Obesity

What is Obesity?

Description
Obesity is a condition due to too much body fat, not too much muscle. It has been described as when a person has a body weight that greater than what is healthy for their height, but does not take into account the added weight of the persons muscle mass (Obesity Patient Education, 2013). This increased body fat percentage put one at risk for at least 30 different medical conditions. Often, too much food and not enough physical movement are to blame. Decreased mobility is one of the biggest causes amongst the elder generations. Obesity is more common among the African Americans and Mexican population. “Adolescents between ages of 12-19 were more likely to be overweight, at 21 percent and 23 percent respectively, than non-Hispanic White adolescents (14 percent). In children 6-11 years old, 22 percent of Mexican American children were overweight, whereas 20 percent of African American children and 14 percent of non-Hispanic White children were overweight.” (Jennifer Bishop, 2005) The unbalance between caloric intake and energy expenditure determines a person’s weight. If a person eats more calories than he or she burns, metabolizes, the person gains weight. The body stores the excess energy as fat. If a person eats fewer calories than he or she metabolizes, he or she could lose or gain weight. The most common causes of obesity are overeating and very low to no physical activity. Ultimately, body weight is thought to be the result of genetics, metabolism, environmental, behavioral, and culture.
A person is considered to be obese when their body weight is at least 20% higher than the normal range. The BMI, body mass index, BMI is a calculation that provides a reliable indicator of body fatness for most people and is used to screen for weight categories that may lead to health problems. A healthy BMI range is between 18.5 and 24.9; BMI range less than 18.5 is underweight, a BMI range between 25.0—29.99 is overweight, and a BMI over 30 is considered obese. For any BMI other than normal healthy range, the person may want to seek professional advice from a medical profession. By maintaining a healthy weight, a person can lower their risk of developing serious health problems. The longer a person is overweight, the harder it becomes for them to lose weight. (Obesity, 2013) Risk
There are many risks a person could encounter due to their weight. Lack of exercise is a major risk for developing obesity overtime. Some individuals enjoy eating large meals and do not partake in any physical activity throughout the day or they eat large meals at night proceeded by a long nights rest. Eating large, high caloric meals and lack of physical activities result in food being stored in your body without proper breakdown. Foods that do not break down properly turns sugar into fat. Overtime the storage of the fat adds up to extra weight and if the person is not involved in any activity the person becomes heavier and heavier leading to obesity. Exercise is one way to reduce ones risk. Exercising does not have to be for a long period of time. It can include walking, regular or brisk, slow run, swimming, or slow jog for a minimum of thirty minutes. It is said “ LOOK UP A QUOTE FOR BURING FAT EXERCISING FOR AT LEAST 30 MINS A DAY”. Most important, when the time comes and the person decides to start any physical activity they should consult their physician to avoid any serious health risks or concerns. Overeating and binge eating are also major contributors for most Americans. When people get stressed, depressed, sad, or bored, the like to eat to help what they are going through. Some people are called closet eaters, they eat small amounts or nothing at all around others and when they are alone, they engorge themselves with whatever they want, sometimes eating until they are sick. These persons typically do not feel like being physically active and based on their size, sometimes are extremely limited and unable to do any physical activities. Another reason for obesity in today’s society is because of the lack of discipline and education taught from the parents. Children rely on parents as their caregivers who have their best interest in mind. They look to them for guidance, to cook, and provide for them. Some parents, based on the household structure, are always on the go and do not have time nor make time to cook home cook meals. They result in buying fast foods instead of a well balanced meal. Would children rather eat a home cook meal or a juicy cheeseburger or hot nuggets along with some hot salted fries? There are cases that show if the parents are obese, then their children are going to follow the same pattern. They will become the product of their environment unless as a young adult they decide to make a change for a healthier lifestyle.
Prevalence
Obesity is one of the most common health problems in the United States. About one-third of all American adults are considered to be obese. Obesity affects both adult and children. Approximately 9 million (about 15%) of American children, ages 6 to 17, are obese; a percentile that has doubled since the 1960s (Symptom Checker). Approximately 12.5 million of children and adolescents, ages 2-19, are obese. By state, obesity prevalence ranged from 20.7% in Colorado to 34.9% in Mississippi in 2011. According to The Center for Disease Control and Prevention, CDC, there is no state that has a prevalence of obesity less than 20%. Of the 50 states, there were 39 states that had a prevalence of 25% or more of obese residents; 12 of these states had a prevalence of 30% or more: Alabama, Arkansas, Indiana, Kentucky, Louisiana, Michigan, Mississippi, Missouri, Oklahoma, South Carolina, Texas, and West Virginia. The southern states had the highest prevalence of adult obesity 29.5%, followed by the Midwest 29.0%, the Northeast 25.3%, and the West 24.3% of adult obesity. Worldwide, at last 2.8 million people die each year as a result of being overweight or obese. An estimated 3.5 million of global deaths are caused by overweight or obese. Approximately 12.5 million of children and adolescents, ages 2-19, are obese. Obesity in youth has almost tripled since the 1980’s. The percentage of children ages 6-11 in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents ages 12-19 who were obese increased from 5% to 19% over the same period, (CDC). The prevalence of increasing BMI’s with regards to income levels were seen more in countries that were of high to upper middle income levels.
Treatment
