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Role Of Public Health Nutrition

Executive Summary

The objective of the study is to justify the role of Public Health Nutrition in prevention of Obesity. A large proportion of the world is trapped with the hazardous disease of obesity. There was a need for a preventive measure in order to address the crucial issue of the disease. The most common victim of the disease are children and youngsters.

Public Health Nutrition plays a significant role in providing resources and guidelines in order to be implemented as preventive measure. The report is based on the strategies and objectives of the PHN:

 

  1. Identifying the prominent factors about health, nutrition and food which give rise to the adverse affect  resulting  in obesity

 

  1. Planning strategies and programs in order to enhance the knowledge about health and aware people about their nutritional status

 

  1. Developing ways to implement policies for masses

 

  1. Involving local community to prevent those at risk.

 

The report thus describes the significance of the principles of Public Health Nutrition in context with Obesity. It is in no doubt that Obesity needs an extensive approach and awareness program so as to communication for effective result. The risk factors of the disease have a wide range where in comes the need of PHN[1]. The inclusive and sustainable abilities of the program would help in controlling, monitoring and evaluating the disease at a very large level. In other words, the program will help people to gain knowledge about the intake of correct nutrition and also they will learn to priorities their food intake habits.

IN ........

tim of the disease are children and youngsters.

Public Health Nutrition plays a significant role in providing resources and guidelines in order to be implemented as preventive measure. The report is based on the strategies and objectives of the PHN:

 

  1. Identifying the prominent factors about health, nutrition and food which give rise to the adverse affect  resulting  in obesity

 

  1. Planning strategies and programs in order to enhance the knowledge about health and aware people about their nutritional status

 

  1. Developing ways to implement policies for masses

 

  1. Involving local community to prevent those at risk.

 

The report thus describes the significance of the principles of Public Health Nutrition in context with Obesity. It is in no doubt that Obesity needs an extensive approach and awareness program so as to communication for effective result. The risk factors of the disease have a wide range where in comes the need of PHN[1]. The inclusive and sustainable abilities of the program would help in controlling, monitoring and evaluating the disease at a very large level. In other words, the program will help people to gain knowledge about the intake of correct nutrition and also they will learn to priorities their food intake habits.

INTRODUCTION: THE CRUCIAL ISSUE OF OBESITY

 

Obesity is a common term to everyone in the world but its meaning and deeper implications are not known to everyone. Obesity is a highly complex medical condition, a state of excess adipose(fat) tissues in body. Not only obesity itself is a disease but it also increases the risk of other diseases like greater risk of mortality and morbidity from conditions including Type 2 diabetes mellitus, coronary heart disease, hypertension, hyperlipidemia[2], reproductive abnormalities, osteoarthritis, back pain and certain cancers, etc. The term has become popular but has also increased many folds, WHO’s[3] report states that obesity has more than doubled since 1980’s. More than 1.9 billion adults are overweight and over 600 million of them are obese. Not only adults but children are also victim of obesity and being overweight, 41 million children are obese. In Australia, 11 million[4] adults are overweight and 5 million of them are obese while 750,000 children[5] are either overweight or obese. According to WHO[6] obesity is a rapidly growing threat to health of populations and the situation is declining in both developing and developed countries rapidly. But the relief is that obesity is preventable and WHO placed it in its list of top ten preventable conditions that require immediate attention as not just adult but childhood obesity is rising at an alarming rate making it one of the most serious challenges of 21st century.

 

In Australia, NHMRC[7] says that obesity pose a major health issue amounting to 7.6% of the burden of premature death and disability, the largest contributor of the biomedical and behavioral risk factors.

