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In the recent era of globalisation, the numbers of obese people across the globe in increasing rapidly and it is necessary to conduct an in doeth research to recognise obesity as a public health issue relevant to nursing as well as to investigate the usefulness of the service available to treat obesity (Biswas, Shaherbano, and Hiremath, 2016). Public health can be defined as the science and strategy of preventing diseases, prolonging life, promoting human health care service by giving proper medication, treatment and care. in the recent years, the public health issues are rising rapidly due to lack of access of the health care service for which it becomes a serious issue that then health and social care providers cannot maximise wellbeing of the social communities as a whole. Through literature review, it is possible to discuss about public health which is organised effort of the society, public and private organisations, communities and individual to prevent spread of diseases control of infection and improving wellbeing of the individuals in the social communities for promoting health. The review of literature provides a scope to gather in depth information and valid data which are suitable for this study to gain understanding and deep insight about the health and social care service available for treating the obese people.
The research aims to analyse the available health and social care service to support the people with obesity as well as identify the risks of obesity among the social communities. World Health Organisation (2002) defines obesity as “abnormal or excessive fat accumulation that presents a risk to health”. In addition to these, According to the National Institute of Health and Clinical Excellence (NICE 2006), there I rapid growth in obesity among the population which is a serious health issue and As per Centre for Disease Control and Prevention (2006), the rate of obesity is higher among the people with Learning Disabilities (LD) where there is 59% of people is suffering from obesity as compared to general people. There are several risk factors for the LD people where they suffer a lot for obesity with increasing burden and disability among the people. Through the literature review, it is possible to explore the issues and the cause of obesity among the LD people so that proper service improvement strategy can be developed further.
The literature review search is important for the researcher where in this study, mixed method is chosen in which both the quantitative and qualitative data are gathered for in depth analysis of the above-mentioned research topic. Research on obesity and the health care implementation of adults are effective for conducting this study efficiently where proper information through secondary sources such as journals, online articles, books and websites as well as newspaper and business letters are gathered to gain deep insight regarding the research topic (Jinks, Cotton, and Rylance, 2010). The online database such as InterCure, Cinahl, Midline, PubMed Central, and Cochrane are utilised for gather relevant information and valid data. In addition to these, the search engines for gathering more information are such as prevalence of obesity, obesity and its implications on health, obesity in adult with learning disability, intellectual disability, obesity and health promotion are effective for analysing the research topic efficiently. The search of journals related to Intellectual Disability Research and Intellectual & Developmental Disability are also helpful to conduct the study proficiently where there are 14 journals are collected to conduct the literature review and analysis. Prevalence of obesity, implications of obesity on health, and health promotion are effective in this regard to understand the risk factors of obesity among the LD people as well as the health promotional activities through which it is posisbel to provide better care and support to the people with LD. 11 different Government websites, relevant publication from World Health Organization, Department of Health and policies from the Nice guidelines for prevention and management of obesity are also utilised for gaining in depth knowledge and deep insight regarding the topic of obesity among the people with LD as well as the health promotional activities to support the people with LD so that they can overcome their health issues and improve their wellbeing (Gate, and Mafuba2014). After gathering the literature and improving knowledge and understanding about the obesity among the LD people, it is easy to differentiate the literature review with developing different themes so that thematic analysis can be conducted further.
Theme 1: There is high numbers of LD people who are suffering from obesity as compared to the normal people without LD. the rate of people with LD suffering from obesity is also increasing at a higher rate due to the risk factors among the LD people.
According to the report published by World Health Organization (2018), here are more than 1.9 billion adults who are suffering from overweight and out of these, 650 million people are obese. It is a serious concern of the World Health Organization to reduce the risks of obesity as in the recent years the percentage of obese people is increasing at a rapid rate. State (USA) Mann et al (2006) has recognised that, high risks of obesity includes mortality and morbidity for which it is necessary to promote health education and health care service so that it is possible to increase awareness among the individuals as well as provide proper car and support to all the people across the globe. According to result, 39.3% women with LD are obese as compared to 25.1% without LD and 27.8% men with LD are obese as compared with 22.7% without LD (World Health Organization, 1995). The above study indicates that, the chances of obesity among the people with LD is high where there is high rate of obesity among both men and women with LD. Robertson et al (2000) supported that, the adults with obesity are living under restricted environment such as less supported group home or institution, having lower BMI and less likely to become overweight or obese. A recent analysis of data collected from GPs across England on the prevalence of obesity in adult with LD reveals that there is high obesity among the people with LD and based on the analysis, those classified as obese were 31% men and 45% women compared to 24% men and 27% women without LD (Public Health England, 2016).