The goal of obesity treatment is to reach and stay at a healthy weight. Obesity is difficult to treat and has a high failure rate. More than 95% of those who lose weight regain the weight within five years (??) Although medications and diets can help, treatment of obesity can not be a short term fix but a lifelong commitment to healthier food choices, exercise, and an overall healthier lifestyle. Some people may need to consult with a nutritionist, dietitian, therapist, or a bariatric specialists if they are considered morbid obese of 100 pounds over their ideal weight and have other health issues. The initial goal is a modest weight loss of 5 to 10 percent of your total weight to. A person should set realistic weight loss goals; short and long term goals. A change in diet is a major start to weight loss. One should understand that weight loss is a slow and long process. It did not take them overnight to gain this weight therefore; it will take time for it to come off. A low calorie diet is ideal for most as it encourages a person to monitor their daily caloric intake. It is also a great idea to keep a food diary to help a person realize their daily intake and sometimes is a real eye opener to the foods they are consuming.
Complications
There are several complications that could arise in women and men if they are obese. For women: possible infertility. A woman has a 6% harder time conceiving than a healthy woman. When a pregnancy occurs, the chance of a serious event occurring while pregnant is higher overall. . For hospitalizations during pregnancy, there is 4-7% greater risk for an obese woman that is obese compared to one that is within normal weight. Another risk is gestational diabetes. Gestational diabetes occurs when pregnant a women who have high blood glucose levels during pregnancy. Untreated or poorly controlled gestational diabetes can have a negative effect the baby. The mother’s pancreas works overtime to produce insulin although glucose does not go across the placenta. When this occurs, it makes the baby’s pancreas make extra insulin to get rid of the blood glucose, which is stored as fat. This leads to macrosomia or a “fat” baby. From birth, theses babies face health problems, one of being obesity. Babies with excess insulin become children who are at risk for obesity and as adults develop Type II diabetes. Women are not the only gender affected, men are too! Men being obese cam develop erectile dysfunction, impotence, and lower fertility. Many men have low testosterone because they have excess abdominal fat. Being obese can also affect kidney functions in which the kidneys can not filter properly in those with chronic obesity. Deaths typically occur in people with a BMI greater than 30.
Sleep apnea- Obesity has been linked to sleep apnea. The most common type of sleep apnea is obstructive sleep apnea. In this condition, the airway collapses or becomes blocked during sleep. This causes shallow breathing or breathing pauses. When a person tries to breathe, any air that squeezes past the blockage can cause loud snoring. Obstructive sleep apnea is more common in people who are overweight, but it can affect anyone. (What is Sleep Apnea?, 2013)
Coronary artery disease (CAD) - Obesity carries a penalty of an associated adverse cardiovascular risk such as coronary artery disease. Largely as a consequence of this, it is associated with an excess occurrence of cardiovascular disease morbidity and mortality (Department of Preventative Medicines, University of Tennessee).
Gallbladder disease – Those who are obese are more at risk for developing gallstones and probable gallbladder disease. . Some evidence suggests that specific dietary factors (saturated fats and refined sugars) are the primary culprit in these cases (University of Maryland Medical Center).
Respiratory problems –Obesity can also cause respiratory problems. Breathing is difficult as the lungs are decreased in size and the chest wall becomes very heavy and difficult to exhale (Medical College of Wisconsin).
High blood pressure (Hypertension) – There are multiple reasons why obesity causes hypertension, but remains that excess adipose tissue secretes substances that are acted on by the kidneys, resulting in hypertension. Moreover, with obesity there are generally higher amounts of insulin produced. This in turn elevates the blood pressure (Weight.com).
Dyslipidemia (High total cholesterol, high levels of triglycerides) the primary source of dyslipidemia is related to obesity. abnormality in, or abnormal amounts of, lipids and lipoproteins in the blood It is characterized by increases triglycerides, decreased HDL levels, and abnormal LDL composition (Howard BV, Ruortolo G, Robbins DC.).
Types of Cancers- In 2002, approximately 41,000 new cases of cancer in the United States were thought to be due to obesity. In essence, about 3.2% of all new cancers are linked to obesity (Polendnak AP. Trends in incidence rates for obesity-associated in cancers in the U.S. Cancer Detection and Prevention 2003; 27(6): 415-421)
Psychosocial/Behavioral Theories The weathering hypothesis
The health status of minorities begins to prematurely deteriorate in young adulthood, it occurs as a response to long term exposure to social and financial stress and prolong active coping with stressful circumstances. With that being said, there is no surprise that obesity is present and on the rise amongst African Americans. According to the Centers for Disease Control and Prevention (CDC), 70 percent of black men and 80 percent of black women are either overweight or obese. Nearly 26 percent of African American children between the ages of 6 and 17 are obese. However, obesity is not the sole cause for concern. Being overweight during childhood and adolescence increases the risk of developing heart disease, cancer, type II diabetes, and high cholesterol at rates far exceeding our non black counterparts. But the question is why are African Americans more overweight than any other ethnic group? Could it be that African-American adolescents are exposed to food advertisements on television than white adolescents? Could it be that African-American communities such as the Spartan market area have fewer supermarkets and recreational opportunities than white communities such as Ghent limiting access to fresh fruits and vegetables such as Spartan Market and Ghent Harris Teeter and safe places for children to play? With many barriers to healthy eating and active living, African-American children and adolescents are more likely to suffer from overweight and obesity than their white counterparts. Therefore, they are at a higher risk of developing serious, chronic illnesses. There are solutions that can help this problem, such as include increasing access to affordable healthy foods in communities and schools, limiting the marketing of unhealthy processed foods, addressing neighborhood safety and recreation, are necessary to prevent childhood obesity and safeguard the health of African-American children.

