Importance of Theory in Nursing

There are many different areas that nurses must focus on in order to provide the best care for a patient. From the first moment the nurse and the patient get to communicate at the admission interview to the point of discharge, the patient’s well being is in the hands of the healthcare team. The nurse plays a pivotal role in carrying out the orders of the doctors and constant communication must occur between all providers to ensure good quality of care. The main focus of this paper is to emphasize the importance of medication reconciliation in the healthcare setting following the client from beginning to end in the hospitalization process.

Definition of Medication Reconciliation

Medication reconciliation is “the verification and communication of a patient’s medication regimen at points of transition in patient care” (Murphy, Oxencis, Klauck, Meyer, & Zimmerman, 2009, p. 2126). The first step in ensuring medication reconciliation is during the health history upon admission to the hospital. Unfortunately accuracy is not always guaranteed during the initial assessment. Many registered nurses (RN’s) and advanced practice nurses (APN), felt “challenged and frustrated by their inability to obtain complete and accurate medication information” (Riley-Lawless, 2008, p. 94). The inaccuracy in fully comprehending the patient’s medication history can lead to unsuitable drug therapy during hospitalization and result in “failure to detect drug-related problems that may have contributed to a patient’s hospitalization” (Murphy et al., 2009, p. 2126) in the first place. In order for the health care team to provide the best care for a client, a comprehensive evaluation of all medications must be done. Sadly, it is not always the client’s fault, but their lack of understanding and knowledge on the medication previously prescribed which impedes the nurse from acquiring accurate information and providing proper care.

Paradigms

Person

Person refers to the human being as a whole, in mind, body and spirit, whether it be “each individual man, woman or child”(Chitty & Black, 2007, p. 294). Each patient who comes to the hospital must be seen as an individual. Each patient has different beliefs, ideas and expectations in their own life. Most clients understand and know their limitations, have their own definition of health, and prioritize their basic human needs in different order from one another. In the care of the patient, it is the nurse’s role to assist them in meeting their basic needs. Medication reconciliation plays an important part in re-establishing homeostasis in the patient’s health. The physician prescribes medication that is essential in the recuperation of the client or many times prophylaxis to their health.

Throughout the care given in the hospital, many health care providers are responsible and held accountable for medication errors. Therefore it is important for everyone involved to check the medication administration record for discrepancies in order to provide safe and accurate care. In a hospital setting, the patient will be discharged where the “physician reviews the medications and finalizes the discharge medications. The nurse then has responsibility for finalizing the instructions, including medications, and reviewing them with the patient”(Levick, Haldeman, & Beck, 2009, p. 19). It is the healthcare team’s responsibility to be knowledgeable of the patient’s diagnosis and to ensure that the medication being administered will promote health and well-being for the patient in the end. The nurse must give information and teaching to the patient prior to discharge from the hospital, consequently providing continuation of care outside of the hospital. The person, as the patient, is the main focus in medication reconciliation, where an individualized plan of care must be given in order to fulfill the patients need and assist in a prompt recovery.

Environment

Medication reconciliation extends to all units in the health care field, including transportation of patients from one setting to another. According to Chitty and Black (2007), the environment “includes all the circumstances, influences, and conditions that surround and affect individuals, families and groups”. Unfortunately, many patients who enter the hospital setting do not always leave to return to their home, but must be placed in long term care. During the transfer from one location to another “adverse drug events attributed to medication changes (due to differences in institutional and outpatient formularies) occurred in 20% of patients transferred from a hospital to a long-term care facility”(Setter et al., 2009, p. 2028). The adverse drug event could have been prevented if the communication between the two institutions would have been greater.

The patient’s well being is jeopardized if medication reconciliation is not followed thoroughly. In certain facilities steps have been taken to improve the communication between each department in a hospital where a computer system was created to assist the health care team in medication reconciliation. This computer system allows clinicians to easily compare current inpatient medications, with home medications that were documented at admission and medications being planned for discharge. According to Levick et. al (2009), ” with this system, the discharge nurse is alerted to any medication changes, even if they take place at the last minute” (p. 19). This provides the discharge nurse with accurate information and precise patient teaching even is changes are made suddenly and unexpectedly. The advances being made in technology affect the environment and the care that is given to the patient. The client is able to benefit from medication reconciliation in an environment that fosters communication between the staff in the healthcare team.

