Ignore this... for words count
THE FOLLOWING TEXT HAS NOTHING TO DO WITH THE STORY!!!!
this is for the words count only!!!
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When I was twelve years old, a drunk driver hit the car my mother was driving while I was in the backseat. I have very few memories of the accident, but I do faintly recall a serious but calming face as I was gently lifted out of the car. The paramedic held my hand as we traveled to the hospital. I was in the hospital for several weeks and that same paramedic came to visit me almost every day. During my stay, I also got to know the various doctors and nurses in the hospital on a personal level. I remember feeling anxiety about my condition, but not sadness or even fear. It seemed to me that those around me, particularly my family, were more fearful of what might happen to me than I was. I don't believe it was innocence or ignorance, but rather a trust in the abilities of my doctors. It was as if my doctors and I had a silent bond. Now that I'm older I fear death and sickness in a more intense way than I remember experiencing it as a child. My experience as a child sparked a keen interest in how we approach pediatric care, especially as it relates to our psychological and emotional support of children facing serious medical conditions. It was here that I experienced first-hand the power and compassion of medicine, not only in healing but also in bringing unlikely individuals together, such as adults and children, in uncommon yet profound ways. And it was here that I began to take seriously the possibility of becoming a pediatric surgeon. My interest was sparked even more when, as an undergraduate, I was asked to assist in a study one of my professors was conducting on how children experience and process fear and the prospect of death. This professor was not in the medical field; rather, her background is in cultural anthropology. I was very honored to be part of this project at such an early stage of my career. During the study, we discovered that children face death in extremely different ways than adults do. We found that children facing fatal illnesses are very aware of their condition, even when it hasn't been fully explained to them, and on the whole were willing to fight their illnesses, but were also more accepting of their potential fate than many adults facing similar diagnoses. We concluded our study by asking whether and to what extent this discovery should impact the type of care given to children in contrast to adults. I am eager to continue this sort of research as I pursue my medical career. The intersection of medicine, psychology, and socialization or culture (in this case, the social variables differentiating adults from children) is quite fascinating and is a field that is in need of better research. Although much headway has been made in this area in the past twenty or so years, I feel there is a still a tendency in medicine to treat diseases the same way no matter who the patient is. We are slowly learning that procedures and drugs are not always universally effective. Not only must we alter our care of patients depending upon these cultural and social factors, we may also need to alter our entire emotional and psychological approach to them as well. It is for this reason that I'm applying to the Johns Hopkins School of Medicine, as it has one of the top programs for pediatric surgery in the country, as well as several renowned researchers delving into the social, generational, and cultural questions in which I'm interested. My approach to medicine will be multidisciplinary, which is evidenced by the fact that I'm already double-majoring in early childhood psychology and pre-med, with a minor in cultural anthropology. This is the type of extraordinary care that I received as a child—care that seemed to approach my injuries with a much larger and deeper picture than that which pure medicine cannot offer—and it is this sort of care I want to provide my future patients. I turned what might have been a debilitating event in my life—a devastating car accident—into the inspiration that has shaped my life since. I am driven and passionate. And while I know that the pediatric surgery program at Johns Hopkins will likely be the second biggest challenge I will face in my life, I know that I am up for it. I am ready to be challenged and prove to myself what I've been telling myself since that fateful car accident: I will be a doctor. If you had told me ten years ago that I would be writing this essay and planning for yet another ten years into the future, part of me would have been surprised. I am a planner and a maker of to-do lists, and it has always been my plan to follow in the steps of my father and become a physician. This plan was derailed when I was called to active duty to serve in Iraq as part of the War on Terror. I joined the National Guard before graduating high school and continued my service when I began college. My goal was to receive training that would be valuable for my future medical career, as I was working in the field of emergency health care. It was also a way to help me pay for college. When I was called to active duty in Iraq for my first deployment, I was forced to withdraw from school, and my deployment was subsequently extended. I spent a total of 24 months deployed overseas, where I provided in-the-field medical support to our combat troops. While the experience was invaluable not only in terms of my future medical career but also in terms of developing leadership and creative thinking skills, it put my undergraduate studies on hold for over two years. Consequently, my carefully-planned journey towards medical school and a medical career was thrown off course. Thus, while ten-year plans are valuable, I have learned from experience how easily such plans can dissolve in situations that are beyond one's control, as well as the value of perseverance and flexibility. Eventually, I returned to school. Despite my best efforts to graduate within two years, it took me another three years, as I suffered greatly from post-traumatic stress disorder following my time in Iraq. I considered abandoning my dream of becoming a physician altogether, since I was several years behind my peers with whom I had taken biology and chemistry classes before my deployment. Thanks to the unceasing encouragement of my academic advisor, who even stayed in contact with me when I was overseas, I gathered my strength and courage and began studying for the MCAT. To my surprise, my score was beyond satisfactory and while I am several years behind my original ten-year plan, I am now applying to Brown University's School of Medicine. I can describe my new ten-year plan, but I will do so with both optimism and also caution, knowing that I will inevitably face unforeseen complications and will need to adapt appropriately. One of the many insights I gained as a member of the National Guard and by serving in war-time was the incredible creativity medical specialists in the Armed Forces employ to deliver health care services to our wounded soldiers on the ground. I was part of a team that was saving lives under incredibly difficult circumstances—sometimes while under heavy fire and with only the most basic of resources. I am now interested in how I can use these skills to deliver health care in similar circumstances where basic medical infrastructure is lacking. While there is seemingly little in common between the deserts of Fallujah and rural Wyoming, where I'm currently working as a volunteer first responder in a small town located more than 60 miles from the nearest hospital, I see a lot of potential uses for the skills that I gained as a National Guardsman. As I learned from my father, who worked with Doctors Without Borders for a number of years, there is quite a bit in common between my field of knowledge from the military and working in post-conflict zones. I feel I have a unique experience from which to draw as I embark on my medical school journey, experiences that can be applied both here and abroad. In ten years' time, I hope to be trained in the field of emergency medicine, which, surprisingly, is a specialization that is actually lacking here in the United States as compared to similarly developed countries. I hope to conduct research in the field of health care infrastructure and work with government agencies and legislators to find creative solutions to improving access to emergency facilities in currently underserved areas of the United States, with an aim towards providing comprehensive policy reports and recommendations on how the US can once again be the world leader in health outcomes. While the problems inherent in our health care system are not one-dimensional and require a dynamic approach, one of the solutions as I see it is to think less in terms of state-of-the-art facilities and more in terms of access to primary care. Much of the care that I provide as a first responder and volunteer is extremely effective and also relatively cheap. More money is always helpful when facing a complex social and political problem, but we must think of solutions above and beyond more money and more taxes. In ten years I want to be a key player in the health care debate in this country and offering innovative solutions to delivering high quality and cost-effective health care to all our nation's citizens, especially to those in rural and otherwise underserved areas. Of course, my policy interests do not replace my passion for helping others and delivering emergency medicine. As a doctor, I hope to continue serving in areas of the country that, for one reason or another, are lagging behind in basic health care infrastructure. Eventually, I would also like to take my knowledge and talents abroad and serve in the Peace Corps or Doctors Without Borders. In short, I see the role of physicians in society as multifunctional: they are not only doctors who heal, they are also leaders, innovators, social scientists, and patriots. Although my path to medical school has not always been the most direct, my varied and circuitous journey has given me a set of skills and experiences that many otherwise qualified applicants lack. I have no doubt that the next ten years will be similarly unpredictable, but I can assure you that no matter what obstacles I face, my goal will remain the same. I sincerely hope to begin the next phase of my journey at Brown University. Thank you for your kind attention. The roots of my desire to become a physician are, thankfully, not around the bedside of a sick family member or in a hospital, but rather on a 10-acre plot of land outside of a small town in Northwest Arkansas. I loved raising and exhibiting cattle, so every morning before the bus arrived at 7 a.m. I was in the barn feeding, checking cattle for any health issues and washing the show heifers. These early mornings and my experiences on a farm not only taught me the value of hard work, but ignited my interest in the body, albeit bovine at the time. It was by a working chute that I learned the functions of reproductive hormones as we utilized them for assisted reproduction and artificial insemination; it was by giving vaccinations to prevent infection that I learned about bacteria and the germ theory of disease; it was beside a stillborn calf before the sun had risen that I was exposed to the frailty of life. Facing the realities of disease and death daily from an early age, I developed a strong sense of pragmatism out of necessity. There is no place for abstractions or euphemisms about life and death when treating a calf's pneumonia in the pouring rain during winter. Witnessing the sometimes harsh realities of life on a farm did not instill within me an attitude of jaded inevitability of death. Instead, it germinated a responsibility to protect life to the best of my abilities, cure what ailments I can and alleviate as much suffering as possible while recognizing that sometimes nothing can be done. I first approached human health at the age of nine through beef nutrition and food safety. Learning the roles of nutrients such as zinc, iron, protein and B-vitamins in the human body as well as the dangers of food-borne illness through the Beef Ambassador program shifted my interest in the body to a new species. Talking with consumers about every facet of the origins of food, I realized that the topics that most interested me were those that pertained to human health. In college, while I connected with people over samples of beef and answered their questions, I also realized that it is not enough simply to have adequate knowledge. Ultimately knowledge is of little use if it is not digestible to those who receive it. So my goal as a future clinical physician is not only to illuminate the source of an affliction and provide treatment for patients, but take care to ensure the need for understanding by both patient and family is met. I saw this combination of care and understanding while volunteering in an emergency room, where I was also exposed to other aspects and players in the medical field. While assisting a nurse perform a bladder scan and witnessing technicians carry out an echocardiogram or CT scan, I learned the important roles that other