John Henryism
Over the last several decades African Americans have had to muster up a barbaric mindset to overcome social and discriminatory obstacles. The John Henryism theory sums up the strategy African Americans have had to use in order to deal with prolonged exposure to stresses by expending high levels of effort to overcompensate which results in accumulating physiological costs. African Americans went through being abused for being who they were. Many were beaten and treated unfairly just because of their skin color. This unfair treatment over the years has caused blacks to have a mindset that they have to go the extra mile just to be accepted. This goes hand and hand with obesity. There are ways to overcome being overweight but it is not easy, especially for blacks. While diet and exercise have long been considered key in helping curb the obesity epidemic among adolescents, new research shows that the benefits are not the same for black girls as it does for whites (The Huffington Post, 2013). In a study published in the Archives of Pediatrics and Adolescent Medicine, researchers found that higher levels of physical activity at age 12 were associated with lower levels of obesity in white adolescent girls by the time they turned 14 (The Huffington Post, 2013). Study authors James White, PhD and Russell Jago, PhD, concluded that racial differences may predispose black girls to retaining fat accumulated during puberty, explaining the disparity (The Huffington Post, 2013). "Our results suggest that prompting adolescent girls to be active may be important to preventing obesity but that using different approaches (e.g. emphasizing reductions in energy intake) may be necessary to prevent obesity in black girls," the authors wrote (The Huffington Post, 2013). The study compared white and black girls ' physical activity and food intake over three days, using a pedometer to measure exercise and a food diary to keep track of what they ate (The Huffington Post, 2013). Factoring in BMI, television viewing and two other obesity measures, White and Jago found that 12-year-old black girls in the top half of the physical activity continuum were only 15 percent less likely to be obese by age 14 than ones in the lower half (The Huffington Post, 2013). White girls in the upper half on the other hand were 85 percent less likely to become obese over the next two years than were those in the lower half (The Huffington Post, 2013). All in all, studies show that black girls have to work twice as hard to keep weight off than their white peers.
Racial Discrimination:
The Racism Bio-Psychological Model
For any race, racism creates stress, and stress typically leads to overeating; and overeating ultimately leads to weight gain. Due to history and history repeating itself, African Americans are faced with more stressors than any other ethnic group. For decades blacks have been discriminated against because of their color pigmentation, however; in more recent years blacks have been discriminated against because of their weight. This discrimination is typically spewed out of the mouths of other races which cause it to be identified as racism. Unfortunately, there are blacks who spew out the same odious words towards other blacks as well. African American women might experience discrimination due their weight far more than anyone else. African American women are naturally more curvaceous than their white peers and they have been taught to embrace that genetic characteristic about themselves as well as many others. For the most part, African American women take pride in their unique God-given shape and are comfortable with it, however; with the media frowning upon being overweight; it is viewed as a slap in the face to others. Since black women are the most obese, does it mean that racism caused them to eat more than any other ethnic group?
“Psychological and social factors also have an impact.” “Women who report more experiences of racism have been shown to be more likely to become obese,” Palmer says. About 55 percent of study participants reported experiencing discrimination at work, according to a July 2012 BWHS newsletter. Palmer also found that participants who live in disadvantaged neighborhoods — where grocery stores are scarce, parks and sidewalks are not maintained or crime is rampant—often gained weight or were obese.” (Zimmerman, 2013).

