Obesity and Asthma
Obesity and asthma are serious medical, social and economic problems of modern society. The topicality of obesity is primarily determined by its high prevalence - 7% of the world’s population are obese (World Health Organization, 2014). According to Flegal (2002), in the United States, 65% - nearly 122.5 million - adult Americans are overweight and obese. In addition, the prevalence of both diseases in recent years has increased significantly, especially in children (Delgado, Barranco, & Quirce, 2008; Shore & Johnston, 2006). In accordance with CDC (2013) data, the prevalence of obesity in African Americans is 2-3 time higher than in any ethnicity and race. Such results have shown the need to use social, race and ethnicity categorization when studying the prevalence of both diseases. Nowadays, the link between asthma and obesity is not completely found (Beuther, Weiss, & Sutherland, 2006). However, it is known that, on the one hand, obesity, even in the absence of asthma, leads to physiological changes in pulmonary functions. It is noted that obese people spend more time within the premises, thereby increasing the chances of developing asthma due to a higher content of indoor allergens, such as dust and tobacco. On the other hand, the presence of asthma reduces the physical activity of the patient (CDC), 2013) and an increased appetite due to anti-asthmatic medication leads to a rise in body weight of the patient. Moreover, the frequency of hospitalizations of patients with obesity due to worsening of asthma over 1 year is 5 times higher compared to patients having normal body weight and the same degree of severity of asthma. The researchers found that the frequency of hospitalization directly depends on the severity of obesity (Delgado, Barranco, & Quirce, 2008). Therefore, modern scientific data confirms the direct link between obesity and asthma. Obesity is a risk factor for asthma, since mechanisms of obesity and asthma are interrelated and, as a rule, obesity is a cause of poor asthma control and it worsens the asthma condition by making asthma symptoms difficult to manage (Delgado, Barranco, & Quirce, 2008).
The Problem Severity
Asthma is a chronic inflammatory disease of the respiratory tract that is characterized by recurrent attacks of dyspnea - shortness of breath, choking due to convulsive spasm of bronchial smooth muscle. Despite the fact that there is a constant fight with the most causes of asthma, such as smoking, poor air quality, insecticides and other chemical substances, the symptoms of asthma are increasingly manifested in the USA. Nowadays, every twelfth citizen of the United States is an asthmatic. The situation is worse among children, where every tenth child has asthma or related respiratory tract diseases. America is home to 25.7 million people suffering from this incurable disease for life. Unfortunately, the number is constantly growing – approximately 7 million asthmatics was found in nine years, from 2001 to 2010, says CDC (2013) statistics illustrated in Figure 1.
Figure 1. Asthma Occurrence in the United States: 2001-2010 (Centers for Disease Control and Prevention, 2013)
The conducted research has also shown that asthma is growing very uneven. It also showed a direct dependence on race and social status. The most striking influx of asthmatics is reported among African American children. The research conducted during the same period showed that depending on various factors, asthma prevalence is distributed differently and African American are twice likely to have asthma that both American and Hispanic. The prevalence of asthma in identified terms is described in Figure 2.
Figure 2. Asthma Prevalence in terms of Age, Sex, Race & Ethnicity, Poverty Status and Geographic Region (CDC, 2013)
According to Vortmann (2008), 28-44% of patients with asthma have various degrees of obesity. Modern studies of the incidence of asthma in patients with different levels of the Body Mass Index (BMI) found a direct relationship between increasing the incidence of asthma with increasing BMI . At the same time, it was found that overweight and obese patients are 10% more likely to have asthma in comparison with the average population (CDC, 2010) as illustrated in Figure 3.
Figure 3. Percentage of Adults who are Obese (CDC, 2010)
Centers for Disease Control and Prevention statistics say that the prevalence of obesity among children and adolescents has almost doubled during the previous 30 years. Similarly to asthma, the problem also is directly connected to the race and social status. Thus, the data consolidated between 2011 and 2013 showed that African American had over 10% more prevalence of being obese than Whites and 7% more than Hispanic (CDC, 2013). It may be noted that teenage obesity should be at the center of attention. Nowadays, there is the great amount of public health, governmental and educational programs dealing with teenage obesity and related problems in the United States. For example, the Centers for Disease Control and Prevention have developed School Health Guidelines to Promote Healthy Eating and Physical Activity in order to improve the situation, simultaneously continuing to fund various other intervention programs.
