Obesity Prevention in Ramsey County, Minnesota

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Community Description

This study was conducted at Ramsey County, Minnesota. Based on the 2000 National Census, the County had a population of about 511,000 people in 18 cities, one township, and two unincorporated areas within 170 square miles. This is the smallest County, yet among the most densely populated in the US. Ramsey County has 206,000 homes, which consist of single families, detached and attached housing, custom homes, condominium, and apartments. It has several public parks and other recreational facilities.

There are 67 percent White, 10.8 percent Blacks, 11.6 percent Asian, 0.6 percent Native American Indian, 7.2 percent Hispanic or Latino, and 2.8 percent of other races. These percentages could be more or less with small margins. Several residents are German and Scandinavian ancestries, but lately many Asians, mainly Hmong, African (Somali) and Latin American immigrants have increased in the County.

More than 25 percent of the population are aged 18 years, 62 percent are aged between 18 and 64 years while 11.6 percent are 65 years old and above. There is 93 male for every 100 female. Families have close links as majorities of children, parents, and grandparents live in the same area.

The County consists mainly of the middle class from the mid-century and new homeowners, but there are also high-end residents. There are distinctions in terms of housing design, family size, and density.

Ramsey County is usually snowing and cold with wind chill for more than six months in a year. These extreme weather conditions prevent most outdoor activities and socialization. Families and neighbors seem to know each other for many years, but they limit interaction with newcomers. The local culture of Ramsey County is not much oriented toward foreigners, foreign cultures or other exotic materials. This culture has complicated studies, especially in which one has to determine the required resources. In addition, the culture of exclusion prevents recent immigrants from seeking help or resources to assist them in cases of ill health or obesity. Obesity has become a major health challenge for many foreigners because of changes in diets by adopting the new American diets and lifestyles. Immigrant populations also reflect the same obesity and overweight characteristics and statistics as natives after living in the county for many years. However, the case of Somali immigrants is exceptional about obesity because the condition is not associated with DM, HTN, and hypercholesterolemia.

Health concern in the County

Description of the Health Issue

According to the US Surgeon General, obesity is responsible for nearly 300,000 deaths in the US (US Surgeon General, 2010). Obesity has become a national health problem. Today, it is linked to other chronic diseases, such as hypertension, coronary heart diseases, diabetes, stroke, osteoarthritis, and some types of cancers. The obesity problem is both at the local and state levels in Minnesota. Although several factors could be responsible for obesity in Minnesota, poor diets and a lack of physical activities, seem to be the major contributors to obesity.

Working-class and other older adults are prone to obesity risks due to a lack of appropriate support, interventions, and other socioeconomic factors. In the past, the children and seniors have received support and attention in the fight against obesity. However, parents and other working populations have not received similar attention. Gallup-Healthways Well-Being Index observes that 59.2 percent of obese people in the US exercise once a week as compared to 69.9 percent of overweight people and 73.8 percent of people with normal weights.

In 2009, African Americans were the most obese at 36.2 percent against the national average of 26.5 percent. Obesity rate among Hispanics was 28.3 percent, which was also higher than the national average rate. Obesity is linked to other health conditions like depression, DM, heart diseases, HPT, diabetes, and high cholesterol.

Table 1: Relationship between obesity and other health risks and body weight.

Health risks	Obese	Overweight	Normal weight	Underweight
High blood pressure	46.2 %	31.1 %	19.3 %	17.2%
High cholesterol	36.8 %	30.1 %	19.2 %	14.1 %
Diabetes	21.1 %	9.8 %	5 %	4.2 %
Heart attacks	6.3 %	4.8 %	3.3 %	4.4 %
Depression	23.3 %	15.3 %	15 %	20 %

Obesity at the national level relative to Healthy People 2020 (2010)

The role of the Healthy People 2020 is to provide a national objective of improving health status of the public in the US. The project aims to increase the number of people with obesity who visits health facilities by ten percent by the year 2020. This would enhance weight reduction, physical activity, and a proper nutrition of fruits and vegetables. Healthy People 2020 posits that the rate of obesity has risen in the last two decades ( Healthy People 2020, 2013). While there is a slight decline, the figures have remained high as the rate of obesity continues to increase among people of different age groups.

Description of obesity at the national level

In the US, the rate of obesity differs across different states. However, there is no state with obesity prevalence of below 20 percent. The Midwest has a prevalence rate of 29.5 percent, whereas the South has 29.4 percent.

The CDC notes that 35.7% of Americans are obese (Centers for Disease Control and Prevention, 2013). The rate rose steadily between 1990 and 2010. Before the year 2000, no state had obesity rate of more than 30%, but in 2010, 12 states had registered more than 30% increment in obesity. Women are more prone to obesity than men are, but the rates are almost the same (men 35.8% and women 35.5%).

The Minnesota Department of Health observes that child obesity has tripled while the case of adults has doubled.

