Prevention of obesity and associated comorbities through nutrition awareness

Written by Miriam Meszaros

  Executive Summary

New Zealand has one of the highest rates of obesity among developed countries (Best Practice [BP], 2012). Obesity and its consequences on other body systems not only place a burden on individuals and families experiencing them, but is costly to the New Zealand economy. Being overweight and obesity related health issues are estimated to cost between $722million and $849million annually (University of Auckland [UOA], 2012), with diabetes costing a further $600 million (One News, 2013). With these statistics it is evident that further action needs to be taken in the area of health promotion related to nutrition. Reducing obesity, cardiovascular disease and type 2 diabetes are part of the Ministry of Health’s targets (Ministry of Health [MOH], 2000). 

The effects of Western civilisation on dietary patterns have had huge implications on health (Cordain et al., 2005). Introduction of convenience foods such as processed foods that are nutrient deficient and energy dense have a significant role in predisposing populations to developing chronic disease (Cordain et al., 2005). Evidence of hunter-gatherer diets and health status indicate that nutrition has taken a turn for the worse. In order to work towards reversing these health implications, health promotion needs to target cooking in the home and preparing meals from scratch therefore excluding processed foods. Maori and Pacific Islanders are disproportionately affected by preventable chronic disease therefore new initiatives in health promotion need to be tailored to meet their cultural needs to encourage participation (BP, 2012). Initiatives around nutrition need to ‘get back to basics’.

The recommendation of this author is to introduce Government funded cooking courses in community settings that will:

  • Teach fundamentals of nutrition
  • Cater to different cultures
  • Be easily accessible (held in local community settings)
  • Teach healthy food alternatives
  • Cook meals from scratch using seasonal produce
  • Available to the public (either through referral of health agency or self sign-up)
  • Compulsory attendance for beneficiaries
  Submission:

There are now families and individuals struggling with the impacts of malnutrition more than ever as evidenced by increasing rates of overweight and obesity globally (World Health Organization [WHO], 2013). World Health Organisation (WHO) states that international rates of obesity have almost doubled since 1980 (WHO, 2013). This figure demonstrates the need for health promotion initiatives to be aimed at nutrition as dietary intake is the foundation to prevention and management of disease (Department of Health, 1991).  This submission explores the current issue of decreasing nutrition among New Zealanders resulting in a variety of noncommunicable diseases otherwise preventable (WHO, 2008). The diseases related to nutrition are obesity, cardiovascular disease (CVD), Type 2 Diabetes and cancer. I discuss the history, incidence, cause, and health disparities of these morbidities within New Zealand and their implications to nursing practice. Finally, I provide and discuss recommendations in regards to the Ottawa Charter to how these could be addressed to improve the health of New Zealanders.

Following the industrial revolution, patterns of Western civilization changed dramatically. As a result of introduced food-processing techniques and staple foods, seven nutrients were altered including glycaemic load, macronutrient composition, micronutrient density, fatty acid composition, sodium-potassium ratio, acid-base balance and fibre content, all of which are fundamental to nutrition and consequently health (Cordain et al., 2005). In addition to this, hunter-gatherer diets give us evidence that the modern Western diet plays a significant role in predisposing populations to developing chronic disease as it is heavily processed and high in salt, saturated fat, refined sugar and alcohol (Cordain et al., 2005). There are currently numerous health promotion campaigns targeted at healthy eating which include ‘5+ a day’, ‘feeding our families’ and several others (http://www.feedingourfamilies.org.nz). Although these have been helpful in educating the public, consumers are still buying convenience foods such as fast-foods and premade meals as evident by looking at supermarket stock and their marketing strategies. Therefore, if the nutrition of New Zealanders is to change, we need to re-educate the population with what healthy eating actually is and reflect back on eating habits in the pre-industrial era in order to ‘get back to basics’ (Cordain et al., 2005).