Sociocultural Causes of Asthma and Obesity
Asthma and obesity prevalence, as it was shown above, is contributed to various social and cultural factors. Low socio-economic position and harmful environment, including tobacco smoke, dust, and toxic substances may cause allergic reactions and asthma. Environmental factors, such as sulfur dioxide, nitrogen oxide, ozone, low temperature, high humidity are also the factors that cause asthma in susceptible people and especially children. In addition, the researchers say that cultural position is not only a risk factor for asthma and obesity occurrence but also a factor influencing the disease flow and treatment. For example, Lieu, et al. (2002) claim that Hispanic parents tend not to provide medication and treatment for their asthmatic children. Low sociocultural status is in majority of cases a risk factor for the absence of the control over asthmatic conditions due to various reasons. In cultural groups that tend to use alternative medicine, the severity of asthmatic symptoms is usually higher (Delgado, Barranco, & Quirce, 2008). Mutual distrust between social and cultural minorities and medical authorities is the cause for decreasing medical care and medicine intake of asthma managing drugs (Lieu et al, 2002).
Intervention and Education Programs
The connection between asthma and obesity creates the necessity of both diseases treatment. There are two possible ways to manage asthma and obesity – to treat obesity and lose weight and to control the asthma symptoms by medication and a healthy lifestyle, which also would have an effect on BMI. Although asthma cannot be cured, the appropriate management can help take control of the disease and improve the overall quality of life. The most usual type of asthma management is medication for short-term disease administration. The frequency of medication intake depends on the severity of symptoms and the disease flow.
However, drugs are not the only measure to be taken in order to control asthma. It is also vital to avoid asthma reasons - stimulating effects, which cause irritation and inflammation of the airways (World Health Organization, 2014). Therefore, the researches show that education and intervention programs implementation are sufficient for asthma management and control since they provide the proper education and management programs that significantly reduce the hospitalization rates, relapse and the frequency of symptoms appearance. As it was already noted, CDC created the set of asthma and obesity control intervention programs. A study by the CDC and the guidelines provided by the National Asthma Education and Prevention Program (NAEPP) outline the fundamental components of asthma management (CDC, 2013). Thus, they include avoiding asthma cause, objective monitoring of symptoms and patient education (CDC, 2013). In addition, “Initiating Change: Creating an Asthma-Friendly School” approach developed by CDC can be used to help campaigners at school and district levels raise awareness in their communities about the significance of asthma-friendly environments. The approach and the 2003 edition of “Managing Asthma: A Guide for Schools” complement each other. The other evidence-based interventions highlighted by CDC (2013) include Manual-based Self-administered Asthma Intervention, Asthma Education Program, Asthma Nurse Education Program and Comprehensive Educational Program.
CDC’s consensus on the first and most important task of the program for the successful treatment of asthma involves education and patient education on various issues of asthma. The effectiveness of asthma treatment in children and adolescents is closely linked with the careful implementation of qualified medical advice by parents and school authorities. Lack parent’s and school’s awareness about the main etiological factors underlying the development and exacerbation of asthma, as well as the existing modern methods of treatment leads to the fact that many asthmatic children ignore the doctor’s prescription, stop treatment on their own or use non-specialized services. The main part of CDC Program is an education being an essential part of a comprehensive program for asthma treatment. Thus, the researchers proposed to implement specialized school-based education in order to improve treatment of asthma in children and control over their disease through education of both the parents and children. The described programs showed promising results. The introduction of such principles reduced the frequency of exacerbations of asthma in children and adolescents in 2.8 times (CDC, 2013). Implementation of CDC’s principles helps the asthmatics realize that they are not alone. They see that the doctors, experts, scientists and, what is most important, the community are eager to help them and they are all united by one desire to manage the severe symptoms of asthma and learn how to overcome the disease.
