Honors Mentorship: The Obesity Epidemic

Jennifer Rodriguez

ALl About ME

Hi! I'm Jennifer Rodriguez, a junior at Chestatee High School. However, I am also a dual enrollment student at the University of North Georgia. I am currently taking all my classes there, except for Honors Mentorship. Last year, I decided to try out Honors Mentorship, because I had heard how helpful it would be for my school career. Since my ideal career is to be a Nurse Practitioner, I did my mentorship at the Hall County Family Health Center. My experience there was exceptionally great! Each week I would practice a lot of hands-on techniques as well as learn from all the nurses. On a normal day, I would take patients into their rooms and take their vital signs and weight. Usually, I would follow Bridget (phlebotomist). However, I would also sometimes follow Niki (Registered Nurse and a Health Coach), Marsha (Nurse Practitioner), Dana (Licensed Practical Nurse), or Melanie (Medial Assistant). My mentor was Marsha but most of the time she was seeing patients that needed physicals or more personal tests which I could not watch as a minor. However, not only was the environment extremely welcoming but so were the nurses. I was able to bond with them in a way that made me feel like they were part of my family. In my entire mentorship, I was able to take vital signs, practice doing some tests, watch a lot of interesting procedures like in-grown toenail removal, the gluing of part of a finger, EKG's, and much more. Overall, I cannot express what a great decision I took when I decided to enroll in the Honors Mentorship Program! All the information I learned, from medical terms to performing EKGs to just getting used to a nurse's routine will helpful to me in the future. Once I get into nursing school and beyond, I will have a good foundation.

About

My REsearch

Research Question: How can the Government work closely with nurses to intervene with the obesity epidemic, while not encroaching with our rights as citizens?

My Books

Annotated Bibliograhy:#1

Nurse Practitioner Workforce: A Substantial Supply of Primary Care Provide

Press

Lucero, Robert, Lindsay Rauch, and Bobbie Berkowitz. "Nurse

Practitioner Workforce: A Substantial Supply Of Primary

Care Providers." Nursing Economic$ 30.5 (2012): 268-294.

CINAHL Plus with Full Text. Web. 31 Oct. 2016.

Annotation:

The Nurse Practitioner (NP) career is introduced as a career which is sometimes restricted by many regulations that have been implemented. However, there has been a steady growth of a demand for more Nurse Practitioners in the United States, as there is a diversity of work settings that need these nurses. The implementation of the Patient Protection and Affordable Care Act has sharply increased the need for primary care providers, more importantly, NPs. The limitations and regulations that restrict NPs from fully providing what they are certified for is the cause of the insufficient amount of NPs as primary care providers. NPs are not given much credit and are categorized in a level which puts them inferior to other healthcare providers with similar degrees. Each state also regulates these nurse differently, which causes differentiations within the scope of practice. Also, certain insurances do not fully pay the NPs when billed directly versus indirectly, which discourages some to choose this career. Therefore, allowing NPs to be able to provide complete care, unify policies within all states, and by better recommending the career and valuing it, this career will be more successful and expand more so than it will if restrictions keep being implemented. As the demand for NPs increases, changes should be made in order to allow these important nurses to provide full care and to not limit them by regulations.

Potential Quotes:

“NPs have been utilized to deliver primary care, traditionally in underserved areas or to vulnerable populations” (Poghosyan et al. 268).

“The RAND Corporation estimated the state of Massachusetts could save between $4.2 and $8.4 billion over 10 years if NPs and physician assistants were permitted to practice primary care to the fullest extent of their training” (Poghosyan et al. 269).

“Patients have better outcomes when physicians partner with NPs to manage chronic conditions such as diabetes compared to patients treated only by a physician” (Poghosyan et al. 269).

“This diversity in oversight may explain the significant variations in scope of practice, which often limits the ability of NPs to meet their patients’ needs” (Poghosyan et al. 270).

