Running head: DIETARY AWARENESS IN REDUCING OBESITY Dietary Awareness in Reducing Obesity Table of Contents Abstract ........................................................................................................................................... 3 Introduction ..................................................................................................................................... 4 Background study........................................................................................................................ 5 Problem statement ....................................................................................................................... 5 DIETARY AWARENESS IN REDUCING OBESITY 2 Objectives .................................................................................................................................... 5 Picot questions............................................................................................................................. 5 Hypotheses .................................................................................................................................. 6 Empirical and Theoretical Literature Review……………………………………………………………………………………...7 Theoretical Framework ............................................................................................................... 7 Literature review ......................................................................................................................... 7 Significance of study ................................................................................................................. 11 Methodology ................................................................................................................................. 12 Research design and Procedure ................................................................................................. 12 Data collection........................................................................................................................... 12 Data analysis ............................................................................................................................. 12 Ethical considerations ................................................................................................................... 13 Limitation of the study .................................................................................................................. 13 Recommendations ......................................................................................................................... 13 Conclusion .................................................................................................................................... 15 Appendix ....................................................................................................................................... 16 References ..................................................................................................................................... 17 Abstract Progressive incidences of increased body weight among the population is a major challenge encountered by the public health sector in developing countries. There exists a considerable DIETARY AWARENESS IN REDUCING OBESITY 3 significance between poor quality of diet and reported cases of weight gain. Overweight and obesity are allied to a number of co-morbidies and chronic diseases including cardiovascular and diabetes. There is massive burden on annual cost of health care to treat and manage the individuals with these conditions and pushing for increased allocation of more funds that could otherwise be channeled towards economic development. This article will aid in providing fundamental information on observing basic healthy diets that significantly reduce the cases of obesity and overweight in the general population. A cross-section study of participants involving self –report vegetarians and non-vegetarians will be involved. Their body mass indices will be determined and recorded. The gathered information will be analyzed through the use of t-test. The results will, therefore, be significance in determining whether the prevalence of obesity is associated with diet, which in fact is an issue of concern in the entire global community. DIETARY AWARENESS IN REDUCING OBESITY 4 INTRODUCTION Background Study Engdahl, (2015) found out that obesity cases occurring in various individuals among the population are associated with high numbers of morbidity. The physicians in the primary care are recommended to screen all the individuals in the communities for obesity thereby improving the awareness programs on community based and individual levels to address overweight and obesity (Lam et al, 2015). Conine & Cross (2013), on the other hand, indicated that even though the cases of obesity are widespread in the United States, the prevalence cases of overweight is found to be higher in particular groups of population especially the elderly and specific geographical areas. According to Diep et al (2015), progressive incidences of increased body weight among the population is a major challenge encountered by the public health sector in developing countries. Brauer et al (2015) documented that there have been little studies focused on assessing the association between the quality of nutritional and dietary consumptions in relation to health outcomes. Nevertheless, research has indicated an inverse relationship between higher diet quality and specific chronic disease mortality (Young et al, 2012). Additionally, studies demonstrate that there exists a considerable significance between poor quality of diet and reported cases of weight gain (Terry-McElreath et al, 2014). However, vegetarian diet has been demonstrated as the effective way of reducing the body weight. If it is followed and balanced with proper considerations then it will act as the