CONTRIBUTING FACTORS OF PHN:

 

What contributes to this problem of obesity in Australia is the unhealthy eating habits of the Australians. People are not well aware of the fact that the food that might taste good is actually going to cost them even better in future. Poor diet is the leading factor of rise of obesity among Australians. There is a high number of beverages consumed by Australians and it is increasing day by day. Many of these are termed as ‘discretionary ‘beverages as they contribute nothing or very less towards nutrition of individual. And sugar sweetened beverages are top selling beverages. They are high risk to the health of the one consuming them. Currently there is no clear guidance on an upper limit for sugar sweetened beverages. Not only beverages but the entire diet lacks on nutrients 

 

The only relief that one can think of is that the problem of obesity is preventable and Public Health Nutrition Services can play a major role in it. Reduction in obesity must be a measure goal and is achievable with the efficient and effective role of Public Health Nutrition Services. The major problems in the policies are associated with sensitization of general public and making healthy food available to them and that to on cheaper rates. Also, there is a need to understand that only Public Health Nutrition Services or the government alone cannot control obesity to do so all the stakeholders[8] are to be engaged in the process. To fight obesity an integrated approach is to be adopted and PHNS[9] can play an effective role in it. From spreading information to planning polices for increasing nutrition level among the population a PHNS is the answer to all the questions regarding the control of obesity. 

How Public Health Nutrition Services can be useful:

 

  • The fundamental causes of the continuing rise in obesity are considered to be societal, resulting from an environment that promotes sedentary lifestyles and over consumption of food, particularly through energy-dense diets.
  • Obesity is observed more in the low income groups as compared to the high income groups there are two reasons[10] for this
    • First being the lack of knowledge about health and nutrition. People are not well aware of the complications that can be caused by unhealthy eating habits.
    • Second is that the healthy or nutrition rich food products are not easily available. And if they are the cost is very high that not all can afford them. So, they switch to easily available and cheaper food options.
  • A Public Health Nutrition Services can easily target to the problem of lack of awareness. If these PHNS Centers are opened in every block they can get in touch with the local people living in their respective blocks and make them aware of the health problems that can be caused by obesity. They can convince people to adopt healthy and nutrition rich food for their wellbeing.
  • Also, PHNS can provide daily diet chart[11] to be followed for the overweight and obese people so that they can reduce their weight and fall in the category of fit people. And for rest of the population a list of what is healthy and what is not healthy could be prepared to effectively influence their choices.
  •  Public Health Nutrition Services can also run various programs for influencing the food choices made by people in their day to day life.
  • If PHNS are to be linked with the government then they can be more helpful as they could help the government in making better polices for the obese people and for people in general.
  • PHNS can provide the right environment for the obese people to help them deal with their physical health problems, mental problem, economic problems, etc.
  • PHNS might also take care of the fact that the intervention must not in any way harm the obese people and it does not deepen the existing inequalities in the society. All the vulnerable[12] groups are to be involved in the benefits of the polices made and the execution of these polices must be done in an appropriate manner.
  • A PHNS can use the “upstream” or socio-ecological approach[13] to prevent obesity. Under which it would aim to shape circumstances and conditions which are underlaying determinant of health and social equity in society. The targets of PHNS would be food environments, physical activity environment and the all over socioeconomic environment which would be inclusive of taxation, employment, education, housing, etc.
  • PHNS would not only aim at improving the situations now on a current basis but would also be continuously indulged into research work for finding effective and efficient methods of obesity prevention and control.
  • Implementation of an on-pack[14] labelling scheme to assist consumers in making healthier food choices at the point of purchase (e.g. the traffic light system utilized in the United Kingdom). The obesity issue is a public health crisis and therefore requires strong government action in these areas and should not rely solely on industry-regulated initiatives.
  • Under PHNS there would be strict guidelines issued to the food industries for manufacturing the various food items. A set of ingredients or a set benchmark of nutrition level of each variety of food item should be fixed.
  • Also establishing Control Boards for keeping a close eye on the policy framing and implementation process.
  • PHNS can organize different competitions for spreading awareness and enthusiasm for staying fit. These competitions can also help the needy people monetarily.
  • PHNS can tie up with the government institutions and offer healthy foods and set standards in public institutions and other specific settings.
  • PHNS while working with the government can restrict food advertising and other formsof commercial promotion which directly influence the food choices made by individuals.
  • PHNS can harness the food supply chain and actions across sectors to ensure coherencewith health. Specific guidelines could be issued to the food related supply chains tomaintain a minimum level of nutrition in their products and if these principles are notfollowed there should be strict penalties.

