Description of A Community Health Problem and its Evidence-Based Solution

Introduction

The evidence-based resource chosen for this assignment is titled "An Evidence-based Guide for Obesity Treatment in Primary Care" authored by Fitzpatrick et al. (2016). The community health problem that is addressed in Fitzpatrick et al.'s (2016) article is obesity. Fitzpatrick et al. (2016) noted that more than two-thirds of United States adults are either overweight or obese. Additionally, the researchers noted that the need to combat obesity is linked to its adverse health impacts. Individuals with obesity are highly likely to develop cancer, type 2 diabetes, and cardiovascular diseases.

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Fitzpatrick et al. (2016) further emphasized that intensive behavioral therapy for obesity has been linked to decreased weight of up to 10% accompanied by reduced risk of developing cardiovascular disease and diabetes. Other benefits attributed to reduced weight in obese people include improved blood pressure, lipids, and diabetes control. Because of the adverse health effects associated with obesity, leading US bodies tasked with public health (e.g., the American Heart Association) have recommended for screening of patients for overweight and obesity by physicians in their practices and provision of intensive behavioral counseling to individuals with high risk for cardiovascular disease.

Despite the recommendation, Fitzpatrick et al. (2016) noted that screening and counselling of patients with diabetes are very low (30%). Because of this, Fitzpatrick et al. (2016) developed an evidence-based guide for the treatment of obesity in primary care. The evidence-based solution to obesity described in the article (behaviour-change counseling model) is known as 5As model (Assess, Advise, Agree, Assist, and Arrange)- a treatment algorithm (Fitzpatrick et al., 2016). In the 5As framework, the term "Assess" refers to the act of screening (by a medical assistant or nurse) an individual for obesity, obesity-related factors that may deter weight loss, and the patient's readiness to undergo health behavior changes. In the "Assess" step, the healthcare professional should not use a language that stigmatizes or shames the patient (Baer, 2017; Sherson, Yakes Jimenez, & Katalanos, 2014). The patient's body mass index (BMI) and waist circumference are also assessed in the "Assess" step. Other factors associated with obesity that are assessed include readiness to change and patient attributes and comorbidities linked to poor weight loss outcomes.

The second step of the 5As is known as the 'Advise" step and involves counselling the affected individual about the health risks linked to his or her current weight status and the health benefits attributable to modest weight loss (Obesity Canada, 2019). The third step, known as "Agree," involves setting appropriate behavioral change goals required to reduce weight, such as dietary and exercise goals. Next, the "Assist" step involves the identification of barriers the patient is experiencing in meeting his other behavioral goals and designing a plan with well-outlined strategies to overcome these barriers. The last step, known as "Arrange," involves assessment of the patient's progress towards the accomplishment of the behavioral goals (Fitzpatrick et al., 2016).

Explanation of How Successfully the Evidence-Based Solution Can Be Generalized to A Larger Population

The 5As evidence-based solution to the problem of obesity through weight reduction strategies can be generalized into a larger population by training healthcare professionals in the community on ways in which they can incorporate the 5As in the identification of the patients with risk of obesity and in helping them achieve weight reduction. At the community level, nurses and medical assistants could help to address the issue of obesity through the use of 5As. Additionally, physicians are useful in the implementation of the 5As because of their training in the medical field. Because healthcare professionals are found in all the communities, they can help in providing intensive behavioral counselling (5As) to affected community members who visit the hospitals.

Additionally, the healthcare professionals can partner with community health educators and community health workers to ensure that that the affected members are aware of the presence of 5As behavioral intervention in their local hospitals. The community health educators and community health workers can also be trained to implement some of the aspects of the 5As, especially those associated with the "Agree" step. Examples include compilation and distribution of inexpensive community resources for physical activity. Physical activity is a crucial component of weight reduction (Cox, 2017; (Daniels, Hassink, & Committee on Nutrition, 2015; Swift et al., 2018).

Limitation Associated with The Evidence-Based Solution with Several Communities or Other Populations

Despite the importance of the 5As evidence-based solution in weight reduction and reversal of obesity, there are limitations that could potentially affect its implementation with several communities. One of these limitations is the shortage of healthcare professionals (Haddad & Toney-Butler, 2019; Miseda, Were, Murianki, Mutuku, & Mutwiwa, 2017; Snavely, 2016). Consequently, healthcare professionals are likely to be time-constrained because of the many health issues they address in their daily practice. Some of these issues may require urgent and pressing attention than weight. Another challenge that could affect the implementation of 5As in several communities is the cost factors. It is an expensive venture to train all healthcare professionals on the use of 5As behavioral intervention in the treatment of obesity.

References

Baer, J. (2017). Losing weight with five a's (5 A's): Assess, advise, agree, assist, arrange framework and motivational interviewing (Mi) for health behavior change counseling. Theses and Dissertations. Retrieved from https://scholarcommons.sc.edu/etd/4008

Cox, C. E. (2017). Role of physical activity for weight loss and weight maintenance. Diabetes Spectrum, 30(3), 157-160. https://doi.org/10.2337/ds17-0013

Daniels, S. R., Hassink, S. G., & Committee on Nutrition. (2015). The role of the pediatrician in primary prevention of obesity. Pediatrics, 136(1), e275-e292. https://doi.org/10.1542/peds.2015-1558

Fitzpatrick, S. L., Wischenka, D., Appelhans, B. M., Pbert, L., Wang, M., Wilson, D. K., & Pagoto, S. L. (2016). An evidence-based guide for obesity treatment in primary care. The American Journal of Medicine, 129(1), 115.e1-115.e7. https://doi.org/10.1016/j.amjmed.2015.07.015

Haddad, L. M., & Toney-Butler, T. J. (2019). Nursing shortage. In StatPearls. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK493175/

Miseda, M. H., Were, S. O., Murianki, C. A., Mutuku, M. P., & Mutwiwa, S. N. (2017). The implication of the shortage of health workforce specialist on universal health coverage in Kenya. Human Resources for Health, 15(1), 80. https://doi.org/10.1186/s12960-017-0253-9

Obesity Canada. (2019). 5as. Retrieved from https://obesitycanada.ca/resources/5as/

Sherson, E. A., Yakes Jimenez, E., & Katalanos, N. (2014). A review of the use of the 5 A's model for weight loss counselling: Differences between physician practice and patient demand. Family Practice, 31(4), 389-398. https://doi.org/10.1093/fampra/cmu020

Snavely, T. M. (2016, March 1). A brief economic analysis of the looming nursing shortage in the United States. Retrieved October 20, 2019, from Nursing Economics website: https://link.galegroup.com/apps/doc/A452050018/AONE?sid=lms

Swift, D. L., McGee, J. E., Earnest, C. P., Carlisle, E., Nygard, M., & Johannsen, N. M. (2018). The effects of exercise and physical activity on weight loss and maintenance. Progress in Cardiovascular Diseases, 61(2), 206-213. https://doi.org/10.1016/j.pcad.2018.07.014