Obesity is a serious health issue in the U.S.A because the rates of obesity have been increasing in children, adolescents and adults for the past thirty years (Waters et al., 2011). The increasing rates of obesity have numerous health implications, and they have increased the rates of approximately 30 health conditions. The health conditions strain the American health care system. Approximately one-quarter of the healthcare costs is associated with obesity (Waters et al., 2011). This paper provides a health promotion of weight loss for the obese adolescents in the U.S.A.
2.0 The role of advanced practice nurse in the promotion of health
The advanced practice registered nurse (APRNs) is an umbrella term for the Registered Nurses (RN) that have met the advanced clinical practice and educational requirements. The APRNs include nurse practitioners, certified nurse anesthetists, certified nurse-midwives and clinical nurse specialists. The APRNs have finished the formal graduate education that can lead to a masters degree in unstring and a Doctor of Nursing Practice degree (Lowe et al., 2012).
2.1 Nurse Practitioner
Nurse Practitioners (NP) offer specialized and primary health care to communities, individuals, groups and families in various settings such a nurse-managed clinics, schools, nursing homes, health maintenance organizations and hospitals among others. The nurse practitioners have specialties in mental health, adult care, family care, gerontological care, women’s health and pediatric care among others. The NPs conduct physical examinations, take histories, diagnose common illness, treat injuries and common illness, issue immunization manage chronic conditions such as diabetes and high blood pressure, counsel patients on healthy lifestyles and disease preventions and refer patients to health providers depending on their conditions (Lowe et al., 2012).
2.2 Certified Nurse-Midwife (CNM)
The CNMs deliver babies in birthing centers, hospitals, and homes. They manage the health of women all through their life span by offering primary care, family planning advice, gynecological examinations, managing low-risk labor and delivery and providing neonatal care to the women as from the adolescence stage through menopause. They also handle reproductive healthcare issues for the women (Lowe et al., 2012).
2.3 Clinical Nurse Specialist (CNS)
Approximately 70% of the Clinical nurse specialists work in the inpatient hospital settings whereas others practice in basic community settings, clinics, private practices and nursing homes. Other than offering psychotherapy and primary care, the CNSs work as administrators, managers, educators, researchers, and consultants. They come up with quality control methods and mentor other nurses (Lowe et al., 2012).
2.4 Certified Registered Nurse Anesthetist (CRNA)
The CRNAs work in the oldest specialties of advanced nursing practice. The CRNAs offer more than 65% of anesthetics every year, and they are the only providers of the anesthetics in one-third of all the hospitals and 85% of all the rural hospitals. They deliver anesthesia and care that is related to it for all the obstetrical, surgical and therapeutic procedures. More importantly, they offer emergency care and chronic pain management services (Lowe et al., 2012).
3.0Current evidence supporting behavioral change and risk assessment
3.1 Evidence supporting Risk Assessment
Roughly, 13 million children and adolescents in the U.S.A are obese thus their body mass index (BMI) is above the 95th percentile (State ofobesity.org, 2016). That is to say, 17% of the children and teenagers between 2 and 19 are obese. Furthermore, 8.4 % of the children are obese in their early childhood, and this increases their chances of being obese during adolescence and adulthood. It is imperative to note that 6.5 % of the adolescents are severely obese (Stateofobesity.org, 2016). In the past 40 years the rates if obesity among children aged six to eleven have increased from 5% to 14% and the rates have tripled in the adolescents aged 12 to 19.Specifically, the rates of obesity among adolescents have increased from 5% to 17.1% (Stateofobesity.org, 2016). The obese adolescents have a higher probability of becoming obese in their adulthood. Approximately 61% of the obese adolescents have additional health risk factors such as high cholesterol and high blood pressure (Stateofobesity.org, 2016). As shown in the figure below, ethnic and racial inequalities persist among the children and the adolescents. Specifically, 26.1 % of the Latino kids and 20.2% of the black kids are obese when compared to 14.1% of the non-Latino white kids and 6.8% of the Asian-American children (Stateofobesity.org, 2016). Evidently, some ethnicities have higher risks of being obese than others. The rates of obesity among children from various ethnicities are summarized in the figure below.
Figure 1: The Rates of obesity among children from various ethnicities
Source: (Stateofobesity.org, 2016)
3.2 Evidence supporting Behavioral Change
Obesity is a prominent risk factor for serious diseases such as cancer, diabetes, high blood pressure, type II diabetes, heart disease and stroke. The health expenses on childhood and adolescent obesity add up to $14 billion every year (Khambalia et al., 2012). Approximately 30% of the children in the U.S.A do not engage in physical activity more than three times every week. Approximately 75% of the high schools students in U.S.A do not consume the recommend vegetables and fruits every day (Swinburn et al., 2011). The unhealthy eating habits have increased the incidence of obesity among the adolescents in the U.S.A hence the generation of the adolescence is less healthy, and its life expectancy is likely to be short. The figure below provides the obesity trends among children and adolescents that lie between 2 and 19 years in the U.S.A since 1971 to 2012.
Figure: Trends in Childhood and adolescent obesity
Source: (Ncsl.org, 2016)
4.0 Health promotion services in community settings
The screening will be carried out on adolescents with the aim of ascertaining whether they are obese, or they have the risk of being obese. The adolescents whose BMI will be more than 30kg/M2 will be referred to the multicomponent and intensive behavioral interventions. The adolescents will be offered intensive counseling regarding the behavioral interventions that can promote weight loss in a sustainable manner.
