Exploring Determinants of Weight Management in Tower Hamlets

1. Executive Summary

A lack of financial security, social status, and personal relationship development is highly associated with weight management. The usage of Dahlgreen and whitehead as an analytical tool might encourage the determinants of health and well-being for managing health issues. Social isolation, unemployment, and sedentary lifestyles encourage health-related issues while loss of self-esteem is observed to be affecting the regular dietary needs of a person. Poverty and ethnicity are two major factors that affect a large number of people residing inside the city. Tower of Hamlets consists of relatively lower-income groups which lead towards health-damaging behaviors and poor diet within the average local community. An activity that relates to healthcare efficiency encourages people to consume healthy foods as compared to unhealthy food. In this assignment some intense research is presented on the increase and management of obesity in Tower of Hamlets. This research is significant in terms of presenting real time data and providing solutions to the issue.

2. Introduction

This report will be exploring social determinants of obesity. The obesity components are associated with a core area such as Tower Hamlet city in London. The report will examine components of obesity which is a contemporary issue in healthcare. "Public Health England's latest figures in 2019/20 show that Tower Hamlets has the seventh-highest proportion of childhood obesity out of all London boroughs at 2%." Obesity is becoming a growing concern for both children and adults in London. Local health inequalities are addressed in this report while strategies are identified for evaluating the availability of local health determinants. This report will identify several factors which are associated with economic status and social health differentiation. People's health differences are required to be managed and opportunities should be incorporated within living a healthy lifestyle (Atkins, and Wannamathee, 2020).

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Mostly the children are found to be obese and they are having excessive fat accumulation which is considered to be unhealthy. An obese has maximum chances of developing diabetes. In the city of consideration Tower Hamlet, there are nearly 1 in 7 children found to be obese. 10 to 11 years olds in London are in deep threat of social discrimination (Blackburn, and Stathi, 2019). Not every person is having an equal opportunity to grow economically. The GP practice shows a low BMI approximately lower than 30kg/m2 in average people. Unemployment and lack of food are part of the country. Hence, living in poverty and eating junk could be in association with abnormal and excessive fat accumulation. At the end of yearly calculations of the growth of the disease, the city has found out a position of fifth for highest proportion in 10 to 11-year-olds. Moreover, technology improvement has left a massive impact on the people buying and ordering food from different food joints. It has also allowed people to pick up grocery material using a drone. It has brought a tremendous change in the way of living for the people and profit is gained by the food joint owners. Eating junk food has caused an increase in obesity by about 5 percent (Brecher, and Fuerst, 2017).

School children are getting fast food within 160m of a school and an increase in unhealthy eating is also observed. Overcrowded homes and experiencing poverty at their peak is one of the major social health determinants of the health aspects. A physical health problem and 86% of the mental health difficulties are fueled by an increase in health inequalities. Social network analysis offers an analysis of health determinants to its core. Cost-effective ways are required to be found out for assessing health inequalities (Busetto et al. 2018). The responsibility of country members is associated with the management of psychological hazards and harmful behaviors. Developing and engagement of strategies to pursue health and wealth development has become immensely important within the lifestyles of people. Health and wellbeing components encourage fast walking, jogging, swimming for 120 minutes to 250 minutes per week identified as important aspects of becoming fit. Healthcare professionals have listed several items that are applicable in monitoring health and these will be discussed in this research.

Health inequalities

2.1 Definition of health inequalities

According to Kings Fund, 2000 Health inequalities are identified to be a key variant that commonly refers to the differences of care which people receive and contribute to their health status. Opportunities are gained for leading a healthy life within unfair and unjust situations (Flodgren et al. 2020). A neighborhood type explains how likely a person will become obese since neighboring activities also influence a person to live up a good life. While a standard BMI over 25 is considered to be overweight, there is an over 30 rate observed for the obese components. It is also observed that 27.3% of children in Tower Hamlets were in relatively low-income families in 2018/19 are becoming prey of the obesity threat.