The Population Health Objectives 2000 recognise reducing obesity, CVD, Type 2 Diabetes, and cancer as goals for New Zealand (MOH, 2000) and Health Promotion Agency (HPA) aims to increase nutrition in order to decrease rates of chronic disease (Health Promotion Agency [HPA], 2012). These diseases negatively impact on individuals, families and communities and are costly to the New Zealand Government. Overweight and obesity alone are estimated to cost the New Zealand Government approximately $722 million to $849 million annually (UOA, 2012) with diabetes contributing a further $600 million (One News, 2013). With these expenses plus the debilitating nature of these diseases it is clear nutrition should be a priority in New Zealand.

There has been an overall upward trend in the weight of New Zealanders resulting in a vast amount of the population being classed as overweight or obese (BP, 2012). This trend has led New Zealand to have one of the highest rates of obesity worldwide within developed countries (BP, 2012). Being overweight is classified as having a body mass index (BMI) above 25 and obese being above 30 (WHO, 2013). Statistics in the New Zealand Health Survey showed results that body weight had increased in males from 16.6% to 24.8% and 20.6% to 26.0% in females over the 1997/2007 decade (Waikato District Health Board [WDHB], 2011). This figure is expected to increase a further 17% over the next decade (WHO, 2008) and can be attributable to the expanding variety of overly processed and energy dense convenience foods readily available implying a direct correlation between the two. The use of convenience foods and ready-made meals has encouraged the public to cook quick and easy meals therefore reducing the amount of cooking skills required today. As a result of this over time, cooking skills have been somewhat lost (Cordain et al., 2005).

Weight gain occurs from an increased intake of energy dense foods and a reduced output of energy such as decreased physical activity (WHO, 2013). Obesity occurs as a result of prolonged weight gain and malnutrition which over time increases negative effects to other body systems putting a person at higher risk of CVD, diabetes, and cancer (WHO, 2013).

Maori and Pacific Islanders are disproportionately affected by noncommunicable diseases therefore reflecting health disparities within New Zealand (BP, 2012). These disparities occur especially with preventable morbidities such as CVD, diabetes and cancer as a result of being overweight

or obese, often occurring at young ages among these populations. Recent national surveys classified 23.3% of Pacific Island children and 11.8% of Maori children as obese compared to European children at 5.5% (BP, 2012). Socioeconomic status has shown to be another contributor to nutrition, where populations in lower socioeconomic areas have higher incidence of preventable morbidities (WHO, 2013). These disparities reflect the need to combat overweight and obesity through new initiatives especially targeting disproportionately affected people.

My recommendation to improve nutrition in New Zealand is to introduce:

  • Government funded cooking courses

BBC reports that the UK has several locally-funded programmes on improving nutritional intake and cooking skills through courses. A study undertaken by Public Health Nutrition Journal states parents who attended these classes “ate more fruit and vegetables and fewer ready meals a year later” and that “Short cooking classes can have a long-term impact on healthy eating” (BBC, 2013). This course included classes on nutrition, cooking simple meals and budgeting and was set out for the duration of four to eight weeks targeted at parents who had pre-school children. In the long-term these efforts were shown to be successful as participants were eating less readymade meals compared to before intervention and there was an overall increase in consumption of fruit and vegetables in comparison with intake prior to the cooking course therefore having a positive effect on peoples diet (BBC, 2013).

My recommendation is to introduce cooking courses similar to the ones discussed above so they are essentially free and easily accessible as I feel there is a gap in the health sector of teaching physical cooking skills in New Zealand. These courses would ‘get back to basics’ and reinforce that current eating patterns negatively affect health. Although I acknowledge implementing this recommendation would be costly, it could increase prevention of chronic disease and is therefore cost effective long-term. My recommendation is discussed in further detail below and in regards to the Ottawa Charter.