 

EFFECTIVENESS OF PUBLIC HEALTH NUTRITION IN PREVENTING OBESITY:

 

The policies and program of public health nutrition has always been beneficial in providing knowledgeable ways to combat the widely spread non- communicable diseases. Although the government tries to do an effort by releasing funds and help but it is a pity that the help is not channeled through right hands thus leading to corruption. The reduction of Obesity can be done by adopting the different strategies[15]. The execution of such strategies is completely dependent on the basis of population. According to researches and data collected in the recent year the obesity has been consistently increasing. The developed nations are more prone to this disease. PHNS thus target the prevention of this disease by getting indulged in the life of every individual who is caught under it. It focuses on the change in the living standards of the person by change the social, economical and other similar factors. We can highlight the following points in order to understand the same:

  1. Changing the food Environment
  2. Enhancing the Eating Behavior
  3. Helping with clinical facilities

These comprises of the different kind of section which could be discussed as follows:

 

SOCIOECONOMIC ENVIRONMENT

 

Junk food has always been the bad choices in eating habits. In order to change the food environment, we need to alter the preference of the people. The science of PHN helps to enhance the physical activity level of the people by enhancing their choices in healthier food.  Materialistic life is one such cause and thus obesity is widespread. There are number of prevention strategies[16] and framework which would change the food environment. The formulation of mandatory and implementing strict laws have proven to be a great benchmark for setting standards.

Strict laws and provisions could be made by formulating policies and these policies can be of a wide range starting from fiscal policies, mandatory nutrition panels on the formulation and reformulation of manufactured food, labelling of nutrition related information on the products, ban or reasonable restrains on the marketing of unhealthy food products, etc. Studies have shown that eating habits of individuals is largely affected by the price of the food products. In a study it was found that if the prices of healthy food items are reduced than there is rise in the consumption of those products. To be specific, in a survey in a cafeteria there as an exponential rise in consumption of low fat items by 9%, 39% and 93% when prices were reduced to 10%, 25% and 50% respectively. This justifies that people are interested and aware of health issues and want to eat health provided that the cost of healthy food is under their budget because in the same survey it was seen that when the prices were brought down to earlier level there was a sharp decline in the consumption of low fat products.

 

Not only does polices affect the behavioural patterns of an individual but also does play a key role in physical activity environment. By physical activity[17] environment and policy’s impact on it we mean that the policy should focus on planning(urban), transport, organizational and other aspects too that influence provision of the physical activity policy. Scientists say that there is not much of a rocket science behind controlling the epidemic of obesity but physical environment and food environment can make a great difference to the current conditions. The physical activity level could be increased in the population if they live in a community that has walking space, parks, or any other means of recreation so that the people do some physical labour. Even better school designs can help reduce the children obesity conditions. In schools facilities and activities like yoga, basketball, cricket, badminton, rugby, gymnastics, etc. could prove to be helpful in raising physical activity level in children. Also, the design of building could help as use of more stairs than elevators can bring a major difference in the physical health of individuals in that building.

 

 

EATING AND PHYSICAL ACTIVITY BEHAVIOR

There is a growing need that policies based intervention must be taken in order to reduce obesity. Policy based school interventions are seen to be helpful in dealing with child obesity[18] situations. Many things could be done including self-assessment, educating children about nutrition, making nutrition policy, reaching parents and making them aware, using social marketing, etc. The leadership role for schools in promoting physical activity in children and youth.[19] School setting is a place which has a lot of scope for promotion of health and physical activities. And its direct benefit would go to the students as they spend a good amount of time there. Also, school’s curriculum[20] could be directly related to health, nutrition, physical activities, etc. to promote good health.

