Obesity: Care in Rural Communities

Adult obesity is a major health concern in the United States. Adults who are overweight or obese are at higher risk for chronic illnesses, which include hypertension, diabetes, and cardiovascular disease. In addition, ob esity significantly contributes to increased healthcare costs. Rural adults experience higher rates of obesity as well as correspondingly elevated mortality and morbidity than their urban counterparts. The United States Preventative Task Force provides recommendations for addressing adult obesity. However, if these resources are not available in rural communities, nurse practitioners cannot follow these recommendations. A cross-sectional study was conducted with rural Missouri nurse practitioners. Findings showed although nurse practitioners feel obesity has a negative impact on the health of their patients, resources are limited to address obesity in their population.

• Obesity
• Diabetes Mellitus
• Coronary Artery Disease
• PVD
• PAD
• CVA
• Chronic Illness

1. Introduction

Obesity is rising and has become a major causative factor of chronic illnesses: (hypertension (HTN), dyslipidemia, type 2 diabetes (T2D), coronary heart disease, various respiratory problems, cardiovascular (CVD) and peripheral vascular disease (PVD), cerebral vascular accidents (CVA), as well as certain types of cancer) [1] [2] . Chronic illnesses and associated lost wages, especially in those younger than 65 years [3] [4] behoove researchers to evaluate utilization of existing resources as well as their availability. If treatment of obesity is not addressed, obesity and obesity-related illnesses will impact our future global health and economy in enormous proportions [5] .

2. Background and Significance

Obesity is defined as one who has a BMI of 30 or greater [3] . Since 1980, the rate of obesity in the United States has doubled [6] , which affects our population without proclivity to age, education, socioeconomic status (SES), gender, or race [2] . Obesity predisposes our population to chronic illnesses and many obese patients have more than one chronic illness [1] . High body weights reduce quality of life and increase mortality rates [1] [4] . Obesity and corresponding co-morbidity rates are higher in rural regions in comparison to urban areas [7] . Annual obesity-related deaths were 112,000 and direct-related medical expenditures were 152 billion dollars in 2009 alone [8] .

Obesity negatively affects workplace productivity. Employers incur elevated healthcare costs, higher absenteeism, and lower productivity associated with hiring obese individuals [9] [10] . The 2010 U. S. healthcare reform act allows employers to charge obese individuals 30% - 50% more for health insurance if they decline to participate in weight-reduction programs [10] . Unhealthy weight causes an increase of sick days: 6 more sick days for men/annum and each year obese women take 9.4 more duvet days than their healthy counterparts. Obesity-related absenteeism costs employers approximately $6.4 billion per year. As a result of lost productivity, wages may be reduced and when attempting to find alternative employment, obese individuals are less likely to be employed and/or promoted than their healthy peers [10] .

Obesity and its related physical impairments significantly influence quality of life [11] and significantly correlate with depression [12] . Regardless of education and income levels, obese individuals are viewed as lazy, unkempt, and inferior to those of normal weight [13] [14] . These negative perceptions discourage obese individuals from being outdoors and being physically active [15] .

In the clinic setting, patients are weighed, their vital signs obtained, and their concerns addressed, however professionals need to address obesity as an underlying cause of chronic illness [16] . The Hastings Center [17] reported that of those surveyed, 88% (n = 227) were unhappy with their weight status. However, patients who receive advice from their practitioners are more likely to follow recommendations for diet and exercise [15] . Therefore, guidelines should be reviewed with the goal of improving community health. Guidelines would support practitioners with their endeavor to address patient’s weight concerns and support patients’ progress toward weight loss goals.

Statement of Purpose

Guidelines are available to direct health care professionals to promote healthy lifestyles. The purpose of this study was to describe how rural health care providers perceive obesity in their communities. A one-time online survey of Missouri Family Nurse Practitioners was utilized to evaluate Nurse Practitioner (NP) perceptions of obesity-related chronic illness, current training and resources, as well as treatment availability to address obesity.

3. Review of the Literature

A search was performed utilizing the PubMed database with MeSH headings, CINAHL, Medline, and Scopus databases. Search limits included publication dates of 2010-2014, English language, human species, and articles linked to full text. The search of PubMed with MeSH and general terms included obesity, abdominal and perception. The general terms used were obesity, attitudes or perception, and community. To further delineate aspects of rural obesity, the search of CINAHL included these terms: rural health personnel, services, and rural populations. The search of CINAHL and Scopus was limited to studies performed in the United States and further restricted to studies with available abstracts. Articles including adult participants, adult attitudes or perceptions of obesity, as well as community perceptions and rural health resources were included. Restricted articles included those addressing maternal issues, childhood obesity, and those primarily addressing chronic diseases or illnesses (Table 1).

3.1. Evaluation of Literature Findings

Boo [18] found weight misperception was manifested both in males and females. Men tend to underestimate and women tend to overestimate their weight [18] [19] . Underestimation of one’s weight affects how a person views their family’s weight and thus, promotes familial obesity [18] . However, the trend toward weight gain may reduce current perceptions of need for weight loss solutions [20] . People who underestimate their body weight are less likely to perceive the need for weight loss solutions, while those who overestimate their weight tend to be more prone to fad dieting due to unnecessary weight concerns [18] [21] . Active overweight individuals considered themselves “generally healthy” and do not perceive health risks associated with being overweight and obese [20] .

3.2. Behavioral Aspects

Cognitive, effective, and behavioral components are all aspects of body image. Obesity has been associated with poor self-esteem, which alters psychological and psychosocial aspects leading to further unhealthy behaviors such as Internet searches for weight loss solutions [22] . Internet searches with obesity and weight loss solutions are considerably high (78% and 75% respectively). Increased Internet searches corresponded with weight: the more the participant weighed, the more they searched the Internet for weight loss solutions and obese individuals overwhelmingly acted upon advice found on various dietary websites [21] (Table 1).

Self-perception of weight status plays an important role in health-seeking behavior. If a patient misperceives their weight, they were less likely to nurture healthy-weight behaviors [18] . Self-misperception of weight status can also promote unhealthy behaviors. With rising prevalence of obesity, individual perceptions have changed suggesting normalization. Therefore, perceptions of risk factors associated with obesity as well as the urgency to seek weight-reduction interventions have been minimized [20] .

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