Developing funded cooking courses aligns with the 5 principles of the Ottawa charter through several principles (Patterson, 2007). Firstly, ‘build healthy public policy’ could be attained through introducing compulsory involvement by all beneficiaries. These people are usually of lower socioeconomic status where nutrition is most likely inadequate and providing compulsory funded classes could benefit these groups. Lifestyle change needs to be “directed at all community levels” therefore making it compulsory to offer courses to all clients in healthcare settings similar to the ABC smoking approach (BP, 2008a). Through introduction of this policy, non-health sectors such as WINZ are involved in building healthy public policy and targeting nutrition in lower socioeconomic groups.

 ‘Create supportive environments’ will be achieved through hosting courses in community settings. These settings would include local community halls, schools, churches or Marae therefore providing a comfortable, familiar and easily accessible environment to individuals, families and the community. These courses would ensure cultural needs are met to Maori and Pacific Islanders through being held at community halls, churches or Marae and taught by health workers of the same cultural group (BP, 2010b). Improving accessibility to the public will let more community members attend thus increasing the likelihood of commitment through family and friend attendance and support (BP, 2012).

‘Strengthen community action’ involves “empowerment of communities to identify their own needs, set priorities, make decisions, and plan and implement actions to achieve better health” (Patterson, 2007, p. 145). This will be made possible through ensuring courses are readily accessible and easy to sign up for. Sign up would be possible through referral by health agencies or individual sign-up. These courses would be tailored to meet community needs by removing barriers commonly faced through ensuring they are culturally appropriate, led by local people, fun and held in community settings therefore easy to get to and beneficial in the long-term. Voluntary sign-up will mean individuals recognise their need for nutritional education therefore making decisions to improve their health status.  This would allow community empowerment and as a result strengthen community action (BP, 2008b).

‘Develop personal skills’ aims at enabling individuals to gain more control over their health and environments by making informed choices that encourage optimum health (Patterson, 2007). These courses would provide an opportunity to learn or enhance nutrition and cooking skills. Nutritional knowledge would include education in a variety of topics including healthy alternatives and seasonal produce. Cooking skills would focus on preparing meals from scratch. Through doing so convenience and premade foods are discouraged and cooking from scratch is encouraged as it will be recognised as being quick and easy to prepare. Such knowledge would enable participants to take control over what goes into their bodies, recognising that healthy cooking at home can be done quickly reducing the need to use convenience foods (BP, 2010a). As a result, personal skills will be developed in individuals, families and their communities.

‘Reorient health services’ aims to make health professionals recognise that health is holistic involving health and several other non-health sectors. As food intake is a major contributor to overall health and wellbeing, sectors need to move away from focusing on cures and treatment options and target prevention. This will be partly achieved through promoting cooking courses in a variety of settings. Patients could be offered courses in general practices in conjunction with CVD and diabetes risk assessments. Best Practice Journal states that “opportunistic testing can help engage Maori in healthy lifestyle programmes” (BP, 2008a) therefore offering courses at the conclusion of risk assessments would enhance direction and support to clients once leaving the appointment.

Overweight and obesity with its linked consequences on other body systems, have direct implications to nursing. A large proportion of individuals who are overweight or obese are cared for by nurses in hospital or outpatient settings, and have comorbidities such as CVD, diabetes and cancer. Nurses have several roles including “reducing inequalities in health, improving outcomes and continuously improving the quality of the care they provide” (MOH, 2013). The role of health promotion is significant in nursing as we need to address current issues such as obesity and discuss these with clients. This obligates nurses to be familiar with health promotion principles and offer support that is suitable for individuals and their needs therefore contributing towards improving health outcomes for New Zealanders.

In conclusion, I believe that introducing government funded cooking classes would have a positive influence on New Zealanders. It would provide individuals and their families with the opportunity to increase their knowledge surrounding nutrition thus impacting the health of their family and community. Through providing policy change and culturally appropriate services, increased target populations would participate therefore influencing health and consequently reducing the prevalence of noncommunicable disease in New Zealand.

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