“Exclusion of NPs from PCMH leadership will restrict and limit NP practice, preventing NPs from using their chronic disease management skills and knowledge in implementing PCMHs” (Poghosyan et al. 272).

“To be able to use this workforce in the most productive way, uniform scope of practice regulations across states, payment policies based on services provided, and better work environments are necessary” (Poghosyan et al. 273).

Assessment:

The article uses profound language and organization that makes it a scholarly article. The article is also very recent, as it was created in 2012. Recent data and information used in the article makes it credible, because it shows that the facts are relevant to the time period. The Nurse Practitioner career has been changing, therefore, the information needs to be relevant. In addition, the article was created by university graduates who have experiences in nursing careers. The authors’ position enforces the fact that they have written a valuable, credible, and relevant scholarly article.

Reflection:

I will use the claims and data that are used in the article to enforce the research about Nurse Practitioners. The article is full of recent information that works as evidence to claim the importance of Nurse Practitioners. Quotes from the text are also useful about explaining the career as a whole. The work includes other information that enlightens relevant aspects to the Nurse Practitioner career. The topics about the identity of the nurses, their work setting, and regulations would help shape the thesis statement and introductory paragraph of a research paper, since the authors use plenty of information throughout the article that support these claims.

Reflection:

The article fits into my potential research very well, because the Nurse Practitioner career is introduced and explained about throughout the entire article. Since the NP career has been changing throughout time and is also being changed with many regulations being implemented throughout the United States, the article covers the difficulties that some NPs face. All these problems add to my ideas because it allows me to cover a completely different area to uncover the career in its entirety and hint about the potential problems future NPs might run into.

This scholarly article is very helpful research-wise, because there are countless different articles that explain the NP career but this article is exceptionally structured to where the reader can easily understand the arguments made. Also, there is a lot of recent information and data that can help prove a claim I may want to make. The article is also relevant to a potential topic in which I may want to explore the popular misconceptions about the NP career. Therefore, I can use this article to build my thesis and to gather ideas of what I would like to claim about. Not only would I use the data and information made in the article, but I would also use this evidence as a foundation for my paper, making it easier to organize the research paper. Overall, the article would truly advance my research paper in terms of evidence, organization, and claims.

Events

Annotated Bibliograhy:#2

Prevention if Overweight and Obesity: How Effective is the Current Public Health Approach

Chan, Ruth S.M, and Jean Woo. "Prevention of Overweight and

Obesity: How Effective Is the Current Public Health

Approach." International Journal of Environmental Research

and Public Health. Molecular Diversity Preservation

International (MDPI), Mar. 2010. Web. 17 Jan. 2017.

Annotation:

Obesity is officially defined and described as a “public health problem that has raised concern worldwide” (Chan and Woo 1). The introduction also introduces the increasing percentages of people growing obese in just a few years as well as the diseases that are very likely to overpower their body as this happens. Body Mass Index (BMI), waist-to hip ratio (WHR), waist circumference (WC), and waist-to height ratio (WHtR) are also explained as a measure of obesity. However, these tests are actually questioned later on, with proof as to why these tests are not accurate with children and the elderly. The main reason is because children and the elderly do not have the same ideal weight or body, their bodies are different than adults. In addition, the chronic diseases that are closely related to obesity are discussed. Diabetes, Cardiovascular Diseases, and even cancers are possible to develop more so in an obese person than a person with a healthy weight. In the following section, the effectiveness of current health stages are discussed. Some of these include setting different prices for healthy vs unhealthy foods, emphasizing nutritionists and health coaches in healthcare settings, and overall promoting the importance of healthy eating. Although these measures are ultimately categorized as effective, they are not sufficient enough to combat such an epidemic. Overall, further measures are needed to fully treat obesity.

Potential Quotes:

“Overweight and obesity are major causes of co-morbidities, including type II diabetes, cardiovascular diseases, various cancers and other health problems, which can lead to further morbidity and mortality” (Chan and Woo 1).

