Cohehre Aphasia by mikesanye


									         Subject: Obesity
• Group of Budapest

     • ICHCI
• Date: 10-09-2007          ?
• Location: Brugge
                     Structure of the presentation
•   Group introduction
•   Introducing the subject – obesity
•   Some facts on “obesity”
     -   Definition of the WHO
     -   Ethiologie
     -   Consequenses (individual and sociaty)
     -   Prevalance and Incidence each country
     -   Statistics

•   Health Care Programs on obesity
•   Reflection on “obesity” and our professions

•   Discussion with the audience

•   Feedback
•   Summary
•   References

Introduction of our group
                      Desi Netherlands-
                      Netherlands- Nursing
                      Louise Denmark-
                      Rikke Denmark-
                      Zeza Portugal-
                      Speech therapist

                      Our Tutor:
                      Erszebeth (dietisian)
      Introducing the subject
The proces of finding the subject


Definition of Obesity according to World
       Health Organization (WHO):

Chronic disease as a result of excessive
grease storage on the body over a

Definition of Obesity according to World
      Health Organization (WHO):

 Is evaluated through the Body Mass Index (BMI):
 This formula will not regard to pregnant women,
 children and athletes.

                      Weight Kg 
                BMI 
                      Height 2 m 

Classification   Alternative      BMI (kg/m²)   Health Risk
Underweight                       ≤18,5         Depends on
Normal Weight                     18,5-24,9     Average
Overweight                        ≥25
Moderate                         25-29,9       Slightly
Severe          Obesity          ≥30
Obese class I   Obesity          30-34,9       Moderately
Obese class II Severe obesity    35-39,9       Severely
Obese class     Extremely        ≥40           Extremely
III              severe obesity                 increased
 Interplay among genetic, biochemical,
hormonal, cultural and behavioural factors.

 - Thus, it is a disease complex with several dimensions, like social and
 psychological, affecting people from every age and socioeconomic

Contributing Factors

     - Increasing the sedentary works;
     - Little time for eat or preparing the food  poor dietary habits;
     - Fast food abounding;
     - Society and technological development (i.e. remote control,
     computer games).

         Life Styles Changes

                                            People eat more and more and
                                                 move less and less.

Obesity is a risk factor to
  many diseases or

Individual Consequenses:
- High risc of diseases like:
       -   Diabetes
       -   Cardiovascular disease
       -   Musculoskeletal disorders
       -   Gallbladder diseases
       -   Some cancers (endometrial, breast, and colon).
       -   Osteopereuse

- Psychologich consequenses:
   - Fear of rejection from the society which could cause social isolation.
   - Also social discriminiation through the sociaty that obese people

- Because of the high risc of diseases or already having some of
  them, obese people have a lower life-expectancy.
Consequenses for the society:

• WHO estimates that 60 % - 70 % of all europeans will be
  overweight by 2030!!

• Costs a lot for the society, think about:
   –   cost for hospitalcare
   –   medication for the diseases
   –   prevention-programs
   –   incapacity (for working)
   –   Medical expenses for the society (insurance)

             In the Netherlands
              Prevalence & Incidence

• In 1989 among the Dutch population:
  – 34 % of men and 24 % of women were overweight.
  – 4% of men and 6% of women were obese.

• In 2005:
  – was 51% of the males overweight, 10% were obese.
  – Of the women 42% were overweight, 12% were

Estimations for the Netherlands
       Males: 13,2 %   - Females 14,3%

        Statistics Netherlands
• The prevalence of obesity is negatively
  related with social class.

        Statistics Netherlands
• The prevalence of obesity increases by age.

            Obesity in Denmark
      From 1987 to 2003 the incidence of obesity in
      Denmark increased to 14%

Prevalence of obesity in the Danish population
in 2003:

• 30-40% = 1,3 mil. were overweight

• 10-13% = app. 400.000 were obese

• And almost 100.000 were severely obese

Estimations for Denmark 2015

Prevalence and Incidence (Portugal)

  - Percentage (2004)
           Male Obesity: 14,5%          Male Overweight: 44,1%
           Female Obesity: 14,6%        Female Overweight: 31,9%

  Along the last years obesity has increased, especially among children.

  - Percentage
           31,56% Children

BMI Class Prevalence in Portugal

Overweight and Obesity Prevalence in Portugal by gender and age group

Overweight and Obesity Percentage in Portuguese Population by Level of

                           Level of Education
                          Primary       Secondary   Superior
        Overweight         38,2%          27,2%      17,8%
        BMI 25-29,9
        Obesity            12,5%           3,7%       3%
        BMI ≥ 30

 Danish health-care program
    Made by the Department of Health
        “Healthy all life” – 2002

Everyone has to work together – connection between
the primary prevention, personal effort, patient’s
counsel, support, habilitation, rehabilitation and other
with relation to public health.

