lower as compared to the $149 billion annual healthcare costs that are associated with obesity (NCHS, 2014). Still, the statistics further indicate that other obesity-related indirect costs can run into billions such as lost productivity and workplace performance estimated at $6.3 Billion per annum.
7. Implementation Timelines
The solution will be implemented incrementally over a five-year period. Given the nature of the problem, a short-term solution is likely to fail and the need for a medium-term approach.
| # | Solution | Implementation Timeline |
| 1 | Family Support & Nutritional education | 1-3 years |
| 2 | Creation of Fitness Centers/Gyms | 1-5 years |
| 3 | Development of recreational parks | Five years |
| 4 | Workplace Wellness Program | 1-2 years |
| 5 | Neighborhood Accessibility to healthy food &beverages | 1-5 years |
| 6 | Education on risk factors | One year |
| 7 | Preventive strategy: Psychological counseling | 1-2 years |
8. Contribution/Importance of Stakeholders to Solution
The proposed solution cannot be implemented without the contribution of key healthcare stakeholders. Since the proposed solution is integrated, it shall require multi-stakeholder participation. Health care systems and hospitals will be critical for implementation success as they have adequate human resources and infrastructural capacity. They will be essential in the dissemination of educational content as they have direct contact with the affected population. The national and state health departments will also play a significant in providing funding, infrastructure and logistical support. The state government will also play a pivotal role, as they will help in designating space for public recreational parks and other public fitness infrastructure. Still, local NGOs and community-based organizations will be pivotal in the implementation, as they will provide support and logistical services.
8.1 Stakeholder Engagement Summary
Successful implementation of the proposed solution will encompass multi-stakeholder engagement. Stakeholders will be analyzed based on their envisaged role. The engagement process will be progressive and shall be conducted through a series of meetings with key leaders. Their willingness to participate will be obtained, after which a work plan will be developed. Resource mobilization will begin as soon as the work plan is developed and shall be done by the resource mobilization team.
8.2 Multi-stakeholder work plan
The multi-stakeholder work plan will be developed to help plan the participation and engagement of stakeholders in the implementation of the solution. The proposed work plan will be as follows:
Multi-Stakeholder Work Plan
| Stakeholder | Description of Resources | Engagement Timeline |
| Families & caregivers | Engagement, education, and support | Ongoing |
| Healthcare Providers & Hospitals | Logistical support, reach out, personnel, counseling, etc. | 1-3 years, ongoing |
| Community Organisations | Logistics, support networks, infrastructure, funding | 1-2 years, ongoing |
| National & State Departments | Logistics, funding, statistics | Ongoing |
| Local NGO’s | Logistics, support networks, reach out | 1-2 years |
| Business owners | Accessibility to healthy foods & beverages | 1-5 years |
8.3 Implementation-Discussion
The solution will be implemented in phases. The implementation phase will take four years. The first year will be largely used for logistics and multi-stakeholder engagement. The first implementation phase will involve multi-stakeholder collaborative engagements and the design of the solution. The second phase will involve execution and implementation of the solution in the target region. The third phase will involve monitoring and evaluation while the fourth phase will involve impact assessment to establish the successfulness or failure of the solution to address the problem.
9. Discussion of Roles
During the process of investigation and proposal writing, the researcher assumed different roles. Firstly, she assumed the scientific role when researching and analyzing data. Secondly, she assumed a detective role while conducting investigations in different hospital departments that includes the adult obesity department. Thirdly, she assumed the role of manager for a healing environment when engaging multi-stakeholders as well as in planning and decision-making process. These three roles were critical in the planning and writing of the proposal.
References
Al-Saud, H., Saeed, S., Dorajoo, R., & Froguel, P. (2014). Obesity. In M. F. Murray, M. W. Babyatsky, M. A. Giovanni, F. S. Alkuraya, & D. R. Stewart (Eds.), Clinical Genomics: Practical Applications in Adult Patient Care. New York, NY: McGraw-Hill Education.
Center for Health Statistics, N. (2013). 2013 National Electronic Health Records Survey. National Electronic Health Records Survey.
Centers for Disease Control and Prevention. (2015). Adult Obesity Facts. DNPAO Data & Statistics, 39, 0–1.
National Center for Health Statistics. (2015). Summary Health Statistics: National Health Interview Survey. CDC, 7, 1–6.
National Center for Health Statistics. (2016). Health, United States, 2015: With Special Feature
On Racial and Ethnic Health Disparities. Health, United States, 2015: With Special Feature on Racial and Ethnic Health Disparities, 107. https://doi.org/76-641496
National Center for Health Statistics. (2017). Health, United States, 2016: With Chartbook on Long-term Trends in Health. Center for Disease Control, 314–317.
National Center for Health Statistics. (2014). FastStats Obesity and Overweight.
National Center for Chronic Disease Prevention and Health Promotion. (2010). Adult Obesity. CDC Vital Signs, (August), 1–4.
National Center for Health Statistics. (2013). Health, United States, 2013. CDC, 142–143.
Nelson, M. C., Gordon-Larsen, P., North, K. E., & Adair, L. S. (2016). Body mass index gain, fast food, and physical activity: Effects of shared environments over time. Obesity, 14(4), 701–709.
Van Wye, G., Dubin, J. A., Blair, S. N., & DiPietro, L. (2017). Adult obesity does not predict 6- year weight gain in men: The aerobics center longitudinal study. Obesity, 15(6), 1571– 1577.