professionals who do not wear white coats have in today's medical field. Medicine is a team sport, and coordinating the efforts of each of these players is crucial for the successful execution of patient care. It is my goal to serve as the leader of this healthcare unit and unify a team of professionals to provide the highest quality care for patients. Perhaps most importantly my time at the VA showed me the power a smile and an open ear can have with people. On the long walk to radiology, talking with patients about their military service and families always seemed to take their mind off the reason for their visit, if only for a few minutes. This served as a reminder that we are helping people with pasts and dreams, rather than simply remedying patients' symptoms. Growing up in a small town, I never held aspirations of world travel when I was young. But my time abroad revealed to me the state of healthcare in developing countries and fostered a previously unknown interest in global health. During my first trip abroad to Ghana, my roommate became ill with a severe case of traveler's diarrhea. In the rural north of the country near the Sahara, the options for healthcare were limited; he told me how our professor was forced to bribe employees to bypass long lines and even recounted how doctors took a bag of saline off the line of another patient to give to him. During a service trip to a rural community in Nicaragua, I encountered patients with preventable and easily treatable diseases that, due to poverty and lack of access, were left untreated for months or years at a time. I was discouraged by the state of healthcare in these countries and wondered what could be done to help. I plan to continue to help provide access to healthcare in rural parts of developing countries, and hopefully as a physician with an agricultural background I can approach public health and food security issues in a multifaceted and holistic manner. My time on a cattle farm taught me how to work hard to pursue my interests, but also fueled my appetite for knowledge about the body and instilled within me a firm sense of practicality. Whether in a clinic, operating room or pursuing public and global health projects, I plan to bring this work ethic and pragmatism to all of my endeavors. My agricultural upbringing has produced a foundation of skills and values that I am confident will readily transplant into my chosen career. Farming is my early passion, but medicine is my future. I am a white, cisgender, and heterosexual female who has been afforded many privileges: I was raised by parents with significant financial resources, I have traveled the world, and I received top-quality high school and college educations. I do not wish to be addressed or recognized in any special way; all I ask is to be treated with respect. As for my geographic origin, I was born and raised in the rural state of Maine. Since graduating from college, I have been living in my home state, working and giving back to the community that has given me so much. I could not be happier here; I love the down-to-earth people, the unhurried pace of life, and the easy access to the outdoors. While I am certainly excited to move elsewhere in the country for medical school and continue to explore new places, I will always self-identify as a Mainer as being from Maine is something I take great pride in. I am proud of my family ties to the state (which date back to the 1890's), I am proud of the state's commitment to preserving its natural beauty, and I am particularly proud of my slight Maine accent (we don't pronounce our r's). From the rocky coastline and rugged ski mountains to the locally-grown food and great restaurants, it is no wonder Maine is nicknamed, "Vacationland." Yet, Maine is so much more than just a tourist destination. The state is dotted with wonderful communities in which to live, communities like the one where I grew up. Perhaps not surprisingly, I plan to return to Maine after residency. I want to raise a family and establish my medical practice here. We certainly could use more doctors! Even though Maine is a terrific place to live, the state is facing a significant doctor shortage. Today, we are meeting less than half of our need for primary care providers. To make matters worse, many of our physicians are close to retirement age. Yet, according to the AAMC, only 53 Maine residents matriculated into medical school last year! Undoubtedly, Maine is in need of young doctors who are committed to working long term in underserved areas. As my primary career goal is to return to my much adored home state and do my part to help fill this need, I have a vested interest in learning more about rural medicine during medical school. I was raised in Cumberland, Maine, a coastal town of 7,000 just north of Portland. With its single stoplight and general store (where it would be unusual to visit without running into someone you know), Cumberland is the epitome of a small New England town. It truly was the perfect place to grow up. According to the most recent census, nearly a third of the town's population is under 18 and more than 75% of households contain children, two statistics which speak to the family-centric nature of Cumberland's community. Recently rated Maine's safest town, Cumberland is the type of place where you allow your kindergartener to bike alone to school, leave your house unlocked while at work, and bring home-cooked food to your sick neighbors and their children. Growing up in such a safe, close-knit, and supportive community instilled in me the core values of compassion, trustworthiness, and citizenship. These three values guide me every day and will continue to guide me through medical school and my career in medicine. As a medical student and eventual physician, my compassion will guide me to become a provider who cares for more than just the physical well-being of my patients. I will also commit myself to my patients' emotional, spiritual, and social well-being and make it a priority to take into account the unique values and beliefs of each patient. By also demonstrating my trustworthiness during every encounter, I will develop strong interpersonal relationships with those whom I serve. As a doctor once wisely said, "A patient does not care how much you know until he knows how much you care." My citizenship will guide me to serve my community and to encourage my classmates and colleagues to do the same. We will be taught in medical school to be healers, scientists, and educators. I believe that, in addition, as students and as physicians, we have the responsibility to use our medical knowledge, research skills, and teaching abilities to benefit more than just our patients. We must also commit ourselves to improving the health and wellness of those living in our communities by participating in public events (i.e by donating our medical services), lobbying for better access to healthcare for the underprivileged, and promoting wellness campaigns. As a medical student and eventual physician, my compassion, trustworthiness, and citizenship will drive me to improve the lives of as many individuals as I can. Cumberland instilled in me important core values and afforded me a wonderful childhood. However, I recognize that my hometown is not perfect. For one, the population is shockingly homogenous, at least as far as demographics go. As of the 2010 census, 97.2% of the residents of Cumberland were white. Only 4.1% of residents speak a language other than English at home and even fewer were born in another country. Essentially everybody who identified with a religion identified as some denomination of Christian. My family was one of maybe five Jewish families in the town. Additionally, nearly all the town's residents graduated from high school (98.1%), are free of disability (93.8%), and live above the poverty line (95.8%). Efforts to attract diverse families to Cumberland is one improvement that I believe would make the community a better place in which to live. Diversity in background (and in thought) is desirable in any community as living, learning, and working alongside diverse individuals helps us develop new perspectives, enhances our social development, provides us with a larger frame of reference, and improves our understanding of our place in society. "How many of you received the flu vaccine this year?" I asked my Bricks 4 Kidz class, where I volunteer to teach elementary students introductory science and math principles using Lego blocks. "What's a flu vaccine?" they asked in confusion. Surprised, I briefly explained the influenza vaccine and its purpose for protection. My connection to children and their health extends to medical offices, clinics and communities where I have gained experience and insight into medicine, confirming my goal of becoming a physician. My motivation to pursue a career in medicine developed when my mother, who was diagnosed with Lupus, underwent a kidney transplant surgery and suffered multiple complications. I recall the fear and anxiety I felt as a child because I misunderstood her chronic disease. This prompted me to learn more about the science of medicine. In high school, I observed patients plagued with acute and chronic kidney disease while briefly exploring various fields of medicine through a Mentorship in Medicine summer program at my local hospital. In addition to shadowing nephrologists in a hospital and clinical setting, I scrubbed into the operating room, viewed the radiology department, celebrated the miracle of birth in the delivery room, and quietly observed a partial autopsy in pathology. I saw many patients confused about their diagnoses. I was impressed by the compassion of the physicians and the time they took to reassure and educate their patients. Further experiences in medicine throughout and after college shaped a desire to practice in underserved areas. While coloring and reading with children in the patient area at a Family Health Center, I witnessed family medicine physicians diligently serve patients from low-income communities. On a medical/dental mission trip to the Philippines, I partnered with local doctors to serve and distribute medical supplies to rural schools and communities. At one impoverished village, I held a malnourished two-year old boy suffering from cerebral palsy and cardiorespiratory disease. His family could not afford to take him to the nearest pediatrician, a few hours away by car, for treatment. Overwhelmed, I cried as we left the village. Many people were suffering through pain and disease due to limited access to medicine. But this is not rare; there are many people suffering due to inadequate access/accessibility around the world, even in my hometown. One physician may not be able to change the status of underserved communities, however, one can alleviate some of the suffering. Dr. X, my mentor and supervisor, taught me that the practice of medicine is both a science and an art. As a medical assistant in a pediatric office, I am learning about the patient-physician relationship and the meaningful connection with people that medicine provides. I interact with patients and their families daily. Newborn twins were one of the first patients I helped, and I look forward to seeing their development at successive visits. A young boy who endured a major cardiac surgery was another patient I connected with, seeing his smiling face in the office often as he transitioned from the hospital to his home. I also helped many excited, college-bound teenagers with requests for medical records in order to matriculate. This is the art of medicine – the ability to build relationships with patients and have an important and influential role in their lives, from birth to adulthood and beyond. In addition, medicine encompasses patient-centered care, such as considering and addressing concerns. While taking patient vitals, I grew discouraged when parents refused the influenza vaccine and could not understand their choices. With my experience in scientific research, I conducted an informal yet insightful study. Over one hundred families were surveyed about their specific reasons for refusing the flu vaccine. I sought feedback on patients' level of understanding about vaccinations and its interactions with the human immune system. Through this project, I learned the importance of understanding patient's concerns in order to reassure them through medicine. I also learned the value of communicating with patients, such as explaining the purpose of a recommended vaccine. I hope to further this by attending medical school to become a physician focused on patient-centered care, learning from and teaching my community. Children have been a common thread in my pursuit of medicine, from perceiving medicine through child-like eyes to interacting daily with children in a medical office. My diverse experiences in patient interaction and the practice of medicine inspire me to become a physician, a path that requires perseverance and passion. Physicians are life-long learners and teachers, educating others whether it is on vaccinations or various diseases. This vocation also requires preparation, and I eagerly look forward to continually learning and growing in medical school and beyond.
