HST5120: Nursing - Epidemiological Literature - Health issue

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Introduction Obesity and being overweight is a serious problem in Aboriginal population of Western Australia. Men are more likely to be overweight but women are more likely to be obese. There are various reasons associated with problem of obesity in indigenous population. Obesity has become a serious health concern and social issue for Aboriginal people. It has become epidemic and driven by the interplay between environment and genetics. Major part of the population is suffering with this health issue due to genetic problems. Various disparities such as unhealthy living conditions, inappropriate food, lack of healthy food resources, lack of education and unemployment are the major reasons behind most of the physical health conditions in Aboriginal people. In the year 2003, obesity caused 11% of the total burden of the diseases on the aboriginal community in Australia (Aboriginal and Torres Strait Islander Health Performance Framework, 2012). Obesity and over weight problems can also be associated with metabolic syndrome and other metabolic abnormalities. Being overweight also increases the risk of other chronic disease, such as diabetes, cancer and musculoskeletal conditions. The paper is going to provide the epidemiological literature for obesity among the aboriginal community of Western Australia. Paper will also discuss the types of treatments and their impacts in reducing the prevalence of disease. Paper will also make future recommendations for future epidemiological studies. Prevalence and Potential Risks of Obesity The data of prevalence of obesity and overweight among Aboriginal population was presented by National Aboriginal and Torres Strait Islander Health Survey (NATSIHS) in the year 2004-05. The samples were collected from the 10,439 Indigenous Australians of all ages. The survey was conducted in the remote and non-remote areas. The data analysis proved that “In 2004–05, of those with a known body mass index, approximately 4% of Indigenous Australians aged 18 years and over were underweight, 36% were of acceptable weight, 29% were overweight and 31% were obese” (Aboriginal and Torres Strait Islander Health Performance Framework, 2012). In the last three decades the prevalence of obesity is increasing on high rate. Obesity was found to be more prevalent in the remote and rural areas. The aboriginal people suffer from disproportionate burden of morbidity and mortality in comparison to non-indigenous population of Australia. The studies have epitomized the gap 10 years among the life expectancy of aboriginal and non-indigenous population of the country (Australian Health Survey 2011-12, 2012). Obesity is considered as the major reason behind this large gap among life expectancy. Obesity is a problem that starts from the childhood. In the year 2012-2013, it was found that nearly one third of the Aboriginal children between the age of 2-14 years were found to be overweight or obese. After the children reach the age of 15 years or over, 66% of them were found to be overweight and obese. The increased burden of obesity and overweight has resulted in reducing the life expectancy of aboriginal people. The prevalence of obesity is higher in adults then in children of aboriginal population. In the year 2008 the prevalence increased to 25%. According to ABS Australian Health Survey (2011-2012), obesity rate rose to 26% (Australian Health Survey 2011-12, 2012). Children whop suffer from obesity in the childhood are likely to suffer with obesity in the adulthood as well. This increases the chances of being suffered with chronic diseases such as diabetes, cardiovascular diseases, and even certain types of cancers.

Potential Risk Factors There are various potential risk factors associate with the problem of obesity and overweight. Aboriginal population mainly lives in the remote or rural areas of Western Australia. This population suffers from various social and economic issues. There are large healthcare gaps found in this population and non-indigenous population of Australia. The major health risk associated with obesity is diabetes. Diabetes is the third most serious health issue in Australia and has resulted in high rates of morbidity and mortality in this population. Aboriginal people were originally displaced from their areas and forced to live with scarcity of food resources and water resources. Food insecurity came up as the major issue for aboriginal people. This population is considered as the minority group and majority of them lives in remote and regional areas. The social determinants for the food insecurity are low income households, overcrowded households, and burden of various diseases. The food insecurity caused health issue and obesity is one of them. Food insecurity resulted in lack of nutritious diet, which increased the exposure of these people towards various health problems, such as “cardiovascular disease, diabetes, some cancers, obesity, gall bladder disease, iron-deficiency anaemia, dental caries, and renal disease” (Browne, Laurence, Thorpe, 2009) The dietary risk factors that resulted in obesity are lack of fresh vegetable and fruits, alcohol consumption, lack of nutrition and lack of physical exercise. The household income of the aboriginal population is very low, due to which they are not able to get quality education and sufficient employment to fulfill their needs. The use of tobacco, alcohol and substance abuse is also very high in this population. Due to which very young children suffer from chronic diseases like asthma. Tobacco also increases the risk for the unborn children and pregnant women. All these factors contribute in increasing the risk of obesity and other chronic disease, which on the other hand increases the burden of diseases and also increases the healthcare cost.

