Public Health Interventional Management: Overweight and Obesity Report

This problem analysis report examines the public health challenge of overweight and obesity, particularly within the Counties Manukau Health region of New Zealand. The report defines overweight and obesity, highlighting its adverse effects on health, including mental health, quality of life, and mortality, and its determinants such as lack of physical activity and increased intake of energy-dense foods. It explores the population demographics of Counties Manukau, detailing the prevalence of obesity across different age groups and ethnicities. The report further analyzes the attributable effects and costs of obesity, including both direct and indirect medical expenses, and outlines existing mandates for action within Counties Manukau. It also discusses the consequences of inaction, the causal links between determinants and the problem, and the focus of intervention strategies, concluding with a call to action to address this growing public health concern.

RUNNING HEAD: Public Health Interventional Management
Public Health Interventional Management

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Abstract
This problem analysis report focuses on the problem of overweight and obesity which is
increasingly being experienced by most of the developed countries including New Zealand. The
term overweight and obesity can be defined as the excessive or abnormal accumulation of fat
that presents a risk to the health of an individual. The problem has become a major concern these
days due to its link with poor mental health, reduced quality of life and death of an individual in
various developed countries including New Zealand. It is the result of changed lifestyle and
behavior of individuals. The determinants of overweight and obesity includes lack of physical
activity in daily routine, increased intake of energy- dense foods, deskbound nature of jobs and
changed modes of transportation that increases physical inactivity. Overweight and obesity is a
problem that does not occur in one day but is a slow and gradual process that occurs over time.
This problem analysis report focuses on the area covered by Counties Manukau Health for the
purpose analyzing the problem of overweight and obesity. It also provides the effects and costs
of overweight and obesity along with mandates for action in Counties Manukau, consequences
for not dealing with the problem, determinants and causal link between determinants and the
problem.

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Contents
Introduction......................................................................................................................................3
Overweight and Obesity – A Public Health Challenge...................................................................3
Population of Counties Manukau....................................................................................................3
Effect of Overweight and Obesity on the population of New Zealand...........................................4
Attributable Effects and Costs of Overweight and Obesity.............................................................5
Mandates for Action in Counties Manukau relating to Overweight and Obesity...........................6
Consequences of not dealing with Overweight and Obesity...........................................................7
Determinants or Causes of Overweight and Obesity.......................................................................7
Causal Links between Determinants and Problem..........................................................................9
Focus of Intervention Action/ Strategy............................................................................................9
Conclusion.......................................................................................................................................9
References......................................................................................................................................11

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Introduction
Overweight and obesity is a public health challenge experienced by most developed countries
including New Zealand. The number of overweight and obese people is increasing day by day
causing greater risk for children and adults. With the rapid increase in figures concerning weight
gain in the last decade, it has become an important issue to be considered. The developed
countries have developed an obesogenic environment as a result of the promotion and
availability of plenty of energy dense foods, decline in manual jobs involved in manufacturing
resulting in occupations that are low paid with long working hours and increase in deskbound
occupations. This problem analysis report focuses on overweight and obesity as the problem
frame using the population served by Population of Counties Manukau.
Overweight and Obesity – A Public Health Challenge
The term overweight and obesity can be demarcated as excessive or abnormal accumulation of
fat that presents a risk to the health of an individual (World Health Organization, 2018).
However, the terms ‘fat’ and ‘obese’ are altogether different. The term fat defines excess flash
on the body whereas the term obese means abnormally fat which is linked with early death and
morbidity. The prevalence of obesity has subsequently increased in almost every country across
the world and has become a major problem. New Zealand is the part of this global trend.
Overweight and obesity is a result of a variety of factors and causes including individual factors
such as behavior and genetics. The term behavior includes inactivity, medication use, dietary
patterns, physical activity, and other exposures. Other contributing factors include education and
skills, physical activity environment and food, promotion and food marketing (Hebestreit, et. al.
2014). Overweight and obesity has become a serious concern due to its association with poorer
mental health outcomes, low quality of life, and foremost causes of death in various developed
countries including New Zealand.
Population of Counties Manukau
The population served by Counties Mankau District Health Board contains some exceptional
features in comparison with other District Health Board populations related to age structure, size,
socio-economic profile and ethnic mix. The geographic area served by Counties Manukau Health

