Tarra L. Penney

Blame, Shame, and Lack of Support: A Multilevel Study on Obesity Management

In this research, we examined the experiences of individuals living with obesity, the perceptions of health care providers, and the role of social, institutional, and political structures in the management of obesity. We used feminist poststructuralism as the guiding methodology because it questions everyday practices that many of us take for granted. We identified three key themes across the three participant groups: blame as a devastating relation of power, tensions in obesity management and prevention, and the prevailing medical management discourse. Our findings add to a growing body of literature that challenges a number of widely held assumptions about obesity within a health care system that is currently unsupportive of individuals living with obesity. Our identification of these three themes is an important finding in obesity management given the diversity of perspectives across the three groups and the tensions arising among them.

Modifying the food environment for childhood obesity prevention: challenges and opportunities.

The prevention of childhood obesity is a global priority. However, a range of complex social and environmental influences is implicated in the development of obesity and chronic disease that goes beyond the notion of individual choice. A population-level approach recognises the importance of access to and availability of healthy foods outside the home. These external food environments, in restaurants, supermarkets, and in school, or recreation and sports settings, are often characterised by energy dense, nutrient-poor food items that do not reflect the current nutritional guidelines for health. In addition, our understanding of these broader influences on nutritional intake is still limited. Particularly, lacking is a clear understanding of what constitutes the food environment, as well as robust measures of components of the food environment across different contexts. Therefore, this review summarises the literature on food environments of relevance to childhood obesity prevention, with a focus on places where children live, learn and play. Specifically, the paper highlights the approaches and challenges related to defining and measuring the food environment, discusses the aspects of the food environment unique to children and reports on environmental characteristics that are being modified within community, school and recreational settings. Results of the review show the need for a continued focus on understanding the intersection between individual behaviour and external factors; improved instrument development, especially regarding validity and reliability; clearer reported methodology including protocols for instrument use and data management; and considering novel study design approaches that are targeted at measuring the relationship between the individual and their food environment.

More than meets the eye. Feminist poststructuralism as a lens towards understanding obesity

AIM   This paper presents a discussion of the application of a feminist poststructuralist-based theoretical framework as an innovative approach towards understanding and managing the complex health issue of obesity. BACKGROUND   Obesity is often viewed as a lifestyle choice for which the individual is blamed. This individualistic, dichotomous and behavioural perspective only allows for a narrow understanding of obesity and may even lead to misperceptions, stereotypes and marginalization of clients experiencing obesity. Feminist poststructuralism can provide a critical lens to understand the social construction of obesity and the broader environmental and cultural contexts of this health issue. DATA SOURCES   The theoretical framework draws from the writings of Foucault, Scott, Butler, Cheek, and Powers, published between 1983 and 2005. DISCUSSION   The concepts of discourse analysis and power relations are explored and discussed in a clear manner so that nurses can easily apply this framework to their practice as they observe, question, analyse, critique and assess the care experienced by clients who are obese. The concepts of personal and social beliefs, values and stereotypes are also discussed and examples of how to apply them in practice are provided. IMPLICATIONS   It is imperative that we continue to question our everyday nursing practices as we work to support clients, especially those who feel marginalized. This focus on power relations and reflective practice can give direction to new possibilities for change in obesity management.

The State of Obesity Management for Women Giving Birth in Atlantic Canada

Objectives The purpose of this survey was to gain insight into the status of birthing facilities across Atlantic Canada regarding obesity management. Specifically, we were interested in learning about the reported number of obese women entering birthing facilities, if body mass index (BMI) was determined from weight and height, and whether this was used to diagnose maternal obesity or not. Clinical, delivery, or equipment-related challenges and the state of existing or planned policies or guidelines specific to this high-risk population were also sought. Methods An online, cross-sectional survey (audit), distributed via email to key staff members at birthing facilities in Atlantic Canada, including nurse managers, nurse practitioners, registered staff nurses and obstetrician–gynecologists. Results and Conclusions Twenty-two responses were received from 38 invitees (57% response rate), representing half the birthing facilities in Atlantic Canada. Despite the fact that the majority of facilities recorded maternal height and pre-pregnancy weight upon admission, these measurements were not used to calculate and document maternal BMI, nor to make a diagnosis of maternal obesity. More troubling, no birthing facilities in our survey had guidelines or care plans in place to deal with this high-risk population, and two-thirds of those surveyed had no plans for their creation in the near future. While maternal obesity was considered a problem, a third of respondents reported no direct access to properly sized lifts or transfer devices in their units. This study provides a useful baseline for monitoring improvements in the care of obese women giving birth in Atlantic Canada.

