The United States is faced each year with increasing incidence of health issues, and this is of concern to individuals, the general population, and the entire country as health insurance, and governmental expenses on intervention keep rising. Health care givers are beginning to stress the need for prevention, as most of these health issues are preventable. About 30% of Americans meet the criteria for obesity (Yanovski, & Yanoski, 2011). This number keeps increasing, and the need for intervention is urgent. The purpose of this study is to highlight that many diseases are acquired from bad diets, and these diseases can be preventable by making healthy choices of food. Dornelas (2008), states that obesity is associated with many risks which include cardiovascular disease, sleep disorder, reflux disease, stress incontinence, and so many more. Decreasing the amount of calories can also have its negative consequence. Eating disorders like anorexia have been associated with the need to avoid being fat, and this possesses its own health risks. Anorexia nervosa increases the risk of osteoporosis, organ shut down, heart muscles shrinkage, kidneys failure and irreversible brain damage occurrence (Berk, 2010). Too much or too little of food consumption has numerous risk factors. The other side effect of these disorders is the psychological impact it has on sufferers.
When the body mass index (BMI) is not in the range of 18.5 to 25 kg/m2, then the person is said to be at risk for diseases. If it is below 18.5 kg/m2, the person is at risk for osteoporosis the thinning of bones which can lead to bone fracture. People with anorexia nervosa fall in this category after losing 25 to 50 percent of their body weight, and lack of food to the body can deprive it of nutrients that it needs to sustain itself. Anorexic individuals stop menstruating because the body needs about 15 percent of body fat in order to menstruate. Malnutrition causes brittle nails, pale skin, fine dark hair in the body and extreme sensitivity to cold temperature (Berk, 2010). If this continues without treatment, the organs start shutting down and can even lead to death. When BMI is more than 25 kg/m2, then the person is said to be overweight, and anything more than 30 kg/m2 is considered obesity. The more obese a person is, the greater the risk association with diseases such as type II diabetes mellitus, cardiac diseases and so on.
The body needs 6 to 11 servings of carbohydrates, 3 to 5 servings of vegetables, 2 to 4 servings of fruits, proteins, and oil, fats and sugars are needed sparingly daily. The average calorie that the body needs is 2000 Cal. This can be adjusted based on height, gender, and activity. Someone with a sedentary lifestyle needs less calorie while, an athlete or active lifestyle needs more. It is important for the general population to know the caloric contents of the food they consume. Carbohydrate and protein contain 4 Cal/gram respectively, while fats/oils contain 9 Cal/gram. The population consumes more fats/oils than needed daily, and one can see that fat is more than double of carbohydrate and protein combined. When the body has insufficient protein, it results in the disease called kwashiorkor, and lack of total caloric intake results in the disease called marasmus. While excess caloric intake causes high cholesterol, type II diabetes, arteriosclerosis, obesity and much more.
Many scholars have speculated the cause of obesity, as some researchers believe it has genetic origin, as well as environmental. The genetic origin deals with lack of fat receptors in the body, which slows the metabolism of fat. The environmental aspect deals with the type of diet individuals consume, and lack of physical activities. The environmental way to deal with this genetic defect is to further decrease the caloric intake, increase physical activities, education, and social support. A study done by Rooney, Mathiason and Schauberger (2011), examined the predictors of obesity in a birth cohort. A cohort of about 795 mothers and 802 children were followed during pregnancy for about 15 years. Characteristics of mothers and offspring were examined to find any predictor of obesity. They found that, gestational birth gain, weight gained during infancy, maternal smoking during pregnancy, and most especially maternal obesity is the strongest predicator of child’s obesity at all times. The result of this study might be due to genetic or due to the fact that the child has been exposed to the same kind of diet as the mother, and this eating pattern continues with the child.
Some theorists also argued that the cause of obesity is the lack of will power. Boutelle, et al. (2011), examined two treatments specified to reduce eating in the absence of hunger in overweight and obese children. Participants were overweight or obese, selected from schools, day care centers, and parents reported child’s eating in the absence of hunger in order to participate. The study was divided into two groups. The first group was the appetite awareness training group, parents were asked to use monitoring to increase sensitivity to hunger and satiety and the coping skills for the children to manage the urge to eat when not hungry. The second group was the cue exposure treatment food group. This is described as cravings, which is eating when not physically hungry. In this treatment, children learned strategies to recognize cravings and suppress it until urges diminished. The results showed that both treatments significantly decreased the urges of eating when not hungry, and as a result, weight decreased. This means that not every food consumed is due to hunger.
