Andrew Pescovitz, Kent Ford

Christine Delong, Cameron Potter, Gabby Bertone

KNH 213

Dr. Miller

29 September 2015

Literature Review

ABSTRACT

As we move further into the 21st century, this country faces a new epidemic in which we need to act upon immediately in order to better the health of ourselves, our children, and our nation as a whole. Obesity has now become one of the major contributors to chronic diseases such as heart disease, type 2 diabetes, asthma, osteoarthritis, and even certain cancers (The Ohio Obesity Prevention Plan, 2009).Obesity is defined as an individual having a BMI or body mass index of 30 or higher. In America as a whole, over one third of the adult population is obese which amounts to close to 78.6 million Americans who are classified as obese (Ogden et al., 2014). These current statistics are alarming and seem to be on a steady rise rather than the desired decline. In Ohio alone, over 65% of adults are now classified as overweight which is a BMI of 25 or greater and over 29% are classified as obese (Scott et al., 2010). As we narrow down our demographic even further to encompass the Butler County area of Ohio, the statistics are just as alarming. In only Butler County, over 25% of all adults are now classified as obese and close to 34% are classified as overweight (Healthy Ohio Community Profiles, 2008). This new epidemic is becoming more concerning every day as the cost of health care rises and the health of our nation and our states suffer. The estimated annual medical costs for obesity for the U.S. was almost 147$ Billion dollars as of 2008 and an individual who was obese can expect to pay close to 2,000$ more annually than an average person (Ogden et al., 2014). These costs to our wallets as well as our health are alarming and will only get larger if we do not act upon this issue as quickly as possible. With the cost of treatment of obesity so high for an individual, prevention is the only option to combat the rise of this new epidemic and turn the health of our county, state, and nation as a whole around. One area of focus in terms of prevention that is usually overlooked is students in college. These young adults are at a critical time in their lives where they are learning to live on their own and develop their own lifestyles so a prevention program that centers on college students has the possibility to have far outreaching effects on the obesity rates of adults as a whole. Recent research suggests that between a fourth and a third of all college students are obese (Furia et al., 2009). This is a population that has significant importance in terms of contribution towards the obesity epidemic of adults in this country which is why we feel that our program focus on college students will be an important aspect of our efforts as a nation to battle the rise in obesity.

FACTORS CONTRIBUTING TO OBESITY IN BUTLER COUNTY

It is becoming even more prevalent recently that dietary behaviors and a lack of physical activity are leading contributors to the obesity problem the state is facing. In 2010, only 29% of adults reported consuming the recommended amount of servings of fruit per day and only 24% of adults reported consuming vegetables at the recommended level of 3 or more times per day (Scott et al., 2010). Physical activity is also becoming an issue for adults to meet the recommended amount of time per week of moderate and vigorous physical activity. As of 2010, only 43% of adults in Ohio reported having achieved the recommended amount of either 300 minutes of moderate physical activity or 150 minutes of vigorous activity or a combination of both (Scott et al., 2010). With the prevalence of fast foods and quick, cheap processed foods in our society today, as well as the growing use of cars, elevators, and

sedentary jobs continue to make it difficult for adults to lead a healthy and active lifestyle, a well thought out and structured prevention plan is necessary to counteract these barriers that we face. This program must not only address the sedentary nature of our daily lifestyles in these times, but also address the various dietary behaviors that many Americans have adopted due to the nature of our lifestyles. Eating a healthy diet and having an active lifestyle can be difficult for many adults and even more so with college students. The demand for academic performance, pressures from friends to participate in unhealthy behaviors and the cost of food can be major barriers to most college students attempting to adopt healthy behaviors that will stick with them for the rest of their lives.

OBESITY CENTERED INTERVENTION PROGRAMS

Many different programs have been used to try and measure the effects of an obesity intervention on the population. Some of these programs have had success and some of them have not. However in order to come up with a framework for a superior program that can be successful, we must review these past programs and pull out useful information to properly structure our program. There are a few key aspects to point out that a handful of particular studies did to incorporate dietary and physical activity programs for college students. Some of the programs discuss ways to counteract the “Freshman 15” and specifically discuss alcohol consumption in undergraduate students. Others focus on specific dietary habits of college students such as snacking, fasting, and grazing. Recent research suggests that “for most people wanting to prevent progressive weight gain, certain dietary behaviors need to be addressed first” (Avery, 2012). Other successful aspects of recent studies use physical activity requirements to introduce behavior change in college students. A study was performed to evaluate the efficacy of assigning a PAP or physical activity passport to students to see if this motivated them to exercise outside of class. The PAP was also incorporated into the curriculum of the students and was evaluated at the end of the semester and affected the student’s final grades. The study found that those who participated in the PAP attended four times as many fitness classes than those who did not (McDaniel et al., 2014). Another important study attempted to utilize online courses for students to educate them on dietary and physical activity behaviors. The college made the class mandatory for every major at the college and the class met twice a week for 8 weeks. The goal was to educate as many students as they could by implementing the mandatory online course and the class designers felt that “it is generally accepted that the best time to intervene in one’s life is during childhood or early adulthood” (McFarlen, Jackson, 2008.) Another study that used internet based courses had good success with students in terms of dietary behaviors. Each student who was enrolled in the course was required to participate in the study for 12 weeks and the study was compared to an on campus course that was offered to students at the same time. The results of the study showed that the online course was more effective than the on campus course in dietary behavior change (LaChausse, 2012.) The online course costs very little and with the prevalence of online activity for students at this time, the online course proved to be more effective at behavior change and cost effectiveness. However the study did find that the course made little to no change in physical activity in the students. Another interesting study done was focused on mobile approaches to weight loss in students. The researchers developed a SMART program which stands for Social Mobile Approaches to Reduce Weight. This program was designed to target specific behaviors that may increase the likelihood of weight loss in college students. The study was done over 2 years with