Description of obesity at the state level

About 63% of adults in Minnesota are obese or overweight based on Trust for Americas Health, but the report indicates that the actual rate of obesity is 25.5 percent of the population (Levy et al., 2013). The rate of obesity in Minnesota is higher than in Ramsey County. Ramsey has obesity rate of 27.8% among men while the rate for women is 23.7%.

Description of the health issue at the local or county level

In 2009, the CDC noted that Ramsey County had obesity rate of 24.5 percent against the national rate of 35.7 percent (Centers for Disease Control and Prevention, 2013). Another report of 2013 by the Institute of Health Metrics and Evaluation noted that men had an increased rate of 3.6 percent while women had 5.1 percent since 2001 in Ramsey County. Obesity is different counties has increased at different rates, but Ramsey and Benton Counties have recorded lowest rates.

The population of interest affected by obesity

The study focuses on working adults aged between 18 and 65 years in Ramsey County, Minnesota. This group makes up about 62 percent of the total population in Ramsey County. People at higher risks of being obese are 10.6% who are below the poverty line. This percentage consists of under 18 and 65 years of age (6.8%). Generally, obesity becomes common among men as their levels of income rise. On the contrary, women with low incomes tend to be more obese than others with high incomes. The condition is common among Hispanic and African American populations relative to whites.

Women with higher education levels have low rates of obesity while highly educated men have higher rates of obesity. Nevertheless, rates for overweight people tend to be similar across different levels of education (Minnesota Department of Health, 2013).

The link between obesity and health inequality

The working class of Minnesota has not received adequate attention in the fight against obesity as compared to children and seniors. The rate of obesity among children has declined because of education, exercise, and nutritional programs. Obesity rate for seniors is 26.3% in Minnesota. This is lower than the rate of baby boomers (45 to 64 years) who are among the working class.

This working-class generation tends to be exceptionally busy. Hence, they prefer quick meals, which are unhealthy. The problem is severe among low-income working class, who do not have adequate disposable incomes for healthy diets and adequate time for recreational and exercise. Moreover, the snowy, cold weather in Minnesota has created limited conditions for outdoor activities.

The major concern is that several obesity programs have excluded working class and show low focus on enhancing healthy living, weight loss, exercise, and general health concerns. As a result, the working class must find their own motivation toward exercise and diets. Moreover, resources are difficult to find or are available in a way that may not meet the specific needs of the working class. A lack of motivation has affected the working class who want to maintain regular diets and exercise just for healthy living.

Few campaigns, public programs, or incentives focus on the working class. Instead, most of these programs aim to reach children, college students, and seniors.

Community resources and partners

Ship

This is a statewide health improvement program, which works with local agencies to prevent some chronic diseases, reduce risk factors, and encourage active lifestyles and healthy diets.

Saint Paul

This is Ramsey County Food and Nutrition Commission, which focuses on operations of local food systems. It aims to create new food policies through open discussions.

Minnesota Center for Obesity, Metabolism, and Endocrinology, PA (MNCOME)

This is an independent endocrinology practice, which provides medical care, provides education, and conducts research.

The Obesity Consortium of Minnesota

This is a multidisciplinary partnership approach that focuses on research, education, and outreach for obese. It has several obesity centers.

Apart from these resources and centers, Minnesota has other several community-based programs to help in managing obesity.

Aspects of the health concern not being addressed

There are several aspects of obesity concerns, which the current system does not focus on despite efforts of the partners involved.

The iodine link

Low levels of iodine intake in the diet lead to sluggish thyroid activities.

Overworked adults

This class has limited hours for vacation or exercise. Others have more than one job. Although some employers have weight reduction programs, such as gym membership and incentives, these programs may not be available in small firms.

Depression

Depression results from economic pressure, vitamin D deficiency, a lack of close family ties, and hormone imbalance.

Finances

Cheap food items have high levels of sugar and simple carbohydrates. Most families choose these foods to save costs. While this is a serious health risk, stakeholders have not addressed it sufficiently.

Availability of healthy food options to low-income families and the homeless

Most available food options are not always healthy. No specific program has addressed this problem thoroughly.

Vitamin D

Minnesota has cold weather with clouds most of the time. Hence, many people do not engage in outdoor activities. Most people tend to avoid outdoor activities during these periods. Many working-class individuals require incentives and resources to take part in such activities.

Information

Although information regarding obesity is available to the public, many working adults cannot easily gain access to it due to a lack of adequate time for searching or reading. Intensive public awareness about obesity should improve awareness and access to information.

Insurance

Many insurance firms have failed to cover obesity and related cases. They should develop covers for obesity because it is now recognized as a disease.