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is mostly the part of the territorial authority of Auckland Council. For integration and service
planning purposes, the region served by Counties Manukau Health is classified into four
localities-Eastern, Franklin, Manukau and Mangere/ Otara.
Out of the 20 District Health Boards in New Zealand, the second largest assessed resident
population is with Counties Manukau Health. Therefore, the population served by Counties
Manukau Health is multi-ethnic with high proportions and numbers of Asian, Maori and Pacific
peoples. In the year 2014, Counties Manukau Health served an assessed resident populace of
509,060 people out of which 16% were estimated to be Maori, 23% as Asian, 21% as Pacific
people and 40% as NZ Other/ European groups.
The ethnicity mix of Counties Manukau population differs in terms of age. The younger groups
have larger proportions of Asian, Maori and Pacific peoples in comparison with the population
aged 65 years and above where approximately two-third of the population consist of NZ Other/
European Groups. In comparison with the population of entire New Zealand, higher proportion
of children is with Counties Manukau. In the year 2014, twenty-four percent of the estimated
resident population of Counties Manukau Health was aged 14 or under. The Pacific and Maori
populations have high percentage of population under 15 years of age as compared to other
ethnic groups (Counties Manukau Health, 2015).
Effect of Overweight and Obesity on the population of New Zealand
The adults of Counties Manukau suffer from much higher levels of obesity as compared to other
Auckland metro District Health Boards Pacific. On the other hand, Counties Manukau suffer
from lower prevalence of overweight presumably due to the reason that majority of its
population have moved from overweight into obesity. However, approximately one out of every
four Pacific peoples were found to be morbidly obese in the sample of Counties Manukau with
Body Mass Index (BMI) 40 or more (23.6% standardized, 22.7% crude prevalence) (Counties
Manukau Health, 2014)
Overweight and obesity affects children, adults and older adults.The obesity prevalence in
Counties Manakau Health population according to the NZ Health Survey 2011-13 combined
cohort by age group and gender has been depicted by the following graph.

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Figure 1 obesity prevalence in Counties Manakau Health population according to the NZ
Health Survey 2011-13 combined cohort by age group and gender
(Source: Counties Manukau Health, 2014)
The graph clearly represents that both men and women are affected by obesity in various age
groups from 15 years to 65+ years. The prevalence of obesity among the population group of15-
4 years was found to be 25% in men and 34.9% in women. Similarly, among the population
group of 25-44 years, it was 42.8% and 50.8% and in population group of 45-64 years it was
estimated to be 43.7% and 41.9%. However, among the population group consisting of people
aged 65 years and above, it is subsequently reduced to 28.7% in men and 36.6% in women.
The obesity among children of Counties Manukau between the ages of 2-14 years was found to
be 18.6% with 29.9% in Pacific People, 24.5% in Maori and 10.2% in Asian children. Among
adults, the total obesity in Counties Manukau was estimated to be 40.5% with 54.35 in Maori,
72.9% in Pacific and 20.7% obesity in Asian people.
Attributable Effects and Costs of Overweight and Obesity
The health and well-being of an individual is adversely affected due to overweight and obesity.
Potential problem include depression, chronic musculoskeletal problems, respiratory difficulties,

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infertility and relationship problems. The life-threatening problems are classified into four
categories: gallbladder disease, cardiovascular disease problems, certain types of cancers
specifically large hormonally related bowel cancers, insulin resistance linked conditions such as
type 2 diabetes (CDC, 2018). The risk of developing life threatening problems and type 2
diabetes is increases with the increase in body fatness.
Overweight and obesity also has various economic and societal consequences on the health care
system of New Zealand. Both direct and indirect medical costs are involved in the medical costs
associated with overweight and obesity (Utter, Denny, Teevale, Peiris-John & Dyson, 2015).
Diagnostic, preventive and treatment services are included in the direct medical costs related to
obesity. Indirect medical costs are associated with mortality and morbidity costs including
productivity. The measurement of productivity is undertaken on the basis of absenteeism (the
cost incurred due to non- presence of employees at work as a result of obesity-related health
reasons) and presenteeism ( reduced productivity of employees while being present at work)
along with premature disability and mortality.
Mandates for Action in Counties Manukau relating to Overweight and Obesity
A Childhood obesity plan was initiated in Counties Manukau which aimed at preventing and
managing obesity in children and youth up to 18 years of age. It was launched in the year 2015
and focused on three areas made up of 22 initiatives:
 Interventions were targeted for obese people
 Support increased for people who are at risk of becoming obese
 Healthier choices made easier for people in New Zealand through the adoption of broad
approaches (Swinburn & Vandevijvere, 2016).
The key focus of the plan is on the environment, food, and being active during all the stages of
life, starting from pregnancy and early childhood (Ministry of Health, 2018).
The guidelines related to Healthy Weight Gain in Pregnancy have been released by Ministry of
Health which raises awareness in pregnant women regarding healthy nutrition. Counties
Manukau Health has contracted directly with Ministry of Health for the purpose of improving

