Running head: PATHOPHARMACOLOGICAL FOUNDATIONS 1
PATHOPHARMACOLOGICAL FOUNDATIONS 12
Pathopharmacological Foundations
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Institution
Pathopharmacological Foundations
Introduction
In the recent years, treatment of many diseases has shifted from conventional medication to focus on holistic healing. Apart from monitoring the medications and treatment, advanced practice nurses are also required to investigate pathopharmacological issues that are related to specific disease processes. In this paper, I am going to discuss obesity. I will analyze the pathophysiology of obesity, and the impacts that the illness has on the patients, their relatives, and populations at both local, national, and global levels. Furthermore, I will explore the strategies that can be embraced to address this disease.
The Pathophysiology of Obesity
Obesity is defined as a medical condition that is characterized by excessive accumulation of body fats. According to Bagchi and Preuss (2012), it occurs when the body secretes excess adipokines, bioactive elements that trigger long-lasting low-grade inflammations and at the same time interrelate with several processes in various organs. Obesity is the chief contributor of the metabolic dysfunctions that affect lipid and blood glucose. On the broader scale, obesity causes dysfunctions of the body organs that are involved in cardiac, excretion, reproduction, and endocrine functions. Bagchi and Preuss (2012) state that obesity causes several organ-specific pathological outcomes if there is a possibility of intra-abdominal fat accumulation. The simplest way of identifying obesity and the risk of medical complications is by determining the waist circumference. The danger of acquiring an obesity-related disease starts when the waist circumference is more than 80 centimeters in women and more than 94 centimeters in men. As a general concept, obesity produces fewer symptoms when the patient is below the age of 40 years. Examples of common symptoms that are associated with obesity include breathlessness, general body malaise, arthritis, excessive sweating, insomnia, back pain, anxiety, and amenorrhea.
Standard of Practice for Obesity
In my state, the only evidence-based pharmacological treatment of obesity is the use of orlistat which is marketed as Xenical in many drugs dispensing units. Since it was approved in 2007 by Food and Drug Administration(FDA), orlistat has been used as one of the principal pharmacological agents of obesity. According to Tyler and Etigard (2015), a research that was carried by NIH Obesity Research Task Force indicated that at least half of the obese people in California are using orlistat to manage their weight. Several pieces of research that have been recently conducted by FDA also show that this drug has fewer side effects and can be comfortably used to control weight. It works by reducing appetite and absorption of calories in the body. Despite the critical role that this drug has played in the management of obesity, its presence has affected the recommended national policies of obesity management. National Institutes of Health (NIH) recommends lifestyle changes as one of the key measures of reducing weight. However, this advocacy has been affected by the presence of orlistat at the community level. Many Americans prefer using this drug rather than changing eating habits.
Clinical Guidelines for Assessment, Diagnosis, and Patient Education
According to the guidelines that have been stipulated by Obesity Society and World Health Organization (WHO), the clinical assessment of obesity is based on the determination of Body Mass Index (BMI) of the patient, waist circumference, and the presence of comorbid disorders. Even though BMI does not determine the body fat directly, its efficacy as a risk estimation tool has been confirmed by several clinical studies. BMI is determined by dividing the total weight of an individual in kilograms (Kgs) by the height (tallness) of the same person in meters squared (m2). In adult males and females, A BMI of 25 to 30 indicates that the person is overweight while a BMI value of more than 30 is considered as obesity. In terms of waist circumference, obesity occurs when the waist circumference is more than 94 and 80 centimeters in males and females respectively. Apart from the above parameters, several laboratory tests are done in the diagnosis of obesity.
The primary tests that are considered in this case include cholesterol test and general lipid profile. Other tests that are carried along the two include blood glucose, liver functioning tests, and thyroid tests. Due to the increase in the number of obesity cases in the United States, Obesity Society, and National Health Services have collaborated and established health promotion programs that are aimed at educating the Americans the need for changing their lifestyles. For example, the campaign to end obesity is one of the key programs that have been established to educate the citizens the need healthy eating. However, the need for health promotion continues to increase, and more programs need to be developed.
Comparison of Standard Practice at the Community and National Level
Just like the national practices, the state policies also emphasize on changes in the eating habits and physical exercises as two principal remedies for obesity. For example, California Obesity Prevention Program (COPP) is based on the principles of encouraging people to eat low-fat foods and to involve in physical exercises. Although obese people are allowed to use medications to manage their weight, many local authorities emphasize the need for avoiding sugary and junk foods as they are the primary causes of obesity. Secondly, legislations have also been passed to ban the advertisement of foods that cause obesity, especially in children. Just like the national practices recommend, many states have also established recreational centers at the community level as a way of encouraging people to get involved in physical activities. Furthermore, most of the state policies are based on the guidelines that are offered by the National health service and obesity society in America.
Characteristics and Resources for an Obese Patient
Several characteristics are exhibited by patients suffering from obesity. These features are as discussed below.