students participating 5 times per week. The results showed that the variable that the researchers were able to improve upon the most was self- monitoring of weight through the mobile program (Kolodziejczyk et al., 2014). Another important part of college life is the dining hall. One particular study attempted to address the issue of portion sizes in the dining hall at a college. The article analyzes students chosen portion sizes for different food groups versus their recommended portion sizes according to their BMI. Some interesting finding of the study showed that students chose significantly larger portions of high carbohydrate foods than that of higher fat foods and that the selected portion sizes could be predicted based on the individuals current BMI (Burger et al., 2007). This is important because when students go to the dining hall they are given free rein on how much food they would like to eat as opposed to ordering specific portions at a restaurant or even cooking food for themselves. Another important study involving college students was done in a Hispanic college sample. The study was designed to evaluate the effect of education and physical activity course focused on college students of a Hispanic back ground. The study found that the students dietary behaviors prior to taking the courses were quite poor compared to national recommendations but the courses did have an impact on the students which did report positive weight loss in the students (D, 2011). Another interesting study that was done recently was one that focused on incorporating a wellness and walking program in students, faculty, and staff of a college campus. The study developed wellness courses for the students, faculty, and staff to attend as well as various ways to incorporate more walking into the participants lives. The study had good success with its program with almost every participant having measurable weight loss as well as an increased knowledge of healthy dietary behaviors following the study (Haines, 2010). The importance of group activity and teaching is clear as a key to success in most of these studies. People tend to have more success in weight loss programs that involve other people or are performed on a community level. One study that was not focuses on college students but used a community based approach towards young adults of an African American community showed great promise. The study was done over a 12 week period with various classes and physical activity events for the adults to participate in. The participant’s weight was monitored throughout the study and at the end of the twelve week program, the participants were weighed one final time, and given a survey of questions to determine whether they had truly learned anything from the program. 90% of the participants were reported to have lost significant weight and the surveys given at the end of the program showed that the individuals had in fact retained the knowledge they were taught in regards to a healthy lifestyle for the future (Treadwell, 2010). Finally, in 2014, a group of researchers attempted to compile data from numerous different weight loss studies to determine which of the aspects of the programs were most effective at producing measurable weight loss results in participants. The review found that the programs that not only incorporated mandatory education classes as well as offered incentive for participation in physical activity had the most profound effect on the participant's weight loss results (Peirson, 2014).

CONCLUSION

After reviewing the literature, it becomes more and more apparent that designing an intervention program that has a multifaceted approach encompassing dietary behavior education, as well as physical activity education produces effective results in reducing weight in individuals who are

overweight or obese. As we move further into the future as a nation the epidemic of obesity will not just go away with time. This is a serious health issue that is plaguing our nation that needs to be addressed as soon as possible for us to have a chance to defeat it once and for all. Early adulthood is an extremely challenging time for most people introducing various new life challenges to young adults that already have enough on their plate. It is time that we make the challenge of creating healthy behaviors that last a lifetime just as important as getting your degree, or getting that dream job. Obesity is a serious problem in this country and teaching young college students the necessary knowledge to prevent this epidemic will be key in our fight as a nation to end obesity. We feel that a program designed around interactive dietary education courses and group physical activity classes will have a profound effect on Butler County college students that can not only last a lifetime for them, but for the future students of our nation as well.

REFERENCES

Avery, A. (2012). Managing Obesity in Young Adults. Practicing Nursing. 23(6), 291-294.

Burger, K., Kern, M., & Coleman, K. (2007). Characteristics of self-selected portion size in young adults. Journal of the American Dietetic Association, 107(4), 611-618.

D, H. (2011, December 1). Multiple Health Behaviors: Patterns and correlates of diet and exercise in a Hispanic college sample.

Furia, A., Lee, R., Strother, M., &Huang, T. (2009). College students’ motivation to achieve and maintain a healthy weight. American Journal of Health Behavior, 33(3), 256-263.

Gokee LaRose, J., Gorin, A., Clarke, M., & Wing, R. (2011). Beliefs about weight gain among young adults: potential challenges to prevention. Obesity (Silver Spring M.D.), 19(9), 1901-1904.

Haines, D. (2010) A pilot intervention to promote walking and wellness and improve the health of college faculty, students, and staff.

Kolodziejczyk, J. K., Norman, G. J., Rock, C. L., Arredondo E. M., Madanat H., Roesch, S. C., & Patrick, K. (2014). Strategies that predict weight loss among overweight/obese young adults. American Journal of Health Behavior, 38(6), 871-880.

LaChausse, R. G. (2012). My Student Body: Effects of an internet-based prevention program to decrease obesity among college students. Journal of American College Health, 60(4), 324-330.

McDaniel, T., Melton, B. F., & Langdon, J. (2014). Promoting physical activity through student life and academics. Health Education Journal, 73(2), 237-244.

McFarlin, B., & Jackson, A. (2008) Development of an online university-based physical activity and obesity education program. Diabetes Educator, 34(5), 766-772-4 passim.

Ogden, L. C., Carroll, M., Kit, B., & Flegal, K. (2014). Prevalence of Childhood and Adults Obesity in the United States, 2011-2012. Journal of American Medical Association, 311(8), 806-814.

Peirson, L. (2014). Prevention of overweight and obesity in adult population: A systemic review. Canadian Medical Association Journal.

The Ohio Obesity Prevention Plan. (2009)

Scott, K. (2010). Ohio State Nutrition, Physical Activity, and Obesity Profile.

Treadwell, H. (2010, September 1.) Addressing Obesity and diabetes among African American men: Examination of a community based model of prevention.