Home > Current Issue > Preventing Obesity and Promoting Cardiometabolic Health: The...

< Previous Article | Next Article >

Journal of Cardiovascular Nursing:

November/December 2013 - Volume 28 - Issue 6 - p 503504
doi: 10.1097/JCN.0b013e31829eae4f

DEPARTMENTS: Progress in Prevention

Preventing Obesity and Promoting Cardiometabolic Health: The Promise and Potential of Policies and the Affordable Care Act
Hayman, Laura L. PhD, RN, FAHA, FAAN; Himmelfarb, Cheryl Dennison RN, ANP, PhD, FAAN
Free Access

Article Outline

Author Information

Laura L. Hayman, PhD, RN, FAHA, FAAN Associate Dean for Research and Professor of Nursing, College of Nursing and Health Sciences, and Associate Vice-Provost for Research, University of Massachusetts Boston. Cheryl Dennison Himmelfarb, RN, ANP, PhD, FAAN Associate Professor, Department of Acute and Chronic Care, School of Nursing, and Division of Health Sciences Informatics, School of Medicine, Johns Hopkins University, and Deputy Director, Johns Hopkins Institute for Clinical and Translational Research, Baltimore, MD. The authors have no funding or conflicts of interest to disclose. Correspondence Laura L. Hayman, PhD, RN, FAHA, FAAN, College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA 02125-3393 ( laura.hayman@umb.edu). The prevalence of overweight and obesity in the United States has increased substantially over the last 4 decades. The most recent (20092010) population estimates based on data from the National Health and Nutrition Examination Survey (NHANES) indicate that 35.7% of adults and 16.9% of children and adolescents are obese. Although there has been no change in the prevalence of obesity among adults or children from the 20072008 to the most recent 2009 2010 NHANES survey, there continue to be racial and ethnic as well as socioeconomic and geographic disparities. Non-Hispanic blacks and Hispanics have a significantly higher prevalence of both overweight and obesity compared with their non-Hispanic white counterparts. Approximately 44% of non-Hispanic blacks are obese and 80% of Hispanics are overweight or obese. Similar racial and ethnic disparities have been observed in children, particularly among Hispanic boys and non-Hispanic black girls. Of note, the prevalence of obesity is highest among low-income children. In addition, geographic disparities have persisted throughout the NHANES surveys conducted from the late nineties (19981999) through 2010. Specifically, the highest rates are observed in the Southeast, Appalachia, and tribal lands in the West and North Plains. Clearly, the changes in prevalence of both overweight and obesity over a relatively short period of time cannot be attributed to genetic factors. Changes in potentially modifiable environmental factors that promote reduced energy expenditure and increased energy intake have been cited as
1 1 1

important factors contributing to the development and expression of overweight status. Taken together, the prevalence and trends in obesity observed over the past several decades have prompted the attention of the scientific community as well as healthcare providers, consumers, and policy makers. Recent attention has emphasized the need for a life course approach to prevention of this adverse health condition and multilevel policy changes necessary to create healthy home, school, workplace, and community environments. The evidence and rationale for emphasis on primordial and primary prevention are compelling. Accumulated data indicate that obesity present in childhood and adolescence is associated with adverse cardiometabolic conditions, including dyslipidemia, elevated blood pressure, insulin resistance, and type 2 diabetes mellitus. In addition, obesity present in childhood and adolescence tracks into adulthood. That is, compared with their normal-weight school-age and adolescent counterparts, obese children and adolescents are more likely to be obese in adulthood. Obesity present in adulthood is also associated with adverse cardiometabolic health and is considered a major risk factor for cardiovascular disease. Collectively, this evidence argues convincingly for prevention of obesity beginning early in life and extending throughout the life course. Obesity results from an imbalance between energy intake and energy expenditure. Viewed within a socioecological life course perspective, patterns of dietary intake and physical activity, central to energy balance, develop early in life and are influenced over time by potentially modifiable contexts, including family, school, and community factors. These critically important lifestyle behaviors are also influenced by policies that affect the food and physical environments of these contexts. Schools are a viable venue for population-based approaches to prevention of obesity and its comorbidities, with potential to reach 95% of our children and youth, including those from diverse racial-ethnic backgrounds and low-income communities. The Congress has recognized the important role that schools play in health promotion and disease prevention. In 2004, the Congress passed the Child Nutrition and Women Infants and Children Reauthorization Act, requiring, by law, that all local education agencies participating in the National School Lunch Program or other federally subsidized child nutrition programs create local wellness policies focused on enhancing the food and physical environments of our schools. Although it was an unfunded mandate, the legislation placed the responsibility of developing a wellness policy at the local level in an attempt to ensure that the individual needs of each local education agency would be addressed. In 2010, Congress passed the Healthy, Hunger-Free Kids Act, adding new provisions for local wellness policies related to implementation, evaluation, and publicly reporting on progress of local wellness policies. Requiring each local educational agency participating in the National School Lunch Program or other federally subsidized child nutrition programs to establish policies for all schools under its jurisdiction, minimum policyspecific requirements are also included. Emphasis is placed on goals for nutrition promotion and education, physical activity, and other school-based activities that promote student wellness; evidence-based nutrition guidelines for all foods available in each school district (with emphasis on student health and reduction of childhood obesity); information provided to the public regarding the content and implementation of the local wellness policy; and periodic public report of progress toward policy related goal attainment. Although the effectiveness of these wellness policies in promoting healthy patterns of dietary intake and physical activity and reducing childhood obesity on a national level remains to be determined, research that has incorporated components of these policy-specific requirements has demonstrated the potential of healthy food and physical activity school environments in reducing childhood obesity.
2,3 4 4 5 2 6 7 8 8 8 9