The picture of health: examining school-based health environments through photographs

Health-promoting schools (HPS) is an effective approach to enhance the health and well-being of children and youth, but its measurement remains a challenge considering contextual differences across school environments. The purpose of this study was to qualitatively explore the physical features of the school environment through photographs of schools that had implemented an HPS approach compared with schools that had not. This study used a descriptive approach, wherein physical features of the school environment were distilled through visual images and qualitatively analyzed. School environment data were collected from 18 elementary schools (10 HPS, 8 comparison schools) from a school board in rural Nova Scotia (Canada). Evaluation assistants captured photographs of the physical school environment as part of a broader environment audit. Overarching themes included the promotion, access and availability of opportunities for healthy eating and physical activity, healthy school climate and safety and accessibility of the school. The photographs characterized diverse aspects of the school environment and revealed differences between schools that had implemented an HPS approach compared with schools that had not. There were increased visual cues to support healthy eating, physical activity and mental well-being, and indications of a holistic approach to health among schools that implemented an HPS approach. This research adds to understanding the environmental elements of HPS. The use of photographic data to understand school environments provided an innovative method to explore the physical features of schools that had implemented an HPS approach.

The Role of Health Systems in Obesity Management and Prevention: Problems and Paradigm Shifts

This paper provides an overview of a new section of Current Obesity Reports, called Health Services and programs. This new section seeks to better understand the problems within health systems around obesity management and prevention and to discuss the latest research on solutions. There are few health system issues that are quite as controversial as obesity and there remain several key problems inherent within existing obesity management and prevention approaches that necessitate the adoption of new paradigms and practices. Beginning with articles on addressing weight bias and stigma in health professional training, promoting new models of weight management provision, reviewing the role of regulation and generating an understanding of obesity through a complex systems lens, this new section will encourage readers to better address the challenging problems in obesity management and in doing so, overcome the ‘paradigm paralysis’ that has characterized the last few decades of obesity research and practice.

Running away with the facts on food and fatness

Last October a coalition of many of the corporate contributors to our obesogenic environment, including some of the world’s largest food manufacturers and retailers, launched the Healthy Weight Commitment Foundation, whose aim, they say, is to try to reduce obesity, especially childhood obesity, by the year 2015. Their plan to do so is to promote application of the ‘energy balance’ concept. The Foundation aims to promote the energy-out aspect of this equation. Their fact sheet says ‘lack of physical activity continues to attribute to the obesity problem’ and goes on to say that ‘more than half of adults do not engage in physical activity at levels consistent with USDA physical activity guidelines of 60 minutes per day’. The fact sheet does not mention the other part of the energy balance equation, energy-in, which is perhaps unsurprising, for these corporations are in the energy-in business. In the same month the American Academy of Family Physicians announced that it would accept a grant from the Coca Cola company to ‘develop consumer education content on beverages and sweeteners for FamilyDoctor. org’, which is their consumer health website. The Wall Street Journal published a supportive editorial, quoting Coca Cola CEO Muhtar Kent as saying: ‘It’s not just about calories in. It’s also about calories out’. It is widely believed that declining levels of physical activity are a major cause of the current obesity epidemic, but new evidence challenges this notion. Besides, it has been estimated that 60–90 min daily is necessary to prevent weight regain in previously obese individuals and 45–60 min daily to prevent the transition from overweight to obesity. Such levels of daily physical activity are, for most people now, surely unrealistic and unachievable.

Evaluation of a health promoting schools program in a school board in Nova Scotia, Canada

A Health promoting schools (HPS) approach aims to make schools a healthy place through a holistic approach that promotes a supportive ‘school ethos’ and emphasizes improvements in physical, social, and emotional well-being and educational outcomes. A HPS initiative in rural Nova Scotia (Canada) provided an opportunity for a population-level natural experiment. This study investigated student well-being and health behaviours between schools with and without HPS implementation and schools with high and low school ethos scores. Student well-being, nutrition, and physical activity were examined in a cross-sectional survey of elementary students in Nova Scotia, Canada in 2014. Multiple regression was used to assess the relationship with student well-being using the Quality of Life in School (QoLS) instrument and health behaviours. The main exposure was attending one of the 10 HPS schools; secondary exposure was the school ethos score. The overall QoLS score and its subdomain scores in the adjusted models were higher in students attending HPS schools compared to those in non-HPS schools, but the differences were not statistically significant and the effect sizes were small. Students in schools that scored high on school ethos score had higher scores for the QoLS and its subdomains, but the difference was only significant for the teacher-student relationship domain. Although this study did not find significant differences between HPS and non-HPS schools, our results highlight the complexity of evaluating HPS effects in the real world. The findings suggest a potential role of a supportive school ethos for student well-being in school.