best remedy for such conditions (Chatham, 2012). According to Diep et al (2015), Body Mass Index (BMI) is extensively used in defining the problem of obesity; it is considered the ruling pillar of explaining obesity. Higher BMI recordings, usually more than 25, are considered problematic to individual health since it is an indication of overweight and thereafter a link to obesity disorder (Ashman et al, 2014). The BMI DIETARY AWARENESS IN REDUCING OBESITY 5 value of an individual can be defined as the body weight in kilograms divided by an individual’s height in square meters (Aljadani et al., 2013). Arguably, an individual with a BMI value that is greater than 30 is termed obese. Overweight and obesity are allied to a number of co-morbidies and chronic diseases including cardiovascular and diabetes. Problem Statement The main focus of this research paper is on overweight and obesity in relation to the kind of diet various individuals are on, it goes ahead determining how different age populations are statistically affected by obesity and if this condition has exposed them to other diseases, and finally if it is possible to conduct some awareness program among the populations alerting on obesity information, its causes, dangers and how to prevent and reverse the condition. Objectives Statements a) To determine the occurrence of obesity rates among the population. b) To evaluate the effectiveness of vegetarian diet on previous studies on reducing obesity. c) To develop an education programs on obesity awareness among population. d) To assess the rate of obesity in relation to age differences. e) To establish presence of any other disease among the obese individuals in the population. Picot Questions Among the individuals in the population, does increased intake of vegetable diet compared to non- vegetarian reduce the rates of obesity? DIETARY AWARENESS IN REDUCING OBESITY 6 Hypotheses H0- There is no significant relationship between increased vegetarian diet and reduced rates of obesity. This is the null hypothesis implying that whether one relies on vegetarian diet or not their risks of exposure to obesity is the same. Being a vegetarian has the same risk exposures to obesity compared to being a non-vegetarian. H1- There is significant relationship between increased vegetarian diet and reduced rates of obesity. This is the alternative hypothesis that this research is yet pegged on, it shows that the vegetarian population is not as exposed to obesity as the non-vegetarian population. In fact, the vegetarians here can be said to have no records of obesity, which is not the case with nonvegetarian. DIETARY AWARENESS IN REDUCING OBESITY 7 EMPERICAL AND THEORITICAL LITERATURE REVIEW Theoretical Framework Various theories have suggested that dietary concerns have a prevalence on obesity rate among the general population. These theories range from planned behavior theory to cognitive theory among others. A study model based on the theory of planned behavior in regard to health diet promotes eating vegetable and low fat diet. This theory shows that when the entire population is informed on the way of using vegetables to promote reduced cases of obesity, they find it difficult to follow these recommendations. On the contrary, they often eat foods that are unhealthy since they perceive so many barriers to eating healthfully. This relation is so essential since with diversity in diet is how the difference comes, it is how a given group of people develop such characteristics (Brauer et al., 2015). Specifically, this can be experienced at family level, which acts as the basis of comparison; in families where people eat unhealthful, non-vegetarian, cases of obesity are immense almost in every member, but in healthy nutrition with vegetarian diet, cases of obesity are never experienced. Literature Review In United States, the prevalence of obesity is an emerging health care concern among adults, adolescents and children, with the general female population being at a higher risk of the exposure as compared to males (Aljadani et al, 2013). The prevalence of obesity worldwide has nearly doubled between 2005 and 2015 as revealed by various sources. The World Health Organization in 2015 estimated that nearly 35% of adults with an age of above 20 years were overweight and about 12% were obese. In developing countries, the rate of obesity has tripled in the last 20 years since lately they embrace the western lifestyle (Conine & Cross, 2013). This culture borrowing behavior has seen the populace in developing countries to adopt the kinds of DIETARY AWARENESS IN REDUCING OBESITY 8 food being taken in U.S; the fast ready food that are more of junky and fleshy with high protein plus calorie content. It is perceived that more than half of Canadian women, 54%, and nearly two thirds of men are overweight or obese. In Iran and other developing countries, the incidences of overweight and obesity cases have been increasing rapidly in the recent years and keen observations reveal unhealthy living and diet as the major cause of the same (Young et al, 2012). However, the worldwide obesity epidemic strongly indicates negative consequences on societies and individuals. Nevertheless, the incidence of obesity is no longer a health care challenge phenomena for only the developed, but it is also wide spreading in the middle and low income countries. Apart from its global widespread, the condition have a number of disorders associating with it, and these are explored in the next section below. Chronic conditions such as cancer, osteoarthritis, cardiovascular, hypertension and diabetes cases are associated with excessive body weight, of which exposes the body to further weakening and dangers of deteriorated health. These are termed as lifestyle diseases since they come as a result of what people consume considering there class while ignoring the protective and nutritive vegetarian diet. Chatham (2012) also