On the other hand, obesity can be managed through community health inhibition programs (CDC, 2013). Through the understanding of public health, contributory factors in obesity and asthma can aid in improving the health of the general public. Moreover, the geographic aspects of the case may be adapted to exemplify rural or urban underserved environments. CDC’s Division of Nutrition, Physical Activity, and Obesity (DNPAO) has developed environmental strategies and policies to make active living and healthy eating inexpensive and accessible to everyone. DNPAO emphasizes that nutrition is crucial for good health and vigorous growth. Furthermore, the agency asserts that proper nutrition aid in disease prevention. What is more, systematic physical activities develop fitness and progress in the general health of an individual? The DNPAO uses a public health approach for the propagation of the role of physical activity and nutrition in preventing and controlling chronic diseases. Generally, health education and program interventions should be based on strategies that facilitate the process of changing obesity-related behavior through good nutrition and a setting that promotes active living (Beuther, Weiss, & Sutherland, 2006; Shore & Johnston, 2006). Apparently, some of the programs designed to manage obesity include active transport to school (skating, walking and cycling to school) and school-based physical education designed to increase the activity level of physical education lessons. The intervention problem for obesity in children is that the issue of excess weight should be guided by criteria, such as age, height, weight, family history, living conditions, physical activity, diet, physiological characteristics and concomitant diseases of internal organs.
Health Belief Model
As it can be seen, the problem of obesity among the young American population, especially among African Americans, is a complex question and involves many factors. Therefore, it is essential to apply appropriate community health promotion models that explicitly support the intervention process. In obesity prevention and intervention plan, the Health Belief Model will be used. Health Belief Model (HBM) was firstly established in the 1950s. It is based on the fact that human willingness to seek help from a doctor or abandon the habit depends on two factors: the degree of the health risk awareness and the belief that certain behaviors will reduce the threat. HBM explains the reluctance of many young people to follow the rules of behavior that reduce the risk of dangerous illness or accident. They do not believe the threat is real, so do not want to change their behavior (Penhollow, 2012).
In the obesity and asthma treatment, HBM is the most common program for the promotion of the community health and education. The model notes that adaptation of required physical activity, healthy diet and overall healthy lifestyle would significantly reduce obesity and related severe diseases, such as asthma, sleep apnea, heart failure and digestion system diseases, which stimulates people to action (Penhollow, 2012). Unfortunately, so far, the majority of the population considers obesity being a cosmetic problem. Reducing weight is not a health promotion but the way to “fit” the common beauty standards. Here, IBM's aim is to explain to people that, in fact, obesity is a multifactorial chronic disease caused by various physical changes in the human body and, as a result, the weight gain. HBM uses four main perceptions in order to construct the new vision of the health: perceived importance, perceived susceptibility, perceived benefits and perceived barriers.
As perceived importance tool the medical knowledge and information on the severity of the disease are used. Medical statistics, Internet and doctor consults will enforce the belief an individual has about the difficulties of the illness; in this case – obesity leading to asthma (Penhollow, 2012). Due to the fact that HBM health promotion program will be used to reduce asthma prevalence among children and adolescents, asthma itself is to be used as personal perceived susceptibility tool. The notion of incurable disease, which is asthma, as a direct and frequent consequence of obesity will motivate people to adopt a healthy lifestyle, healthy diet and engage in physical activity (Abraham, Kazman, Zeno, & Deuster, 2012). Obviously, the direct danger of becoming incurably sick motivates and encourages people to prevent the obstacles of its appearance. Here, the notion of high probability is used, i.e. the higher risk factors are shown to the patients, the higher is the probability of engagement into prevention program and healthy lifestyle adoption (Penhollow, 2012). Perceived benefits, in this case, are the belief that the treatment of obesity will have positive results, such as a reduction of asthma development (Abraham, Kazman, Zeno, & Deuster, 2012). Finally, the perceived barriers factor is the admission to the gradual change in behavior and the overcoming the obstacles to transformation on the way to a new set of behaviors embracement (Penhollow, 2012). Here, the point is to perceive an individual that appreciation of the benefits for healthy lifestyle facilitates the barriers to lifestyle change.
