Tuesday, 16 December 2014

Obesity – the epidemic that can be stopped if we address it as a societal as well as individual issue

Lin Perry, PhD RN RNT
Faculty of Health, University of Technology, Sydney and South Eastern Sydney Local Health District

Response to Lee, G. (2014), Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing. doi: 10.1111/jan.12584

Health services around the world are all now very familiar with the impending ‘pandemic’ of obesity. Until recently I resisted use of the term ‘pandemic’, in recognition of the primarily psycho-social origins of the problem. However, with the American Medical Association's determination of obesity’s disease status, it would seem that ‘pandemic’ it is.

Lee (2014) provides a very neat synopsis of this obesity ‘pandemic’: its precursors and consequences, its place in history and its dominance of the future. Simple advice – ‘eat less and exercise more’ – is cited as the 1816 solution, and for Lee, the ‘humble healthcare practitioner’ and ‘healthcare changes led by a nurse or similar practitioner’ remain the mainstay, albeit with ‘a need to acknowledge the local environments and the issue of socio-economic deprivation’.

I don’t disagree with these statements but I do think the emphasis is not quite right.

I do believe that nurses have a pivotal role to play in health promotion and the World Health Organisation has emphasised the need to strengthen the capacity of this workforce to meet the demands it is facing (World Health Organisation 2006). Nurses deliver the bulk of health education and health promotion initiatives world-wide. Nurses are visible and accessible as health behavioural role models. Nurses have the socio-economic benefits of above-average education, high health literacy and, generally, the social advantages of being employed. Yet our and others’ work shows that nurses are not just equally but even more affected by this ‘pandemic’ than the populations they serve (Bogossian et al 2012; Perry et al 2014). Our 2014 findings from 5,000 New South Wales nurses are beginning to tease out the implications of this for nursing as a profession and a workforce.

What is very clear, both from what Lee et al (2014) discuss and what we are finding, is that we must address this ‘pandemic’ from within as well as without, taking policy and practice steps to address obesity within the nursing workforce in order to enable nurses to play their pivotal role in addressing this within the world’s populations. Many common characteristics of the nursing workplace can be labelled as ‘obesogenic’. These include, for example, lack of facilities for healthy eating (Wong et al 2010), working practices that exhaust without opportunity for exercise, lack of change facilities to support cycling or running to work, etc. Many could be relatively easily addressed.

It is not a case of ‘physician (or nurse) – heal thyself’; it is not just a case of individual responsibility to ‘eat less and exercise more’. The power-brokers and policy-makers in nursing and healthcare as well as the wider world need to play their parts in making the environmental and socio-economic changes required to halt this pandemic. Halting it in nursing would be a good start.

Lin Perry
Faculty of Health, University of Technology, Sydney and South Eastern Sydney Local Health District
Editor, Journal of Advanced Nursing


Bogossian FE, Hepworth J, Leong GM, Flaws DF, Gibbons KS, Benefer CA, Turner CT. A cross-sectional analysis of patterns of obesity in a cohort of working nurses and midwives in Australia, New Zealand, and the United KingdomInternational Journal of Nursing Studies 49 (2012) 727–738

Lee G. Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing 2014 DOI: 10.1111/jan.12584
Perry L, Gallagher R, Hoban K, Shea A. The health of nurses: health risk factor profiles of Australian metropolitan nurses. Wellbeing at Work Third International Conference, Copenhagen 2014 

WHO (2006). Resolution WHA59.27. Strengthening nursing and midwifery. Geneva, World Health Organization.
Wong, H., Wong, M., Wong, S., Lee, A., 2010. The association between shift duty and abnormal eating behaviour among nurses working in a major hospital: a cross sectional study. International Journal of Nursing Studies 47, 1021–1027

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