Health

Health is defined differently from person to person. One definition of health is a “state of optimal functioning or well-being” (Taylor, Lillis, LeMone, & Lynn, 2008, p. G-10). It is the patient’s own level of health to where it is most favorable to them. Someone who has a chronic illness and is solely confined to a bed, might see themselves as healthy for simply being able to dress by themselves one morning, while an athlete might see a an injury to their foot as an impairment to his or her own health. A person’s view of health also changes daily on how their body is responding to the environment and treatments being done at the present time. This is one of many factors that prompts the nurse to provide individualized care to each patient under her care.

The patient’s health is greatly affected by medication reconciliation. The nurse must ensure that the correct medication and dosage is being given to the patient to reach a therapeutic affect and not to cause an adverse reaction. If the client gets an overdose of a medication, the health care team will be held accountable for probable damages that the medication caused. Initially, the medication is ordered to be administered and to cure the disease or control the symptoms. If an error is made along the chain of medication reconciliation, then the physical damage done to the body could be irreversible and even fatal if not caught in enough time. Medication reconciliation is put in place to prevent such accidents from occurring in the health care setting. It has “been identified as a mechanism to promote patient safety and prevent harm by reducing medication errors” (Riley-Lawless, 2008, p. 94). It is extremely important for the nurse and everyone involved in the care of the patient to promote the health and well-being of the client. It is a crucial step in the treatment for the healthcare team to ensure that medication reconciliation is being followed through in order to provide the best care possible to the client who comes in the hospital seeking help.

Nurse

Medication reconciliation is of the nurse’s primary role in giving the patient good quality of care. In order for the nurse to expect a full recovery or to manage the patient’s health issues, careful attention must be paid to the medications being administered. The nurse must check the doctor’s orders with a drug guide book to ensure that the drug or drugs that will be administered will not cause an adverse reaction or cause further health deterioration to the patient. Medication reconciliation is a process that begins at the admission interview. The nurse must acquire all the medication information in which the patient is currently taking, follow it through with the care of the patient, and finally teach the patient about the medications that will be sent home with them. Since not all patients get discharged home and some get relocated, communication between the two places must be established in order to prevent side effects and drug interaction. The nurse plays a major role in medication reconciliation in order to provide the patient with top quality care and must ensure that no damage will be caused by a medication error.

Nursing Implications

Medication reconciliation exists to ensure that the patient who comes in seeking medical care is given the best possible care free of errors by the healthcare team. It is the nurse’s job to apply the knowledge gained in school and experience at work to ensure the physician is ordering the proper amount of medication for the patient and that the drug is going to be beneficial in the treatment of the medical diagnosis. It is very important for the nurse to be certain that everything about the drug will be fully explained to the patient in simple terms so that they are able to fully comprehend the right dosage, the reason for the medication and how to properly self-administer the medication.

Medication reconciliation also occurs within the hospital, from unit to unit. It keeps the flow of communication open with the other healthcare team members to give appropriate care to the client. Medication administration follows the patient from the moment of admission to the point where the patient is eventually discharged or transferred to another facility. It is imperative that no medication given to the patient will harm the client and cause further deterioration to their health.

Conclusion

In conclusion, medication reconciliation is essential to providing optimum care for the patient in any healthcare setting. Medication reconciliation follows the four paradigms in nursing and is essential in providing good quality care to anyone who seeks medical assistance. It opens up the field of communication between all units in the hospital that are involved in the client’s care and maximizes the interaction of two facilities in case a patient gets relocated. Medication reconciliation also decreases the chances of giving the patient a wrong medication or dosage. All healthcare members involved in the client’s care must be aware of the medications involved and must be check for errors in order to ensure a therapeutic result in the patient’s health.