Obesity's rising prevalence places a significant financial strain on health-care delivery systems and the economy as a whole. Obesity's effect is being studied in ever-increasing numbers of studies that are evidence-based. The nature of the research, on the other hand, varies depending on the study population. This research paper aims to add to the existing body of knowledge about the costs of obesity. Many academic articles were found through a computerized search of electronic databases, and those that applied to both the direct and indirect costs of obesity were reviewed. Absenteeism, presenteeism, loss of productivity, and early mortality are all examples of indirect costs. The immediate consequences are related to management and hospital stay. Indirect costs are higher for most of the countries, but the heterogeneity of the research hindered comparison. Greater good exists in avoiding unhealthy diet as an even treatment of itself has potential side effects. There is a need for further research in all states to determine the actual indirect and direct costs of obesity and other weight-related diseases.
Key words: cost, benefits, unhealthy, healthy, obesity.
Is it expensive to eat healthily? The cost of healthy food vs. the cost of obesity
Introduction
Weight-related disease conditions are tough health issues to address. The causative factors of obesity are usually multifactorial with major factors being behavioral and partly genetics. The behaviors are dietary patterns, physical inactivity and medication among other things. In our society, there are additional contributing factors. These factors include food, environment, education, skills and food marketing and promotion. Obesity and related diseases have serious financial and health implications. There are several disadvantages of eating unhealthy, which can be avoided by eating healthy.
Literature review
In 2008, the expenditure on obesity alone in America was 147 million dollars. The annual estimate of medical cost from obesity and related illness is at 190.2 Billion dollars in the United States. This amount is almost twenty-one percent of the yearly expenditure on health care in America. The yearly national productive cost of obesity is 79 dollars per obese individual and 132 dollars per person for obesity-related absenteeism (Trogdon, Finkelstein, Hylands, Dellea, & Kamal-Bahl, 2008).
In 2005 US study, the direct costs were all medical costs while the indirect ones were calculated from absenteeism and presenteeism. They were estimated to be 30.3 billion and 42.8 billion respectively (Dee et al., 2014). In a Swedish study; the direct costs were from hospital inpatients only while indirect costs were from lost productivity due to high mortality. The estimate costs were SEK 2.17 and 2.93 billion respectively (Dee et al., 2014).
Objectives
To find out economic cost of obesity
To determine benefits of healthy eating
To determine health consequences of obesity
To find out the treatment implication of obesity
To find out other challenges of obesity and its treatment
Method
The study is a retrospective study that analyzes previous scholarly articles on the research topics related to the cost of obesity. Electronic databases were used to search for relevant materials. The three websites included in data search are PubMed, Google Scholar, and Google search engines. With PubMed, there were only sixteen articles with only two articles being eligible for inclusion. The other databases had over 10,100 results. Few studies that based on the relevance of research title were chosen. The keywords were: cost, unhealthy diet, obesity, scholarly articles, America, healthy diet, benefits. Recently published were given preference for review.
Findings
Economic cost of obesity
In a Canadian study in 2010, the indirect cost due to morbidity was 5.96 billion Canadian dollars. The percentage of results that were indirect was 54 %( Dee et al., 2014). Childhood obesity in itself consumes about 14 billion dollars in direct medical costs. If children are obese today, the adults will be obese tomorrow. This rise will add significantly to the expense of the medical care of obesity-related medical condition (Wang, Chyen, Lee, & Lowry, 2008). In the next two decades, the projected savings on medical costs will be 549.5 billion if the obesity rates are to be constant are its 2010 levels (Finkelstein et al., 2012)
The indirect hidden and direct costs of obesity stifle organizations and businesses that stimulate growth, developments, and jobs in the American cities. In ten cities with the highest prevalence and incidence rates of obesity, the costs (direct) of obesity and its related conditions are at about five million dollars for every 10,000 of its citizens. If the ten state cities reduce their rates of obesity to the mean level of the nation, their total savings would be about $ 500 million. This saving can be used to benefit other aspects of health care or even improve another sector of the economy altogether (Bhattacharya & Bundorf, 2009).
In another study in German in 2011, the direct costs were from inpatient and outpatient management, rehabilitation and administrative and research costs. The indirect costs were from sickness absence, early retirement, and mortality. These costs were estimated to be at 4.85 and 5.02 euros respectively (Dee et al., 2014).
There is also a higher cost to the nation for unemployment and disability benefits. Businesses are undergoing losses (estimated to be at $ 4.3 billion annually). Even more poorly, these costs will keep rising (Cawley, Rizzo, & Haas, 2007).It is not an impossible task to stop bad eating habits. Poor eating and nutrition habits affect health, overall wellbeing and safety of the individuals. For the people of age over twenty years, 34. 2% of them are overweight while 33.8% being obese. What is worse is that 5.7 percent of these adults have morbid obesity. (Cawley, Rizzo, & Haas, 2007).
Every year, American loses about 39 million workdays due to obesity and other weight related disease conditions (Reichert, n. d.). Imagine those many unproductive days and the impacts that come with them. The proportion of those who get sick every year due to poor, unhealthy diet is about 17 percent of the population. That translates to about one person for every six people. To even worsen the situation, 3000 reported deaths from illness are related to foods. Just by appropriate dietary consumption all, the above problems are avoidable (Reichert, n. d.).
In Minnesota alone, the financial costs of obesity were 1.3 billion dollars as of 2003. The financial implication for children with obesity is hard to know, as there is no clear data. (Koplan, Liverman & Kraak, 2005).
Benefits of healthy eating
Good practice on eating start at birth giving the best nutrition to the children that benefits them through their life. Healthy eating not only helps by preventing obesity, but it also reduces the risk of the three most killer diseases, cardiovascular diseases, cancer, and stroke. The World Health Organization states that 80% of all types of heart diseases, diabetes (type 2) and stroke are preventable if only people ate healthily. There will also be a 40 percent reduction in cancer if only people chose to eat a healthy diet, engaged in physical activity and stopped the use of tobacco (Barbour, 2011).
It is cheaper to eat healthy meals than an unhealthy diet. Fruit and vegetable diet reduces the chances of tumors and other diseases of chronicity. Statistics from the American CDC Center shows that only about 21% of adults take in the required amounts of fruits each day. The statistics are better for the recommended vegetable intake as at least 33 percent of adult Americans take in the right quantity of vegetables each day (Barbour, 2011).These proportions are however low. The food intake schedule of each person varies, as the calorie requirement of each person is different. Several factors influence these variations including the number of years lived, the weight of the person, the level of physical activity and the height of the person. The Daily Food Plan is a tool that helps one determine what amount of calories to take and what groups of food that the calories must come from. The balanced diet contains foods that are readily available and include vegetables, fruits, leans proteins like meat and milk products with low-fat quantity. There are multiple combinations of these foods that can provide the body with the nutrient it requires. Therefore, it is not hard to control weight.
Eating health might not be the easiest thing to do. However, the choice to eat well will be the smartest decision one can make. Consuming healthy diet means little or no intake of foods that have excess glucose content, fats that are saturated and foods that have excess sodium content. That, therefore, includes a large number of fast foods. These foods include refined snacks, drinks like sodas and chips. Eating healthy does not only make one better in terms of health and fitness, but it also saves unforeseen future medical expenditure.
The brain needs enough and quality energy to work efficiently. The people who work with efficiency are more likely to get promotions or salary increases. The sick ones, for instance, those suffering from obesity superimposed with stroke are not in a position to work. Debra Nessel of the Torrance Memorial Medical Center reports that her patients frequently feel raised focus immediately following the improvement in their diets. According to 2012 Population Health Management, consumption of unhealthy food puts one at 66% increased the risk of productivity loss. Further, unhealthy food represents the biggest determinant factor for poor productivity out of the 19 potential causative factors, some of which include lack of physical activity, chronic pain, and financial instability (Hu, Liu & Willett, 2011).
The food that one eats influences the brain, including the hypothalamic center, which controls pleasure and mood among other things. There is no food known to have antidepressive effects. However, maintenance of stable blood sugar through proper diet helps one to feel better on most days. A diet that has rich contents of vitamins and minerals, like fruits, vegetables, and whole-grain have a lower risk of depression. The list also includes food rich in omega 3 fats like nuts and salmon among other fishes. Eating well means more vigorous energy, more solid foods, better sleep, and decreased joint pain. People who eat healthily also have a greater way of focusing their minds on changing to a healthier dietary pattern. Healthy food leads to a reduction in stress. When the body is under chronic stress, it breaks down protein to replenish energy stores. Certain diets have the capacity to regulate the level of cortisol. Consumption of omega-3 fatty acids and magnesium may lead to a reduction in the levels of cortisol. Eating a diet rich in protein increases the protein store and keep the levels of cortisol low (Hu, Liu & Willett, 2011).