“The related health care costs are also substantial. In the United States, the total costs associated with obesity accounted for 1.2% gross domestic product (GDP)” (Chan and Woo 1).
“BMI was 3−4 units lower in Asian populations compared to Caucasian populations for the same body fat percentage” (Chan and Woo 2).
“BMI cannot make a discrepancy between fat and muscle mass. The reliability of BMI as an index of obesity is thus questionable, and therefore, other anthropometric indices are proposed to determine the degree of fatness in the elderly” (Chan and Woo 4).
“Of all physical health problems, type II diabetes has the strongest association with obesity” (Chan and Woo 4).
“The recent report by the World Cancer Research Fund and the American Institute for Cancer Research (2007) also suggested that there was convincing evidence that overweight and obesity increased the risk of cancers of the esophagus, pancreas, colon and rectum, breast (postmenopausal), endometrium, and kidney” (Chan and Woo 5).
“The etiology of obesity is multifactorial, involving complex interactions among the genetic background, hormones and different social and environmental factors, such as sedentary lifestyle and unhealthy dietary habits” (Chan and Woo 5).
“The development and implementation of obesity prevention strategies should target factors contributing to obesity, should target barriers to lifestyle change at personal, environmental and socioeconomic levels, and actively involve different levels of stakeholders and other major parties” (Chan and Woo 6).
“There are many key settings, such as schools, home environment, workplaces and community, in which policies could target to directly influence the eating and physical activity behaviors” (Chan and Woo 7).
“At the physician practice level, a lack of time to address obesity during routine office visits, a lack of reimbursement, inadequate training and low self-efficacy in handling patients of excess weight are some barriers to an effective management” (Chan and Woo 8).

Assessment:

The article is credible as the URL is a “.gov” URL. Also, the article is fairly recent, meaning the data and information are up to date and valid. This is important because the obesity epidemic has been changing and will continue to change. In addition, the article was created by scholars, who have deeply researched the topic and extracted and conducted varies tests to prove their hypotheses. The organization of the article helps the authors convey their information in an orderly fashion as well as make smooth transitions. The article is also an informative article meaning no bias is driving the research, only factual evidence.

Reflection:

I will use the statistical data to prove the validity and the effectiveness of the different methods. This article is rich in facts detailing how obesity should be treated/prevented. In addition, for background information, there is also more data about how obesity is actually measured and the flaws of these tests. This is very important since a valid test is needed to prove a disease in order to treat it. Although I had not thought of this part of treating obesity, with the article, I have began to question and to think about the topic more in depth. The quotes I saved will also drive my research in a way in which more topics will want to be discussed in the research paper, more specifically, as part of my thesis and introductory paragraph.

Annotated Bibliography Summary/Reflection:

As obesity is on a steady growth, there is a vital importance to find ways to treat and prevent such illness. Since nurses play a big role in the health of individuals, they must be the ones to help individuals choose a healthier lifestyle. In this article, obesity is specifically explained but also the touches on healthcare, the different measurements of obesity, and effective and noneffective ways that could help reduce this problem. Therefore, this article will be very helpful with my essay topic, since a variety of different approaches are made. Many tests and data are also given, and could be easily made into arguments or help emphasis another. This is also helpful in giving more ideas of what could be discussed about obesity, not only how the problem be solved.

The article is carefully structured to formulate a well-rounded article. The introduction introduces the overall problems obesity is causing. Percentages and numbers inform the reader that obesity is a popular topic, since many countries are now spending hundreds and thousands of dollars to help stop expanding it. The World Health Organization has been extremely involved in doing so, but has not yet found a definite solution. There is also a sharp difference between obesity in children, adults, and the elderly that is stressed about. Different levels of measurements and different diseases as a result of obesity are discussed. In addition, in order to touch on the causes of obesity, many factors are discussed in order to understand that there are a variety of factors that play a big role in the lifestyle of individuals. To conclude the article, the different methods of trying to find the solution are discussed. Various tests with results are explained and an ultimate conclusion of whether or not they are helpful in combating the disease are given as well.