Nursing is an evolving discipline in the development of science i.e. theory and research and in professional practice. We have a rich history of thought from Florence Nightingale to the recent nurse researchers, theorists and clinicians. Moreover, nursing professional practice includes integration of knowledge from the broad conceptualizations of models to the level of practice theory. The nursing theoretical frameworks serve in powerful ways as guides for articulating, reporting, recording nursing thought and action. Nurses must know what they are doing, why they are doing, what may be the range of outcomes of nursing, and indicators for measuring nursing impact (Parker, 2001). The aim of this paper is to study, compare and contrast two nursing models given by two nursing theorists who have made major contributions in the field of nursing practice. These models are; Roy adaptation model and Orem’s Self-care model.

Introduction to the theorists, Sister Callista Roy and Dorothea E. Orem

Sister Callista Roy received a bachelor’s degree in nursing in 1963 from Mount Saint Mary’s College as master’s degree in pediatric nursing in 1966, a master’s degree in sociology in 1975 and a doctorate degree in sociology in 1977, all from the University of California, Los Angeles. Roy first proposed her model while studying for her master’s degree, where she was challenged by Dorothy Johnson to develop conceptual models of nursing. Therefore, the development of the adaptation model for nursing has been influenced by Roy’s personal and professional background. She had her experience as a pediatric staff nurse where she mainly noticed the children and their ability to adapt in response to major physical and psychological changes.

Dorothea E. Orem was born in Baltimore, Maryland. She received her diploma in nursing from Providence Hospital School of Nursing in Washington, DC, baccalaureate in nursing from Catholic University in 1939 and master’s degree in 1945 from the same university. She decided to develop her theory after she and her colleagues were given an assignment to produce a nursing curricula for practical nursing for the department of Health, Education and Welfare in Washington, DC. Between 1971 and the 1995 editions, there have been some changes in Orem’s theory, notably in the concept of an individual and the idea of the nursing system. Orem delineates three theories; self-care, self-care deficit, and nursing system.

Focus of Roy’s and Orem’s Model

Roy’s model was initially developed for education; however, it continued to work in research and practice settings. Roy’s model focuses on the concept of adaptation of man. Her concepts of nursing, person, health and environment are all interrelated to this central concept. According to her model, the person receives inputs or stimuli from both the environment and the self. Adaptation occurs when the person responds positively to environmental changes. This adaptive response promotes the integrity of the person which leads to health. Ineffective responses to stimuli lead to disruption of the integrity of the person.

Self-care model was given by Dorothea Elizabeth Orem in 1970. The focus of the model is self-care, self-care agency, self-care demand, self-care deficit, nursing agency and nursing system. Self-care is a requirement of every person, man, woman and child. Self-care is viewed as function and the capability of an individual which means that the things an individual can do and able to do. When self-care is not maintained, illness, disease or death will occur. Self-care requisites result in the regulation of structural and functional integrity and human development. There are three categories of self-care requisites; universal, developmental and health deviation self-care requisites. According to Orem, there are various basic conditioning factors (age, gender, developmental state, health state and health care system, sociocultural orientation, and family system, patterns of living, environment and available resources) that can influence the categories of self-care requisites. The essence of Orem’s model is entirely the nurse-patient relationship.

Metaparadigm of both the Models

The Person:

Roy described the person in terms of system and adaptation, a biopsychosocial being in constant interaction with a changing environment. She defines person as a recipient of nursing care, as a living complex, adaptive system with internal processes (the cognator and regulator) acting to maintain adaptation in the four adaptive modes: physiological (biologic), self-concept (psychological), role function and interdependence (social). The cognator controls processes related to perception, learning, judgment, and emotion i.e. psychological adjustments. The regulator functions primarily through the use of the autonomic nervous system in making physiologic adjustments.

On the other hand, Orem expressed that the individual person is the primary focus in the model. People are basically rational beings who assess situations, reflect and understand them. Based on this person as agent or having agency that chooses to perform specific actions and goal directed. Moreover, in comparison to Roy’s model, she also indicated that empowering person helps to cope with the causes and effects which ultimately progress to the positive adaptation of an individual.

Nursing:

Roy’s goal of nursing is to help individual adapt to changes in his psychological needs, self-concept, role function and interdependent relations during health and illness. Nursing fills a unique role as a facilitator of adaptation by assessing behavior in each of these four adaptive modes and intervening by managing the influencing stimuli (George, 1995).