Most people are probably familiar with the concept that healthy diet control weights. However, it still deserves mention. This is because more than half Americans have weight-related conditions. Obesity is also responsible for a fifth of deaths in America. Even a reduction in weight by at least 5-10 % lowers hypertension. The reduction also decreases the levels of bad cholesterols and incidence of diabetes mellitus (type 2). Uncomplicated healthy dietary behavior such as replacing sodas with water and choosing vegetables over chips or French fries reduces weight in addition to saving money. An obese patient spends about $ 2741 more on health care annually compared to the non-obese lean patient.The weight of an individual is not a determinant of health. Thinness does not necessarily mean being healthy, neither being overweight does not mean being unhealthy. However, the consumption of a healthy diet can mean a significant improvement in health even for thin people who are junk food eaters. Junk food has one thing in common. They have small quantities of micronutrients like minerals and vitamins and very high calories. Lack of consumption of these minerals and vitamins for a long time leads to early death. BMJ journal publications give evidence that five servings of vegetables and fruits minimize the risk of dying from any weight-related causes (Hu, Liu & Willett, 2011).).
Diseases, in general, reduce life expectancy. They, also, cost lots of money and make people feel bad. The same situation (or even worse) applies to obesity. Moderate to vigorous exercise, in combination with a healthy diet of vegetables and fruits prolong lives for women in their 70 years of age. This fact is according to the Journal of the American Geriatrics Society. Healthy eating can play a significant role in how long you will live (Glover, 2017).The foods that have less unhealthy nutrients are easily available. Whole grains and wheat together with rice and barley undergo slow digestion. In their less refined forms, they have a slower metabolism. The slow digestion means less effect on insulin hormone and the glucose levels. Such in turn leads to less hunger. Besides, vegetables and fruits have tremendous protective effects against diseases. In addition, it is evident that they have an added advantage of weight reduction than most vegetables and fruits.
Whole grain and barley have greater proof in weight control than fruits and vegetables (Ledoux, Hingle, & Baranowski, 2010). The persons who raise their intake of whole grains gains only about 0.4 pounds less every year. The person who takes whole fruits losses about 0.5 pounds less yearly (Mozaffarian, Hao, Rimm, Willett, & Hu, 2011). Moreover, vegetables together fruits have huge solvent quantity, making people feel more satisfied on fewer calories.
It is a known fact that the people who take in large quantities of drinks with sugar have a greater probability of developing lifestyle diseases. They specifically include metabolic disease like obesity and diabetes (Vartanian, Schwartz, & Brownell, 2007). Prospective analyses of 88 studies showed clear associations of soft drink intake with increased caloric intake and body weight (Vartanian, Schwartz, & Brownell, 2007). There is 0.08 increase in the units of BMI with additional daily intake of 12 ounces of drinks that are sugary (Malik, Willett, & Hu, 2008). In yet another study, it was found that people who had regular drinks with sugar content had about twenty-six percent chance higher probability of suffering from type 2 diabetes and obesity than people who took less quantity of refreshments with high sugar content. The risk of development of coronary artery disease is also higher in such people (Malik et al., 2010).
Fast foods are famous and preferred because of some of their characteristics. One, the package is higher and in larger portions. Secondly, their prices are also small in comparison to organic food. Thirdly, they have high consumability. Fourthly, they all have a relative higher sugar (Pereira et al., 2005). CARDIA study, for example, had a sample population of 3000 young adults followed up for 13 years. The sample population of those who had a higher intake of fast foods at the inception of the research had a mean of 13 pounds higher than the sample population that consumed low quantity of fast foods. The initial sample had also high levels of lipids compared to the second group. The second sample also had smaller circumferences of the waist in comparison to those who took in large quantities of fast foods. Additionally, the consumers of fast food had extremely higher chances for the onset of metabolic syndrome (Duffey, Gordon-Larsen, Steffen, Jacobs, & Popkin, 2009). All the above problems can be avoided with consumption of healthy diet.
There is no difficulty in eating healthy. You are what you eat. Everyone should switch to healthy diet. There are payoffs from the small changes in dietary improvement. A few tips to stay healthy and win against obesity are available. There is need to stay hydrated. Hydration reduces cravings and prevents the feeling of being fuller. There is also need to sticking to the meals. One needs to eat at the same every day if possible. Being active also goes a long way in being healthy. There is also a need for preplanning around cravings. Good behavior comes at no cost. It also comes one at a time. Small changes in person's daily life in terms of diet can help them a great deal. In fact, it also helps them save money.
The cause of obesity is not any other strange factor. It is purely through individual's choice. Obesity is something that all people can avoid if they so the wish. It results from an imbalance of energy expenditure (physical activity) and consumption (dietary habits). The cause of healthy bodyweight is vegetables and fruits. In states like Minnesota, the young adults take in fruits and vegetables to a level that is too low with the recommended one. The recommendation is that there should be consumption of fruits by children and youth at least five times in a day. In a study done on students, there was only 21% of students in grade 6 who took fruits and vegetables more than five times in a day. The percentage of those in grade nine was only 15% (Koplan, Liverman & Kraak, 2005).
Health consequences of obesity
Obesity is a serious concern because it has associations with many adverse health outcomes. It is the leading cause of death together with other lifestyle diseases. Obese people have poor mental health outcomes. Additionally, those with obesity have reduced the quality of life in general (Roberts, Deleger, Strawbridge, & Kaplan, 2003).
Obesity results from being overweight. It is worse when one has a fat deposition in some parts of the body. Obese men and women who have an abdominal diameter more than 102 cm have increased chances of developing stroke, suffering Diabetes mellitus, heart diseases and premature loss of life in comparison to men with a smaller circumference. The same case applies to women who have circumference more than 88 cm or high waist-hip ratios. Visceral fat (in the body) is even more hazardous than the abdominal subcutaneous fatty tissue. Avoiding overweight helps one prevent the above conditions (Wadden & Berkowitz, 2016).
There is also a high association of obesity and metabolic syndrome. In fact, data shows that about 60 percent of patients who are obese also have the syndrome (Barbour, 2011). The syndrome has three or more of the following conditions. There is increased blood pressure above the normal limit; there is also increasing fasting sugar and increased serum triglycerides. The increases in abdominal circumference and low HDL cholesterol are other possibilities (Barbour, 2011).
Some types of neoplasms are more common in obese patients than in thin people. The three common ones are colorectal, ovarian and breast cancers. There is also increment in the risk of developing of thromboembolic diseases. Additionally, the prevalence of some gastrointestinal disorders rises in obesity. They are diseases of gallbladder and GERD among others. The prevalence of dermatological conditions is also high in obese patients. The risks of surgery and obstetric conditions are certainly high in comparison to lean body patients. In patients who are obese, the risks of an impairment of pulmonary functions arise. Major psychotic depression among other psychiatric diseases also happens in those with obesity. Myriads of other problems occur in obesity including hormonal conditions and hemoglobin abnormalities. Even socially, these people are likely to face isolation (Dee et al., 2014)
A terrifying aspect is that other disease/conditions come with obesity apart from it being an all-time cause of death. Hypertension and dyslipidemia are other diseases in association with obesity. Also, there is diabetes (type II diabetes mellitus) and chronic heart diseases. Obesity and some of these diseases are risk factors for stroke development. Other diseases that come with obesity is gallbladder disease and osteoarthritis. Respiratory problems like breathing difficulties and sleep apnea are also common in obese people. Some neoplastic diseases are an additional problem in obesity including endometrial cancers, breast, kidney, gallbladder, and colon and liver cancers. Psychotic conditions like depression, mood, anxiety, and other form mental disorders are additional risks that obese people have. Lastly, these people have body pains, difficult physical functioning, and low quality of life as a whole (Hu, Liu & Willett, 2011)
Treatment implications of obesity
Once people become obese, they are subjected to dietary control techniques. However, using these techniques, there is only 20 percent of people who will lose 20 lb of weight and maintain the loss for over 20 years. Only 5 percent of obese people will lose 40 lbs. of weight (Wadden & Berkowitz, 2016). The weight loss using the dietary measures is about 7 percent of the weight at baseline. Continuous close contact with the health care providers is more beneficial than any other specific treatment regimen. One can imagine what it takes to have close contact with health workers. The doctors have to choose the patients carefully to decrease frustration among patients. It takes great motivation to have patients undergoing an active program of treatment (Wadden & Berkowitz, 2016). Therefore is wise to prevent the condition as treatment using the conventional dietary mechanisms yields no much positive result.
The treatment of obesity is far much more complex. There is a need for many team members to be on board to manage the condition. In treatment, weight loss combined with diets that are hypocaloric are encouraged. There is a need for behavior modifications to change the behavior of eating. Additionally, there must be social support and aerobic exercise to emphasize on the loss (Wadden & Berkowitz, 2016). There should be no need risk all these factors which might not be available when one can avoid the condition from the beginning. The emphasis on treating diabetes is weight loss. The instructions on a diet are the same for those who do not have obesity. The principle is the same. The instructions are to have foods that not processed. Additional instructions are to limit diets that have large quantities of energy without the provision of other nutrients. Therefore, people should strive to avoid the condition even before it sets in.
The dietary requirement is, however, more involved in the treatment than in prevention. Keeping the loss of weight constant over a long time calls for overhaul changes in the dietary behavior of a person. There is an obligation of clinicians to impart knowledge to obese patients on fundamental behavioral techniques. The modification of actions is more formal in treatment than in prevention. Something formal is usually more complex than informal. Additionally, there is the requirement of a plan of menu and record of actual behavior. There is involvement of planning and keeping records. One goes through hustles and stresses of self-monitoring just to make sure they are on track (Wadden & Berkowitz, 2016).No complexities arise with preventive measures.
