肥胖问题(英文论文).doc

AbstractObesity has been tagged by the World Health Organisation (WHO) as the new crisisin public health because of increasing evidence that the condition easily leads to ahost of life-threatening diseases like arteriosclerosis, diabetes, cancer, asthma,arthritis, etc. An enormous amount of scientific research has been done on obesitybut there is as yet no consensus on what constitutes obesity, what are its exact causesand contributory factors, and how exactly does obesity deteriorate into seriousmedical cases. The only point of agreement seems to be that a determined andconcentrated effort needs to be undertaken to arrest the growing number of lives thathave been wasted by obesity, which also causes an enormous drain on a nationshealth service resources. For such an effort to be effective, however, everyoneinvolved should have a clear understanding of why it happens so that appropriatesteps can be taken. This dissertation set out to do just that: provide a clearer grasp ofthe causes of obesity and the extent to which the problem has degenerated to guidefuture activities designed to mitigate the prevalence of obesity.For the purpose of this paper, UK was made the focus of the study because ofincreasing concern that obesity has reached unwieldy proportions in this country,especially among children. In fact, childhood obesity is now the object of a PublicService Agreement that the British government usually reserves for problems withserious national repercussions.CONTENTS PAGE1. Introduction2. Rationale2.a. Aim2.b. Objectives3. Methodology4. Literature Review4.a. Obesity-related Diseases4.b. Public Heath Issue4.c. Obesity in UK4.d. PSA Target4.e. Prevention and Intervention5. Causes and Effects6. Influencing Factors6.a. Diet6.b. Nutrition6.c. Physical Activity6.d. Media advertising7. Findings & Analysis8. Conclusion & Recommendation9. Reference List1. IntroductionThe 2002 Health Survey for England made a disturbing declaration that over half ofthe UK population was overweight or obese. In the same year, the National Office ofStatistics (NOS) came up with a more detailed report, blowing up the problem bysaying that obesity was affecting children more than adults. The NOS revealed that22 percent of all boys and 28 percent of all girls in the 2-15 age bracket were eitheroverweight or obese. The study raised the same alarm by asserting that about 1million of all obese persons in UK were less than 16 years old, indicating a steady andrapid yearly increase in the prevalence rate for childhood obesity in the country. Thisis a cause for general concern because obesity in childhood tends to be irreversibleand obese adults are highly vulnerable to a range of ailments that include heartdisease, diabetes, arthritis and certain strains of cancer. Since the future of a nationlies in the hands of its children, what future awaits a nation with a disease-pronecitizenry?This upward trend in the prevalence rate of obesity started as early as the 1970s withthe release of a number of government studies, notably the 1974-94 National Study ofHealth and Growth and the 1995 Health Survey for England. Between 1984 and1994, the reports noted a doubling in the prevalence of obesity among Britishchildren, from 0.6 percent to 1.7 percent in boys and from 1.3 percent to 2.6 percentin girls. Among adults, the prevalence rate rose from 6 percent in 1980 to 17 percentin 1998 in men and from 8 percent to 21 percent in women. Obesity is determined bymeasuring a persons body mass index (BMI), or the body weight according to height,rate of growth, sex and age. Among boys, they are obese if 25 percent of body weighis fat, while it is 32 percent in girls. Based on the BMI measurement of the generalpopulation in the succeeding 10-year period (DoH, 2004; POST, 2003; RCP, 2003;Comptroller & Auditor General, 2006), there is a steady and worrisome increase inthe number of obese persons in UK. This calls for an organized and concentratedmulti-sector action, which requires a thorough and definitive study beforehand to seewhere to plug the holes in the public health system.2. RationaleAccording to the WHO (WHO, 2002) obesity may have assumed the proportions of aglobal epidemic but UK presents an interesting case for a country-specific studybecause it holds the distinction of being the country where the first obesity-relatedcase of type-2 diabetes was reported (NHS, 2002). This is an indication that obesityhas become a runaway problem in UK, which is supported by recent public healthbulletins expressing due alarm over the situation. It is necessary then that anattempt must be made to assess the overall picture so that it can be properlydetermined if an organised, resource-intensive and massive intermediation effort iswarranted, and what particular strategies are appropriate. This can only beaccomplished by examining the exact influences of diet, physical inactivity, nutritionand media on the supposed increase of obesity cases in UK; by seeking to determinethe magnitude and extent of the problem in the UK context; by underscoring thesocial and psychological factors that brought about and contributed to the situation;and by evaluating the effectiveness of the prevention and intermediation measuresthat have been tested for government adoption to mitigate the problem. A closeexamination of these factors may give stakeholders an idea of where to start attackingthe problem and where to concentrate the effort.2.a. AimThe principal aim of this dissertation is to determine how deleterious has been theeffects of media advertising and programming, physical activity and diet and nutritionon the overall health and fitness of the British population as regards to obesity. Inputting up these trends for closer inspection, the aim of