Similarly, Orem defines nursing as a human service and facilitates that nursing special concern is a person’s physiological needs for the provision and management of self-care action on a continuous basis in order to sustain life and health. However, the goal of nursing in both the theories is to overcome the patient’s limitation whether it is psychological or physiological needs.

Health:

According to Roy and Andrews (1999) health is a state and process of being and becoming an integrated and whole person. Likewise Orem (1985) sees health as an ideal when living things are structurally and functionally whole. Health can be viewed as a human adaptive system within a changing environment. Lack of integration represents lack of health. Adaptation is a process of promoting this integration i.e. maintaining physiological, psychological and social integrity. Similarly, according to Horsburgh (1999), Orem views health state as the basic conditioning factor also comprises on physiological, psychological and social imbalances most likely to influence adult self-care abilities and behaviors.

Environment:

According to Roy (1999), environment is all the conditions, circumstances that influences surrounding and affect the development and behavior of persons or groups. Environment is the input into the person as an adaptive system involving both internal and external factors. Any environmental change demands increasing energy to adapt to the situation. Factors in the environment that affect the person are categorized as focal, contextual and residual stimuli. Focal stimulus mostly confronts the person that precipitates the behavior. Contextual stimuli are all other stimuli present that contribute to the behavior caused or precipitated by the focal stimuli. Residual stimuli are factors that may be affecting behavior but whose affects are not validated.

Orem acknowledges self-care requisites to have their origins in human beings and the environmental factors, elements, conditions, etc. Environmental factors influences health care abilities of a person and are shaped within a person’s sociocultural context. Furthermore, she proposed the similar concept of Roy’s theory that man and environment interact as self-care system. If the system of man and environment gets change, the adaptation of self-care system will be affected.

Compare & Contrast of both the Models with Literature Support

Identification of the underlying assumptions is necessary to internal and external evaluation of the theory which deals with logic, consistency and congruence with the practical world (Barnum, 1998). The concept of person, health, nursing and environment are well defined however there are some similarities and differences among the two models. Firstly, Roy’s model focuses mainly on psychological aspects of a person. She discusses about the adaptation of a man and stresses on ways of adaptation and coping mechanisms whereas Orem’s model focuses greatly on physiological and sociological aspects of a person and lacks psychological aspects. She talks about individualism, autonomy, self-directed and self-reliance. Moustafa (1999) also noted that Orem’s theory is generally accorded to the physiological and sociological wellbeing of the person, undermining the importance of mental health. For e.g., a person who is a paranoid schizophrenic will not admit that he needs help regarding his self-care demands and without acceptance of the self-care deficit, it will be difficult to care for the person using Orem’s theory concepts.

Secondly, according to Roy (1999) environment is internal and external stimuli and the person receives inputs from the external and internal environments. In her earlier writing (1981) that environment is different from internal stimuli and now she viewed internal stimuli is a part of environment. However, the question arises if internal stimuli are a part of environment than how it is different from the person’s adaptation level? Moreover, Roy’s model of nursing management specify that the manipulation of the stimuli is different from the manipulation of people however the question still remains the same can internal stimuli be manipulated without manipulating the person? It seems that the relationships of adaptation to person, health and nursing are clear however the person-environment interaction is less clear. In contrast, Orem simply proposed that the change in person-environment system will ultimately change the entire self-care system. Both the models highlight similar factors but the objective of both the theorists differ as in case of Orem, it is self-care whereas Roy as adaptation. Nevertheless, both the models can be interrelated as for e.g., in order to perform self-care successfully, a person needs to adapt to the internal and external stimuli or the environment. The person needs to be stress free and comfortable both physically and psychologically. Both adaptation and self-care is a behavior of a person that are influenced by various factors such as culture, personality, socioeconomic status, education, age, gender and available resources etc.