Parenting style can affect the way children eat. Hoerr, et al. (2009) study with 715 children and their parents (43% African American, 29% Hispanic and 28% White) with food intake in several groups were calculated from three days of dietary recall from 3 pm until bedtime. Hoerr et al. found that children from authoritarian families take more fruits and vegetables than children from indulgent or uninvolved parents. This shows the effect parenting can have on children. When parents’ influence are lacking, the children do not have a guide to doing the right things. Children need guidance to making the right choice in life; including choosing the right diet. This is why early education is important to begin from home.
Dornelas (2008) found that as obesity increased, so did referrals to weight loss surgery; because the need to reduce weight is urgent due to high risks associated with it such as cardiovascular disease, diabetes, cancers, arteriosclerosis. Psychotherapists need to be trained in order to handle the underlying cause of obesity, which is entangled with other psychological problems. Obesity is a disease which needs to be treated, both physically and psychologically. Dong, Sanchez, and Price (2004), examined the relationship between obesity and depression in nuclear families among siblings and parents with a total number of 1730 European Americans, and 373 African Americans. Many variables were measured, and they found that depression was greater with an increase in body mass index (BMI), across gender and racial groups, even after controlling for the presence of chronic diseases. The offspring of depressed parents were also more likely to be depressed.
Furthermore, to predict type II diabetes in individuals at risk, the BMI, or the size of the waist can help do so. When fat accumulates centrally in the abdomen, the circulating fats can cause insulin resistance, as fat is less likely to cause insulin resistance when it accumulates in other parts of the body. Tsenkova, Carr, Schoeller, and Reff (2011) in perceived weight discrimination amplified the link between central adiposity and non-diabetic glycemic control and the result showed that hip-to-waist-ratio (central adipose deposition) has been significantly linked to significant increase in HbA1c (monitors long time diabetic control). It also shows that weight discrimination increases the psychosocial stressor and this increases the HbA1c as a result of stress. Decreasing weight can help eliminate type II diabetes.
The psychological impacts that poor diet has on individuals who suffer, are numerous. People with anorexia nervosa have body image distortion, they are always anxious, they have poor impulse control, are emotionally inhibited, and they avoid close relationship outside the family (Berk, 2010). Anorexic individuals do not see themselves as thin they see a different image of themselves in the mirror, as this shows that the disorder is not just physical, but psychological as well. Even though thin is being admired, anorexic individuals are looked down on as being so thin that they are unattractive. They parents of anorexic adolescents may be very controlling and emotionally distant from their children. In pursuit of absolute thinness and perfection, these individuals are afraid of losing control, so they are always nervous and about six percent end up committing suicide.
To prevent the problem of anorexia nervosa, parents need to emphasize the need for healthy diet, and not criticize the physical appearance of their children. They need to create a routine for family meals; physical activities, as emotional and social support for their young ones are very important in healthy growing of a child. Most anorexic individuals were formerly overweight or obese before the sought solution which landed them in this category. It is not how the media portrays thinness that matters, but how the parents make the children feel. If children have confidence and high self esteem and approval from the parents, it would be hard for peers or media to change that in the children. Godart, et al. (2006) study in a multidimensional treatment for anorexia nervosa, included patient and parent counseling, but not the entire family. The results showed that patients who got therapy with their parents had better outcome than those who got individual therapy. This suggests how parents can help their children feel good about themselves.
People who are obese face many challenges like those with eating disorders, as they are socially discriminated against when compared to normal weight counterparts. They are viewed to be less attractive, and this makes it more difficult to find mates. Employers find it harder to hire obese employees because of fear of high cost of medical expenses that results from obesity. With these social isolations, obese individuals are more than likely to be depressed. Even though the study by Goodman and Must (2011) showed that severely obese youths in their sample did not have high level of depressive symptoms, other studies support an increase in depressive symptoms in obese individuals. In relationship of obesity to depression, Dong et al. (2004), found that obesity was associated with depression, even after controlling for chronic physical diseases. Dornelas, (2008) reported low self-esteem, poor body image, social discrimination and mistreatment in the job, experienced by individuals who are heavier than normal. It is this social mistreatment that usually cause depression; those with social support that feel good about themselves, might not be feeling depressed.
Women were more likely to be viewed negatively when overweight than men, and this makes it harder for women to adjust socially. It is this social stigma that causes women to have harder time coping with depression than their male counterparts. The psychological effect of obesity is worse among women, according to Ferguson, Kornblet and Muldoon (2009). In the study, women were found to have more negative effects than men. They had a lower quality of life, a dissatisfying sex life and more public distress, even though these women had lower BMI than the men did. This is like a cultural norm that women have to look more beautiful and attractive than men do, so any woman that does not conform to this norm is being frowned upon.