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infant nutrition. Two interdependent work streams are involved i.e. health services development
and community action.
A national level policy has been implemented as the ‘Actions to Encourage Healthy Weight and
Healthy Lifestyles’. This encouraged the families to live healthy lives by way of making good
choices in food, sustaining a healthy weight, being physically active, not indulging in practices
like smoking and drink alcohol (The Hub by Superu, 2018).
Consequences of not dealing with Overweight and Obesity
The risk of suffering from various health problems increases due to overweight and obesity
(Hutchison, Matto, Harrigan, Charlesworth & Viggiani, 2007). Such health problems include
diabetes, heart disease and certain cancers. Overweight and obesity in pregnant woman may lead
to health problems for the woman and her child. Not dealing with overweight and obesity on
time can result in various consequences including sleep apnea, heart disease, type 2 diabetes,
strokes, certain types of cancer, high blood pressure, kidney disease, fatty liver disease,
osteoarthritis, and pregnancy problems such as increased risk of cesarean delivery, high blood
sugar during pregnancy, etc. (National Institute of Diabetes and Digestive and Kidney Diseases,
2018).
With the increase in BMI, the risk of non-communicable diseases also increases. The chances of
obesity, disability and premature deaths are increased in adulthood in cases where an individual
faces obesity in its childhood. Along with the future risks, obese children also experience
complications in breathing, hypertension, insulin resistance, increased risk of fractures,
cardiovascular diseases and psychological effects (Williams, Mesidor, Winters, Dubbert &
Wyatt, 2015).
Determinants or Causes of Overweight and Obesity
The major cause of overweight and obesity is an imbalance in energy between calories consumed
and calories expended (Rossen & Rossen, 2011). Worldwide, there has been:
 An increase in the intake of energy-dense foods. These include foods that are high in fat.

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 Increasing urbanization, deskbound nature of various types of jobs and changing
transportation modes leading to rise in physical inactivity.
 The patterns of physical activity and diets have also been changed as a result of societal
and environmental changes linked with the lack of supportive policies and development
in sectors such as agriculture, health, urban planning, transport, distribution, food
processing, education and marketing.
An important role is played by the cultural and familial patterns of food intake along with the
accessibility and intake of high fat diets, highly palatable foods, high energy and increasing
portion sizes. Calorific intake is increased due to sugar sweetened soft drinks and fast food
outlets (Wolin & Petrelli, 2009). Physical activity has been reduced due to current lifestyles in
which greater reliance is on the use of technology as a labor saving device (Burns et. al., 2009)
Figure 2 Obesity: Determinants and Actions
(Source: Counties Manukau Health, 2014)

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Causal Links between Determinants and Problem
The determinants lead to the actual problem of overweight and obesity when no steps are taken
to prevent the occurrence of the problem. Overweight and obesity is initiated when an individual
eats too much and moves too little. When the consumption of high amounts of energy is made,
specifically sugars and fat and the energy is not burned by way of physical activity and exercise
then the surplus energy is stored by the body in the form of fat which slowly results into obesity.
Obesity does not happen overnight but is a result of poor lifestyle choices and diet over time
such as eating and drinking alcohol in large quantities, consuming too much sugary drinks and
fast foods. Nowadays, people are least involved in physical activities as their jobs require them
to sit at a desk for the entire day. Instead of preferring walking or cycling, they rely on their cars.
Also, they never get time for exercise and tend to watch TV, play computer games and browse
the internet for relaxation. The causes of overweight and obesity is undertaken by almost
everyone these days but obesity is actually caused to those who take no steps for its prevention.
Focus of Intervention Action/ Strategy
This suggests that the intervention actions and strategies that are implemented by the government
needs to be focused on creating awareness that how poor lifestyle choices and behaviors can lead
to overweight and obesity over time. The awareness programs should also include the steps to be
taken for the prevention of such problem such as increasing physical activity by walking, cycling
and exercises, less intake of energy dense foods, etc. The focus should be on the prevention of
obesity before the birth of the child along with taking steps right after the birth. The promotion of
healthy food habits should be made along with increasing awareness regarding the harmful
effects of fast foods and energy dense foods in the people residing in New Zealand.
Conclusion
The focus of this problem analysis report was on the problem of overweight and obesity faced by
estimated resident population of Counties Manukau Health. From children to older adults,
overweight and obesity is the problem that is experienced by everyone these days due to the
adoption of poor lifestyles and behaviors. Therefore, it can be concluded that for preventing
overweight and obesity, physical activity should be included in the daily routine in the form of