Biogenetic and Environmental Interactions
New research out of the University of Texas MD Anderson Cancer Center indicates that African-Americans are genetically predisposed toward obesity (Nace, 2013). The study found that African-Americans shared 32 gene variants that have been previously found in obese individuals in Asian and European populations (Nace, 2013). “In African-Americans, genes played a greater role in causing increased BMI (Body Mass Index) than in Caucasians,” said Professor Christopher Amos of the University of Texas. “To date, the effects in both African-American and Caucasian participants are too small to explain much of the genetic variability in obesity rates, and this may be because the variation reflects both genetic and environmental contributions. Since the environmental factors have not been studied, the actual contribution from genetic factors may be greatly underestimated.” (Nace, 2013). Naturally, environmental factors play into whether or not a person is obese, but finding genetic traits that incline a person toward obesity might give scientists clues as to how they can begin fighting obesity from a genetic level (Nace, 2013). “I would love to stress that this paper is really just a start or a foundation for understanding the role of genetic variation in obesity,” said Professor and co-author of the paper Jason Moore from Dartmouth. “We expect obesity to be influenced by hundreds, if not thousands of genes and many, many environmental factors. While some genetic variants are likely to increase or decrease weight in all people, most are likely to influence weight in specific people depending on their genetic background and their unique environmental history including diet, toxic metal exposure, exercise, etc. We will not fully understand the genetics of obesity until we can fully investigate these context-dependent genetic effects.” (Nace, 2013). More than 50 percent of adult African-Americans are obese, versus 35 percent of non-Hispanic white adults (Nace, 2013). By finding the genetic markers that skew a person toward obesity, medicine might be capable of finding a way to help limit the number of obese adults, which would, in turn, help lower the levels of heart disease and diabetes in the population as a whole (Nace, 2013).
Social-environmental Theories
Racial/Ethnic Segregation
Racial ethnic segregation can be correlated with mortality rates, lack of health related resources and obesity. Research shows that racial residential segregation may be detrimental to health. Racial segregation is one of the primary explanations why many female African-American adolescents are faced with living in under-resourced neighborhood environments (Kim, 2011). Segregated black neighborhoods provide an unhealthy separation as compared to similar white neighborhoods. For example, two to three times as many fast food outlets are located in segregated black neighborhoods than in white neighborhoods of comparable socioeconomic status, contributing to higher black consumption of fatty, salty meals and in turn widening racial disparities in obesity and diabetes (Cooper, 2013). Black neighborhoods contain two to three times fewer supermarkets than comparable white neighborhoods, creating the kind of “food deserts” that make it difficult for residents who depend on public transportation to purchase fresh fruits and vegetables that make for a healthy diet (Cooper, 2013). Fewer African-Americans have access to places to work off excess weight that can gradually cause death (Cooper, 2013). A study limited to New York, Maryland and North Carolina found that black neighborhoods were three times more likely to lack recreational facilities where residents could exercise and relieve stress (Cooper, 2013). Regardless of their socioeconomic status, African-Americans who live in segregated communities receive unequal medical care because hospitals serving them have less technology, such as imaging equipment, and fewer specialists, like those in heart surgery and cancer (Cooper, 2013). The predominantly white doctors in those communities are also less likely to have certification from the American Board of Medical Specialties, an accepted standard of professional competence (Cooper, 2013).

Risk Exposure
A high prevalence of social or environmental health risk in predominantly minority communities lead to a higher prevalence of diseases and death. African Americans typically live in areas with greater availability to fast food restaurants which increase chances of being obese and suffering from diseases. Advertisements in African American communities such as the Spartan Market area often promote unhealthy items like alcohol, cigarettes, burgers, fried chicken, pizza, cookies, hot dogs etc. Research shows that chronic diseases usually emerge in middle age after long exposure to an unhealthy lifestyle involving the use of tobacco, lack of regular physical activity, and consumption of diets rich in highly saturated fats, sugars, and salt. This type of unhealthy lifestyle typically results in higher levels of risk factors, such as hypertension, diabetes, and obesity. Low-income youth and adults are exposed to disproportionately to more marketing and advertising-promoting products that encourage the consumption of unhealthful foods and discourage physical activity (e.g., fast food, sugary beverages, television shows, video games) (Institute of Medicine, 2013; Kumanyika & Grier, 2006; Lewis et al., 2005; Yancey et al., 2009). Such advertising has a particularly strong influence on the preferences, diets, and purchases made by children, who are the targets of many marketing efforts (Institute of Medicine, 2006; Institute of Medicine, 2013). Due to the typical living conditions and other risks in minority communities, those living in these neighborhoods are at a greater risk for obesity.