Children who are obese are often bullied at schools. Other children make fun of the obese children, because they think that these children lack the will power to control eating. So it is not that obese individuals are depressed because of their obesity, but because of how other people make them feel. Flodmark’s (2005) study in the happy obese child found that obese children in a community with social support are not depressed and do not find their obesity to have a psychological impact in them, but a clinical sample of obese children show low self esteem, and poor quality of life. With this, it can be suggested that it is not obesity that causes depression, rather attitude toward obesity is mostly what leads to depression. To avoid the psychology impact of obesity, the society can socially support the sufferers by not discriminating against them, so that they worry about the medical impact of obesity and not the social aspect.
Arguments can be made about the causes of eating disorder. In the case of anorexia nervosa, it is caused by a compulsive fear of getting fat, especially in adolescents and young adults. This problem is mostly seen in the western world, where admiration for thinness is the norm. This disorder has a psychological basis because, suffers have a distorted body image, where they see themselves as fat even after having been severely malnourished and underweight. At the same time, they vigorously exercise to enhance further weight loss. According to Berk (2010), about six percent of anorexic individuals die of suicide or physical complications. This happens in families were physical appearance and social acceptance are emphasized, where perfect achievement and thinness are well regarded. These patients strive hard to achieve the ideal image, but may never be satisfied with their body image no matter how hard they try.
Obesity is mostly common in people with a sedentary lifestyle that acquire more calories than needed. It is more in industrialized nations where technology has made life easier with little or no man power to do work. The mode of transportation has also helped to facilitate obesity, as people no longer walk from places to places or ride the bicycles, instead they drive from place to place, use the trains, get in the city buses, as these reduce physical activities that aid in energy expenditure. Ersoy, Imamoglu, Tuncel, Erturk, and Ercan (2005) study in three different district found that people from low socioeconomic status, less education, less active professions and men who were unemployed had a higher BMI. This is so because these people had a more sedentary life style than those in high socioeconomically status or those that had jobs.
Another group where obesity trends exist is with the socially economic disadvantaged. In this group, providing the basic necessities of life is difficult, so little money is spent on healthy foods. The foods that are cheap are the ones that are unhealthy while the healthy choices are expensive to afford. Juby and Meyer (2011) state that policies and recommendations make it hard for poor families to buy nutritious food like fruits and vegetables, at the same time, cheaper foods tend to have more calories and provide fewer nutrients. They call this obesity related malnutrition. In a study done by Ludwig et al. (2011), the Department of Housing and Urban Development (HUD) randomly assigned vouchers to 4498 women with children from 1994 to 1998, 1788 were told that the voucher is only redeemable if they find housing in low income neighborhood with canceling offered to them, and 1312 were given no specification and canceling also offered to them. One thousand three hundred and ninety eight total individuals were selected as the control group that was offered none of the opportunities. A survey follow up from 2008 to 2010, showed that the prevalence of BMI more than 35 and type II diabetes were more in poverty neighborhood than the other groups.
Ersoy et al. (2005) acknowledged that people from high socioeconomic status and education ate more fruits and vegetables, and used more vegetables, olive or corn oils in their cooking. This shows the need for education and the effect of understanding of the benefit of good diet, and also having the money to afford it. The study also highlighted that female education was more effective in controlling obesity for future generations. Another study by Colineau and Paris (2011) supports the influence of family involvement as a collective goal to eating healthy, and feedback increases significantly with mother’s involvement. This might be true because of the domestic role that a female plays at home. Women are mostly in charge of grocery shopping, cooking and nurturing. If they make this positive changes, and teach their children early enough how to eat right, then less problem with obesity can manifest during their adulthood.
Treatments – it is necessary for health care providers to emphasize the importance of healthy diet to parents, and for parents to start cultivating good eating habits at home. Parents can help inculcate discipline in their children to make better choices of food they eat. A well balanced diet with low fat and sugar according to the food pyramid needs to be followed. Although, weight loss advocates argue that food rich in protein helps suppress appetite, and care needs to be taken in following such recommendations, as the body needs a balance diet from all food categories to function well. What need to be emphasized are reduced portions of meals and healthy choices, rather than excluding vital nutrients that the body needs to function well. Training individuals is needed to keep record of what they eat is another way to help them monitor the quantity and quality of the foods they eat. Thirty to 35 percent of obese people believe they eat less than they do (Blaine & Rodman, 2007). People do not need to diet and feel deprived of what they like, but they should be encouraged to choose food from varieties of what they like but size the portion and calories of what they eat.
