Genetics/Inherited disorders case study

The textbook identifies the prevalence of major multifactorial adult disorders in the United States (Table 5-5, p. 165). Locate this information for your own health region or state (this may be readily available through the web sites for your health region or state health department): what similarities/differences in prevalence do you see? Explain the significance of knowing the prevalence of common disorders for the practice of a nurse practitioner.

Obesity (Group F)
Group F: Obesity
Obesity is on the rise in both the United States and in Ohio. With each passing year, more Americans are being diagnosed with obesity and Ohioans are among their ranks. As McCance and Huether (2006) point out obesity can be defined as a body mass index (BMI) that is greater than 30 (p. 165). The text also goes on to state that "a survey published in 2002 showed that approximately 30% of American adults are obese, and an additional 35% are overweight (BMI greater than 25 but less than 30)” (McCance and Huether, 2006, p.170.) The number of obese American is rising at an alarming rate. According to the CDC, the latest NHANES study shows 32.2% of adults are obese in the USA as of 2003-2004. When considering adolescents and kids- the data mirrors that for adults. Basically, 17% of American kids are overweight. The CDC’s NHANES study found that the percentage of children that were overweight increased from 7.2 % to 13.9% among 2-5 year olds between 1988-94 and 2003-2004 (CDC, 2007). Among 6-11 year olds the overweight rates shot from 11% to 19% during the same time period (CDC, 2007). 

Ohio is on the same path as the rest of the country, and one could argue that Cleveland in particular is at risk. We are in the highest incidence rate of obesity category when compared to the rest of the country (http://healthyamericans.org/reports/obesity/release.php?StateID=OH). Men’s Fitness magazine named Cleveland the country’s 18th fattest city in America. The rankings were based on criteria such as access to health care resources, prevalence of fast food restaurants, public park space, and air quality (http://www.msnbc.msn.com/id/10737777/). Even though this study might not stand up to scientific critique, it is helpful in pointing out the major culprits leading to obesity that we, as health care providers in Cleveland, are up against.

According to the Healthy Americans website, Ohio ranks 10th in the nation! We have the 10th highest level of adult obesity in the nation at 24.9 percent.  Even our high school students are getting fatter. We have the 4^th most overweight high school student level at 13.9 percent. We have the 33rd highest overweight level for low-income children ages 2-5 at 11.1 percent. The Cuyahoga County Board of Health (CCBH) notes that “a recent survey of over 1,700 kindergarteners across Cuyahoga County found that almost 36% of these children were overweight or obese. 
The problem is not going away. Not only are the numbers alarming, but obesity affects our budget too. "Ohio spent an estimated $289 per person in 2003 on medical-costs related to obesity, which was the 11th highest amount in the nation" (Healthy Americans, 2007). According to the Cuyahoga County Board of Health (CCBH), a 2002-2003 study by the Ohio Department of Health indicated that the top three causes of death for Cuyahoga County residents were: “diseases of the heart – accounting for 34.8% of all the deaths in Cuyahoga County,” malignant neoplasms, and cerebrovascular disease. This is significant when you consider that the CDC has recognized that being overweight or obese is a major modifiable risk factor associated with all of these leading causes of death.

Taking into consideration that obesity is an important risk factor for stroke, heart disease, hypertension and type II diabetes, we need to address the issue as future Nurse Practitioners. The fact that obesity is on the rise means that education and prevention need to be emphasized anytime health care is provided. We need to point out to our clientele, who may have children, that being a parent means responsibility and how they eat and what lifestyle choices they make will affect their children. McCance and Huether (2006) continue "a strong correlation exists between obesity in parents and their children" (p. 170). Lifestyle and environment play a crucial role.
When helping our patients to modify their lifestyle choices we need to be clear about the factors that contribute to the obesity. A sedentary lifestyle burns fewer calories and leads to obesity. Interestingly, prolonged TV watching has been correlated with obesity. A Nurses’ Health Study demonstrated that “after adjusting for age, smoking, exercise level and dietary factors, every two-hour increment spent watching TV was associated with a 23 percent increase in obesity” (Bray, 2007). Sleep deprivation can also lead to weight gain. One study suggests that too little sleep can lead to excessive eating and result in weight issues. Other risk factors include: smoking cessation, social networks (talk about self efficacy), diet choices, fast food consumption, night-eating syndrome, socioeconomic factors, and psychogenic disorders.

Another reason for having a good handle on obesity when it comes to our patients is the intimate role that it plays in the development of metabolic syndrome (syndrome X). According to Meigs (2007), abdominal obesity is especially of concern when gauging health risks to our patients. Abdominal obesity is directly linked with insulin resistance, hyperinsulinemia and hyperglycemia. Type II diabetes mellitus is the result. With time adipocyte cytokines “may also lead to vascular endothelial dysfunction, abnormal lipid profile, hypertension, and vascular inflammation, all of which promote the development of atherosclerotic cardiovascular disease” (Meigs, 2007). Thus, it is clear that being overweight caries with it a number of potential health concerns as is evidenced by the Framingham Heart Study cohort: “an increase in weight of 2.25kg or more over 16 years was associated with a 21 to 45 percent increase in the risk for the developing the syndrome” (Meigs, 2007).
It is important for us to know the prevalence of common disorders as nurse practitioners so that we can meet the needs of the populations we serve. It may be necessary to have a team of professionals in place to do consults for the obese patient that is having a particularly difficult time losing weight. As nurse practitioners we can have endocrinologists, nutritionists, psychiatric resources (for the depressed individuals), exercise physiologists, social work resources to help find affordable gym options and a whole support system in place to help combat the obesity that has become endemic to northeast Ohio and the Cleveland area in particular. We can better anticipate our patients’ needs when we are aware of the conditions that affect them. 
For anyone interested the following website provides obesity stats for the last twenty years for Ohio: http://health.msn.com/reports/obesity/ohio.aspx
At the bottom of the site a BMI calculator is provided so everyone can figure out their body mass index (BMI). We are also including an attachment which is a PowerPoint presentation of the trends in obesity in the United States over the last few years.

References
Bray, G. A. (2007). Etiology and natural history of obesity. Retrieved November 20, 2007 from the UpToDate database.
Cuyahoga County Board of Health: http://www.ccbh.net/ccbh/opencms/CCBH/services/administration.html
http://health.msn.com/reports/obesity/ohio.aspx
http://healthyamericans.org/reports/obesity/release.php?StateID=OH
McCance and Huether. (2006). Pathophysiology: The biologic basis for disease in adults and children. (5th ed.) Philadelphia: Elsevier Mosby.
Meigs, J. B. (2007). The metabolic syndrome (insulin resistance syndrome or syndrome X). Retrieved November 20, 2007 from the UpToDate database.
Tierney, Saint and Whooley. (2005). Current essentials of medicine. (3^rd ed.). New York: Lange 
	Medical books/McGraw-Hill
www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_adult_03.htm
www.cdc.gov/nchs/products/pubs/pubd/hestats/overweight/overwght_child_03.htm
www.cdc.gov/overweight
www.cnn.com/HEALTH/library/DS?00314.html
www.msnbc.msn.com/id/10737777/
www.nlm.nih.gov/medlineplus/obesity.html
www.obesityinamerica.org