Resource Deprivation
Racial/ethnic disparities in health status exist because minorities are more likely than whites to live in communities that are lacking in the necessary infrastructure to support a healthy lifestyle. Low-income neighborhoods frequently lack full-service grocery stores and farmers’ markets where residents can buy a variety of fruits, vegetables, whole grains, and low-fat dairy products (Beaulac et al., 2009; Larson et al., 2009). Therefore, residents especially those without reliable transportation, may be limited to shopping at small neighborhood convenience and corner stores, where fresh produce and low-fat items are limited, if available at all. One of the most comprehensive reviews of U.S. studies examining neighborhood disparities in food access found that neighborhood residents with better access to supermarkets and limited access to convenience stores tend to have healthier diets and reduced risk for obesity (Larson et al., 2009). When available, healthy food is often more expensive, whereas refined grains, added sugars, and fats are generally inexpensive and readily available in low-income communities (Drewnowski, 2010; Drewnowski et al., 2007; Drewnowski & Specter, 2004; Monsivais & Drewnowski, 2007; Monsivais & Drewnowski, 2009). Households with limited resources to buy enough food often try to stretch their food budgets by purchasing cheap, energy-dense foods that are filling – that is, they try to maximize their calories per dollar in order to ward off hunger (Basiotis & Lino, 2002; DiSantis et al., 2013; Drewnowski & Specter, 2004; Drewnowski, 2009). While less expensive, energy-dense foods typically have lower nutritional quality and, because of overconsumption of calories, have been linked to obesity (Hartline-Grafton et al., 2009; Howarth et al., 2006; Kant & Graubard, 2005). Low-income communities have greater availability of fast food restaurants, especially near schools (Fleischhacker et al., 2011; Larson et al., 2009; Simon et al., 2008). Fast food consumption is associated with a diet high in calories and low in nutrients, and frequent consumption may lead to weight gain (Bowman & Vinyard, 2004; Pereira et al., 2005). Minorities typically live in communities that are lacking opportunities for exercise that links to weight gain. As we saw in our previous project, lower income neighborhoods such as the Spartan market area have fewer physical activity resources than higher income neighborhoods like Ghent. Research shows that limited access to such resources is a risk factor for obesity (Gordon-Larsen et al., 2006; Sallis & Glanz, 2009; Singh et al., 2010b). Residents that live in the Spartan Market area do not have facilities and they are more prone to becoming obese and suffer from other health diseases. Many minority communities also lack access to basic health care, or if health care is available, it is lower quality which results in lack of diagnosis and treatment of emerging chronic health problems like obesity.

PERSONAL/ FAMILY:
Acceptability, Preference, Cultural Acceptance of obesity is diverse around the globe compared to the United States. Obesity has reached epidemic proportions in the U.S. It has increased in both sexes and in all racial, ethnic, and socioeconomic groups. Unfortunately, those who live in the United States have come to accept this epidemic of those who are obese or better understood the disease as an ethnic evolution. Based on the opposing ethnic group’s views of obesity, Americans that stereotype the disease have found reason to accept or reject it as a part of their individual preferences. The U.S. culturally seems to desire an average sized person with the body mass index of 18.5 to 24.9 where you are consider the ideal weight, compared to a person who has a BMI of 30 to 39.9 where you are obese. However, obesity is medically unacceptable especially when it becomes dangerous for the doctor to treat. Therefore, some doctors may not accept medical responsibility for those who are morbidly obese.
Culture pertaining to obesity includes having an understanding of its cause, course, and cure, and the extent to which a society or ethnic group views obesity as an illness. Illness is shaped by cultural factors governing perception, labeling, explanation, and valuation of the discomforting experiences (39). Illness experience is an intimate part of social systems of meaning and rules for behavior; it is strongly influenced by culture. For example, childhood obesity is currently a major concern with the United States. It is not tolerated in any countries. Culture is believed to contribute to disparities in childhood obesity in numerous ways. Although many families have shown concern about the issue studies have proven that many of the families are not doing much to change the increasing rates. For instance, exposure to food-related television advertising was found to be 60% greater among African American children, with fast food as the most frequent category (54). Marketing strategies for food often target specific ethnic groups. This marketing, in turn, may produce alterations in belief systems as to the desirability of foods high in calories and low in nutrient density. Culture influences child-feeding practices in terms of beliefs, values, and behaviors related to different foods (43). Affordability, availability of foods and ingredients, palatability, familiarity, and perceived healthfulness prompt African American families to retain or discard certain traditional foods and to adopt novel foods associated with the mainstream culture.
PERSONAL/ FAMILY: Education, Literacy, Income level
Lack of health education about obesity can result in the patient having problems obtaining, processing, and understanding basic health information. For example, patients with a poor understanding of good health may not know when it is necessary to seek care for certain symptoms. While problems with health literacy are limited to minority groups, the problem can be more pronounced in these groups than in whites due to socioeconomic and educational factors. In the United States there are many different languages spoken and not many physicians have taken the time to go beyond their native language. Language differences restrict access to medical care for minorities in the United States who are not English-proficient.
Although the lack of financial resources is a barrier to health care access for many Americans, the impact on access appears to be greater for minority populations. Many minorities that face the obesity epidemic have lower income jobs where they do not get paid as much. Many people live pay check to pay check therefore, they have to eat foods they can afford for their families which are fats, high sodium, and saturated foods; all contributing to obesity. Lack of a stable income results in whether families can purchase healthy or unhealthy foods. Fast foods, snacks, and soft drinks have all been linked to rising obesity prevalence among children and youth (20). Fast food consumption, in particular, has been associated with energy-dense diets and to higher energy intake overall. Calorie for calorie, refined grains, added sugars, and fats provide inexpensive dietary energy, while more nutrient-dense foods cost more (21), and the price disparity between the low-nutrient, high-calorie foods and healthier food options continues to grow. Lack of diversity within the educational, literacy/language, and income level impacts the overall health in a negative way.
PERSONAL/ FAMILY:
Involvement in Care
Parent’s involvement is so important. Children generally become overweight or obese because they do not get enough physical activity in combination with poor eating habits. A parent’s involvement in their children’s healthcare is very critical. Involvement from parents can easily serve as guidance, and influence a healthy diet that consists of healthy choices. This change in family eating habits and activity levels divert the focus off of weight. Involvement for the parent is more than just healthcare but includes engaging in different activities to help prevent chronic diseases earlier in life. Joining sport teams, exercising, and spending time with the family to include more physical activities instead of less physical activities can lead to a decrease in the rising obesity rate.
Children model the types of physical activity undertaken by their parents; thus, a parent in a culture that views rest after a long workday as more healthy than exercise is less likely to have children who understand the importance of physical activity for health and well-being (55). Compared with their white counterparts, African American adolescents have greater declines in levels of physical activity with increasing age and are less likely to participate in organized sports (56). A study by the Kaiser Family Foundation (57) found longer periods of television viewing among African American children than among non-Hispanic white children, with Hispanic children in between. Therefore, it is up to the parent to make cultural changes to help prevent obesity. Parents can start being involved in their children’s life becoming positive role models, encourage their children to become more active, to eat healthy, exercise together, and educate them on obesity. Parents should also incorporate what foods cause it, and show the negative outcomes of eating unhealthy foods.
PERSONAL/ FAMILY:
Health Behaviors, Attitudes and Beliefs
Obesity can be caused by negative dietary and lifestyle habits. Those who are obese tend to rely on food to help their behavior. Jennifer C. Collins mentioned how food is often used as a coping mechanism by those with weight problems, particularly when they are sad, anxious, stressed, lonely, and frustrated. In many obese individuals there appears to be a perpetual cycle of mood disturbance, overeating, and weight gain. When they feel distressed, they turn to food to help cope, and though such comfort eating may result in temporary attenuation of their distressed mood, the weight gain that results may cause a dysphonic mood due to their inability to control their stress. It is a result of negative health behavior which is psychological as a physical problem. Individuals who suffer from psychological disorders suffer eating disorders were they may have more difficulty controlling their consumption of food, exercising an adequate amount, and maintaining a healthy weight.
In additional society views obesity very negatively and tends to believe that people who are obese are weak-willed and unmotivated. Obesity is not something people chose to be however, their diet choices and lack of physical activities have lead them down this path. Obese individuals have typically made multiple attempts to lose weight, with little or no success. Their failed attempts result an attitude of discouragement, frustration, hopelessness, and learned helplessness about the prospect of losing weight in the future on their own. These tend to cause denial in believing as long as they exercise they can eat whatever foods they want. Some believe as long as they eat fruits and vegetables, they are healthy and should not worry about their health status. Those who are obese tend to believe they are fine and they feel like they can handle the issue themselves, some are taught by their cultural to overcome challenges. Some have strong faith and believe that God will handle their health issues. These types of beliefs within some African American project values of behaviors, social attitudes, and beliefs negatively influence individual development because statements like these are not solution to a healthy lifestyle.