· Life expectancy; people suffering from obesity have a reduced life expectancy as compared to normal people. This is based on the fact that they are at a higher risk of suffering from obesity-related diseases that easily cause death. According to Myle and Elliot (2015), a research that was conducted by Clinical Trial Service Unit at Oxford in 2014 indicated that the average life expectancy of an obese patient (BMI figure of 30 to 35) is decreased by three to five years as compared to that of a healthy person.
· The risk of contracting other lifestyle diseases; obese people are at a higher danger of contracting other lifestyle diseases as compared to normal people. According to the report that was published by obesity society in 2014, at least, one-third of the obese Americans suffer from illnesses such as diabetes, hypertension, gallstones, osteoarthritis, and gout as a result of obesity.
· Low quality of life; people suffering from obesity have a low quality of life. They are stigmatized by the society and are not able to engage in normal daily activities. Furthermore, these patient are at a higher risk of suffering from mental disorders such as clinical depression and anxiety which reduce joy and quality of life.
Despite the significant challenges that are experienced by people suffering from obesity, these people have different resources that they can use to address their challenges. These resources are as discussed below.
· Treatment options; several treatment options are available for obese persons. These include changing eating habits, use of medications such as orlistat and phentermine, physical exercises, and surgery.
· Availability of financial and social support; due to the increasing burden of obesity, the federal government has established various programs that provide financial and social support to patients suffering from obesity. Examples of these programs include Obesity society, Obesity action coalition, and American Obesity Treatment Association (AOTA).
· Easy access to medical support; apart from financial and social support, many hospitals have also established obesity awareness centers to help people who are suffering from this disease. As a consequence, obese people can easily access medical care.
Disparities of Management at National and International Level
By considering both national and international policies of obesity management, it is evident that there is no significant variation. This is based on the fact that the national strategies for fighting obesity are based on World Health Organization (WHO) policies. However, there are two identifiable dissimilarities at national and international level. The first one is based on the focus. Unlike the national policies that emphasize more on physical exercises as a means of reducing weight, the international policies focus more on lifestyle changes. Both WHO and International Obesity Task Force (IOTF) recognize the change of eating habits as one of the key management strategies of obesity. The second difference is based on the idea that international policies are educationally based while national policies emphasize more on treatment. At the international level, health education is recognized as one of the key measures of addressing the issue of obesity while national policies stress the need for establishing community centers where obese people can be treated.
Three Factors that Can Help Obese Patients Manage their Condition
· Access to care; since obesity is a disease, patients suffering from it must seek medical attention. Therefore, availability of medical care is one of the factors that can help patients manage their conditions
· Financial resources; this is the second factor that plays a significant role in the management of obesity. In obesity, finances are required to buy anti-weight drugs such as orlistat; and to also help the patient change his or her lifestyle.
· Change of behavior; any person who wants to manage his or her weight must be ready to change his lifestyle pattern. For example, the patient must be prepared to engage in physical exercises and at the same time change his or her eating habits by avoiding sugary and high-fat foods.
How Lack of these Factors Lead to Unmanaged Disease Process
If the patient is not having the above factors, he or she will not be able to manage the condition. For example, lack of medical centers means that the patient will have limited access to medical support that is necessary for management of obesity. Secondly, financial constraints limit the ability of the patient to purchase drugs that are required for the management of obesity. This is mainly experienced in physically handicapped patients who in many cases opt to use drugs to manage their cases. Thirdly, patients who are not willing to change their lifestyles cannot effectively manage their weight. Obesity is accurately controlled when the patient agrees to change his or her eating habits.
Characteristics of a Patient with Unmanaged Obesity
Patients with unmanaged obesity exhibit various characteristics. The first characteristic is a continued increase in weight. Unmanaged obesity leads to accumulation of fats in the body leading to a constant increase in weight. Such people also experience increased values of BMI. The second characteristic of unmanaged obesity is sleep deprivation. Obese people experience episodes of insomnia, and this affects the balance of essential hormones in the body. The third aspect of unmanaged obesity is depression and anxiety. According to Ritter (2014), many obese people are inactive, a situation that causes the person to gain more weight and thus allow depression to grow further. Finally, unmanaged obesity leads to the acquisition of obesity-related diseases. Examples of these diseases include hypertension, diabetes, gout, and gallstones. People are suffering from unmanaged obesity also lack self-worth due to stigmatization by the society.
How Obesity Affects Patients, Families, and Populations
Obesity affects the patients by reducing their quality of life. It increases the risk of acquiring other diseases such as hypertension and diabetes. As a consequence, the patients living with obesity have a fear of these diseases and in most cases this leads to anxiety and depression. Furthermore, obese people are always teased and stigmatized by the society, and this affects their ordinary lives. Families are also affected by obesity especially those who are living in poverty. Since obesity requires medical intervention, the relatives may find it difficult to raise the amounts of funds that are needed for medical intervention. Secondly, obesity may affect fertility and interfere with the reproductive life of couples. In terms of population, obesity impacts the community by increasing the economic burden of health. According to Ritter (2014), United States spends approximately 200 billion dollars on managing obesity-related issues every year. If this trend continues, United States will be forced to pay huge amounts of money to manage obesity in future.