Equal health opportunities in society for everyone –
therefore special effort towards some risk factors.
Danish health-care program
  “Healthy all life” - risk factors
   • smoking
   • alcohol
   • nutrition
   • physical activity
   • severe overweight
   • accidents
   • work environment
   • factors of the environment

     National Action Plan against Obesity
             - Recommendations and Perspectives

•   Danish National Board of Health, Centre for Health Promotion and
    Prevention, 2003

Documentation-basis of the action plan

•   A Danish Nutrition Council Report

Contents of the Plan

•   Proposals of action:
     – Objectives
     – Target groups

•   Recommendations:
     – Types of initiatives
     – Levels of proposed action                                       29
         Objectives of the Action Plan
  “to contribute to producing awareness and cultural norms in the Danish
            population that promote normal weight development”

               “to counteract habits that lead to overweight”

“to contribute to reducing bodyweight for persons who already suffer from or
  have a special risk of developing obesity – especially persons with type 2
                     diabetes and cardiovascular disease”


                                    • Maintaining existing initiatives

                                    • Supporting new initiatives

                                    • Evaluating new initiatives           30
• Categories of initiative

   – Structural:      eg. legislation

   – Normative:       eg. guidelines

   – Informational:   eg. campaigns

   – Research & Development of Methods

• Levels of action

   – Private:         individual/family

   – Community:       eg. trade & industry, day-care centres,
                      schools etc.

   – Public sector:   state, regions and municipalities         31
Target groups                 Objectives            Examples of action-proposals
“Children and adolescents     “Health promotion     ▲ Parents as role-models regarding both nutrition &
in general“                   and obesity           physical activity, ▲ cooking-skills.
                              prevention”           ▲ healthy food- and meal services in schools
                                                    ▲ guidelines, ▼soft drink vending-machines▼TV
“Children and adolescents     “Loss of weight or    ▲ Coarses for teachers and educators.
with overweight and/or        weight                ▼Stigmatisation, ▲ protection against mobbing.
special risk of developing    stabilisation“–       ▲ integrated services to detect and treat obesity. ▲
overweight or overweight      treatment             Information campaigns.
related complications”

“Adults in general”           “Promotion of         ▲ Implementing traffic-policies, ▲ strengthen the
                              lifestyles that       subject of nutrition in health education.
                              prevent overweight”   ▲ Workplaces should create frameworks for increased
                                                    physical activity. ▲ Cycle paths.
“Adults who are moderately    “Weight               ▲ Knowledge of health consequenses. ▲ Adopting
overweight (BMI = 25-29,9)    maintenance or        health policies establishing norms regarding persons
and/or with special risk of   weight loss”          with special needs.
developing obesity or                               ▲ Implement strict regulations on healtheducation.
obesity related diseases”                           Secure availibility of professional staff.
“Adults with obesity (BMI ≥   “Weight               ▲ Adopting policies preventing mobbing and exclusion
30)”                          loss/Weight           from labour market. ▲ Providing ”prescription for
                              maintenance as a      exersice”. ▲ Developing more certainty in healthstaff
                              way of preventing     regarding the tackling of obesity. ▲ Treatment services
                              obesity related       for people with BED.
  Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

                                                           in obese people and in people
                                                               that would have a particular
• Objectives                                                     risk of develop obesity
                                                               (diabetes/obese class II and
        - contribute for reduction of weight;                    cardiovascular disease)

        - contradict determinants habits of overweight.

                      Contribute to the development of a
                     cultural promotion of healthy weight in
                           the Portuguese population
Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

      - This process involves cooperation and partnership
      between public, private and non governmental sectors

                         That act in health area

                 With local and regional responsibilities
  Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

Target Groups

       - Underweight or overweight at birth;
       - Obesity familiar antecedents;
       - With some alimentary disease in the past;
       - Women with multiples pregnancies;
       - Women in menopause period and post-menopause;
       - Recent Ex-smokers.

   Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

         1. Intervention Strategies;
         2. Educational Strategies;
         3. Collecting and Information Analyse Strategies.

  Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

1. Intervention Strategies
          - Improving all identification and attendance process of people
with risk factors;
          - Improving the patients diagnosis, treatment, recuperation and

  Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

2. Educational Strategies
         - Involve actions with informative, pedagogic and formative

                 Direct to health professionals and to
              population in general, almost obese, obese
              or ex-obese, including specific groups that
               promote a big habilitation and capacity at
                         health management.