Structural/Financial:
Availability

Given the increased health risks associated with obesity, it is vital that obese persons have continuous access to, and make a lot of use of, medical care services. Certain subgroups tend to have disproportionately high prevalence’s of obesity such as low socioeconomic status and minority groups, have reduced access to care, no studies have specifically examined whether or not obese persons have the same access to health care as do their lean counterparts (KR, Fontaine, and Bartlett SJ. NCBI). Approximately 34 percent of U.S. adults and 17 percent of children and adolescents are obese; for children enrolled in Medicaid, the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit covers all medically necessary services which can include obesity-related services (Quality of Care Obesity | Medicaid.gov). For adults, the states can choose which services to provide, with most states choosing to cover at least one obesity treatment, while Children’s Health Insurance Program Reauthorization Act (CHIPRA) established an obesity demonstration grant program, which was funded through the Affordable Care Act, for multi-sector programs for the purpose of carrying out community based activities (Quality of Care Obesity | Medicaid.gov). The Centers for Disease Control and Prevention (CDC) has the lead on the demonstration program, and is working closely with the Centers for Medicare and Medicaid Services (CMS), Health Resources and Services Administration (HRSA), the National Institutes of Health (NIH), and other Departmental agencies (Quality of Care Obesity | Medicaid.gov). The Affordable Care Act includes a range of provisions that seek to promote general prevention and obesity-related preventive efforts and coverage; this includes: coverage of tobacco cessation services for pregnant women, requiring insurance plans to include preventive services in the benefit packages, and enhanced federal match for a state that eliminates cost-sharing requirements on preventive services that meet the U.S. In addition, the law also calls for states to design public awareness campaigns to educate Medicaid enrollees on the availability and coverage of obesity and preventive services (Quality of Care Obesity | Medicaid.gov). First Lady Michelle Obama is raising awareness of childhood obesity through her campaign Let’s Move. As a nation, we are taking steps to become healthier.