Holistic treatment options

Holistic treatment for obesity includes visits to medical centers, observing diets, and increasing levels of physical activities. Nevertheless, some holistic therapies could help in managing obesity. Some examples of holistic therapies include:

Chiropractors re-adjust the spine and joints of obese people. They relieve pain and pressure to facilitate exercise.
A kangen water expert believes that taking highly iodized water helps in weight loss and reduces body acidity levels.
Reiki involves energy manipulation by a reiki practitioner, who uses his or her hands to direct the energy to ones chakra or energy center within the body to enhance healing. This stabilizes the body and improves nutritional needs and appetite.
Theta healing relies on thought and prayer through natural intuition and alters brain wave cycles to the theta state. It reprograms the subconscious mind that blocks weight loss.
Yoga for the mind and body exercise

Outcome Identification

The Ramsey County Community Health Improvement Planning Committee aims to decrease the rate of obesity or overweight from 61% to 56% by 2018. It will focus on improving intake of fruits and vegetables and exercise.

The Minnesotas Statewide Health Improvement Program (SHIP) aims to reduce cases of obesity through enhanced clinical care, physical activities, and healthy diets.

Overall, the goal is to reduce obesity trends through sustained downward trends. There is a need to improve awareness among working adults and encourage them to adopt healthy living. They must understand available resources, nutrition, and support programs. In addition, working adults should engage in regular medical checks, avoid unhealthy foods, take social activities, and seek information about obesity.

Nursing actions to improve obesity (Minnesota intervention wheel)

Continuous public education and awareness

Working-class adults do not easily get relevant information about obesity due to their busy schedules. Nurses should encourage public awareness and campaigns that focus on this population of interest.

Collaboration

The culture of Ramsey does not foster inclusion. Hence, foreigners may find it difficult to get relevant information or resources in cases of obesity. Nurses should encourage different stakeholders to work together in the fight against obesity.

Advocate for resources

For a long time, available resources on obesity have focused on children and seniors and neglected the working-class population. Nurses should advocate for resources that meet the obesity needs of this specific group.

Working with the community to improve obesity cases

Continuous education and collaboration are the best approaches to fighting obesity in Minnesota. Nurses should use their knowledge to educate the community about obesity. At the same time, the community members must also cooperate and attend public seminars about obesity. This would enhance creation of awareness and public education.

Public and private partnership

This would involve collaboration among independent stakeholders in the health sector and the government to improve obesity outcomes.

The government should formulate policies that support healthy living and diets. The focus should be on restricting junk foods and other simple carbohydrates among working-class adults. In addition, the government must also finance and support obesity-related programs.

The private sector should support nurses, outreach programs, and provide free medical checkups for Ramsey County residents. They can directly fund such projects or engage in such activities themselves.

Overall objectives for implementing these activities

The major objectives of implementing these activities are to reduce obesity in Ramsey and improve healthy living among the public. These activities would improve access to information, knowledge on obesity, treatment, and medical checkups, and increase intake of fruits and vegetables and physical exercise.

A timeline for the expected outcomes

For every identified case of obesity or overweight, there would be an immediate intervention to control the condition. Hence, most programs will run on a continuous basis because of the nature of obesity. This would include focus on diets and physical activities.

Regular medical checkups would be arranged during the last weekend of the month to facilitate attendance.

Evaluation

The program evaluation would include the use of feedback from the public and specific populations of interest. A survey questionnaire shall be used to gather data related to effectiveness of the nursing interventions on improving obesity and overweight conditions, healthy living, diets, exercise, collaboration, partnership, resource provision, and advocacy programs. Nurses shall use feedback to improve the program appropriately.

Conclusion

Although many programs and informational resources concerning obesity and overweight exist, many working-class adults are not aware of them. These available resources and information require effort and dedication to get them, particularly among working-class adults who may not have adequate time to search for information and resources about obesity.

The problem of obesity has risen among working-class populations but declined slightly among children and senior adults. However, there is a rising trend among high school teenagers, especially girls.

There is a need to improve public awareness, healthy diets, and physical activities in order to curb obesity. A focus should be on preparing and consuming healthy meals for the family, encouraging access to information, collaboration, regular medical checkups, and incentives to encourage outdoor activities.

Ramsey has a low level of obesity (24.5%) relative to the national level, which is 35.7% for adults and 17% for children. These rates reflect a significant increase in obesity compared to rates registered few decades ago. Hence, there is a need to put strong measures and interventions to tackle the rising cases of obesity not only among children and senior adults, but also across different age groups. If left unchecked, obesity would be responsible for several deaths in Ramsey County.

References

Healthy People 2020. (2013). Nutrition, Physical Activity, and Obesity. Web.

Centers for Disease Control and Prevention. (2013). Adult Obesity Facts. Web.

Levy, J., Segal, L. M., Thomas, K., St. Laurent, R., Lang, A., and Rayburn, J. (2013). F as in Fat: How Obesity Threatens Americas Future 2013: Adult Obesity Rates Hold Steady but Remain High. Web.

Minnesota Department of Health. (2013). Overweight and Obesity Prevention. Web.

US Surgeon General. (2010). Childhood Obesity Prevention. Web.

A community genogram/profile reflecting the health status of the community

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