An additional factor that is important in the treatment of obesity is a fully functional support system. Many people might not even have this support. On the other hand, consumption of healthy diet to prevent obesity does not require any form of social support. There is a need for family and peers to keep one in check to reinforce change of behavior and help in the prevention of isolation and loneliness (Wadden & Berkowitz, 2016). The situation is worse for those who have a severe form of obesity. These people require a very aggressive form of treatment. They also need a diet that is very low in calorie. The calories must be below 800Kcal/d as such results in quick weight loss and prevention of complications of metabolism. They have to maintain the program for at least 4-6 months. The average loss of weight in a week is 2lbs being a maximum loss of appropriately 15 percent of the baseline weight (Wadden & Berkowitz, 2016).
The programs in treatment usually involve the replacement of meals to get a few calories. The maintenance of weight in the long term, together with meals replacement have not predictable outcomes. There is a need for the concurrent change of behavior together with diets that have low calories in combination with regular moderate exercise and regular monitoring.
Various side effects result from a reduction in calories intake. They need close monitoring by the clinicians. They include Cardiac arrhythmias, Cold intolerance, Fatigue, Gallbladder disease, Gout, and Orthostatic hypotension (Foster, 2006).
Some drugs are available to treat obesity. However, various controversies surround the appropriateness of the medications. Some guidelines recommend that drugs are usable for obese clients with Body mass index exceeding 30 or 27 with risk factors for obesity. Apart from the controversy, very few studies say that medications help with long-term outcomes of obese patients (Xia, Kelton, Guo, Bian & Heaton, 2015).
The FDA recommends many medications for use in obesity. Some include phentermine, diethylpropion, and mazindol. These catecholaminergic drugs have very few utility and are the only applicable short-term. Another common drug that was approved by FDA is Sibutramine. However, there was a withdrawal of this drug from the market in 2010. The reason was a demonstrable association with strokes and heart attack (Xia, Kelton, Guo, Bian & Heaton, 2015).
Another common medication is Orlistat. It blocks the absorption of fat by limiting the functions of the lipase in the intestine. The drug, however, results in many gastrointestinal side effects, including, but not limited to diarrhea and cramping. It also reduces the absorption of vitamins. Additionally, there are no long-term benefits of this drug regarding clinical outcomes. In some clinical trials, some drugs resulted in some additional loss of weight if they were used for two years. However, in other studies, there is no benefit regarding metabolic parameters and clinical outcomes (Foster, 2006).
There is also the role of surgery for patients with severe obesity. It is called Bariatric surgery. The procedure of choice is operation on the intestines. The common is a by-pass operation through laparoscopic means. The weight loss in this method is great. Some studies point out a weight loss that is almost a third of the initial weight (Foster, 2006). However, there are complications in 40 percent who undergo this surgery. Some of the complications include Ulcers-marginal, Neuropathy, Narrowing or stenosis of the stoma and Stones in the gallbladder among others. The death rate while being on the operating table is higher in those patients who have Medicare insurance. The mortality rate in one year is about 7.5 percent of men in Medicare (Foster, 2006).
Another common type of operation done on obese patients is Gastric banding (GB). This surgery results in minimal weight loss. However, the complications are fewer. A significant disadvantage is the need of continuous follow up to adjust the band (Foster, 2006).
In the youth population, the death rate and morbidity from obesity and related disorders rise in proportion to a class of obese condition. The proportionality is not the case in old age. The relative risk decreases with age. In the elderly, weight is not a risk factor (Koplan, Liverman & Kraak, 2005). It, therefore, means then, that obesity takes away the vibrant young people who are the backbone of our country's growth and development. The old might not have the positive impact on the economy as the youths do.
In America, there are no new medications or combinations of drugs that have approval. However, several of the drugs are under investigation. One such drug is Lorcaserin. It did not undergo approval phases because of the side effects. One outstanding one is the increased acquisition of breast adenocarcinoma. Another combination under trial was that of phentermine and topiramate. The combination did not undergo approval due to increased development of psychotic symptoms and having toxic effects on the neonates (Xia, Kelton, Guo, Bian & Heaton, 2015). Therefore, it is wise to avoid being obese as the medications themselves have many side effect.
Other challenges of obesity and its treatment
Obesity and its related disorders also have a tremendous impact on the recruitment of armed forces. There are certain variables one must fulfill to join the American army. There is usually a consideration for body fat percentage in addition to heights and weights. These variables were compared to the baseline requirement for the specific ages of the American army. Ten years ago, this comparison revealed that 5.7 million men exceeded the requirements and therefore could not qualify to join the army. The number of women was even worse at 16.5 million. It is, therefore, clear that weight and fat are a big hindrance when it comes to the labor force in the army. If only people could watch their weight, the pool of people to join the army will increase (Cawley & Maclean, 2011).
Some diseases have been well researched on. For such conditions, the data is available and guides the management process. For obesity, there are not enough data in most of the states. The lack of data impairs the preparedness by the States and the entire Nation to curb the rise in the incidence of obesity and the related conditions. A study done in Minnesota gives a recommendation for the need for information on the weights and heights of children and youth (Koplan, Liverman & Kraak, 2005). The data is to help them follow the problem of overweight and obesity, identify solutions, and track progress. The data for the trend of obesity is unavailable; however, there is a likelihood that is a representative of the national data. The growth rate of obesity in children is the same for adults. The availability of the data is not a rule in the United States. The weight estimates are not available for states in the nation. The only accurate information is the nutrition surveillance program. The program tracks indicators of children enrolled in their hospital units. The data shows that the rate of obesity in children from 2-5 years of age rose by 41 percent (from 9.8 to 13.8% in 1995-2004). Many states lack children data for height and weight to measure their BMI. They rely on the self-reported Body Mass Index measurement of students in high school through the CDC Youth Risk Behavior Survey (Koplan, Liverman & Kraak, 2005). It is because of this lack of preparedness by the State to curb obesity, that one should not get obesity. Probably, the condition is worse in different States.
There is a remarkable growth rate of the number of children who are obese and overweight in the United States. The prevalence has grown four times among the adolescents and the children between 6-11years old. It has tripled for those between the 12-19 years of age. The data is from the 1971-1974 and 1999-2002 respectively (Miller, 2006).
Discussion
There is both direct and indirect cost of obesity. The direct expenses of this condition involve all the preventative measures undertaken. Others direct costs are diagnostic and treatment/management of obesity or those related to it. There is also huge indirect financial implication through morbidity and mortality. An example of indirect cost is productivity. The measure of productivity include losses due to workers being absent from work or reduction of productivity while being at work. There is as well premature mortality and morbidity.
Variation in the calculation of indirect and direct costs exists. It is evident that the costs of direct cost are less than the direct costs in most studies. The cost of health care rises with the increase in the weight and the loss of productivity. There is enough worldwide literature on the cost implications of obesity and its related disease. Nonetheless, the review and synthesis of these past research materials are strenuous as they are heterogeneous in terms of their sources of data, their approach in methodology, the quality of data and scope. In theory, the use of longitudinal data that comprise measured BMI, morbidity, utilization of health care, mortality and loss of productivity gives the best quality on the costs of obesity.
It is reasonable to imagine that there are ties between youth obesity and future adulthood weight-related diseases and costs. When compared to countries in the world, Americans spend the lion's share of their Gross National Product on health care. The proportion of money spent on the preventive programs is only a fifth of the GDP. Prevention of obesity would hugely reduce the expenditure on the chronic health diseases in total.
The prevalence rate of obesity is on an upward trend as time passes. This growth pulls the country's resources to deal with the menace. It is; therefore, wise to do the little things to stay obesity-free than getting into a pool of sick people who are ever increasing in large numbers.
Healthy behaviors avoid obesity. A healthy pattern of diet and regular physical activity prevents weight-related disorders. Prevention of excess weight gain goes a long way in prevention of obesity. The excess weight gain is avoidable through the striking balance of the calories that is consumed and that required the body. Consumption of diet that is free of fat or that has minimal fat with a combination of water helps prevent weight gain in obesity. Additional foods that prevent obesity are vegetables and small quantities of protein. These diets are in addition to fruits and whole grains recommended by the Dietary Guidelines for Americans as good behaviors in the prevention of obesity. It is not hard to create environments that are safe or those that prevent/discourage obesity. Community, childcare, and schools all play a role. Home healthcare and workplace all have an impact as they influence daily habits of people in terms of food consumption. If all these sectors collaborate, the nation can save huge amounts of money.
In weight loss, exercise plays a crucial role and has so many advantages. In prevention or treatment, the value is the same. There is no point to wait to incur all the costs of obesity and suffer all the diseases. Exercise increases the daily consumption of energy. It is also useful for maintenance of weight over a long term. Also, moderate to vigorous exercise leads to a reduction in energy expenditure at basal level (BEE) and preserves lean body mass. On the other hand, the use of exercise alone in the treatment helps a little. There is a need for combination with other forms of treatment. The use of exercise with a combination of diet causes more loss of weight when compared to exercise alone. Up to one hour of exercise combined with healthy eating has a positive impact in terms long-term maintenance of weight (Wadden & Berkowitz, 2016).
The greatest contributor to overweight and obesity in America are poor dietary habits combined with a lack of physical activity. If only people can change their habits, the figures will be too low. There will also be much savings from the costs of obesity.