Definition of health

Graham and Kelly, 2004, have explained that health inequities refers to those that are perceived to be unfair and unjust differences.

2.2 Definition of the issue in concern: obesity

Obesity is identified as an issue of concern as London has the largest population where any number of children and adults are suffering from it. Statistics show that "more than 1 in 5 children (20.8%) in Reception are overweight or obese in the borough”. Hobbs, M. 2017, gives an idea on the types of neighborhood that lives an impact on being obese. Living an unhealthy, inactive, and sedentary lifestyle with the partnership of junk food delivery apps is leading towards being overweight and becoming obese. “The most recent data (2020/21) shows that rates are improving and are now slightly lower than London (21.8%) for the first time (Kyle et al. 2017)". Children's health and wellbeing are important these days since managing obesity has become the topmost priority of the local council.

Definition of the issue in concern

2.3 Literature review to healthcare management

Trust for London, 2021, has shown how Tower of Hamlets has secured seventh highest proportion of childhood obesity. Healthcare management is highly focused in Tower of Hamlets and above 5% of the total medical budget is used for the development of obesity threats in this particular region. “11.1% of Year 6 children in Richmond upon Thames are obese in 2019/20 with just a 0.1 percentage point increase compared to a decade ago”. Friant-Perrot, M. and Gokani, N., 2020, despite progress of healthcare management, a clean and green neighborhood for feeling healthier is important for managing obesity.

Obesity is identified to be doubling the health and health-related issues of becoming premature and risking type 2 diabetes, coronary heart disease, and cancers. Bambra, 2016, An approximate of 13.3 million in medication costs and 352 million in social cost has been included in the improvement of healthcare. It is important to manage obesity since the disease improves the risk of dying in a premature condition. Increasing the child's risk of developing immense health conditions, including coronary heart disease, cancers, and type 2 diabetes (Panca et al. 2018). Obesity is found to be a major reason for unhealthy childhood and bullying in schools.

Addressing health inequalities in Tower of Hamlets

Tower Hamlets Health and Wellbeing Board, n.d. Health inequalities are caused due to unequal employment opportunities within the city and not gaining almost low-cost eating and physical inactiveness. The Health and Wellbeing Strategy has children's weight and nutrition as one of its five priorities, with the Mayor and Young Mayor also highlighting it as a priority." However, most people do not have ideas on this and fall prey to the corruptive systems, and remain unhealthy.

3.0 Identification of local health determinant and their intermediate relationships for contribution to the health issue

Unemployment

Norström, F et al, 2014 explains that being unemployed can be bad for health since it is leaving a negative impact on a range of health outcomes, through self-rated health management. Bartley, M., 1994 has outlines four mechanisms which might affect health and lower self-esteem. The borough profile which has a consistent count rate of obesity to become the highest in May 2020 rising above 19000 for a rate increase higher than London and Great Britain. “The borough has followed the national and regional trend where people are out of work, do not seek for work or out of work”.

Low income or poverty

Public Health England, 2017 gives evidence on the child poverty has become an important issue for public health whilst the childhood poverty leads to premature mortality and poor health outcomes for adults. Low income families are more likely to become overweight due to lack of exact nutrition with fruits and food that are rich in fibre. Marmot Review (2010), gives an idea of mortality rates. Buying whole grains and nutrient dense food is specially categorized within high income group which gradually is being mitigated. Carlota, Q., and Joana, Oliveira 2017, gives a highlight on obesity probability to be developed. According to Ipatenco, S, 2018, cost of eating healthy is observed to be more than the junk food items and higher prevalence of health damaging behavior along with consumption of alcohol can cause obesity.