As per the study, the factor of which the obesity among the people is creasing are such as lack of daily activities, poor diet and weight gain for which the people with LD are suffering from obesity and there are high risks for the individuals with LD (Patience, 2018). BMI was calculated by using the World Health Organization Expert, 1995 where the study reported that 35% adult are obese. In addition, a similar research in England in a residential service for people with LD reported 27% people are suffering from obesity (Patience, 2018). During the National Health Survey Interview in United State, it has been found that between the period of 1997 to 2000, there is 34% people who are obese and the people have learning disabilities and as compared to this, there is 26.6% people without LD who are obese and from this assessment, it can be stated that, there is high risk of obesity for the people with LD as compared to the general population (World Health Organisation, 2002). According to World Health Organisation (2018), the prevalence of obesity was 47.5% higher in people with LD living in group or family homes compared to 37.5% respectively. being a female, living in a community, or in a deprived environment, having a mild learning disability, down’s or Prader-Willi Syndrome, and having a mental health illness are the factors that raise the Chances of having obesity among the people (National Statistics, 2018).
The data are gathered from administrative service record, medical record, and developmental disabilities profile and it has been explored that, the people with LD are suffering from obesity, hypertension, diabetes, high cholesterol, overweight, abnormal weight gain and blood pressure. It was necessary for participant to have visited primary care between July 1, 2001 and June 30, 2005 and the result showed that out of 291 participants, 43% were obese. From the 43%, 19.9% had hypertension, 26.5% had hypercholesterinaemia, 4.5% had diabetes mellitus and 38.8% had psychiatric comorbidity (NICE, 2014). In another quantitative study, Henderson et al (2008), supported the study of Nancy et al (2009), found that there are serious impacts of obesity on coronary heart disease in adult with LD (World Health Organisation, 1988).
Theme 3: Role of education on the LD people to mitigate the problem of obesity so that the issue of public health, lack of access of the proper treatment and support in the society can be minimised properly.
Education plays an important role in improving the health condition of the people as well as for the successful health promotion where the people can understand and gain deep insight about the ways to improve health condition. The educational program provides proper information about the dietary planning and nutritional value of different food so that the people can focus on developing the behaviour of healthy eating habits. The people with LD needs proper information about good nutrition and diet plan so that they can balance their eating habits and intake the healthy foods for the benefit of their wellbeing (Spanos, Melville, and Hankey, 2013). It is the role of the health and social care professionals to share proper information about the preparation of the food and the nutrition value of each food in daily life so that the people can improve their healthy eating habits and facilitate changes in the eating habits which would be beneficial for the health condition of the people with LD who are suffering from obesity.
Education regarding the knowledge and training to maintain obesity at home in a natural activity are also necessary for the people to raise awareness among them a. The information sharing regarding the risks of obesity and other health deterioration also need to be provided to all the people through developing proper educational activities where the health and social care professionals can raise awareness among the people and increase their participation in managing obesity and overcoming the health issues (Carmeli et al., 2008). Plan for a healthy and entertaining meals of high nutritional value is an important aspect for independent living and it can be developed through providing effective education raining program. Information and education regarding the relationship between energy intake and expenditure as well as raising awareness in doing daily exercise among the people is also necessary where the health and social care professionals can provide proper information about daily activities through which the people with LD can improve their wellbeing and overcome the risks of obesity.
Theme 4: There is crucial impacts of the social factors on supporting the LD people who are suffering from obesity.
Social changing such as changes in friendship and relationship in the society, social inclusion and taking active part in the social activities are considered as the important predictors for improving the BMI rate among the people with LD and in this regard the social factors hereby play a significant role in improving the condition of the patients with LD and obesity, where it further helps to change the physical status through proper treatment, dietary information exercise. In addition to these, social support, cooperation of the health and social care professionals and support from the family members are also necessary for the people with LD in order to overcome their health issues successfully. It is necessary for the health and social care professional to arrange social community development program and include all the people with LD so that they can take active part and this is considered as motivational program where the care profiles can encourage the people with LD with proper dietary planning, exercise and social activities in their daily lives that would be beneficial for overcoming the risks of obesity among the people with LD (Cronin, Ryan, and Coughlan, 2008).
Theme 5: Impacts of behaviour with people with LD and its implications of obesity
Behavioural change plays a crucial role in supporting the adults with LD where they are also suffering from obesity including healthy behaviour cooperation and lifestyle of the person. The health and social care professional found that, lack of proper sleep raises the chances of obesity among the people with LD and in this regard the people need to sleep properly for being healthy. Lack of sleep can cause fatigue, stress, less physical activities, lack of energy in doing daily activities and weight gain. Hereby, the lifestyle of the individuals affects the health condition of the people (Hsieh, Rimmer, and Heller, 2014). On the other hand, Healthy eating, meal provision, snacking, water and fruits intake as well as exercise programme and aspect of everyday life such as gardening, walking, climbing stairs and assisting in housekeeping are important activities in the daily lives of the people which are helpful to being healthy. Hereby both the social charities and exercise are contributing factors for resolving the chances of obesity among the people with LD. In this regard the activities such as gymnasium or swimming pool together with movement and stretching making sure individuals are comfortable and not worsen any existing condition and dancing activities are also effective behavioural changes and changes in daily activities which improve the health condition of the people with LD (Agha, M., and Agha, R., 2017). Hereby, the behavioural changes and improving the soil activities and exercise are necessary for all the people with LD where they can improve their wellbeing and avoid the risk of obesity.