Thirdly, both of these models primarily focus on individualism. None of them takes the viewpoint of family, society, or a community as a whole. However, with certain modification, the models are seen empirically tested on various age groups such as among student’s community, elderly, various disease specific groups etc. Roy sees person as a living complex, adaptive system acting to maintain adaptation in four adaptive models (physiological needs, self-concept, role function and interdependence) whereas according to Orem, person as rational beings who has mastery over their destiny. In other words, the individual as a person is independent to choose and select whatever they want. It is normal for the person who wants to attain optimum levels of self-care. However, this is not true at all the time; a person looking for a secondary gain from the illness may not give importance to his/her wellness. Regarding health, both of them believe that health is a state and a process for becoming an integrated and whole person. However, these models lack the spiritual and existentialist aspects of a person. These models describe nurse as a facilitator. The aim of the nurse in Roy’s model is to help man adapt to changes brought about during the health illness continuum whereas according to Orem’s model, nurse facilitates the self-care abilities of a person which is more towards the physiological needs of a person.

Lastly, Orem’s model is somehow culturally biased. In scientifically advance culture, people believe that sickness is because of natural reason. However, some cultures believe on traditional and folk premises. Therefore, these perceptions are still failing to recognize the variety of health related cultural belief and practices. Orem’s theory does not explain the traditional and folk health believes even she called a scientifically advanced culture (Orem, 1991). On the contrary, Roy’s model talks about the person’s relationship with the world and God on philosophical premises. Persons use human creative abilities of awareness, enlightenment and faith. In my judgment I feel that as an external stimuli or factor, cultural and religious believes can hinder in adaptation process.

Furthermore, both the theories are very complex and have broad concepts for the practical implication. Roy’s model is difficult to categorize the behaviors of the person in the four adaptive modes (George, 1995). In addition, there is an overlapping of concepts definitions. Similarly, Orem’s self-care model is used with numerous configurations; this multitude of terms such as self-care agency, self-care demand, self-care deficit, requisites can be very confusing to the reader. Abdul (2002) also noted that Orem’s work is easy to explain but difficult to differentiate among numerous terminologies and hypothesis. The holistic approach of these models helps prevent putting too much emphasis on aspects of illness and allows for the inclusion of health promotion. In addition, they are easy to apply as a family center model. Both have been found very useful in inpatient and outpatient settings as well as in work settings and in the community. However, it is difficult to apply Roy’s model in intensive care units where situations change rapidly (George, 1995). Moreover, the clinical research generating from these theories have health promotion application also. Nursing, when define in terms of focus ( for knowledge and practice), is a specialized health service necessitated by an adults inability to maintain the amount and quality of self-care i.e. therapeutic in sustaining life and health , even in recovering from disease or injury, or in coping with their effects through adaptation.

Application of models in clinical Practice & Conclusion

Roy’s ad Orem’s model have greatly influenced nursing profession. The integration of both the models is not only applicable in clinical practice but also in nursing education, administration and research. These models guide nurses to use observations and interviewing skills in doing an individualized assessment of each person. It is a useful guide in nursing assessment and formulating nursing diagnosis. Therefore, apparently both the models are valuable in nursing clinical practice. Alligood and Marriner-Tomey (2002) state that conceptual or theoretical models of nurse practice are significant to the field, providing the profession with a guide to patient care and with a general frame of reference that connects the structural environment to the patterns of behavior and relationships within the organization. Nurses have a unique role to promote health in majority of the setting by utilizing these theory in acute healthcare settings, community settings, rehabilitation nursing, palliative care, in learning disability nursing etc. The goal of both the theories is giving assistance adapted to specific human needs and limitations. I suggest that the concept development of different models and analysis will contribute to further identification of functional theories in nursing. Thus, we need to continue our efforts to develop diverse types of theories and consider the advancement of the nursing discipline.

Measuring body shape can be a rich data about health and the risk of disease. Measuring anthropometry manually could be time-consuming, only a few indexes of shape (e.g. body girths and their ratios) are used regularly in clinical practice or epidemiology, both of which still rely primarily on body mass index (BMI). Three-dimensional (3-D) body scanning provides high-quality digital information about shape.