Tower of Hamlet council, 2000 shows how 44% of the older people living inside the borough where people are having a low income and deprived of their good health in Britain. Highest rates of low income families are observed to be increased in London where exposure to higher health damage has been observed. Hopps kat, 2020 shows that the number of takeaways In Tower of Hamlets is quite higher which it is due to technological improvement that makes easier to order food. According to the data provided by CEDAR 1.56 takeaways per 1000 people and the number is rising as well. According to Borwick, V., and Pencharz, M. 2013, have observed that the increased density of fast food restaurants are related with BMI as increase in the intake of fast food is occurring quite often.

Housing

Tower Hamlet Council, 2020 explains that homelessness becomes a great issues health determination. Public Health England, 2017, has highly activated the inequality of health and social care services, depression and anxiety. Overcrowded homes to fuel poverty and ethnic groups are more likely to associate to the social determinant of health. Black minority ethnic household accounts for the 78% of housing register. Tower Hamlet Council 2020, has been identified as 7ath highest waiting list nationally where 18808 household are located in the waiting list. As mentioned in Kings Fund, 2000, the poor quality and overcrowded housing conditions are associated with increased risks of cardio vascular disease, respiratory diseases and anxiety.

Social and community networks

“The Chartered Society of Physiotherapy (CSP), 2017, says, obese individuals often have complex bio-psychosocial barriers to physical activity participation”. Tower Hamlets Health and Wellbeing Board, n.d. In Tower Hamlets, rrelationship between the inequalities affecting health are differentiated between social classes. Material explanations are blamed upon poverty, poor housing conditions, and lack of resources in health and lower social classes. The income gap and gender inequality are rising while it comes to the access to healthcare components at its core. Some irreversible components encourage the distribution of goods and burdening of social standards.

Schaefer, D. R., and Simpkins, S.D., 2014 explains that social determinants of health are essential to be discussed since “countries with less social inequality have higher levels of economic performance and human development, and stronger political institutions.” Gender, ethnicity, race, class, and age are intertwined which leads to complex forms of energy usage and engaging in overlapping social differences and cross-cutting differences. “Lowest “5-a-day” rates in Tower Hamlets with 90% of the Bangladeshi community suffering from Iron or Vitamin D deficiency (Reilly et al. 2018). 30% of Tower Hamlets residents take no exercise, levels of activity particularly low in the Bangladeshi community”. the borough Tower Hamlets has 1.56 takeaways per 1,000 people - and the number is rising”.

An increased body mass index shows how social isolation and loss of self-esteem are increasing the difficulties. In the city of Tower of Hamlets, people start over development of health problems within the age of 54 compared to 64. Obese people are often observed as having a bio-psychological barrier to the physical activity of participation (Salas et al. 2017). Exacerbating weight problems decreases the life quality and personal development of a person.

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5. Conclusion

Some actions that can be taken into consideration for healthy settings include interventions, short-term outcomes, medium term outcomes and long-term outcomes as a part of obesity logic model [Refer to appendix 2]. The model allows to understand following concepts such as:

Reducing sugar and fat in school meals

Working with other London Borough to understand where the campaign against obesity lags

Food supply chain improvement and improvement of physical activities in schools

Inactivity level reduction and healthy meal management at yearly stage

Affordability in healthy food items

Another segment which is handled by the people of the borough effectively for reduction in obesity includes Whole system approach [Refer to appendix 1]. The system is having n numbers of key elements which includes senior leadership and effective collaboration. “This senior leadership will enable a broad and senior partnership to be convened that is able to take significant action across the system, replicating the successful model seen in Amsterdam and elsewhere.” Another aspect of this model is flexibility and system-thinking approach. This includes an effective reliability on developing partnership components to solve childhood obesity. Some important authorities like NHS, CVS and private schools can be asked to become partners within community management of obesity.

Housing is a well-established determinant of health and living in an unhealthy condition with overcrowded communities is associated with an increased risk of cardiovascular and respiratory disease. Lack of space encourages breathing issues and fuels poverty. Inequality in health and aspects are causing homelessness. This UCL institute has identified a health equity estimation of up to 1.3 to 2.5 million potential years that have lost lives due to inequalities. Black Minority Ethnic households account for 78% of all households on the housing register which invokes complexity in overweight peers. As a part of concluding the issue, clear evidence is identified in using Public Health factors in England in 2021.