the dissertation is to ascertainthe extent of their influence on public health so that they serve as basis for theremedial measures that should be undertaken.2.b. Objectives1) Give an accurate perspective on the influence of the modern environment onobesity, focusing on factors suspected as responsible for increasing thenumber of obese persons in UK, such as improper diet and nutrition, theemergence of a sedentary lifestyle and medias unwitting promotion of theseunhealthy habits.2) Investigate whether obesity has become so widespread a health problem as towarrant drastic measures and a concentration of government resource3) Identify the factors that contributed to the unwieldy increase of obese childrenand adults in UK.4) Evaluate the effectiveness of measures that have been undertaken to combatobesity and identify the measures that can be undertaken to reverse the upwardtrend in the prevalence of obesity in UK.3. Methodology3.a. Choice of Research DesignResearch for this paper has leaned heavily on the observation method, which used thequantitative approach to generate what is known as secondary research data. Thequantitative conduct of research was given preference over the qualitative approach,which employs the direct communication method, because of the universality andmulti-dimensional nature of obesity as a growing social and public health problem.The study also takes on the characteristics of both the descriptive and causal researchstrategies, which were useful in helping meet the varied requirements of this research.The main requirements included descriptive research of this condition as well as adiscussion of its causes. Descriptive research helps describes the history,characteristics and scope of the problem, while the causal research determines whichfactors or variables are causing a particular behaviour. We believe both methods areuseful to this paper as it focuses on the problem of childhood obesity and thebehaviour relating to the unhealthy eating habits of British children.In the direct communication method, research is conducted by face-to-face ortelephone interviews with the use of surveys and questionnaires. Its scope ofcoverage, however, is narrow and is carried out to reveal only specific data. Thereforethis method would be of little use to this study anyway. On the other hand with theobservation method used for this research, which was carried out with a wide varietyof tools to bear on an equally large range of study related to obesity, the researchpanned out to gather data from all possible sources which include books, tradejournals, websites, government studies, papers from seminars and other institutionalpublications, to give us the widest choice of perspective on the subject area. Sinceobesity is a multi-sided subject, a mass of information is required to make realisticcomparisons between theories and evolving concepts and therefore validate our theorythat the problem encompasses the whole range of human behaviour, food intake,eating patterns, physical exertions and media advertisement. Secondary dataaccording to Curwin (1996, p.46) can come from within or outside the organisation.External secondary data are those collected from research involving textbooks,journal articles and reports, while internal secondary data comes from organisationinitiatedsurveys, annual reports and service feedback. The overall advantage ofsecondary data in research is flexibility, since it is often information that an individualorganisation cannot collect on its own. By using the observation method of researchto collect secondary data from what others have written and expressed on obesity, thiswriter was able to pin down the theories and findings to fill in the gaps and makecomparisons on what has been done and what still needs to be done to address theproblem of obesity. The theories and findings include: girls are more prone to obesitythan boys; obesity is more prevalent in children than adults; obesity leads to lifethreatening diseases; and obesity is influenced by diet, nutrition, media and physicalactivity. As research developed with emphasis on secondary data collection, theresearcher also gained valuable insights and understanding of the problem by focusingattention on its broader implications. In a study that hews as close as possible to thedescriptive and causal type of research, the researcher can pinpoint the specifictechniques used in intervention and prevention programs and specify which of theseelements have a high or low efficiency ratings. It also allows the researcher todetermine which behaviours, habits and activities are contributing to both child andadult obesity.There is a more practical reason for choosing the observation method of research inthis project over the direct communication approach. Obesity is a condition that noone can be proud about, such that no person would ever relish being called fatso tohis/her face no matter how overweight he/she is. Experience confirms what theliterature suggests that obesity threatens ones pride and self-image, which often leadsto self-pity and depression, because society tends to exclude and discriminate againstoverweight persons. The 2000 poverty and social exclusion survey in UK, forexample, noted that overweight workers receive less income and occupy lower jobclassifications than average normal-weight persons, a clear case of discrimination atthe workplace. RCP (2003) found that obese women especially are often depressedwomen who lose interest in studies and are discriminated at work. For this reason, theprobability is high that a study employing the direct communication method ofresearch would give no useful insight because obese persons are expected to clam upif personally interviewed about their weight problem. The