Appointments

Obese patients made significantly more visits to General Practitioners (GP), Nurse Practitioners (NP), and hospital outpatient units than patients within normal weight ranges, and were admitted to the hospital more often (Frost GS, Lyons GF, 2005). The human resource burden to general practice is significantly higher in the obese population than in the normal weight population, and the increase in prevalence of obesity will continue to put pressure on General practitioners and Patient nurses time unless appropriate action is taken (Frost GS, Lyons GF). Many obese patients suffer from weight stigma from family, friends, and even from their physicians because of their weight, health, and overall lifestyle. Because of that they are afraid of knowing the severity of their health from their physicians. When a person dealing with obesity is setting up an appointment, he must have a relationship with their physician by doing daily checkups and taking the physicians advice, such as making healthy changes in your diet, track how much you are eating or drinking each day, or begin increasing your activity level (Staff, Mayo Clinic, June 2013). However, some cases there may be physicians that are not as sympathetic and may be prejudice against those that are obese (TODAY.com." TODAY.com. N.p., 1 July 2011).

How Organized

In every medical care facility they have “An Organized Health Care Arrangement (OHCA), which is an arrangement or relationship recognized in the HIPAA privacy rules. These rules allow two or more Covered Entities (CE) who participates in joint activities to share protected health information (PHI) about their patients in order to manage and benefit their joint operations (Organized Health Care Arrangement 1995-2003). The revised HIPAA privacy rules allow CE to share PHI for treatment, payment, and health care operations (TPO) but every CE with whom PHI is shared for health care operations must have a relationship with the patient (Organized Health Care Arrangement 1995-2003). Because of HIPAA and the organized health care arrangement, the health care facilities are able to function in an organized fashion with all patients.

Transportation

The American Ambulance Association (AAA) advocates the creation of policy and procedure when it comes to the use of training, continuing education, the use of appropriate equipment available to meet the needs of the patient, and minimize the chance of injury to workers (Transportation of the Morbidly Obese, Aug, 2002). Patients transferring and handling injuries typically represent at least 50% of health care provider workers compensation annual costs (Transportation of the Morbidly Obese, Aug, 2002). In Boston, the Emergency Medical services recently debuted an ambulance with a mini-crane and reinforced stretcher to transport patients weighing up to 850 pounds, but the cost of it all would be $12,000 to retrofit the ambulance (Kevin Md, June 2011). It is not just an ambulance and how advanced their technology is to bring an obese person into healthcare; there are also public transportations, such as buses, trains, cars, and etc. In 2011, the Federal Transit Authority proposed raising the assumed average weight per bus passenger from 150 pounds to 175 pounds, which could mean that across the country, fewer people will be allowed on city transit buses (Cholia Ami, March 2011). The transit authority also proposed adding an additional few inches of floor space per passenger because of the increasing girth average of passengers over the years (Cholia Ami, March 2011). These upgrades to accommodate people with a larger waistline costs about $25,000, and with these upgrades, the cost will eventually passed on to the consumer and because of this, we must change our lifestyle.

Insurance coverage
Health Insurance covers many of our medical needs, including individual health insurance, family health insurance, short term health insurance, group health insurance student health insurance, dental insurance, vision insurance, accidental death, critical illness, travel insurance, and even pet insurance, but nothing says anything about covering for Obesity or obesity related health insurance. The American Medical Association has officially recognized obesity as a disease, a decision that could change the way physicians and insurance companies deal with the condition (CBS News, June 19, 2013). Even the Centers for Disease Control and Prevention estimates that 36 percent of American adults are obese (CBS News, June 19, 2013), which would make more than one and 3 American adults considered to be obese. Because of the statement The American Medical Association made and declared to be true, many insurance companies are impacted and having agreed on not placing obesity into insurance coverage’s. As it stands, insurance policies “generally excluded obesity treatment, which limits the treatment of obesity-related conditions, including diabetes, high blood pressure, even cancers that are caused by obesity”, which will cover but will be limited for patients (CBS News, June 19, 2013). Once obesity is established, there are physical mechanisms that take hold that make it very difficult for people to lose weight, because as people gain weight, damage occurs to the signaling pathways between the fat cells, the stomach, the intestine and the brain; the brain can’t tell how much food is coming in and how much fat is stored. (CBS New, June 19, 2013). The medical group has no official say on what insurance companies, cover, but the group’s announcement put the spotlight back on the debate on how insurance companies can help fight the obesity epidemic that’s taking a huge toll on this country (USA Today, July 4, 2013). Those extra pounds rack up billions of dollars in weight-related medical bills. It costs about $1,400 more a year to treat an obese patient compared with a person at a healthy weight; research shows (USA Today, July 4, 2013).