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regular exercises, cycling, walking, etc. Moreover, the intake of energy dense foods, fast foods,
alcohol in large quantities should be avoided and the intake of healthy food should be increased.

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References
Burns, D., Costello, J., Haggart, M., Kerr, J., Longshaw, K., & Thornton, E. (2009). The public
health challenge of obesity: is it the new smoking?. Journal of Community
Nursing, 23(11), 4-9.
CDC. (2018). The Health Effects of Overweight and Obesity. Retrieved March 13, 2018 from
https://www.cdc.gov/healthyweight/effects/index.html
Counties Manukau Health. (2014). Counties Manukau District Health Board. Retrieved March
13, 2018 from http://www.countiesmanukau.health.nz/assets/Blog/teamcounties/obesity-
way-forward-a-paper-presented-to-elt-august-2014.pdf
Counties Manukau Health. (2015). Demographic Profile: 2013 Census Population of Counties
Manukau. Retrieved March 13, 2018 from
http://www.countiesmanukau.health.nz/assets/About-CMH/Demographics-and-
populations/Census-2013-profile-for-residents-of-Counties-Manukau.pdf
Hebestreit, A., Börnhorst, C., Pala, V., Barba, G., Eiben, G., Veidebaum, T., ... & Pigeot, I.
(2014). Dietary energy density in young children across Europe. International Journal of
Obesity, 38(S2), S124.
Hutchison, E. D., Matto, H. C., Harrigan, M. P., Charlesworth, L. W. & Viggiani, P. A.(2007).
Challenges of Living: A Multidimensional Working Model for Social Workers. SAGE
Publications.
Ministry of Health. (2018). Childhood obesity plan. Retrieved March 13, 2018 from
https://www.health.govt.nz/our-work/diseases-and-conditions/obesity/childhood-obesity-
plan
National Institute of Diabetes and Digestive and Kidney Diseases. (2018). Health Risks of Being
Overweight. Retrieved March 13, 2018 from https://www.niddk.nih.gov/health-
information/weight-management/health-risks-overweight
Rossen, L. & Rossen, E. (2011). Obesity 101. Springer Publishing Company.

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Swinburn, B., & Vandevijvere, S. (2016). WHO report on ending childhood obesity echoes
earlier recommendations. Public health nutrition, 19(1), 1.
The Hub by Superu. (2018). Actions to Encourage Healthy Weight and Healthy Lifestyles.
Retrieved March 13, 2018 from http://thehub.superu.govt.nz/project/actions-encourage-
healthy-weight-and-healthy-lifestyles
Utter, J., Denny, S., Teevale, T., Peiris-John, R., & Dyson, B. (2015). Prevalence and recent
trends in overweight, obesity, and severe obesity among New Zealand
adolescents. Childhood Obesity, 11(5), 585-589.
Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015). Overweight
and obesity: prevalence, consequences, and causes of a growing public health
problem. Current obesity reports, 4(3), 363-370.
Wolin, K. Y. & Petrelli, J. M. (2009). Obesity. ABC-CLIO.
World Health Organization. (2018). Obesity and overweight. Retrieved March 13, 2018 from
http://www.who.int/mediacentre/factsheets/fs311/en/
Yofee, L. (2009). How to Avoid the Obesity Epidemic. Retrieved March 13, 2018 from
https://www.everydayhealth.com/healthy-living/obesity-prevention.aspx