came to learn how a number of studies have documented that obesity during the early middle age gives an indication of increased diabetes and cardiovascular risks in the following two to three decades. National recommendations recognizes basic care as a critical move on prevention and management of obesity among various individuals in the entire generation. However, higher BMI approximately accounts for 16% of the world wide’s diseases burden (Diep et al, 2015). Additionally, there has been projected costs of health care attributed to obesity. Arguably, there is tremendous burden on health care systems attributed to obesity and overweight. In other study DIETARY AWARENESS IN REDUCING OBESITY 9 work it was found that the annual cost of treating and managing obesity in the United States amounted to about 16.5 % of the domestic spending on medical care; this figure shows much burden and imbalance on expenditure that comes with economic obesity condition. According to Chatham (2012), overall positive results and improved clinical outcomes have been attributed to effective dietary and behavioral interventions. There has been a considerable relationship between unhealthy, non-vegetarian, diet and increased weight gain. Psychological and economical concerns of health risks associated to individuals with overweight and obesity. However, the causes of obesity are complex although ultimately it is caused by imbalances in the amount of energy consumed and utilized (Terry-McElrath et al, 2014). Considering this information, the paper is yet to view the necessity of vegetarian diet and its actual essence in connection to this common condition. Studies have indicated that recommendation of vegan diets reduces the overall weight indefinitely due to low content of fat (Diep et al, 2015). Additionally, the studies have suggested that there is a need to fully clarify the fundamental mechanism that leads to significant loss in weight among the vegans population as compared to omnivores. Brauer et al (2015) found that vegan diets may well play a very beneficial role in preventing cases of obesity and promoting population health. Vegetarian diet incorporates a range of feeding patterns leaving out all other diets such as; fish, animal meat and products including milk and eggs. BMI increases with a broader variety of consumed animal products, which is in accordance to studies previously conducted by various scholars and researchers. Prospective studies establish that in red meat consumers, the BMI value was considerably higher while intermediate value in individuals who eat fish (white meat consumers) and lowest value among the vegans. Nevertheless, the sheltering properties of vegetarianism against increased obesity could be owing to evasion of DIETARY AWARENESS IN REDUCING OBESITY 10 major food groups and calories displacement towards various food groups (Terry-McElrath et al, 2014). In connection to this prospects to obesity in various levels depending on what an individual consumes, it is also necessary to understand the impact the same disorder on different age groups commencing on the childhood. According to Lam et al (2015), childhood obesity status has serious negative health effects during adolescent and adulthood. The rising prevalence of obesity among the pediatric population within the society is a major determining factor on increased cases of type 2 diabetes in young children. However, it is perceived that children, 39% of girls and about 32% of boys, born in 2010 were at lifetime risk of developing diabetes type 2 (Chatham, 2012). The prospective economic and health care burden caused by type 2 diabetes among the young children is devastating and may cause severe complications in adulthood. Additionally, it is more likely that overweight condition in childhood will progress into adulthood. Arguably, when an overweight child approaches the age of 5 years there is a likelihood that more than 50% overweight will persist. There exists a major concern that 60% to 80 % of obese adult cases will persist with the condition to old age or even death (Young et al, 2012). According to Chatham (2012), diets that are plant based are found to contain low density in energy, considerable high carbohydrates complex, water and fiber that accounts for increased satiety and latent energy expenditure. However, dietary patterns that are plant based should be advocated for achievement of maximum health thereby warranting obesity prevention. Epidemiology research studies have constantly indicated that vegans are thinner as compared to the non-vegetarians. There is a need by the government to evaluate policies and measures to help reduce obesity in childhood and adulthood. Other researchers, however, found out that overweight DIETARY AWARENESS IN REDUCING OBESITY 11 can be reduced through improving diet for all, through clear regulations to implement guidelines on reduction of sugar content on various products such as fizzy drinks. Additionally, these policies will enhance health benefits thereby providing solutions to a number of health issues that are related to obesity cases. The Vegan society in the United States have been intensifying campaign on the production of major plants rich in protein associated with reduced weight, such plant example are pulses and lentils (Brauer et al., 2015). Although obesity is a very multifaceted issue of concern with numerous contributing factors, the vegan diet has been found to provide quite a notable protection against obesity and overweight. However, it has been considered a remarkable step towards solving or counteracting obesity that is deemed a national disaster. Significance of Study The study will help in providing fundamental information on observing basic healthy diets that significantly reduce the cases of obesity and overweight in the general population. This will enable the health sector on promoting improved public health through awareness