Hood, G., Toleikyte L., and Ashiru-Oredope D, 2019 suggest that cost effective ways to assess health inequalities include uses of HEAT. Tackling health issues while people are gradually becoming overweight should be incorporated in the "healthy mile" initiative where running and walking of both adults and kids are prioritized. It is also observed that “friendships among overweight adolescents may reinforce unhealthy behaviors that further exacerbate weight problems”.

Young people are losing their self-worth and they are treated with various complex diseases for not being fit for the health derivatives. Social network analysis offers various tools to understand complex social and biological relationships contributing to health. Creation of online surveys to encourage understanding of how the different health issues are evolving and how the food habits are changing each day. Peers are being selective in terms of choosing a friend. The overweight friends are often not liked by the children and the people who are left out are gradually sliding into mental problems. Psychological barriers and lack of physical activity are analyzed to be most threatening for the kids.

Five A’s frameworks for managing obesity can be encouraged since it is successful everywhere. Ask, access, advise, agree, assist are part of 5 A's that represent models from the US department of health and human services. All these are aligned within a certain development index and the linear and sequential model helps in streamlined and straightforward process development. One of the most complicated tasks includes understanding complexities within the patient's mind that prevent them from exercising or eating healthy. Using patient-centered language while acknowledging the importance of strong therapeutic relationships has become important for managing behavioral changes.

This initiative of healthcare management is identified to be important in terms of managing the strategic plan-based priorities.

A borough where residents like to live in

Tower of Hamlet is a place where young children are found out to be physically inactive and need support to become active in working and contributing towards health.

Customer-based council development to manage to change needs of the borough

Residents and specifically children should be put at the heart of the plan to support a clean and greener neighborhood and work with a range of partners to process the changes through which complex issues have been addressed (Nobles et al. 2019). Physical activity and sport strategy are incorporated within Tower of Hamlet’s obesity management components such as:

“Health and wellbeing strategy (2017-2020)

Open Space Strategy (2017-2027)

Tower of Hamlet's local plan (2019-2031)

Transport Strategy (2019)

Physical activity and sport strategy (2019)”

Obesity is identified to be doubling the health and health-related issues of becoming premature and risking type 2 diabetes, coronary heart disease, and cancers. An approximate of 13.3million in medication costs and 352 million in social cost has been included in the improvement of healthcare.

6. Recommendation

Local schools are also required to participate in this cycle distribution and running competition to encourage healthy living (Wang et al. 2018). Using the Dahlgren and whitehead model can be effective while health equity assessment tool is in actions [Refer to appendix 3]. Improving access to healthy food is essential for Tower of Hamlets to gain complete access to the fast-food business. Local food businesses are expected to reduce the levels of fats, sugar, and other unhealthy components. The Food4health scheme should be encouraged more for people to give access to early eating habits and manage physical activity. Tower of Hamlet authority participation in the health and wellbeing board is important as well for an emphasis on high-risk groups.

Physical activity improves upon people to pay attention towards their work and having a fresh start. Services that can be improvised for children’s overall growth are found to be toyhouse designs to play actively and have healthy eating courses. A resource arrangement for 0 to 4 years helps in developing a healthy kid and avoiding unhealthy health conditions. NHS is also taking n number of decisions to help in progressing a healthy life and cutting the junk food out of lives by encouraging the “healthy mile”. Some breakfast clubs are available in most of the schools to provide children with a healthy start to the day and local schools are expected to volunteer on these matters. Tower Hamlets has also designed a council that works on a “number of ways to make it easier and active for accessing green spaces (Watson et al. 2018)". In the year 2011, the government published the "Healthy Lives, Healthy People segment". A list of actions is for managing the downward trend in excess weight management of children by the end of 2020 is planned. The target range is identified to be 6 years.