Contact

Annotated Bibliograhy:#3

Nurses On the Frontlines of the Obesity Eidemic

Wallis, Claudia. "Nurses On the Frontlines of the Obesity

Epidemic." School of Nursing. Columbia University, 14

Dec. 2015. Web. 13 Feb. 2017.

Annotation:

As a Nurse Practitioner in the Cardiomyopathy, Rodriguez works with an obese patient, Mathew. She has been monitoring him since his heart transplant. His long-term health is critical of his weight and now has frequent meet-ups with the NP. Her conversation is very helpful in giving patients like these different options and substitutes, as well as focusing on the fact that many obese patients also have other illnesses /diseases that must be regarded as well. Later in the articles, information is given about how obesity has been treated with various methods including surgery. The difference in the obesity spectrum are also provided, as many children are now suffering from this disease. Different evidence has shown different consequences but some of them are mistaken due to confounding variables. Towards the end, there is a more focused point on the nurse's point of view. Since this is an article from a university, the methods that the Nursing Students are taught by their teachers for ways to help with obese patients are also examined. All this information is very important for my paper since there is a definite tie between the article and my research question.

Potential Quotes:

“If they are presenting with a high body mass index...nutrition is a huge component of their health and well-being” (Wallis 2).
“She works slowly and carefully with her young patients and their families, mindful of cultural food preferences and putting an emphasis on step-by-step changes to avoid discouragement” (Wallis 2).
“As for adults, one recent report calculated that the average American is 24 pounds heavier today than in 1960” (Wallis 3).
“We’re really at the crux of making change, ” states Rodriguez (Wallis 3).
“When a patient embraces lifestyle changes after surgery—such as a low-fat, low-carb, high-protein diet and regular exercise, she says, “often we see that it filters down to the rest of the family” (Wallis 4).
“In examining 21 studies published between 2005 and March 2012, they found substantial evidence that breastfeeding tends to protect children from becoming overweight or obese, but the relationship falls short of being definitive due to a large number of confounding variables” (Wallis 5).
“Mexico, the only nation in the world with a higher obesity rate than the U.S., last year approved a national “junk food tax” that adds eight percent to the cost of calorie-dense snacks and sugary soft drinks. Researchers and policymakers around the world are eager to examine whether this policy innovation will help to rein in that country’s runaway obesity” (Wallis 6).
“Earlier this year, the CDC revealed that the obesity rate had declined 43 percent among children ages 2 to 5—from 13.9 percent to 8.4 percent—the first broad decline in any age group and a rare bright spot in the epidemic. Researchers suspect that a variety of factors contributed to the drop: the rising popularity of breastfeeding; improvements in the federally funded Special Supplemental Nutrition Program for Women,Infants and Children (WIC), which distributes food to low-income women; First Lady Michelle Obama’s Let’s Move program, which reaches 10,000 child care centers; and other state, local, and federal policy changes” (Wallis 5).
“ One ongoing project supports the Abyssinian Baptist Church (ABC), long a pillar of Harlem, in creating a community kitchen that will offer cooking and nutrition classes to promote healthy eating and primary prevention of obesity” (Wallis 6).

Assessment:

(Analyze and explain why this source is credible)

The article I am using is credible because the publisher is Columbia University of nursing. As educators who are teaching future nursing students, this is credible because they know the methods that will work when working with obese patients. The article is also very recent which is important because the obesity epidemic is changing and it is important that the information and methods are up to date with dealing with this problem according to what is going on right now. The URL also hints to the article as a credible, scholarly article, as it is a “.edu” address.

Reflection (not the summary):

The article uses a great real-life example of how nurses should talk with their patients about this problem. Many times, nurses just recommend or even sound like they are demanding their patients to change their lifestyle, but they ultimately discourage their patients. Therefore, I will use this information to help prove the fact that nurses have a big influence of the lifestyle of their patients but there is also importance in the methods they use to promote a healthy lifestyle. I will also use the methods that they use to teach their students in my research paper to provide a variety of methods that can be used. Although there are a limited number of statistics used, the quotes from the nurses are very informative and helpful.