  Health Care Programs (Portugal)

National Fight Program to Obesity – 2004-2010

3. Collecting and Information Analyse Strategies
         - Involves actions that improve the epidemiological knowledge of
obesity and make possible get information about obesity impact in
individual health.

                Health Care Program Netherlands
Preventive Program: Nederland in balans 2005-2010

•    Taking care of persons with healthy weight don’t come above a BMI of 25.

•    Taking care of persons with overweight (bmi of 25 or more) become more


1.   Stimulate the knowledge en allerting about healthy weight.

2.   Explain the rol of the energybalans.

3.   Stimulate knowledge about the riscs of overweight.

4.   Give options of how you can change your behavior which are practical usefull.

             Activity program:
• Give information about healthy food, excersicing and
  energybalans by television, magazines and internet.
• Make healthy food easy en good looking!! Helping
  choosing healty food.(marks, reciepts)
• Changing product, assortiments in cantine’s,
  sportcantine’s: Connection NOC NSF. (sportasociation)
• Promote activities which are directed to excercing.
• Treath overweight quick and soon as possible.
• Activities at school (see next slide)
• Investigations about overweight.
• Handle Overweight International:
  Harmony betweem WHO and EU

   Healthcareprogram Youth till 19
Started the project Youth and overweight.
- Promotion of expertise
- Distribution of materials about overweight
- Campagne of Healthy food and excersice.
• Information for primary school, meterials and cooperation with
   Teleac (childeren television compagny)
• Healty food in schoolcantine’s.
• Promotion excersice in schooltime and in sportclubs.
• Much cooperation with child welfare, school’s and intermadairy
   of childeren en youth. (Internet use, magazine’s)
• Inform en reach parents (magazine’s parents)

       Obesity & Occupational Therapy (OT)
•   OT not among the disciplines mentioned in the Danish National Action Plan
    against Obesity… (!)

•   OT expertice is relevant and unique as part of a diverse interdisciplinary effort
    in both:

     – health promotion,
     – disease-prevention and
     – treatment of obesity

•   Obese people… gradually deprived of occupations

•   OT not care-oriented focus: Activity perspective for lifestyle-change

      A holistic and activity-oriented paradigm
•   Human activity as:
     – a result of physical, cognitive, affective and spiritual
       processes interplaying with environmental factors and
       circumstances of given activities


                         the individual,
                        the occupation
                       the environment

•   Both individual and group-level OT.

•   OT tools help clients identify occupational problems, and
    to clarify the reasons for them

     – Client-centeredness
     – OCCUPATIONAL perspective = disease is not determinant
       for outcome of OT.

•   OT can support a client with obesity in:
     – defining what is MEANINGFUL in sense of his or her daily
       activities, and
     – in achieving a meaningful occupational life
 Examples of relevant OT competences:
   – Anatomy
   – Physiology
   – Pathology:
      • Cardiovascular disase
      • Diabetes 2

   – Psychology:
      • Motivational & volitional factors
      • Roles & habits

• Activity-analysis and adaptation to client’s needs.

• Bottom-up perspective: the client’s ambassador, not the
Resources over weaknesses:

• OT goal: To enable occupation by means of

OT’s strive to secure and endorse the vital human
  needs of:


      …the need and right to be acknowledged as an
             equal existence, unconditionally


         … the need and right to live an active life

                  …and BECOMING

   … the need ad right to develop and grow at all times
  Reflections – Speech Therapy
The prevention of this disease is very important to avoid future problems in
several areas, include the speech therapy, like apoplexy and aphasia;

                                         In spite of the obesity isn’t directly
                                            connected to speech therapy

 In this cases the speech therapy besides his regular intervention should
 be attend to physical condition of his patient and give some advices
 about alimentation with the coordination of the nutritionist or dietician.

 In another situations the speech therapist can intervene in the obesity
 prevention in schools at several levels with other professionals.

  Importance of the
            Obesity and Nursing
• Mostly: First disease  hospitalcare  treating obesity
  and stimulate information about healty weight, excercising.

• Important: Focus on preventive function of nursing!
- Childhood and Youthcare
- Give attention to healthy food & weight by patients before
  getting diseases (weighing patient, look at intake daily
  food & drinks)
- Give attation to psychological factors of eating behavior
- Stimulate excercising in hospital, at home, work and in
  daily life.
- Help making solutions for changing habits

1. Not getting obese is a individual
   responsibility and not society?

2. The health care professions can not do
   everything to prevent the epidemic of

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    &ct=clnk&cd=2&gl=nl                                                                     50
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