Theme 5: Enhancing the practice and strategic planning of health promotion for resolving the issue of increasing number of LD people suffering from obesity, where through health promotion it is also easy to resolve the problem of lack of access to public health for the LD people in the society.
NICE guidance (2006) suggested that, health promotion is the way of improving management and treatment facilities where it focuses on changing the lifestyle of the individuals through arranging weight loss program where the people under obesity are suffering from gaining weight. Through developing person-centred approach, the health and social care professionals try to make effective decision and develop proper care plan for the people suffering from obesity where the program is effective to change the lifestyle of the individuals, include daily exercise and improve the healthy eating habits (Sohler et akl., 2009). For successful health promotion, it is necessary to empower the patient so that they can take active part in the decision-making planning for getting proper care and support according to their health needs and personal preferences (Melville et al., 2008). It is the duty of the care giver to promote healthy living among the individuals and encourage them to do daily exercise and improve healthy eating habit for reducing the risks of obesity. The impact of nurse-led screenings and health promotion activities in a two-part study in Northern Ireland for people with LD is effective where health and social service trust plays crucial role in providing better care and support to the individuals with LD who are suffering from obesity (Doody, Doody and Owen, 2012). The research was conducted within two clinical nurses who take active part in the school and clinic for identifying the percentage of obese people and it has found that, 36% were overweight, 12% are obese and 32% are highly obese people as per their BMI rate where the survey was conducted among 25 participants (Giraud-Saunders, and Marriott, 2016).
Hereby, it is necessary for the health and social care professionals to develop proper intervention planning for the people with obesity who can understand the health promotional and physical activity programs for improving their health condition so that they can reduce their risk of obesity. The intervention process of weight loss program, school education for health promotion who are effective where the care givers try to share proper information about healthy living, healthy dietary planning, improving the social activities, the daily life activities such as dancing, swimming and playing and exercising re effective to motivate the people who are suffering from obesity. The training program and health promotional campaign in this regard are crucial for supporting the individual with LD where they are suffering from obesity. Health promotion in this regard is effective to promote healthy wellbeing of the individuals with LD where proper instruction of eating and living style are helpful for the people to overcome the issue of obesity (Shoneye, 2012). Hereby, proper health promotional activities, social development program and social campaign are useful to increase the participation of the people with LD and get proper support and instructions about the activities that would be helpful for the people with LD the to reduce the risks of obesity.
The issue of lack of access of proper health and social care service is high among the people with LD and in this regard, the role of the disability nurses is crucial where the nurses need to promote health screening, heath protective service and immunisation so that the people with LD can get proper health and social care service so that they can overcome their health issues and enhance their wellbeing. People with LD suffers from many chronic conditions such as obesity and the mortality and morbidity can be protected by the disability nurses who tries to promote health screening and proper care for the people with LD so that all the individuals can get proper health and social care service (Giraud-Saunders, and Marriott, 2016). Heath literacy in this regard is the only way to promote health where the learning disability nurses can assess the individuals through health screening and support them with proper care and treatment so that the people can overcome their issues and live a normal life like other (Henderson et al., 2008). The learning disability nurses in this regard play an important role in acknowledging the actual needs and preferences of the individual with LD as well as cooperate and interact with them properly so that their expectations can be met successfully with proper care and support (Marshall, McConkey and Moore, 2003). The skill and abilities of the learning disability nurses are efficient for increasing the chances of positive changes with health prevention actions, changing lifestyle of the individuals and continuous motivation of the people with LD. The learning disability nurses are also trying to cooperate with the people with LD and monitor their progress aby sharing information where simple language, provision of accurate instructions, trying new ideas one at time while checking understanding are contributing factors for supporting the people with LD and reduce the risks of obesity among the people (Heller et al., 2011).
The literature review is effective to understand the aspects of obesity among the people with LD where the percentage of obese people among the LD is higher as compared to the general population. Studies found that the people with LD has high risks of obesity where lack of daily activities exercise and other health issues deteriorate the health condition. Obesity is a serious concern as it raises the morbidity and mortality rate for which it is the responsibility of the social care workforce and learning disability nurses to promote health screening and immunisation of the people with LD, so that they can access proper care and support from the health and social care professionals. The health education program including exercise, information about nutrition, community-based activities and group support for adults with intellectual disabilities and improving daily activities among the people with LD will provide a scope to support the individual and reduce the risks of having obesity among them. Greater collaboration and communication with the nurses and doctors, as well as proper support to the people with DL, health education and health promotional activities are beneficial to provide proper care to the people with LD so that they can overcome the risks of obesity.
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