Not just the environment at school alone but the home environment also plays a crucial role as the major time is spent by one is in his/ her house. If the particular settings are adopted in house then a major change could be brought. At home television viewing s identified as a great threat to health and a key factor in increasing overweight and obesity incidents. So, strategies to reduce the television time must be adopted like placing television in living room instead of the bedrooms, making family rules to restrain television viewing, trying not to watch television while having dinner, etc. another major point is to keep eye on shopping habits of family members. Healthy food must be purchased, regular meals should be practised, enough opportunities for physical activities, parents should be the role model of healthy eating, etc. Also, intervention is possible at restaurants, cafeteria, other food service settings, supermarkets, workplace[21], etc. on components like availability and price of healthy food choices, quality of food, portion sizes, within-outlet promotions, and point-of-choice nutrition information.

HEALTH SERVICES AND CLINICAL INTERVENTIONS

 

There are a number of problems that were detected relating to the obesity management programs. The major barriers were that comes to mind while thinking of failure to control obesity is that there is fault on the parts of both physicians and the people. People don’t take care of their eating habits and don’t go for regular check-ups while physicians don’t really address obesity in daily routine. There are several potential policy areas in which the involvement of primary care in reducing overweight and obesity could be increased. These areas include increasing number of dietitians and nutritionists in hospitals and subsidization of weight-loss medication, providing professional and organizational support and training, and by offering financial incentives. There were various studies conducted for knowing the effect of health facilities but there was no clear result drawn out but this is sur that the problem of obesity could be treated in a better way if there is provision for incentives, care is provided, dietician’s advice is followed and proper care is taken.

 

BARRIERS IN EFFECTIVENESS OF POLICY APPROACH

 

Obesity and overweight prevention will definitely involve modifications in one’s lifestyle because they are closely linked to the day to day decisions and choices that one makes. These modifications can be done through behavioural change[22] at individual level. Policy formulation should be such that the entire burden doesn’t fall on that policy itself because policies alone can’t get rid of obesity. Small steps at individual level will have to be taken starting from the use of internet because it reduces physical activities to a great extent. There is also high dependency on internet for entertainment too. Also, changes are to be done on computer based school learning and homework that makes the physical activity quotient of a child zero. The habit of snack consumption is also to be get ridden with. The area which is left from the policy approach is the increased competitiveness in lives that results in stress. And people in stress at times turn to food and fall prey to the habit of stress eating and access eating. This in turn give them other health issues including overweight and obesity. Tackling the unhealthy lifestyle is impossible unless there is reduction in poverty. Healthy food habits cannot be induced upon anyone as the person barely meets his/her daily need. The food industry has a major role to play it can become a key stakeholder in changing the unhealthy eating habit scenario by implementing adequate nutrition standards. But for this hey will have to for once drop their motto of profit earning and start producing healthy food items.

 

 

CONCLUSION

 

The health hazards and the cost attached to the problem of obesity and overweight is real high. The components of obesity are complex and interdependent. These components vary from food habits, poverty, socio-cultural factors, etc to hormones, genetic background, etc. to address these issues an integrated policy approach[23] is must and PHNS are the best way of doing it. With Public Health Nutrition Services all these complex factors of obesity and overweight could be countered. Policy formation would be done keeping all entire population in mind and for the implementation of the policies all the stakeholders will be responsible. Collectively with Public Health Nutrition Services’ support obesity could be controlled.  Factors like poverty, lack of knowledge, lack f availability of healthy food, lack of awareness among individuals, etc. will be targeted by Public Health Nutrition Services in their achievable goals. There will be many barriers in policy formation and execution but if an individual gets influenced by the PHNS idea of good health than obesity is easy to control. The prevention of obesity and overweight ultimately depends on an individual only. As one can provide for policies, implement them but can’t force individual to adhere by them or to take care of his own nutrition. Tough motivation and behavioral psychology might help a little but individual has to help himself to stay healthy.