The need for exercise should be stressed for everyone, not just the obese individuals. Exercise helps the body to transport sugar into all parts of the body, and maintain healthy weight, and it helps prevent insulin resistant in the body. Van Baak (2010) recommends physical activity rather than just exercise; it is body movement that results in energy expenditure over the resting energy. Physical activity is also essential in reducing the effect of genetic tendency of being overweight. Physical activity as Van Baak (2010) states is what is needed not just exercise, as this can be done by doing chores at home, walking instead of driving, instead of sitting down and watching television, one can simply have leisure activities. Exercise offers physical and psychological benefits that restrict overeating (Berk, 2010).
Government tries to help fight obesity by creating policies based on evidence of what has worked to lower the prevalence of obesity. Unfortunately, most of these policies have not been proven to be of any significance. Recours, Hanula, Travert, Sabiston and Griffet (2011) found that adolescents’ motivation to physical activities decreased significantly from 2001 to 2008, despite government’s seven year health strategy for nutrition. One can conclude that it is not what the government does that helps eliminate obesity, but it is the parental education and involvement at home that really helps children more. If children are not being told the benefit of staying healthy, or are not supported or encouraged by their parents to participate in physical activities, then the zeal to participate will likely not be there.
Care givers have to teach cognitive skills and behavioral strategies to individuals to cope with tempting situations. Long time adaptations have to be made because statistics show that most people regain weight after one year of losing it and anorexic people, never fully recover from it. Boutelle et al. (2011) used behavioral strategies to deal with children who were eating when not hungry. This footstep should be followed to achieve this success. There is need to increase length of therapy for these individuals, to enable them develop new habits and skills to deal with their situations. The need to support these people is very important, this is done by encouraging them and not being critical of them, as this will make them feel good about themselves and help them maintain normal weight.
It is necessary to educate people with eating disorders such as anorexia nervosa and obese people about the implications of these diseases. Health care givers are trying to create this awareness to general public, and fortunately organizations like American Diabetes Association (ADA) and North American Association for the study of Obesity (NAASA) are using increased educational efforts to fight this epidemic disease and create awareness of the implications of these diseases. Schools should also incorporate nutritional studies in their curriculum, so that children can take the lessons home and further educate their parents who have no prior knowledge of good nutrition.
So many studies have been done on eating disorders and obesity, and these studies have focused on different ethnicities, cultures and the alarming results are still similar to each other. There are indications that genetics enhance the probabilities of getting anorexia nervosa or obesity, but this cannot manifest unless the environmental factors permit. The Rooney et al. (2011) study examined the predictors of obesity in a birth cohort, and found that maternal obesity was the strongest predictor of child’s obesity. The limitations in this study is that Rooney did not analyze children outside their biological homes, to differentiate if the obesity was caused by the gene they inherited from their mothers, or maybe obesity was due to the same diet from which the mother ate as well. Even though some studies found that adopted children were most likely to maintain weight similar to biological families, one can explore this further in the Fernandez et al. (2008) study. Does nature overcome nurture?
Flodmark’s (2005) study about the happy obese child was a very interesting one, as this study showed that obesity is not the cause of depression, but the social treatment of those that are obese is usually what causes the depression. If the society treats the obese individuals the same ways normal weight individuals are being treated, the case of having depressed individuals would be the same in obesity and thinness. Depression might cause further increase in size, since they obese individuals avoid societal bias against them, they might avoid outdoor activities which might help them lose some weight. This is something one has to learn to socially and emotionally support these individuals.
Finally, this literature review examined the problems faced when there is improper nutrition, its financial burden and the effect it has in our health. It explored the causes of anorexia nervosa and obesity, and previous studies on this topic, which showed that obesity has a genetic base, but environment gives way for its manifestation. The Boutelle et al. (2011) study showed that behavioral strategies can be used to combat eating when not hungry. There are many ways one can fight obesity and related diseases, through physical activities, nutritious healthy meals, social support, and having positive body image.
In conclusion, evidence shows that families that work together to maintain a healthy diet succeed more than individuals that work on their own. There is a need for physical and mental support for those trying to gain or lose weight. The support needs to initially start from home. The studies reviewed above highlighted the positive impacts that families have on individuals who struggle with weight. Most times the problems begin from home, and the solutions need to start from home as well. Families need to have dinners together, discuss the importance of healthy meals and incorporate physical activities into their agenda.
Furthermore, there is need for social support for these individuals. Supporting them socially can help them psychologically to avoid depression, anxiety and low self esteem. Provisions can be made to accommodate them with stylish dresses in stores; this approach might help them feel good about themselves. It is social support from families and friends that help these individuals maintain healthy weight after intervention ends.
References
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Thanks to Eberechi C Ekechukwu