campaigns through evidence based policies on lifestyle modification and diets. In this regard, it will help on promoting quality of life and welfare of individuals. More resources will be available to support and empower them economically rather than spending considerable resources in managing conditions associated with obesity including diabetes and hypertension. DIETARY AWARENESS IN REDUCING OBESITY 12 METHODOLOGY Research Design and Procedure A clinical report of vegetarians and non-vegetarians participants will be reviewed and the demographic characteristics such as age, gender will be merged. The individual information will be managed by researchers and their BMI will be determined quantitatively to try and get infer on relationship between diet, BMI value and obesity. The participants with chronic conditions and those taking anti-obesity therapy will be excluded. The study will be conducted in Jackson Memorial Hospital Miami, USA. Data Collection Thirty (30) vegetarians and thirty (30) non-vegetarians will be considered and observed for a given time frame and their information recorded in password secured software with their age, and gender of indicated against their BMIs. Non-vegetarians will be considered as the control group who exposed to every food type, where the vegetarian category of individuals who had been on the diet for less than 2 years will be excluded. Non-vegetarians undergoing anti-obesity therapy will also be excluded. Their Body Mass Index will be determined and recorded. The data will help defining relationship between diet and obesity. Data Analysis The gathered information will be analyzed by applying the use of t-test; a statistical analysis test that is applied when the population is normally distributed with a sample size of not greater than thirty. Considering the features of t-test and when it is supposed to be applied, it is automatically becomes the most appropriate test for analyzing variables in this case. The BMI value among both genders will be determined categorically and quantitatively. The BMI value for different ages will be used to determine whether the prevalence of obesity is associated with a DIETARY AWARENESS IN REDUCING OBESITY 13 particular age of individuals in a given society. T-test will be the most appropriate to compare the BMI among individuals in control and intervention group. The results obtained will help in answering the research question as to whether increased vegetarian diet can reduce the cases of obesity among the general population. Ethical Considerations Moral values govern every aspect of research work. Ethical considerations in research help in confidentiality of the respondents and is considered the important part of the research. The used data will be secured in a personal computer with a password and the actual names of the respondents will not be used. This will be important in safeguarding the dignity and safety of every participant in the subsequent publication of gathered information that will be obtained in the research study. Limitation of the Study The main limitation of this study is that the participants may not tell the truth about their diet and this might influence the results negatively. One of the drawbacks of this research study is that it will be carried in only one facility. This may not be effective enough in decision making as the findings may be unsatisfactory. These reasons are enough to bring about a serious deviation in the findings hence resulting into wrong conclusion, which will thereby compromise the entire research work. Recommendations In relation to the above findings in the literature review, there is a need to conduct more research on other food varieties and combinations that will help the communities to observe healthy lifestyles thus avoid cases of obesity and overweight through dietary patterns adjustments. DIETARY AWARENESS IN REDUCING OBESITY 14 This is necessary in the distinction of real natural vegetarian and genetically modified vegetarian foods. The study should also focus on considering other research design like random sampling other than the self- reporting individuals or rather participants, which will promote unbiased observation that results to unmodified results. Every individual should be know how to use the BMI machine so that all be in the position of knowing their stance and not wait until it is too late before seeking help, this will save families across the globe. Based on the analysis of the literature of the subject it has been recommended that to reduce the rate of obesity need to do more educational material and this proposal is expected to have the approval of the respective authorities and the University of Turabo. After conducting this research, it is worth noting that a better part of the population is ignorant about obesity, right from its causes to dangers. It is therefore very necessary to conspire with the government of the day and ensure that education program or an awareness promotion is done for a good period of time in the entire country. This will help people understand the dangers and symptoms as well as causes of the same, and if one is already positive it will be possible to educate them on how to get rid of it. Everyone, rich or poor, young or old , male or female should be reconsider exercising for thirty minutes to one hour every day in order to burn any content of excess calories that might exist within the body system. Lastly, the agricultural sector in every country should be embraced since it is the major source of pure vegetarian diet without any problems. Center for Disease Control and Prevention In accordance to CDC analysis, obesity has been a serious problem in the U.S. repressing both adults and children alike. Statistics from 1960 to date shows that obesity has nearly tripled in her adult population; from 13% that was experienced between 1960 and 1962 to 36% in 2009, 2010. Data on children is availed