Why the Affordable Care Act? Signed into law on March 23, 2010, the Patient Protection and Affordable Care Act (PPACA) has several critically important provisions designed to prevent and manage obesity across the life course. Of note are the major HR 3590 provisions that enabled the Childhood Obesity Demonstration Projects that provided grants to community-based obesity intervention programs, and the Community Transformation Grants designed to support community-based efforts to prevent chronic conditions. HR 3590 also includes provisions for prevention and public healthfocused programs enabling population-level obesity intervention efforts, community-based care that targets communities with disproportionate rates of obesity, and better research and data collection to ensure what we are doing works to reduce obesity. Equally as important, provisions are outlined in Section 4002 of PPACA, the Prevention and Public Health Fund, enabling a significant investment in the nations capacity for prevention and promotion of the health of the public. Collectively, provisions emphasized in PPACA have the promise and potential for prevention of obesity and its comorbid conditions on an individual and population level. Critically important is the allocation of requisite funding to implement and evaluate PPACAs provisions. As the largest group of healthcare professionals in the United States, nurses (and organized nursing) must mobilize our advocacy efforts and partner with other like-minded organizations to support PPACAs mission and goal: improving the health of the public.
10 10

Back to Top | Article Outline

REFERENCES

1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of Obesity in the United States 2009 2010. Hyattsville, MD: National Center for Health Statistics, 2012. National Center for Health Statistics Data Brief, Number 82. Cited Here... 2. Hayman LL, Helden L, Chyun DA, Braun LT. A life course approach to cardiovascular disease prevention. J Cardiovasc Nurs. 2011; 26 (4): S22S34. Cited Here... | View Full Text | PubMed | CrossRef 3. Estabrooks PA, Fisher EB, Hayman LL. What is needed to reverse the trends in childhood obesity? A call to action. Ann Behav Med. 2008; 36: 209216. Cited Here... | View Full Text | PubMed | CrossRef 4. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention and treatment. Circulation. 2005; 111: 19992012. Cited Here... | View Full Text | PubMed | CrossRef

Pediatric Patients
Development of the heart and the circulatory system occurs very early in life. By the third week of fetal development, a tubular heart is pumping and circulating blood. The lungs are nonfunctional, however, so the blood is oxygenated through the umbilical vessels of the placenta. Because there is no need for blood to be circulated to the lungs for oxygenation, fetal circulation has two major differences. First, a gap between the two atria, the foramen ovale, allows blood to flow from the RA to the left atrium Second, the ductus arteriosus provides an external short circuit between the pulmonary and aortic blood vessels .Through these mechanisms, only a small amount of blood enters the pulmonary circulation, and both the right and left ventricles pump blood into the systemic circulation. At birth, major changes occur. As the baby takes his or her first breath, the lungs and pulmonary blood vessels expand. The foramen ovale closes, separating the left and right atria, and the ductus arteriosus also closes, isolating the pulmonary and systemic blood vessels. The right ventricle now pumps blood to the pulmonary circulation, and the LV pumps blood to the systemic circulation, just as in the adult heart. The position of the heart, however, is more horizontal in the chest of infants and children than in adults .The adult heart position is usually reached by 7 years of age. Hyperlipidemia in children is often related to a genetic process. Early detection is important, because the risk for cardiovascular events is greatly increased at a much younger age in this population. All children should be tested early if a family history exists. Dietary therapy is generally recommended after age 2, and drug therapy may be used after age 10, to bring the cholesterol down to desirable levels.

Geriatric Patients
Functioning of the cardiovascular system gradually declines with age. arteriosclerosis maximum cardiac output is reduced, and calcification of weakened vessel walls, or , d. This stiffening of the blood vessels may lead to an aneurysm, which can cause stroke, infarct, or massive hemorrhage, depending on the vessel involved. Formation of these atherosclerotic plaques can increase the risk of thrombi formation and, thus, the risk of developing coronary artery disease. Changes in the ECG occur secondary to histologic changes within the conduction and neurologic systems. Common ECG changes in older adults include P-R interval prolongation (i.e., first-degree AV block); Q-T interval prolongation; left-axis deviation; and bundle-branch block.

Hyperlipidemia in elderly patients carries a higher risk for CHD than in younger patients. Many studies have found that increases in body weight associated with aging (especially central obesity) contribute to abnormal lipid concentrations in elderly people. C Central obesity is more strongly associated than lower-body obesity with diabetes, hypertension, altered lipid profiles, and gallbladder disease. Excess upper-body fat associated with insulin resistance leads to increased hepatic production of triglycerides and cholesterol-rich lipoproteins. Levels of HDL cholesterol are higher in women than in men until menopause, but then they are equal. In men, triglycerides increase until age 50 and then decline.