The intervention plan in terms of HBM will focus on three categories: diet, physical activity, and energy balance; environmental and sociocultural factors of a diet and physical activities; finally, the third category would be focused on prophylactics, therapy, and application of clinical treatment (Wexler, 2013). Such focuses have to be utilized by social workers, psychologies, and physicians. The main thing about all three categories is education since educational tools are the most useful ones in intervention programs as it was shown in the example of CDC interventions implementation above. Subsequently, the implementation of all three focuses will create comprehensive, strong and multifold intervention strategy.
Implementation and Evaluation
It was found that a major role in the pathogenesis of obesity plays a dysfunction of the central nervous mechanisms - cerebral cortex and hypothalamus (hypothalamus) being the centers that regulate an appetite. Poor coordination between energy consumption and appetite determining the arrival of energetic material and the intensity of metabolic processes causes accumulation of fat (Dixon & Clerisme-Beauty, 2013). It was proved that diet with high content of vitamins, fiber and other biologically active ingredients (whole grains and cereals, fruits, vegetables, herbs, nuts, etc.) and limiting the use of digestible carbohydrates (sweets, sugar, cakes, bread and pasta flour grades), as well as physical exercise, especially cardio and aerobic ones, can both prevent and reduce obesity. Therefore, the health promotion intervention plan will focus on educating the target population on the need to avoid a sedentary lifestyle characterized by physical inactivity and proper eating habits.
Of all therapies and types of obesity treatment, physical activities are the most prevalent and long-term ones. In addition, its prevalence is determined by its ability to reduce the consequences of obesity, such as asthma, by enforcing and improving the overall physical condition of an individual. In fact, the lack of physical activity and sedentary lifestyle is the main cause of obesity occurrence in African Americans (Dixon & Clerisme-Beauty, 2013). The researches show that aerobic and cardiac physical activities are the most effective in prevention and treatment of respiratory tract related obesity consequences since they regulate the breathing rhythm and the amount of oxygen breathed in during the exercises (Wexler, 2013). Furthermore, the health intervention will promote moderate aerobic fitness, since it is connected with lowering of atherogenic lip and lipoproteins profile among the overweight population. Drug therapy can also be a useful tool in treating obesity and related problems. However, it should be taken into account that medication provides a short-term effect and is appropriate for individuals having a BMI? 30kg/m2 (Wexler, 2013). In addition, pharmacotherapy is very exhausting for the human body, since it provides a very fast and energy-consuming result (CDC, 2013). The results evaluation will be performed by means of a community health survey via self-administered question. The survey data will allow evaluating the program outcomes and obtaining an evident data for further program implementation.
The presented intervention plan is expected to reduce the prevalence of obesity and, as a result, asthma within the population. The program is expected to have a long-term and terminable result but does not tend to show a quick positive tendency. With some time, the amount of obese people within the population is expected to be reduced, and the shift in BMI towards the normal range is expected, as well. As a result, a decrease in obesity rates will also cause a decrease in asthma prevalence. In addition, besides the positive outcomes for the obesity problem, the program is expected to have the positive outcomes for the community health as a whole due to the healthy lifestyle promotion not only among the target population but also in common individuals. Therefore, the plan is effective enough to influence the much-required behavioral and lifestyle change for the good health of the community.
Obesity has become one of the most widespread and prevalent problems during the last two-three decades. Obesity is related to several other severe diseases, such as asthma. The research above shows that the correlation between asthma and obesity is direct and it exposes children and teenagers to future severe health problems. The investigated health promotion programs, implemented by CDC, show positive dynamics in the solution of the obesity problem. However, the need for more extensive and comprehensive intervention plans implementation is obvious due to the fact that despite CDC and National authorities’ efforts, the problem is still growing. The proposed HBM intervention for community health promotion is said to be a useful solution for obesity and related asthma problem among children and adolescents and promote a healthy lifestyle within all population.