Obesity, on the other hand, is the accumulation of excess body fat, whereby a sizeable amount of adipose tissue goes untapped. Obesity results from the imbalance between energy intake and energy expenditure. This imbalance may be the result, individually or concomitantly, of excess caloric intake, decreased physical activity, metabolic disorders, and genetics (National Institutes of Health, 1998; Berg, 1993). Genetics are seen to influence whether an individual can become obese, while environment determines whether the individual actually does become obese, as well as the extent of the obesity (Meyer & Stunkard, 1993).Obesity is a health disorder in which a person gains at least 20% of the usual body weight because of the increase in the fat cells (adipose tissues) in the body. This accumulation of excess fat causes serious threat to health. The adverse health conditions can lead to various physical and emotional problems. These include cardiac diseases, high pressure and even different forms of cancers, apart from depression and diabetes.

In recent times, obesity has become one of the vital health problems in the society. According to estimates, there are more than 1 billion obese people in the world.

Generally, faulty food habits, excess intake of food and hormonal imbalance are the main causes of this disorder.

1.2 Symptoms of Obesity

a) Excessive weight within a short period of time. He/she usually gains 4-5 kilos every month, such that the metabolism process becomes difficult to control.

b) The chest area tends to look larger, especially in men as the body fat starts getting accumulated in that area at the initial stage. In women, fat gets accumulated in the waists, thigh, upper arms and breasts. This is a major symptom of obesity.

c) The size of the abdomen tends to enlarge. At times, there are whitish marks on the abdomen areas due to the excess accumulation of fatty tissues.

d) Another preliminary symptom is that the person tends to have shortness of breath. He cannot breathe properly because of the accumulation of excess fat in the chest area and below the diaphragm.

e) Most people start suffering from indigestion due to an excess of abdominal fat. At the same, time, Urinary incontinence or urine leakage happens, mostly to women. Although most of this underreported, this can be taken as a serious symptom of obesity. Abdominal obesity is also marked by symptoms such as snoring and sleeps disturbances.

f) One of the scientific ways of understanding obesity is by calculating the body mass index (BMI). It is the ratio of the person’s height to weight. According to the World Health Organization, if the BMI is in the range of 25-29, a person is overweight and if the BMI is 30 and above, the person is considered to be obese.

1.3 Effects of obesity on human body

The effects of obesity extend far beyond physical weight and related health problems. Obesity side effects can include a greater risk of mental health problems and low self-esteem. Social attitudes on obesity range from avoidance to outright discrimination and bullying.

The effects of obesity on physical health are well documented. The Stanford Hospital (2010) reports obesity causes up to 300,000 premature deaths a year in the United States alone. Obesity health effects range from backaches and joint pain to life-threatening conditions. The following is a list of health conditions attributed to obesity. This list is by no means exhaustive; the effects of obesity on physical health care, unfortunately, many and varied.

Physical disorders

Obesity can cause serious physical disorders. It may lead to chronic diseases, disability and eventually death if not treated correctly and at the right time. Let us examine some of the physical effects of obesity.

Decreased mobility – It becomes difficult for obese people to move around. They often feel tired and breathless as they have much accumulation of fat in the chest, neck and associated areas of the body. There is a constant feeling of breathlessness and fatigue, which leads lack of activity and movement.

Cardiac disease – People who are obese generally have frequent chest pains and higher risks of heart attack. Congestive heart failure is also common for such people. At the same time, it is common for obese people to have high blood pressure compared to those who maintain a healthy body weight.

Cancer – It has been observed that obese people have an increased risk of certain cancers. These include cancers of the gall bladder, uterus, colon, prostrate and kidney, among others. Obese women are more prone to breast cancers in their mid-lives.

Arthritis – Obesity is strongly associated with joint pain and arthritis. It is common for obese men and women to have osteoarthritis, which is a joint disorder, causing ache and inflammation especially in areas such as lower backs, waists and knees.

1.4 Measurement of Obesity

BMI is a measurement of body weight based on height and weight. Although BMI does not actually “measure” percentage of body fat, it is a useful tool to estimate a healthy body weight based on height. Due to its ease of measurement and calculation, it is the most widely used diagnostic indicator to identify a person’s optimal weight depending on his height. BMI “number” will inform one if one is underweight, of normal weight, overweight, or obese. However, due to the wide variety of body types, the distribution of muscle and bone mass, etc., it is not appropriate to use this as the only or final indication for diagnosis. In adults, a BMI of 25 to 29.9kg/m2 means that person is considered to be overweight, and a BMI of 30kg/m2 or above means that person is considered to be obese.