References

Journals

Atkins, J.L. and Wannamathee, S.G., 2020. Sarcopenic obesity in ageing: cardiovascular outcomes and mortality. British Journal of Nutrition, 124(10), pp.1102-1113.

Blackburn, M. and Stathi, A., 2019. Moral discourse in general practitioners’ accounts of obesity communication. Social Science & Medicine, 230, pp.166-173.

Brecher, O. and Fuerst, F., 2017. Obesity and Urban Form: Evidence from London. Available at SSRN 2934006.

Busetto, L., Dicker, D., Azran, C., Batterham, R.L., Farpour-Lambert, N., Fried, M., Hjelmesæth, J., Kinzl, J., Leitner, D.R., Makaronidis, J.M. and Schindler, K., 2018. Obesity management task force of the European Association for the study of obesity released “Practical Recommendations for the Post-Bariatric Surgery Medical Management”. Obesity surgery, 28(7), pp.2117-2121.

Flodgren, G.M., Helleve, A., Lobstein, T., Rutter, H. and Klepp, K.I., 2020. Primary prevention of overweight and obesity in adolescents: An overview of systematic reviews. Obesity Reviews, 21(11), p.e13102.

Kyle, R.G., Wills, J., Mahoney, C., Hoyle, L., Kelly, M. and Atherton, I.M., 2017. Obesity prevalence among healthcare professionals in England: a cross-sectional study using the Health Survey for England. BMJ open, 7(12), p.e018498.

Liu, D., Mason, A., Marks, L., Davis, H., Hunter, D.J., Jehu, L.M., Smithson, J. and Visram, S., 2019. Effects of local authority expenditure on childhood obesity. European journal of public health, 29(4), pp.785-790.

Nobles, J., Christensen, A., Butler, M., Radley, D., Pickering, K., Saunders, J., Weir, C., Sahota, P. and Gately, P., 2019. Understanding how local authorities in England address obesity: A wider determinants of health perspective. Health Policy, 123(10), pp.998-1003.

Panca, M., Viner, R.M., White, B., Pandya, T., Melo, H., Adamo, M., Batterham, R., Christie, D., Kinra, S. and Morris, S., 2018. Cost‐effectiveness of bariatric surgery in adolescents with severe obesity in the UK. Clinical obesity, 8(2), pp.105-113.

Pineda, E., Sanchez-Romero, L.M., Brown, M., Jaccard, A., Jewell, J., Galea, G., Webber, L. and Breda, J., 2018. Forecasting future trends in obesity across Europe: the value of improving surveillance. Obesity facts, 11(5), pp.360-371.

Ralston, J., Brinsden, H., Buse, K., Candeias, V., Caterson, I., Hassell, T., Kumanyika, S., Nece, P., Nishtar, S., Patton, I. and Proietto, J., 2018. Time for a new obesity narrative. The Lancet, 392(10156), pp.1384-1386.

Reilly, J.J., El-Hamdouchi, A., Diouf, A., Monyeki, A. and Somda, S.A., 2018. Determining the worldwide prevalence of obesity. The Lancet, 391(10132), pp.1773-1774.

Salas, X.R., Forhan, M., Caulfield, T., Sharma, A.M. and Raine, K., 2017. A critical analysis of obesity prevention policies and strategies. Canadian Journal of Public Health, 108(5), pp.e598-e608.

Watson, F., Taylor, A., Rayner, M., Lobstein, T. and Hinks, R., 2018. Priority actions for addressing the obesity epidemic in England. Public health nutrition, 21(5), pp.1002-1010.

8.0 Appendices

Appendix 1: Whole System Approach

Whole System Approach Whole System Approach

Appendix 2: Obesity Logic model

Obesity Logic model

Appendix 3: Dahlgren and whitehead health determinant rainbow

d whitehead health determinant rainbow

Appendix 4: Health Equity Assessment Tool (HEAT)

Health Equity Assessment Tool
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