from 1970, where again records show a tripled rate; between DIETARY AWARENESS IN REDUCING OBESITY 15 1971 and 1974 obesity rate was 5%, but by 2009, 2010 it had grown to 17% (May, Freedman, Sherry, Blanck, & Centers for Disease Control and Prevention (CDC), 2013). This trends show that obesity will still rise in the near future if nothing substantial is done, and in U.S. there still exists disparity in obesity rates depending on age, sex, ethnicity and socio-economic eminence. United States Census Bureau In an article titled ‘Current Population Report,’ it is revealed that the age structure of USA economy is expected to change over the coming years, after observing historical trends. The population of the old is expected to rise, which commenced from 2012 through 2050. That is sixty five years and above are expected to stand at around 83.7 million by 2050, which is almost a double figure when compared to 2012 standings (Ortman, Velkoff, & Hogan, 2014). This population will however expose the economy to medicare challenges; for example the number of obese will be high and the government will have to cater for it in its budget limiting the growth of other sectors. This diverse population will be so cumbersome to manage considering the fact that obesity is linked to a number of health complications that normally persist in old age. Conclusion Observing balanced nutrition can effectively reduce the cases of obesity and overweight among individuals in the population. There is a necessity to increase awareness on other measures that can be incorporated together with dietary needs to reduce obesity in the society. As a control measure, this article has shown the vegetarian diet is the best control for all these without putting yourself into pills and other unnecessary pills plus excess money splash to rectify the condition. However, it is recommended for additional research to further explore the prospective correlation between vegetarian and BMI among the general population. DIETARY AWARENESS IN REDUCING OBESITY Appendix Potential Budget Particulars Cost ($) Laptop 60 Transport allowances 70 Lunch 80 Salaries for researchers 100 Education to general population 20 Manual handouts 5 Writing materials 8 Airtime 10 Grand Total 353 16 DIETARY AWARENESS IN REDUCING OBESITY 17 Reference Aljadani, Patterson, Sibbritt, Hutchesson, Jensen, & Collins, (2013). Diet Quality, Measured by Fruit and Vegetable Intake, Predicts Weight Change in Young Women. Journal of Obesity, 2013, 1-10. doi:10.1155/2013/525161 Ashman, Collins, Hure, Jensen, & Oldmeadow, (2014). Maternal diet during early childhood, but not pregnancy, predicts diet quality and fruit and vegetable acceptance in offspring. Maternal & Child Nutrition, 12(3), 579-590. doi:10.1111/mcn.12151 Brauer, Gorber, Shaw, Singh, Bell, & Shane, (2015). Recommendations for prevention of weight gain and use of behavioral and pharmacologic interventions to manage overweight and obesity in adults in primary care. Canadian Medical Association Journal, 187(3), 184-195. doi:10.1503/cmaj.140887 Chatham, (2012). The DASH diet health plan: Low-sodium, low-fat recipes to promote weight loss, lower blood pressure, and help prevent diabetes. Berkeley, CA: Rock ridge University Press, Callisto Media. Conine, & Cross, (2013). MIF deficiency does not alter glucose homeostasis or adipose tissue inflammatory cell infiltrates during diet-induced obesity. Obesity, 22(2), 418-425. doi:10.1002/oby.20555 Diep, Baranowski, & Baranowski, 2015). The impact of fruit and vegetable intake on weight management. Managing and Preventing Obesity, 59-78. doi:10.1533/9781782420996.2.59 DIETARY AWARENESS IN REDUCING OBESITY 18 In Engdahl, (2015). Obesity. Lam, E., Partridge, & Allman-Farinelli, (2015). Strategies for successful recruitment of young adults to healthy lifestyle programs for the prevention of weight gain: a systematic review. Obesity Reviews, 17(2), 178-200. doi:10.1111/obr.12350 May, Freedman, Sherry, Blanck, & Centers for Disease Control and Prevention (CDC). (2013). Obesity—United States, 1999–2010. MMWR Surveill Summ, 62(Suppl 3), 120-128. Ortman, Velkoff, & Hogan, (2014). An aging nation: the older population in the United States. Washington, DC: US Census Bureau, 25-1140. Terry-McElrath, O'Malley, & Johnston, (2014). Accessibility Over Availability: Associations Between the School Food Environment and Student Fruit and Green Vegetable Consumption. Childhood Obesity, 10(3), 241-250. doi:10.1089/chi.2014.0011 Young, Morgan, Plotnikoff, Callister, & Collins, (2012). Effectiveness of male-only weight loss and weight loss maintenance interventions: A systematic review with metaanalysis. Obesity Research & Clinical Practice, 6, 84. doi:10.1016/j.orcp.2012.08.174. Sistema Universitario Ana G. Mendez Course Code: NURS 503 Course Title: Nursing Research Project: From Proposal to Publication Instructor: Dr. E. Velis. Email: velise1@suagm.edu Individual Assignments/Projects Variables and Scales of Measurements (20% of the final grade) Instructions and Grading Scale: Based on the topic of your interest, study research questions and hypotheses. I. Identify and organize all variables you will need to include in your study. (40 points) 1. Type of variables. a. Independent/Predictor variables (20 points) Quantitative Qualitative b. Dependent/Outcome/Response variables (20 points) Quantitative Qualitative II. Scales of measurements proposed. (20 points) Nominal Ordinal Interval Ration III. Identify available sources of data/information related to your topic of interest. List the sources of information selected (website where the data will be extracted). (10 points) IV. Prepare a 15 minutes PowerPoint presentation to be presented/discussed in class. (30 points) Due date: See Blackboard. Submission subsequent to the due date will result in a reduction of 10 full points (out of 100) for each day late. Dr. Velis
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