The use of BMI as a measure of body composition has met with some criticism (Blew, et al., 2002; Duerenberg, Yap & van Staveren, 1998; Gallagher, et al., 1996; Prentice & Jebb, 2001). Clinical and laboratory studies often employ more sophisticated measures of body composition and distribution, such as: measures of electrical impedance; underwater weighing; or circumference measures determining fat distribution via a waist to hip ratio. While these measures allow for a very detailed examination of body composition, they require specialized equipment and training to collect, and are not practical for large surveys. Notwithstanding, BMI has shown to be a relatively strong metric for body composition. Recent studies show that electrical impedance is not superior to BMI as a predictor of overall adiposity (Willett, et al., 2006) and in clinical samples, Ensrud and colleagues (1994) found the relationship between BMI and functioning to be stronger than that for waist to hip ratio and functioning.

1.5 BMI Table for Adults

This is the World Health Organization’s (WHO) recommended body weight based on BMI values for adults. It is used for both men and women, age 18 or older.

Category

BMI range – kg/m2

Severely underweight < 16.5

Underweight 16.5 – 18.5

Normal 18.5 – 25

Overweight 25 – 30

Obese Class I 30 – 35

Obese Class II 35 – 40

Obese Class III > 40

1.7 Ethnicity

Analyses have revealed significant differences in size and body shape between ethnic groups and social categories within the US population, and have further demonstrated significant differences in body shape between US and UK white adults. These differences may prove to play a key role in accounting for differences in morbidity and mortality between these populations and social groups. (Table1.2)

Table 1.2 Body shape in American and British adults: between country and inter-ethnic comparisons

Comments

Wells et al. (2007)

Adults17+ yrs from UK (3907M and 4710F white), and from USA (1744M and 3329F, 709M and 1106F African and 639M and 839F Hispanic).

Two National Sizing Surveys, SizeUK and SizeUSA, were conducted using identical instrumentation, study design and recruitment strategy.

All Outcomes (except height) adjusted for height P< 0.01; P < 0.0001.

In USA, socio-economic status was associated with increasing height and decreasing waist girth in white and Hispanic, but not African Americans. Compared to white British, white Americans had larger weight and girths, especially waist girth in men.

Long Study population, some subjects may withdraw before the end of study, Lynch et al. (2006)

5,115, by ethnicity (Black/White), sex, age (18-24years/25-30 years).

Body size judgments were obtained using the Stunkard figure rating scale.

Black men (p < 0.05) and 1.48 vs. 0.96 for White women vs. Black women (p < 0.0001)).

Black men were slightly younger, and had higher BMIs than White participants.

Stunkard scale was for White persons, may not be good for Black persons.

Pepper et al (2010) 70 women evaluated for waist and hip circumference and waist: hip ratio via laser scanner and tape measure.

In a subset of 34 participants, 8 repeated measures of laser scanning were performed for reproducibility analysis.

Interclass correlation coefficient .992, p < 0.01.

Evaluation of waist and hip circumferences measured by body scanning did not differ significantly from tape measure (p > 0.05).

Small study population

1.8 Causes of Obesity

Obesity does not just happen overnight, it develops gradually from poor diet and lifestyle choices and, to some extent, from ones genes (the units of genetic material inherited from ones parents).

Lifestyle choices are an important factor in influencing your weight. Eating more calories than you need may be down to unhealthy food choices. For example, unhealthy food choices could be:

• eating processed or fast food that is high in fat,
• not eating fruit, vegetables and unrefined carbohydrates, such as wholemeal bread and brown rice,
• drinking too much alcohol – alcohol contains a lot of calories, and heavy drinkers are often overweight, and
• eating out a lot – as you may have a starter or dessert in a restaurant, and the food can be higher in fat and sugar,
• eating larger portions than you need – you may be encouraged to eat too much if your friends or relatives are also eating large portions, and
• comfort eating – if you feel depressed or have low self-esteem you may comfort eat to make yourself feel better.