researcher believes this isthe most suitable research design and method for this paper to achieve its aim andobjectives.3.b. Construction of the MethodThe research method was constructed such that the reference materials selected forthis paper separately address the issues discussed in sections four and six, whichinclude the main factors, diet and nutrition, physical activity, media and advertising.One of the more important issues, for example, is whether the measurement for bodymass index is appropriate for both children and adults. The resource materials andassessment schematic of the research on the reliability of BMI are as follow:Epstein, et al. (2000) the authors claim that BMI is the universal standard forobesity measurement long accepted as accurate for both children and adults. Thiscontention is supported by both the authors use of primary research and outsidereferences dealing with the same subject, which reached an acceptable number of over50 works. The authors are psychologists by profession, which indicate that they haveno bias for the blanket acceptance of the BMI measurement since their main interest isthe relationship between behaviour and obesity. They used the primary researchmethod on obese persons seeking their professional service by measuring the patientsBMI and then employed the secondary research method by reviewing the works ofhealth professionals dealing with the subject of obesity.Royal College of Physicians (2003) the RCP research team suggests that the BMImeasurements may not be applicable to children because they grow faster duringpuberty. Therefore, the RCP calls for the development of a new measurement systemthat considers this basic difference between children and adults.BUPA (2004); Parliamentary Office of Science and Technology (2003); andComptroller and Auditor General (2006) these UK agencies agree that the BMImeasurements of UK children are enough indication that childhood obesity hasreached epidemic proportions in UK. No less than 30 references were used by each ofthose three agencies in supporting the argument that childhood obesity is a cause foralarm in UK. Also most of the references used by these agencies were based onexperiments and hypotheses made by dieticians, nutritionists and other experts onobesity.For the research linking obesity to such diseases as hypertension, diabetes, asthma andcancer, the sources used for this paper include those of the UK- based POST (2003),Social Issues Research Centre (2005) and Issue Briefs on-line. Separate works werealso scanned to establish the influence of diet and nutrition, physical activity, mediaand advertisement on childhood obesity. WHO (2003), Luce (2005) and McLaren(2006) found strong links between childhood obesity and unhealthy diet, mainly thehigh intake of energy-dense food, while BUPA (2004) and WHO (2003) believe thelack of nutritional value in childrens food intake worsens the problem. For thisreason, the above-named agencies suggest that the nutrition standards in all schools beexamined and that early breastfeeding must be encouraged based on studies thatbreastfed babies are less prone to obesity. The main references to support the claimthat lack of physical activity causes obesity were Issue Briefs (2006), DoH (2004) andRCP (2003). The influence of media and advertising is discussed persuasively byBredbenner (2002), McLaren (2006), POST (2003) and Luce (2005).All these experts and agencies present their views with the suitable clinical andempirical evidence, such that they may have influenced in to UK authorities intotaking childhood obesity as a serious health problem as to be eventually chosen as apublic service Agreement, which requires a concentration of efforts and resources.3.c. SampleTo help collect data on the larger perspective of obesity, data was gathered from non-UK studies that include those of James, et al. (2006); Steinbeck (undated); Luce(2005); Issue Briefs (2005); Epstein, et al. (2000); and WHO (2003) mainly to seehow other countries are coping with the same problem. These reports are useful tothis research in many ways. For example James, et al., (2006) set global strategies forpreventing childhood obesity, Steinbeck of the University of Australia suggestedtreatment for both childhood and adult obesity, Luce (2005) links the fast food culturewith childhood obesity, Issue Briefs of the US-based Henry J. Kaiser FamilyFoundation attaches importance to the role of media in childhood obesity, and theWHO (2003) report blames improper diet and nutrition as the cause of obesity thatleads to chronic diseases. An in-depth study of childrens responses to televisionadvertisements by Roedder (1981) was considered as another reference but eventuallyexcluded since there are enough materials on the same subject that are based on theUK context. Among these are BUPA (2004), Livingstone (2002), Bredbenner (2002),Lyness (2005), Mclaren (2006), Social Issues Research Centre (2005) and POST(2003), which are also more recent. Luce, for one argues persuasively that mediaadvertisements exert a great influence on UK childrens choice and POST (2003) putsa large part of the blame on advertisers for promoting food high in fat, sugar and saltcontent.Literature ReviewA literature review is an interpretation and synthesis of published research on aparticular field and should provide the reader with a statement of the major questionsand issues related to the field under study. On that note, this literature review ispreceded by a discussion of the questions and issues surrounding obesity, such as theapplicability to children of the BMI measurements for obesity. The first part of thereview emphasizes that inaccurate data sometimes come from research based onexaggeration and professional lapses, as may