4.2 Referral Opportunities
The local communities will be included in the weight management program for the obsese adolescents. The exercise referrals will focus on referring the obese adolescents to fitness programs that will be based in their communities. There will be referrals to the lifestyle weight management programs. In addition to that, projects such as gardening schemes and community walking will be launched at the community level to help the adolescents in exercising.
7.0 Strategies to promote health
7.1 Micro-level strategies
7.1.1 Family Involvement
The family will play a significant role in the reduction of obesity among children. Behavior changes in the adolescents’ lives will involve their whole families. The families will be encouraged to offer support to the adolescents with the aim fostering healthy lifestyles. The families will be required to modify their food habits in a bid to reduce the incidence of obesity among the adolescents
7.1.2 Developmentally appropriate approach
The treatment of the obese adolescents will use parents as the exclusive motivators of lifestyle changes. The treatment programs will be flexible to accommodate the adolescents' inputs. There will be email-based and phone-based programs that will help the adolescents to manage their weight.
7.1.3 Dietary changes
The adolescents will be advised to avoid severe restrictions on the intake of food. They will be encouraged to reduce the portions of their meals and energy intakes. More importantly, they will be encouraged to consume foods with low contents of fat and low glycemic index. The increase in fruit and vegetable intake will be advocated. Furthermore, they adolescents will be guided on how to reduce high –sugar drinks and foods. More importantly, they will be advised to use water as their major beverage.
7.1.4 Increased physical activity
The weight management programs for the obese adolescents will be advocated enhanced physical activity thus thy will include the incidental and planned lifestyles. The weight management programs will aim at reducing sedentary behavior among the obese youths.
7.1.5 Discouraging of sedentary behavior
The adolescents shall be advised to reduce the time they spend playing computer games, watching movies and television, and using electronic media. They will be encouraged to find alternatives to motorized transport such as cycling.
7.1.6 Behavior modification
Modification of behavior plays an instrumental role in the reduction of obesity. Accordingly, the weight management program will focus on building confidence in the adolescents. Further, the adolescents' readiness for change will be assessed after which they will be guided to how to change habits that are associated with physical activity and eating. The adolescents will be assisted to set realistic and attainable goals for their lifestyle changes.
7.2 Macro-level strategies
7.2.1 Community-based partnerships
The campaign against obesity will leverage the power of partnerships. It will generate the influence, momentum and resources' required for the eradication of obesity. Specifically, urban planners, elected officials, and state agencies will play a part in the eradication of obesity (Karnik & Kanekar, 2015).
7.2.2 Social Marketing
Social media will be used to foster positive behaviors in a large number of adolescents within a short duration. The marketing messages will emphasize on the essence of healthy lifestyles (Bleich et al., 2013).
7.2.3 Advancement of specific causes
National champions that have beat obesity will be identified, and they will reenergize the obese adolescents to spread the enthusiasm of leading healthy lifestyles. The champions will communicate and unite the adolescents towards the common goals of reducing the incidence of obesity. Furthermore, the champions will help in raising funds for the campaigns and incentivizing changes among the adolescents (Bray & Bouchard, 2014).
7.2.4 Focus on schools
Schools shall be advised to offer healthy meals to the children. They will be required to educate children concerning obesity and its implications. More importantly, they shall incorporate Physical Education lessons in their classes. The Senate will be asked to enact sound nutrition policy that will be followed by all the schools. Understandably, the federal policies will help in incorporating all the fitness standards (Cecchini et al., 2010).
7.2.5 Public Education
There will be public education that will aim at enlightening the adolescents and the public at large about the minimum standards of physical education and fitness testing. Furthermore, the education will shade light on the nutrition standards for vending machines and meals (Gortmaker, 2011).
8.0 The cost-effectiveness of the health promotion strategies
In this case, cost-effective programs will cost less than $20,000 whereas those that will cost more than $20,000 will be not cost effective. Family Involvement will cost about $8000; hence, this program will be cost effective. The Developmentally appropriate approach will cost about $22,000; hence, the program will not be cost effective. Campaigns for Dietary changes will cost $25,000; hence, the approach will not be cost effective. Discouraging of sedentary behavior will cost $5,000, and this will make it a cost-effective program. The campaigns for Behavior modification will cost $7,000 thus it will be cost effective. The Community-based partnerships will cost $30,000 thus it will be costly. Social marketing will cost nothing, accordingly it will the most cost-effective program. The advancement of specific causes will incur amounts adding to $35,000 thus; they will not be cost effective. The program that will focus on schools will cost about $11,000; hence, they will be cost effective. Finally, Public Education will incur costs amounting to $100,000 thus it will be the most expensive program.
In conclusion, advanced practice nurse plays a crucial role in promoting health in the U.S.A. Current evidence regarding adolescent obesity supports risk assessment for the obese adolescent and calls for behavioral changes in them. The health promotion services that will be used to promote health among the obese adolescents include referral opportunities and screenings. The micro-level strategies that will be employed in promoting weight management among the obese adolescents include family involvement, developmentally appropriate approach, dietary changes, increased physical activity, discouragement of sedentary behavior, and behavior modification. The macro-level strategies include community-based partnerships, social marketing, advancement of specific causes, focus on schools, and public education.
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