Lack of physical activity is another important factor that is related to obesity. Many people have jobs that involve sitting at a desk for most of the day, and rely heavily on their cars to get around. When it is time to relax, people tend to watch TV, or play computer games, and rarely take any regular exercise. If you are not active enough, you do not use up the energy provided by the food you eat, and the extra calories are stored as fat instead.

Some people tend to stay the same weight for years without much effort, whereas others find they put on weight quickly if they are not careful about what they eat. This could be due, in part, to your genes. Some genetic conditions can increase your appetite, so you end up eating too much. There are also genes that determine how much fat your body stores. A particular genetic variation could mean that your body is more likely to store fat than somebody else.

1.9 Patterns of Obesity in the Population

The composition of the body and how fat is stored changes with age, and different metabolic and hormonal factors influence body fat accumulation throughout the life spectrum (Schwartz, 1995; Beaufrere & Morio, 2000). In cross-sectional studies, peak values of BMI are observed in the age range 50-59 in both men and women, with gradual declines in BMI after age 60 (Flegal, et al., 1998; Hedley, et al., 2004;), although premature mortality of the obese may influence these cross-sectional relationships (Williamson, 1993). Rates of overweight and obesity in longitudinal studies generally increase with age until age 75, when there is a small drop (Flegal, et al., 1998;).

Men are more likely than women to be overweight, but women are more likely to be obese, especially with BMIs greater than 35 (Hedley, et al., 2004). Differences in overweight and obesity rates for women vary starkly by race and ethnicity but are not as apparent for men (Flegal, et al., 1998; Hedley, et al., 2004). According to the National Center for Health Statistics analysis of NHANES data (Hedley, et al., 2004), 77.5 percent of Black women are overweight, compared to 71.4 percent of Mexican women and 57 percent of White women. The prevalence of obesity is similarly skewed with the rates for Black, Mexican and White women at 49.6 percent, 38.9 percent and 31.3 percent, respectively. In fact, over 10 percent of middle-aged Black women have BMIs greater than 40 (Flegal, et al., 1998).

1.10 Relationship of Body Size to Mortality and Disease

It is well established that overweight and obesity are significantly related to higher rates of several chronic health conditions including diabetes, hypertension, high cholesterol, coronary heart disease, arthritis, and certain types of cancer (Mokdad, et al., 2003; Flegal, et al., 2007). The relationship between obesity and mortality has been less definitive, but recent research has documented a stronger association than years past.

1.11 Relationship of Body Size to Functional Status

The shape comparison of average women obtained from 3 different surveys gives an indication of the profound changes that have occurred in anthropometry over the last half-century. The average UK woman has increased substantially in weight and body girths since 1951 (Kemsley, 1957), gaining 16 cm in WC despite being only 4 cm taller. The average contemporary US woman has even greater waist and weight than her UK counterpart, despite being 3 cm shorter. As is well recognized, the US population began the trend toward obesity earlier than did European populations, and, without progress in obesity prevention, the UK population is likely to continue to expand in weight and girths.

In cross-sectional analyses, obese individuals tend to have an increased prevalence of both upper and lower body functional limitations (Apovian, et al., 2002), and the relationship between obesity and limitations appears to be slightly higher for elderly women than elderly men (Davison, et al., 2002). Longitudinal studies find that these relationships hold for the onset of limitations as well (Ferraro, et al., 2002; Himes, 2000; Jenkins, 2004). Excess weight adds stress to the skeleton and weight-bearing joints, increasing the likelihood of arthritis and joint problems. Physiologically, excess weight leads to increased insulin resistance, damages connective tissues and leads to atherogenesis. It is hypothesized that these changes can lead to decreased functioning (Ferraro & Booth, 1999).

Obesity may also limit physical activity, depriving individuals of the benefits of exercise and leading to the development of limitations in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) such as climbing stairs, getting out of bed, or going shopping.

1.12 Aim and Objectives

Aim and objectives are to study the physiological effects of obesity and 3D body scanning.

• To study UCL population in conjunction with Wellbeing UCL survey
• To examine available data from UCL Wellbeing survey
• To statistically analyse data obtained
• To evaluate the data
• To make deductions from these data about the effect of obesity on the physiological parameters have looked at.
• To conclude with implication of my findings