Annotated Bibliography/ Reflection:

The fact that nurses play a major role in the lifestyle of their patients is evident all around the world. This is why the importance of healthcare has risen over the years. However, there is importance in the methods that each nurse uses, especially when working with obese patients. In this article, the methods nurses should use are covered in order to effectively promote a healthy lifestyle. The nurse's perspectives and way of approaching this problem through the article helps look at a different perspective in which the role of nurses is more defined. The quotes that are given are helpful in providing information.

The article covers many different aspects that are needed to encapsulate obesity. The example, the quotes, and the rest of the information covered in the article is logically presented through the careful structure of it. In the introduction, Nurse Practitioner Rodriguez is introduced when talking with one of her patients about the obesity problem. Many substitutes and ideas that are given to the patient are generic and helpful for any obese patient. In the middle portion of the article, background information is given about obesity in general. This smooth transitions flows into the methods that have been and/or will be used to solve this problem. In depth, example like the food junk tax, labeling, and the construction of groups that promote such lifestyle are discussed closely. Overall, the article is effectively structured to convey the most important information about obesity.

Interview: Nurse

Anchor 1

---What do you believe is the major factor/cause of obesity based on your experiences with patients?

Bridget: People do not realize how bad unhealthy foods are and so they keep on eating those kinds of foods until they come to realize that they have gained weight. It also makes them harder for them to lose that weight because there is a drastic change in their diet and then they must start exercising which may be harder for them at first.

Jennifer (I): Yes, I can agree with that, especially if it is a lot of weight they have gained.

Reflection: There is sometimes too many “treats” and “snacks” that can get out of hand and it just keeps growing until they put on weight. So, I can agree that many times people just do not realize how bad foods are to their health.

---Who do you believe are the most influential people for obese patients (like spouses, doctors, family members, etc.)?

Bridget: Spouses and family members, I think are the most influential. It is because they just have so much influence on every aspect of their life, especially if someone cooks for them or just in general they have that power.

Jennifer (I): Family members have that ability so it is important for them to understand too.

Reflection: I can relate to this a lot because I am easily convinced to choose one food over another sometimes so I know how much of an influence family members/spouses are.

---How do you think nurses can work with the government to help treat/stop obesity?

Bridget: Well, like Michelle Obama, who implemented healthy eating, that was a great step for helping with obesity in schools, I think portion control is also very important.

Jennifer (I): Yes, both are very important.

Reflection: With obesity, there are many factors that need to be considered before recommending any foods/medications.

---Is there a method you think would be the most beneficial to combating this disease (like increasing taxes on unhealthy food, implementing label regulations, etc.)?

Bridget: I do not think increasing taxes on unhealthy foods because that would lead to more problems. Instead, there should be more substitutes, like McDonald’s does options between French fries and applesauce and options like that. Since, overall, that person must make decisions because it’s their health.

Jennifer (I): Yes, mostly when they have the calorie and nutrition on the menu, you can compare options.

Reflection: Now, more restaurants have calorie counts and nutrition labels and I think that helps people choose healthier options.

---What do you use to determine healthy and unhealthy foods to recommend your patients?

Bridget: I will usually recommend lots of gluten-free foods, healthy carb foods, and little fat intake, especially saturated fat.

Jennifer (I): Definitely, because most people just look at the calorie and determine that one food is healthier just because of the calorie count.

Reflection: Some foods appear to be healthier than others based on just maybe calories or carbohydrate amount, but everything matter, not just one. Therefore, it is important to pay attention to all aspects of food.

---Could the BMI scale have flaws due to the different bodies of people?

Bridget: At the time, they are tested, the weight and the height are really all that matter, so no overall I do not think that it is heavily flawed, although everybody is different.