Reimbursement Level
Reimbursement means to repay, refund, pay back, or compensate for money spent or lost, which plays a role in insurance. Obesity now is considered as a disease by Centers for disease control and prevention, and the American dietetic Association, and many other distinct medical organizations. In the United States, a major reimbursement challenge is to promote acceptance of obesity as a chronic disease and acceptance of its treatment by health management organizations private insurers, and the government (Pub Med.gov, 2005). Reimbursement of obesity treatments using “condition coverage” based on the presence of other diseases does not allow obesity to be treated independently as a disease in itself. It is necessary to make major investments in research to determined the best methods and to match the treatment with the individual, to prevent obesity in vulnerable populations, and to develop more effective drugs and treatments for those already overweight or obese (Pub Med.gov, 2005). Recent work demonstrates the benefits of weight loss from intensive lifestyle modification, and one barrier to counseling may be lack of reimbursement (Pub Med.gov, 2006). The questionnaire inquired about major treatment modalities for obesity, including details of coverage: Sixteen of 19 eligible plans (84%) responded. All plans provided some coverage for bariatric surgery. Nine out of 16 companies (56%) stated that they covered individual dietary counseling, but only five paid for intensive counseling. Less than 50% of plans reimbursed other forms of lifestyle modification or weight loss medication. Surgery was covered significantly more often than all other treatment modalities. No differences in reimbursement were found by plan type or by number of enrollees. Insurance reimbursement for obesity in Pennsylvania does not consistently reflect recent evidence for the benefits of lifestyle modification. Given the increasing evidence for the clinical and cost-effectiveness of nonsurgical weight loss therapy, coverage policies may begin to change (Pub Med.gove, 2006).
Public Support
There are many support groups for preventing obesity and how to treat obesity by being active and eating healthy. However, there are also policies that would constrain consumer choices such as limits on the amount or type of food that can be purchased or taxes on unhealthy foods or drinks (Norc, 2011). There is wide public understanding of the connection between obesity and the health impacts of being overweight such as diabetes and heart diseases. In order to prevent these health risks many individuals outside of being obese or overweight would participate in strong support government policies that would add more physical activity time in schools, provide information about health choices, and incentives to the food industry to produce healthier options (Norc, 2011).
Recommendations for eliminating health disparities
The major goal for people who suffer from obesity and want to receive treatment is to reach and maintain a healthy weight; and if the individual who suffer from obesity can’t do it by sure will power then that individual must participate in a weight loss program that requires change in dietary changes and physical activity. In participating in the dietary change and physical activity, there are also behavioral changes, prescription weight loss and weight-loss surgery (Mayo Clinic Staff, 2013).
*Dietary changes: Reducing calories and eating healthier are vital to overcoming obesity, which includes: A low-calorie diet, feeling full on less, adopting a healthy-eating plan, meal replacements and be wary of quick fixes (Mayo Clinic Staff, 2013)
*Exercise and activity: Increased physical activity or exercise also is an essential part of obesity treatment: Exercise and Increase your daily activity (Mayo Clinic Staff, 2013)
*Behavior change: A behavior modification program can help you make lifestyle changes, lose weight and keep it off: Counseling and Support groups (Mayo Clinic Staff, 2013)
*Prescription weight-loss medications: Losing weight requires a healthy diet and regular exercise. But in certain situations, prescription weight-loss medication may help. Keep in mind, though, that weight-loss medication is meant to be used along with diet, exercise and behavior changes, not instead of them (Mayo Clinic Staff, 2013)
*Weight-loss surgery, also called bariatric surgery, is an option. The surgery offers the best chance of losing the most weight but it can pose serious risks. Weight-loss surgery limits the amount of food you’re able to comfortably eat or decreases the absorption of food and calories, or both (Mayo Clinic Staff, 2013).
Aside from losing weight, there is also joining an insurance company that is sponsoring an affordable care act that can help insure you, partially.

Ornita References
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Mike References
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Nace, Mike. "MD Anderson Scientists Say Obesity in African Americans Might Be Genetic." Bio News Texas, 10 May 2013. Web. .

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References: Huffington Post. "Exercise Not as Beneficial for Black Girls as Whites, Study Says." Huffington Post, 05 June 2012. Web. . Cooper, Kenneth J. "Residential Segregation Contributes to Health Disparities for People of Color." America 's Wire, 2013. Web. . Zimmerman, Rachel. "Why Are 4 Out of 5 Black Women Obese, Overweight?" Wbur 's Commonhealth Reform And Reality. N.p., 29 Nov. 2012. Web. . Nace, Mike. "MD Anderson Scientists Say Obesity in African Americans Might Be Genetic." Bio News Texas, 10 May 2013. Web. . Kim, Huiyun. "Racial Segregation, Peer Groups and the Prevalence of Obesity Among Female African American Adolescents." Michigan Journal Of Social Work And Social Welfare, Volume II, Issue I, 2011. Web. . "Why Low-Income and Food Insecure People Are Vulnerable to Overweight and Obesity." Food Research And Action Center, 2010. Web. .