Conclusion
Healthy eating has greater benefits than unhealthy food. The price people pay for unhealthy food has huge impacts. The cost is both direct and indirect. Obesity in itself is a killer disease with adverse physical and health outcomes. Together with its related diseases, there is the doubling of the consequences. Good dietary habit combined with moderate to vigorous exercise, not only prevents obesity but other chronic non-communicable diseases like cancer, stroke and heart diseases. It has economic, social, and physical impacts. Healthy eating is cheaper and helps one avoid all the above problems. There are no standards conventional measures of treatment of obesity. The treatments options available do more harm than good. The treatment has an emphasis on weight loss. It means the aim is the same both before one becomes obese and after. The difference is that the struggle to lose weight after obesity has more complication than in non-obese patients. There is a need for everyone to make it a habit of trying to eat healthy diet alongside engaging in physical activity. The practice is beneficial to everyone, whether their weight exceeds the normal range; they are underweight or have an appropriate weight-height scale (BMI). The simple changes in diet can have huge positive impact on the well-being of a person. The research on obesity and the determinants factors of indirect costs in many countries are varied and heterogeneous in terms of quality and scope. There is a need for further research especially in other states in America to find out the exact indirect and direct costs of obesity.
References
Bhattacharya, J. & Bundorf, M. (2009). The incidence of the healthcare costs of obesity. Journal of Health Economics, 28(3), 649-658. doi:10.1016/j.jhealeco.2009.02.009
Cawley, J. & Maclean, J. (2011). Unfit For Service: The Implications of Rising Obesity For Us Military Recruitment. Health Economics, 21(11), 1348- 1366. http://dx.doi.org/10.1002/hec.1794
Cawley, J., Rizzo, J., & Haas, K. (2007). Occupation-Specific Absenteeism Costs Associated With Obesity and Morbid Obesity. Journal of Occupational and Environmental Medicine, 49(12), 1317-1324. http://dx.doi.org/10.1097/jom.0b013e31815b56a0
Dee, A., Kearns, K., O'Neill, C., Sharp, L., Staines, A., & O'Dwyer, V. et al. (2014). The direct and indirect costs of both overweight and obesity: a systematic review. BMC Research Notes, 7(1), 242. doi:10.1186/1756-0500-7-242
Duffey, K., Gordon-Larsen, P., Steffen, L., Jacobs, D., & Popkin, B. (2009). Regular Consumption from Fast Food Establishments about Other Restaurants Is Differentially Associated with Metabolic Outcomes in Young Adults. Journal of Nutrition, 139(11), 2113-2118. http://dx.doi.org/10.3945/jn.109.109520
Finkelstein, E., Khavjou, O., Thompson, H., Trogdon, J., Pan, L., Sherry, B., & Dietz, W. (2012). Obesity and Severe Obesity Forecasts through 2030. American Journal of Preventive Medicine, 42(6), 563-570. http://dx.doi.org/10.1016/j.amepre.2011.10.026
Foster, G. (2006). Clinical Implications for the Treatment of Obesity. Obesity, 14(7S), S182-S185. doi:10.1038/oby.2006.303
Hu, F., Liu, Y., & Willett, W. (2011). Preventing chronic diseases by promoting healthy diet and lifestyle: public policy implications for China. Obesity Reviews, 12(7), 552-559. doi:10.1111/j.1467-789x.2011.00863.x
Hu, F. & Malik, V. (2010). Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemiologic evidence. Physiology & Behavior, 100(1), 47-54. http://dx.doi.org/10.1016/j.physbeh.2010.01.036
Koplan, J., Liverman, C., & Kraak, V. (2005). Preventing childhood obesity: Health in the balance: Executive summary. Journal of the American Dietetic Association, 105(1), 131-138. doi:10.1016/j.jada.2004.11.023
Ledoux, T., Hingle, M., & Baranowski, T. (2010). Relationship of fruit and vegetable intake with adiposity: a systematic review. Obesity Reviews, 12(5), e143-e150. http://dx.doi.org/10.1111/j.1467-789x.2010.00786.x
Malik, V., Popkin, B., Bray, G., Despres, J., Willett, W., & Hu, F. (2010). Sugar-sweetened Beverages, Risk of Metabolic Syndrome, and Type 2 Diabetes: A meta-analysis. Diabetes Care, 33(11), 2477-2483. http://dx.doi.org/10.2337/dc10-1079
Malik, V., Willett, W., & Hu, F. (2008). Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. American Journal of Clinical Nutrition, 89(1), 438-439. http://dx.doi.org/10.3945/ajcn.2008.26980
McGuire, S. (2012). Ervin RB, Kit BK, Carroll MD, Ogden CL. Consumption of added sugar among U.S. children and adolescents, 2005-2008. NCHS data brief no 87. Hyattsville, MD: National Center for Health Statistics. 2012. Advances in Nutrition: An International Review Journal, 3(4), 534-534. http://dx.doi.org/10.3945/an.112.002279
Miller, B. (2006). National Center for Health Statistics2006212 National Center for Health Statistics. Hyattsville, MD: Centers for Disease Control Last visited December 2005. Gratis URL: http://www.cdc.gov/nchs. Reference Reviews, 20(4), 42-43.
Mozaffarian, D., Hao, T., Rimm, E., Willett, W., & Hu, F. (2011). Changes in Diet and Lifestyle and Long-Term Weight Gain in Women and Men. New England Journal of Medicine, 364(25), 2392-2404. http://dx.doi.org/10.1056/nejmoa1014296
Pereira, M., Kartashov, A., Ebbeling, C., Van Horn, L., Slattery, M., Jacobs, D., & Ludwig, D. (2005). Fast-food habits, weight gain, and insulin resistance (the CARDIA study): 15- year prospective analysis. The Lancet, 365(9453), 36-42. http://dx.doi.org/10.1016/s0140-6736(04)17663-0
Reichert, A. Obesity, Weight Loss, and Employment Prospects – Evidence from a Randomized Trial. SSRN Electronic Journal. doi:10.2139/ssrn.2200378
Roberts, R., Deleger, S., Strawbridge, W., & Kaplan, G. (2003). Prospective association between obesity and depression: evidence from the Alameda County Study. International Journal of Obesity, 27(4), 514-521. http://dx.doi.org/10.1038/sj.ijo.0802204
Trogdon, J., Finkelstein, E., Hylands, T., Dellea, P., & Kamal-Bahl, S. (2008). Indirect costs of obesity: a review of the current literature. Obesity Reviews, 9(5), 489-500. http://dx.doi.org/10.1111/j.1467-789x.2008.00472.x
Vartanian, L., Schwartz, M., & Brownell, K. (2007). Effects of Soft Drink Consumption on Nutrition and Health: A Systematic Review and Meta-Analysis. American Journal of Public Health, 97(4), 667-675. http://dx.doi.org/10.2105/ajph.2005.083782
Wadden, T. & Berkowitz, R. (2016). Advancing the revolution in the behavioral treatment of obesity. Obesity, 24(10), 2029-2030. doi:10.1002/oby.21641
Wang, L., Chyen, D., Lee, S., & Lowry, R. (2008). The Association Between Body Mass Index in Adolescence and Obesity in Adulthood. Journal of Adolescent Health, 42(5), 512-518. http://dx.doi.org/10.1016/j.jadohealth.2007.10.010
Xia, Y., Kelton, C., Guo, J., Bian, B., & Heaton, P. (2015). Treatment of obesity: Pharmacotherapy trends in the United States from 1999 to 2010. Obesity, 23(8), 1721-1728. doi:10.1002/oby.21136
When determining a legal health record, different issues should be considered, including accreditation and CMS guidelines, as well as the specifics of the organization's operation, such as Healthcare Electronic Records (HER) options, State Laws, and IT systems, among others (McWay, 2016). Ideally, the legal health record is a subset of data that the organization's IT and HER systems capture and preserve. Furthermore, the definition of a regular health record may necessitate the participation of many people both inside and outside the organization. A legal health record provides a consistent information release, avoiding uncertainty and potential liabilities that may arise due to inconsistency. A permitted health record can be created either electronically or manually as an official document indicating the legal health services that have been provided to the patient (McWay, 2016). In most cases, a legal health record is a business record kept by healthcare organizations and can only be made available to a patient if a written request is made or the law obligates the care provider to give access to law enforcement agencies.
B: The "Montana Code Annotated 2014" section 41-1-402 (3) states that "a minor who has a child may give effective consent to health service for the child" (Montana Legislative Services, 2015). Therefore, under the law a minor may give valid consent for health services in a situation where she or he is a parent of a child that requires health services. The minor has the legal right to give consent for health services to be administered for the child. In the event that a healthcare organization fails to allow such a minor the right to consent for the provision of health services for her child, then it would be liable for criminal liability.
Criminal liability under HIPAA provisions are enforced by the U.S. Department of Health and Human Services Office for Civil Rights. In the event that a complaint is filed, investigations are conducted in addition to compliance reviews. These are done to determine whether the organization was in violation of legal provisions that provides for a minor to give consent for the provisions of health services to her child. The failure to comply with provisions provided for in the "Montana Code Annotated 2014" can result to civil and criminal penalties. In the event that the organization refuses to adequately resolve the problem, civil penalties are imposed.
C. The "Montana Code Annotated 2014" section 50-16-603x (2) that health care information may not be released except "when the health care information pertains to a person who has given written consent to the release and has specified the type of information to be released and the person or entity to whom it may be released" (Montana Legislative Services, 2015) The law protects the privacy of health information and any organizations that act in contravention of this provision may be liable for civil and criminal liability. A patient's information cannot be released to any entity without consent since it is subject to doctor-patient confidentiality agreement. Confidentiality is essentially safeguarding and protection of private information that is shared between the patient and healthcare provider.