Jennifer (I): Height and weight are very important, and I think that they are the two major factors to determine whether a patient is obese or not.

Reflection: Every human body is different, however I do think that the scale is overall correct and consistent, since they are the most prominent aspects.

---How do you work around the fact that some people have illnesses that prevent/ slow down the ability to lose weight and can you list a few?

Bridget: As a person with Polycystic Ovary Syndrome (PCOS), it is hard because of my insulin levels. There are lots of different factors that must be considered. But the disease and illnesses other than obesity should be considered first before starting a new diet or medications.

Jennifer (I): Yes, one factor needs to be taken care of at one time.

Reflection: Many diseases are easily affected and so I agree that those should be taken of first.

-Have you worked with a lot of obese/overweight patients that have been interested in weight loss surgery or medications?

Bridget: Not as much surgery but lots of medication. I think they just find it as an easy fix to lose the weight with the medication than just by eating healthy and exercising, even though if they truly want to see the results then they must do it all.

Jennifer (I): Yes, that was my guess, more people would want to take medication to help them with their weight loss.

Reflection: Although the medication can help, it is also important to exercise and eat healthy. Medication by itself will not help with weight loss.

---From a Nurse's standpoint working with a Health Coach at the clinic, do you think implementing more health coaches could help this epidemic or do you think there wouldn't be a big effect?

Bridget: It is a great idea because she can touch on a more personal level. With Niki here, patients are more susceptible to lose the weight because she keeps them accountable. Overall, health coaches would be very helpful in helping with this problem.

Jennifer (I): Yes, a person who will keep them accountable gives them more incentive to work towards their goal.

Reflection: From talking to Niki’s patients, I can agree that she keeps them on track and gives them helpful advice. Overall, she builds a nice relationship with her patients which has a big impact on their life.

---Do you think the people that lose weight are more susceptible to gaining it back than any other person?

Bridget: It depends, someone who gets surgery and is on medications usually gain it back because they did not necessarily “work” to lose it. People who put in all their efforts and eat healthy as well as exercise daily will be able to keep it off longer.

Jennifer (I): That was what I was thinking, just because they get very dependent on those medications and/or surgery.

Reflection: Most people try and find an easy solution to their problems but in the long run, they must deal with that problem again. The surgery and medications by themselves are almost temporary, whereas a good diet and exercise will lead to a healthy lifestyle, not just a “good” deal.

Anchor 2

Interview:College student

---What/who motivated you to lose weight?

College Student: When I was a junior in high school I went to Disneyland for Spring Break and when I got back I was looking at the pictures that we had taken throughout the week and I noticed that wasn't too happy about my appearance so that's when I decided to start working out and dieting. I also didn't want to have any health problems, for example like diabetes or depression or anything like that especially because I am still young.

---Are there methods you found to be the most beneficial (like tips or tricks you used)?

I started off with going to the gym every day and eating right. I didn't starve myself but I didn't binge either. I just ate what I wanted and worked it off later. I also did not use any powders or supplements to increase the stamina of my workouts.

---Do you think the government can do something to help with the high obesity rate?

I honestly think this is more of a personal experience because if you want to lose the weight you're just going to have to do something yourself. Because even is the government tells you that fast food isn't good for you, it's not like they are going to take all the restaurant chains out.

---During the process do you think your doctor/nurse impacted you in any way?

I didn't start working out because they told me to, but when I went in for my check-up 6 months later, and after losing 30 pounds, they congratulated me and that just motivated me to the max.

---Did you use the BMI scale during your weight loss period?

No, I did not. I wish I would have because I really wanted to compare fat percentages but that's okay.

Additional Information: Working out, for me, has had a very big impact on my stress levels. When I was overweight, I was always stressed and embarrassed but now that I have lost 60 pounds I don't stress about that at all.

*A big shout out to the student who allowed me to interview them about this personal topic. *

Anchor 3