Geraldine A. Lee, NFESC, PhD
Obesity is one topic that elicits a response and attempting to convey an important message in an editorial can prove testing. In response to the commentary from Perry, there are two very important points that need to be taken into consideration. Firstly, obesity is a complex global problem that nurses alone cannot address and secondly singling out a particular workforce such as nurses is not an ideal approach especially with the evidence regarding circadian disturbance associated with shift work.
Obesity is not a single entity and is an independent risk factor for conditions such as hypertension, type 2 diabetes and cardiovascular diseases (CVD). In relation to CVD, many physiological markers such as C-reactive protein, interleukin-6 and other cytokines have been implicated in the development of CVD in obese individuals but the paradoxical relationship between obesity and mortality is not fully understood (Ghoorah et al. 2014). Given this, we need scientists and clinicians of all disciplines to play an active role in investigating and managing obesity. Nurses are well placed to deliver education and advice to patients but care needs to be delivered in collaboration with other healthcare professionals, in particular dieticians and physiotherapists. Many studies in obesity report positive results with motivational interviewing and cognitive behavioural therapy and unfortunately not many nurses have these skills or qualifications. I would also argue that epigenetics and obesity as a speciality topic is not mandatory in most nursing education courses (either at pre-registration or post-registration). The World Health Organisation acknowledge the importance of educating healthcare professionals about diet and physical activity (Branca et al. 2007) and a multidisciplinary approach seems the most appropriate approach.
Obesity is not only prevalent in high-income countries but also in low to middle-income countries with 1 billion adults overweight globally and 300 million clinically obese with these numbers expected to increase. Although nurses are visible and highly educated in high-income countries, this is certainly not the case in low and middle-income countries and thus my statement that healthcare professionals playing a role and not just nurses. The on-going Ebola crisis brings home the lack of nurses and resources.
Although nurses play a pivotal role, I disagree with Perry’s comment that; ‘Halting it [obesity] in nursing would be a good start’. From a physiological perspective, attempting to address obesity solely in nurses is unwise. There is a plethora of research highlighting the negative effects of shift work on the body, down to the molecular level with evidence of increased risk of diabetes and obesity (Wang et al. 2011; Feng & Lazar, 2012; Archer et al. 2014). A recent study reported that 97% of rhythmic genes are out of sync in those who work shifts and this has serious implications in terms of potential transcription errors (Archer et al. 2014). The recent Health Survey for England data revealed that shift workers are sicker and fatter (Weston, 2014). Shift workers were more likely to have a long-standing illness, have diabetes, be obese, smokers and have lower daily fruit and vegetable consumption than non-shift workers. This suggests that attempting to treat obesity in nurses is not advisable. From a research perspective, it would be more appropriate to manage and treat obesity in a group who don’t work shifts as it is clearly a major confounder.
There is no doubt that national and international policies are important and all shift-workers including nurses should have access to healthy food rather than the usual unhealthy vending machine options at 4am. I am not advocating that individuals alone can correct their obesity but like the ill-effects of cigarettes now known to us all, there is no excuse for people not to be aware that having a diet high in saturated fat and not doing the minimally required physical activity leads to weight gain and obesity. Given that most of us overestimate our height and underestimate our weight, suggest that some self-truths, especially at this time of the year, wouldn't go amiss. The news today from the European Court of Justice that obesity can constitute a disability has major ramifications within the European Union that may adversely hinder progress in reducing obesity (The Guardian, 2014).
There is high quality evidence supporting eating less and moving more but many of the effects are short-lived (less than 2 years) and that is why the healthcare practitioner has a vital role to play in collaboratively managing long-term health problems associated with obesity. The job is too big for nurses, individuals and society have to take responsibility too.
Geraldine A Lee, NFESC, PhD.
Lecturer, Department of Postgraduate Research,
Florence Nightingale Faculty of Nursing & Midwifery,
Kings College London,
Archer SN, Laing EE, Moller-Levet CS, van der Veen D, Bucca G. et al. (2014) Mistimed sleep disrupts circadian regulation of the human transcriptome. Proceedings of the National Academy of Sciences of the United States of America; 1111 (6): E682-689.
Branca F, Nikogosian H, Lobstein T (2007) The Challenge of Obesity in the WHO European Region and the Strategies for response-summaries. World Health Organisation: Denmark.
Feng D, MA Lazar (2012) Clocks, Metabolism, and the Epigenome. Molecular Cell 47 (2): 158–167.
Ghoorah K, Campbell P, Kent A, Maznyczka A, Kunadian V. (2014) Obesity and cardiovascular disease: a review. European Heart Journal: Acute Cardiovascular Care. DOI: 10.1177/2048872614523349.
Lee, G. (2014), Obesity, the epidemic that CAN be stopped? Journal of Advanced Nursing. DOI: 10.1111/jan.12584
The Guardian (2014) Obesity can be disability, EU court rules. Accessed on 18/12/14 at http://www.theguardian.com/society/2014/dec/18/obesity-can-be-disability-eu-court-rules
Wang XS, Armstrong MEG, Cairns BJ, Key TJ, Travis RC (2011) Shift work and chronic disease: the epidemiological evidence. Occupational Medicine 61 (2): 78-89.
Weston L. (2014) ‘Shift Work’ in The Health Survey for England. The Health and Social Care Information Centre; London.