Financial Costs Associated with Obesity for Patients, Families, and Populations
The financial costs that are associated with obesity from diagnosis to treatment vary from one state to another and from one country to another. However, Segnon (2015) states that the average per-person direct financial cost from diagnosis to treatment of overweight is 266 dollars and of obesity is 1723 dollars. Currently, there are 2 million families with obese individuals in the United States. In fact, 5.6 million men and 15.5 million women who are qualified for army jobs exceed the military’s enrolment criterion for body weight and fat, and this limits their ability to secure employment in the army. According to Segnon (2015), each family spends approximately 1500 dollars on medical expenses for their obese family members. In the national capacity, United states spend an average of 185.8 billion dollars on catering for medical costs of obese people every year. In fact, researchers estimate that obesity-associated medical expenses might rise by 50 to 64 billion dollars by the year 2030 if the trends remain unchecked.
How I Will Promote Best Practices for Managing Obesity
To develop the best practices for managing obesity, there is a need to increase awareness of the issue of obesity at the community level. The members of the society must be educated how this disease occurs, the effects of obesity, and the measures that can be used to address this matter. Most of the people do not have enough information on the above issues, and this affects the ability of the health department to fight obesity. It is also important to educate the people on the subject of healthy eating and the need to avoid fatty diets. Furthermore, I intend to advocate for an increase in fitness centers where people can go and exercise.
Implementation Plan for Management of Obesity
Health Education and Community Awareness
This is the first strategy that will be embraced to address the issue of obesity in the society. Health education and community awareness will be done by carrying out mass education at the community level. For example, this will be done by organizing seminars at the community which focus on educating the members of the society the need for healthy eating. In the workshops, the members of the society will also be taught how obesity occurs, the association between lifestyle and obesity, and the measures that can be adopted to prevent and treat this disease. Through health education, the members of the society will gain valuable information that will help them change their lifestyles and avoid this disease.
Advocating for Establishment of More Medical and Fitness Centers
This is the second strategy that will be embraced to address the issue of obesity in the society. I will liaise with other stakeholders in the health sector and request the government to build more medical and fitness centers. By doing this, I will ensure that the medical care is easily available to the people who are suffering from obesity. Although state governments have tried to establish medical care programs for obese people, I feel that the need for obesity centers has not yet been fully fulfilled. Establishment of more fitness centers will also be a great way of addressing the issue. Fitness centers provide an opportunity for obese persons to exercise and reduce their weight.
Advocating for Regulation of Junk Foods Consumption
This is the third strategy that will be used to decrease the issue of obesity in the society. As stated above, one of the leading causes of obesity is consumption of junk foods. In this case, I will liaise with both federal and state licensing agencies and establish laws that regulate the number of restaurants that sell fast foods in the country.
The Appropriate Evaluation Method
Three steps can be used to assess the above three strategies. These steps are population-based as they focus on the target population. To determine the effectiveness of health education, the evaluation process will focus on the number of people who are informed on the issue of obesity. The role of health literacy is to educate the masses on the issue of the disease in question. Therefore, the process will be considered to be effective if it reaches more people and inform them the problems that surround obesity. To determine the effectiveness of the second strategy, the evaluation will involve examination of records in the medical and fitness centers. If the number of people seeking these services has increased, then the process will be considered to be effective. Records of weight loss will also play a significant role in determining the effectiveness this strategy. The third strategy can be evaluated by determining the number of fast food restaurants that have been opened since the plan was executed as compared to those that were opened before the policy was implemented. If there is a reduction, then the system will be considered to be successful.
Conclusion
As discussed above, obesity is one of the major diseases that are affecting many people in our current society. Obesity increases the risk of acquiring other lifestyle-related illnesses such as hypertension, diabetes, and osteoarthritis. Therefore, it reduces the quality of life for the patient. In most cases, obese persons are also stigmatized by the society, and this increases their possibility of becoming depressed. Families of obese persons also feel the impact of the disease considering that in most cases they have to give financial support to their patient. Although several strategies have been adopted in the past to address the issue, there is a need for government and other health stakeholders to increase awareness on the subject of obesity by establishing more medical care centers. The government must also establish laws that regulate the sale of junk foods. However, these processes must be regularly scrutinized to determine their efficacy.
References
Bagchi, D., & Preuss, G.H. (2012). Obesity: Epidemiology, Pathophysiology, and Prevention, Second Edition. Boca Raton: CRC Press.
Myle, F., & Elliot, G. (2015). Effects of overweight and obesity: A critical approach. International Journal of Obesity ,39(56), 97-102.
Ritter, C. R. (2014). Obesity. Mankato: The Child’s World.
Segnon, H. (2015). Economic impact of obesity. New York: M.E. Sharpe.
Tyler, A., & Etigard, L. (2015). Efficacy of Orlistat in weight management: Why the drug is becoming common. Journal of Obesity and Weight Loss Therapy,12(23), 57-64.