Critical Assessment of the Epidemiological Evidences Most of the epidemiological studies conducted for understanding the problem of obesity in aboriginal population are observational (with cross-sectional surveys and case control) and few of them are experimental with randomized control trials and longitudinal studies. The longitudinal study of Phillips et al (2013) stated that obesity is the major health concern in aboriginal children. The growth and development of obesity in aboriginal children is based on historical anthropometric data. The study also revealed that children, who are classified as obese are likely to be obese and overweight in future as well. According to 2012-13 Australian Aboriginal and Torres Strait Islander Health Survey stated that people who are overweight in the early age are more likely to suffer from obesity in future. The people living in remote and non-remote areas are likely to suffer from obesity with a slight difference in percentage. The study of Saini, & Quinn (2013) provided the systematic review of the randomized control trials to identify the health related issues in the aboriginal population. The study revealed that aboriginal people have lack of healthcare education and knowledge that pose a major barrier to access healthcare services timely. Due to this gap, people are not able to access services and health related problems become more severe including obesity. They are not completely aware about the benefits and limitations of the healthcare services and healthcare interventions. The healthcare researches on the aboriginal communities are very limited and often exclude the cultural factor in healthcare research. Thus, Saini, & Quinn (2013), explain that use of randomized control trials in the aboriginal communities is very limited that have increased the knowledge gap. O’Dea, (2005), provides the observational study of the indigenous population and their health related issues. The case control study offered the evidences that death rate is higher in aboriginal population than non-indigenous population due to obesity, diabetes, kidney failure and social disadvantages. The poor quality food and lack of appropriate food resources are found to be vital reason among the healthcare issues including obesity. According to O’Dea, (2005) “The strongest predictor of risk is central obesity: indeed risk increases sharply with even moderate increases in fat on the abdomen. Increasing age is also a risk factor – but much more so when combined with increasing weight.” The increasing weight in the aboriginal people and less physical activity lead to the term “diabesity”, which displays the important link between being overweight and chronic illness of diabetes. The author also explains the link between weight gain and kidney failure with the help of case control examples. The study used the Hunter Gather Lifestyle framework, which is based on promoting good health and protect people against chronic illness. This approach was found to be resulting in significant therapeutic changes in the health of aboriginal people. Some of the other treatment explained includes proper screening of overweight and obesity, diabetes, providing proper supply of healthy food, promoting physical exercises and many community based programs. Burns and Thomson (2008), provides the case control studies that explain the link between the birth weight and growth in infancy. The study also identified the genetic indicators and environmental determinants that affect the growth and development of the children. Malnutrition, infections and poor health was found to be the major reasons of impaired growth, which increases the risk of obesity. Johnston et al (2013) is the qualitative research that focuses on improving the health of aboriginal population by targeting the individual behaviors and clinical strategies. The study looks towards the environmental determinant, the gap found in the evidences is that it do not provide the precise relevance in most of the cases, also the data offered towards the complexity of the problem is rough. The study also displays the lack of local knowledge of the communities. The study of Richard, Gauvin, & Raine, (2011) is based on the ecological model of the health promotion, but gap in the evidences can be seen in weak analysis of the problem and lack of appropriate evidences related to health disparities and obesity. Bussey, (2012) provided the systematic literature review of the historical diet transition and health transition among the aboriginal people of Australia. The longitudinal studies and evidence included illustrated the health burden in the aboriginal community that gave rise of problems of being overweight and obesity. The study also provided the importance of the hunter gatherer diet. This kind of diet is considered to be relevant in various studies to work against overweight and obesity. Recommendations The problem of obesity and overweight is a very complex health problem in the aboriginal community of Western Australia. It includes various causative factors such as, genetic, metabolism, behaviors, socioeconomic status, environment and culture. The obesity prevention studies often ignore the socio-economic and cultural factors from the studies. The new epidemiological research requires identifying and evaluating those socio-economic and cultural factors related to the aboriginal community. The monitoring of the obesity and overweight is required to be monitor in the people with different age groups: Recommended target groups:

men aged 25–40 years
menopausal women
Aboriginals children and adolescents •
Aboriginal older people
Aboriginal from low socio-economic groups

Recommendation measure should include:

Weight
Height
Socio-demographic information
Practices and attitude of the target population towards weight management.

Study should include indices derived from the measurements would be to include BMI in order to compare the cut-points of the children and adults, and must also include z-scores to compare and cross reference the data from the young children. The self-reported data must be included with the validation of the self-reported data. Such study with the inclusion of the cultural belief related to weight lose measures will be beneficial for understanding the health issue in detail. Conclusion Obesity and overweight problems are among the most complex healthcare issue in Aboriginal population of Western Australia. There are various studies that provide the details about this health issue and risk associated with obesity and overweight problems. The risk factors associated with obesity are very high; they include risk of various chronic diseases like diabetes, cardiovascular disease, mental health issues and musculoskeletal issues. The paper discussed the prevalence of obesity in Western Australian Aboriginal community and provided the evidences for being the major and potential public health problem. With comprehensive research it was found that epidemiological studies related to health risks of obesity and overweight issues in aboriginal population are very limited. The limited resources provide longitudinal data, case control studies and literature review related to health problems in Aboriginal population. However, studied targeting the aboriginal population with obesity problem is limited. This provides the basis for the development of a new epidemiological research. Thus, paper also provided the recommendations for the new study that could provide relevant evidences in the future research.

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