In the event that the organization discloses confidential health information without the written consent by the patient directing the scope of information to be released to a designated person, then it may be liable to legal action. Under HIPAA provisions for civil penalties, an organization may be liable for civil penalties for acting in contravention to the Code and knowingly disclosing private and identifiable health information.
D. The "Montana Code Annotated 2014" Section 50-16-540 expressly states that the provision of health care information may be subject to a fee that does not exceed fifty cents for every page that is copied. An administrative fee that does not exceed $15 may be charged for search and processing of health care information. Section 50-16-541 (1) states that after a patient has submitted a written request for a copy of all or part of his/her health care information, the provider is required by law to "make the information available to the patient for examination, without charge, during regular business hours or provide a copy, if requested to the patient" (Montana Legislative Services, 2015). However, under section 50-16-542 (1), a health care provider may be compelled or obligated to refuse the request for the examination or copying of health care information. The circumstances that could warrant such a denial include if "knowledge of the healthcare information could reasonably be expected to cause danger to the life or safety of any individual" (Montana Legislative Services, 2015).
These provisions are in compliance with HIPAA rules on accessibility to healthcare information. According to HIPAA, health providers are expected to comply with a patient's right to examine and receive a copy of his or her health care information. In addition, the patient has the right to request corrections or amendments be made to the health records that are maintained by the healthcare provider. The patient should be given directions and guidelines on the use or sharing of personal health care information. The patient has the right to determine and give consent on how private health information is used by the service provider. For instance, a patient must give consent prior to his or her health information can be used for purposes such as marketing and research.
However, if the health care provider determines that by giving the patient access to health information it can result in harmful outcomes, then a patient may be denied the opportunity to examine or get a copy of such information. In addition, HIPAA rules indicate that third parties may gain access to an individual's health information. Though the privacy rule defines who can access, examine and copy a patient's information, there are those that may be granted express permission by the law to do so (U.S. Department of Health & Human Services, 2018). However, access to a patient's health information is only granted with the aim of protecting the patient. A health care provider can allow other professionals to examine and copy a patient's health information with the aim of coordinating the provision of care and treatment for the patient. A patient's information may be made accessible to family members or individuals that are directly responsible for covering healthcare costs for the patient (U.S. Department of Health & Human Services, 2018).
The patient has the right to deny or object to such individuals being given access to private medical information. In addition, the provider may be legally required to allow law enforcement agencies access to a patient's health information. These agencies may examine and make copies of the information especially where a criminal act is suspected such as unexplained gun shot wounds. The major similarity between the "Montana Code Annotated 2014" and HIPAA laws is that and individual's health information cannot be shared with a third party with the written consent of the patient. The only conditions that others can access private and confidential health information is when there is an express provision under the law (U.S. Department of Health & Human Services, 2018).
References
McWay, D. C. (2016). Legal and Ethical Aspects of Health Information Management. New York, NY: CENGAGE Learning.
Montana Legislative Services. (2015). Montana Code Annotated 2014. Retrieved from http://leg.mt.gov/bills/mca/41/1/41-1-402.htm
U.S. Department of Health & Human Services. (2018). Your Rights under HIPAA. Retrieved from https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/
The Food and Drug Administration is an agency of the Department of Health and Human Services regulating pharmaceuticals. The Food, Drugs, and Cosmetics (FD&C) Act and the Public Health Service Act define the agency's mission. The FDA's responsibilities and authority apply to all 50 states and the US territories and possessions. Furthermore, the FDA oversees a diverse range of products, including drugs, foods, biologics, cosmetics, veterinary products, tobacco products, and medical devices. Nonetheless, the regulatory agency's primary responsibility is to supervise the healthcare sector. The key responsibility of the agency is to oversee the safety as well as the effectiveness of the medical drugs that are marketed in the United States. FDA divides its roles and responsibilities into two phases, which are the premarket approval and the post-market approval. The agency has the role of reviewing the manufacturer's applications to market their medical drugs, devices in the country. This means that drugs cannot be vended in the United States devoid of the endorsement by the FDA. The continued regulation of the drug safety and efficiency continues with the proviso that the medical product is still on the market. This is done through tracking, supervision and the reporting of the studies, and effectiveness of the drugs and other medical products used by the public. Furthermore, the agency seeks to promote product integrity in the healthcare industry in addition to regulating the advertisement of the medical products and the regulation of tobacco use. Equally important is that the agency disseminates information regarding drug safety and effectiveness to the clinicians and the general public alike.
The Role of the FDA in the Healthcare Industry
The Food and Drug Administration (FDA) as an overseeing agency is operating within the U.S Department of Health and Human Services. The undertaking of the agency as specified in the Food, Drug, and Cosmetic (FD&C) Act is to endorse the well-being of the public by punctually and proficiently reviewing drugs, medical devices and biologics as well as enforcing apt measures in the promotion of regulated products in an opportune manner (Gulfo, Briggeman & Roberts, 2016). Besides, the FDA also implements other regulations, particularly Section 361 of the Public Health Service Act and other concomitant rules, many of which are not unswervingly connected to drugs and food. For the reason that the FDA regulates a wide variety of products, it is broken into the Office of the Commissioner and four other directorates which are Office of Food and Veterinary Medicine, Global Regulatory Operations and Policy, Medical Products and Tobacco and the Office of Operations. Whereas it's regulatory mandate covers all the 50 States, FDA's responsibilities extends to the District of Columbia and American Samoa among other U.S belongings and territories.
The FDA plays a crucial part in the protection of the public well-being as well as in the minimization of the risk involved in the distribution of ineffective and unsafe medicine in the United States (Spears, Francer & Turner, 2015). Conceivably, equally significant for the health industry is the concern for the medical specialists to be well acquainted regarding the convenience and hazards of the drugs they recommend. This means that the sharing of information is vital to health care delivery just as is the importance of the medical treatments and approval of medicines. This underlines the importance of the FDA as a regulatory body in the United States. Although the agency's scope is very wide, it is closely connected to those of other government agencies in a bid to oversee the safety of cosmetics, drugs, food, and medical devices among other health connected clinical products. Considering the agency is the controlling authority of about 25 percent of the country's economy, it is important to understand the roles and responsibilities of the Food and Drug Administration that fall under its regulatory framework in the healthcare industry.
Roles of the FDA
The quality, cost as well as access are three extents of the healthcare system that the FDA regulates. That is to say, the agency regulates medical products thereby impacting on these measures. Faris & Shuren (2017) notes that medical products account for a larger proportion of more than 15% of the health costs. FDA's evaluation of the products ensures their effectiveness as a major constituent of the health care quality. Besides the agency facilitates the availability of the medical products to consumers to enhance the access to the healthcare services. Still, in healthcare perspective, it is worth noting that the regulatory requirements of the agency upsurge the quality of medical products reaching the market. The regulatory agency may also raise the cost of the medical products or delay the access of the consumers to them. Put differently, the FDA has the power to influence the health care system through its direct regulation of the medical products.
The FDA works closely with other federal government agencies to facilitate a comprehensive management of the medical devices, counter cyber security threats, ensure continuous improvement of medical devices and incentivizes varying marketed and distributed medical devices to lessen their risks (Faris & Shuren, 2017). Medical devices are very critical in people's health worldwide. Starting with an everyday household like thermometers to multifaceted implantable like deep-brain stimulators, the public relies on the agency to facilitate the legal marketing of the medical devices and ensure they are safe and effective. The FDA ensures that the data provided by the medical device manufacturers reflects the risk profile of the devices. Moreover, the FDA recognizes that even though medical devices are becoming digitally interconnected and interoperable and can improve the care of patients and efficiencies in the health care system, they can as well be vulnerable to security breaches. For this reason, the FDA has the duty to encourage the medical device manufacturers to address the cyber security threats to ensure the safety of patients and better protect the public health. In addition, the agency continues to ensure the effectiveness and safety of all the medical devices at all the phases of the life cycle, in the face of potential cyber threats.
The Food and Drugs Administration has the duty to provide premarket approval for all medicinal devices, drugs and biological products that are to be marketed in the United States. The agency gathers evidence to ensure the safety together with the effectiveness of the medical supplies. The FDA's market pre approvals are designed to issue an initial permission decision. Besides, the premarket approvals rely on the type of the medical supplies since a majority of the processes are based on the evidence provided by the clinical trials.
Equally important is the need for post-market regulation. The FDA is also responsible for the safety and effectiveness of the medical products it regulates including food, once they are on the market. The agency facilitates this by tracking the products, inspecting them and through enforcement (Madden, 2009). Also, the agency has different enforcement authorities for diverse product types. For instance, the FDA has a compulsory recall authority for the infant formula and medical products which do not apply to the prescription of drugs and other foods. Therefore, the post market controls enforced by the FDA seek to modify the drug labels or even to withdraw drugs that have issues in their use in the marketplace. Also, it is worth noting that the role of the regulating globalized markets, inspection, and importation of medical products is the responsibility of the FDA. Matters related to the inspection and importation encompass a vital element to the post market-activities of the agency.
The FDA has the role of regulating the advertising of prescription drugs, which is one of its important function. Even though the Federal Trade Commission is obligated to oversee the advertising of nonprescription drugs, the FDA regulates the product labeling that the adverts the nonprescription drugs should reflect (Fang et al., 2016). The agency requires that television adverts be submitted for review before they can be disseminated. The decision on whether the advert can be aired depends on the review where the impact of the drug on particular population groups is considered. Such information concerns the information regarding the seriousness of the risks listed in the drug's labeling as well as the date that the drug was approved.
After the medical devices, drugs and other biologics have been approved, the FDA continues to monitor its safety. The agency requires the manufacturers of such products to report all serious and unexpected adverse reactions within a fortnight of becoming aware of the danger. They should also report the outcome of the medical research they conduct on its approved products. Consumers, patients, and health professionals can also report the adverse reaction to the agency through the FDA's MedWatch reporting system at any time (Day, 2009). Besides, the FDA has the duty to gather information concerning probable adverse reactions to the products that have been approved to be used in the United States. The agency has provided procedure upon which physicians and the consumers can express their concerns about drugs and adverse events.
While the safeguarding of medical product integrity was a significant charge of the FDA's forerunners, it remains to be a vital concern of the agency. Basically, the agency directs its expectations and stipulation that every manufacturer and stakeholder of the marketplace must meet (Spears, Francer & Turner, 2015). This allows the agency to oversee the manufacturer's facilities, transportation, and warehouse plan to make certain that safety and effectiveness of the products are prioritized. The tracking of product integrity is enforced by the chain-of-custody document provided by the FDA to record the movement of drugs from the manufacturing point through the supply chain to the final dispenser.
In due course, the FDA's undertaking is to offer clinicians in the medicinal market place with the access to effectual as well as safe drugs, medical devices, and biologics in not just efficient but prompt and well-timed manner. The healthcare marketplace, which entails physicians, patients, and buyers, operates to ascertain the finest products for every patient (Gulfo, Briggeman & Roberts, 2016). In particular, the agency has enforced restrictive policies with regard to new drugs in the medical marketplace in efforts to anticipate the medical results of the medical treatment. In addition, FDA has an explicit purpose of determining if a drug is satisfactorily effective by evaluating the drug's pharmacological effects on an illness in addition to anticipating its clinical utility. It is only after the FDA has permitted the use of medical drugs, devices, and biologics that the medical marketplace can adopt the best treatment from those approved. This means the agency is at the top of the funnel when it comes to ensuring the safety and effectiveness of medical products at the marketplace.
Concerning drugs, the FDA's role is a lot more complicated. In most instances, the agency requires that the manufacturers who strive to sell their drugs in the U.S. either over the counter or through prescription should substantiate the safety and effectiveness of the products. The prescription and over the counter drugs, which includes the generic drugs are controlled by one of the FDA's divisions called the Center for Drug Evaluation and Research (CDER). Besides, the division regulates more than just drugs, for instance, notable products include antiperspirants, toothpaste, sunscreen, and dandruff which are all considered drugs. The FDA approves drug manufacturers seeking to sell their new prescription drugs after they pass the test in various ways. The first phase includes the laboratory and animal test, which is then followed by the tests in humans to verify their safety and effectiveness if applied to treat or diagnose a disease. Witten, McFarland & Simek (2015) asserts that FDA physicians together with scientists determine whether the drug's benefits outweigh the known risks and whether it satisfies the quality standards for the approval to be issued. Recent moves by the agency to dispense its role has been a mandate to the pharmacists to dispense consumer guides with some drugs that overtly detail the risks of the medicines. The FDA provides such guides to comprehensively provide intricate information than the drug information sheets that were traditionally issued by the pharmacists.
Also, under FDA's watch is the regulation of the vaccines, blood as well as the biologics. They are controlled by the organization's evaluation and research division for biologics that seeks to protect and advance the public health (Gulfo, Briggeman & Roberts, 2016). This is fulfilled through ensuring the products are safe and effective in addition to being accessible to those in need of them. The FDA similarly affords the public with the information relating to vaccines, blood, and biologics to encourage the safety and proper usage of the products. The agency's trained scientists and medical personnel assesses vaccines by performing rigorous and far-reaching tests to control their effectiveness and safety. Moreover, every significant information is reviewed in a marketing application before the FDA can approve its use by the public.
Tobacco use has been recognized as one of the leading avertable cause of disease and death in the U.S. The Family Smoking Prevention and Tobacco Control Act gives FDA the power to control the manufacture, supply and the marketing of tobacco products with the aim of protecting the public health ("What does FDA regulate?", 2017). As recent as August 2016, the agency finalized a rule that seeks to regulate all tobacco products, which extends to products like the cigars, e-cigarettes and hookah and pipe tobacco as part of their role to improve public health. Prior to the enforcement of this policy by the agency, tobacco products found their way to the market without proper review of their ingredients, how they have manufactured as well as their potential dangers (Yancy, 2008). The agency requires that warnings be provided on the roll-own-tobacco, cigarette tobacco, and other tobacco products. Besides, the new FDA rule restricts access to tobacco products by those younger than 18 years and provides the foundation for the future policies relating to tobacco.
Into the bargain, the agency has the responsibility of demonstrating a greater awareness of the effects of nicotine to the public arena and the healthcare fraternity (Yancy, 2008). A part from protecting the kids and nonsmokers from secondhand smoke to lessen diseases and deaths related to tobacco, the FDA is aggressively tackling the issue of the addiction. The agency is obligated to ensure that it has proper scientific and regulatory foundation to effectively and efficiently ensure the safety of the general public. There is need to strike a fitting balance between regulating and encouraging the development of innovative tobacco products that could be less dangerous than cigarettes. Besides, the FDA is obligated to ensure it addresses the crucial public health issues such as the role of flavors in tobacco products. Above and beyond, the agency is committed to encouraging innovativeness that has the potential to impact positively on public health together with informed policies and efforts that would encourage smokers to quit, protect kids and nonsmokers from secondhand exposure to smoke.
Conclusion
The Food and Drugs Administration is the federal agency that is obligated to oversee the safety and effectiveness of medical drugs, devices, and biologics among other health-related products in the healthcare industry. Even though the agency's activities are authorized by the Federal Food, Drug, and Cosmetic Act, the FDA is correspondingly in charge of the implementation of provisions in other laws with the notable example of the Public Health Service Act. These two Acts gives the agency the authority to perform its roles in most human biologics. Given that the agency regulates many products, it is divided into five offices to perform agency-wide functions.
As mentioned above, the primary function of the FDA is to oversee the safety and effectiveness of medical drugs, devices, and biologics sold in the United States. Nonetheless, the agency divides its roles and responsibilities into two phases, which are the premarket approval and the post-market approval. The former ensures the agency certifies the drugs, medical devices or biologics before they are marketed to ensure they are safe and effective while the latter ensures the agency tracks and inspects the products to ensure consumers get safe and effective products as well. Other roles of the agency include the approval of drug manufacturers to sell new treatment drugs in the U.S. As a regulator, the FDA ensures that the manufacturers of medical devices provide information that reflects the risk profile of the device in addition to ensuring the devices work effectively and are safe for use by the public. Furthermore, the agency ensures that vaccines, blood, and biologics protect and advances public health by ensuring their effectiveness, safety, and availability when needed. Other roles include the regulation of the tobacco products, regulation of the advertising of prescription drugs as well as the maintenance of communication channels through which information relating to drug safety and effectiveness to clinicians, pharmacists, consumers and the general public is conveyed.
References
Day, P. (2009). The Food And Drug Administration Faces New Responsibilities. Nutrition Reviews, 18(1), 1-5. http://dx.doi.org/10.1111/j.1753-4887.1960.tb01621.x
Fang, H., Harris, S., Liu, Z., Zhou, G., Zhang, G., & Xu, J. et al. (2016). FDA drug labeling: rich resources to facilitate precision medicine, drug safety, and regulatory science. Drug Discovery Today, 21(10), 1566-1570. http://dx.doi.org/10.1016/j.drudis.2016.06.006
Faris, O., & Shuren, J. (2017). An FDA Viewpoint on Unique Considerations for Medical-Device Clinical Trials. New England Journal Of Medicine, 376(14), 1350-1357. http://dx.doi.org/10.1056/nejmra1512592
Gulfo, J., Briggeman, J., & Roberts, E. (2016). The Proper Role of the FDA for the 21st Century. Mercatus Research, Mercatus Center At George Mason University, 1-36.
Madden, B. (2009). A dual track system to give more-rapid access to new drugs: Applying a systems mindset to the US food and drug administration (FDA). Medical Hypotheses,72(2), 116-120. http://dx.doi.org/10.1016/j.mehy.2008.10.012
Spears, J., Francer, J., & Turner, N. (2015). Embracing 21st Century Information Sharing: Defining a New Paradigm for the Food and Drug Administration's Regulation of Biopharmaceutical Company Communications with Healthcare Professionals. Food And Drug Law Journal, 70(1), 143-160.
What does FDA regulate?. (2017). Fda.gov. Retrieved 3 August 2017, from https://www.fda.gov/aboutfda/transparency/basics/ucm194879.htm
Witten, C., McFarland, R., & Simek, S. (2015). Concise Review: The U.S. Food and Drug Administration and Regenerative Medicine. STEM CELLS Translational Medicine, 4(12), 1495-1499. http://dx.doi.org/10.5966/sctm.2015-0098
Yancy, C. (2008). The FDA and Tobacco Regulation. New England Journal Of Medicine, 359(21), 2294-2294. http://dx.doi.org/10.1056/nejmc08204