1. OUR TOPIC: IMBALANCED NUTRITION, MORE THAN BODY REQUIREMENTS RELATED TO INTAKE AS EVIDENCED BY INCREASE OBESITY AND DECREASED PHYSICAL ACTIVITY IN KALKASKA COUNTY MICHIGAN. Community Plan of Care Project: By: Amanda Sprague Heather Torre Andrea Haney Michelle Bettis

2. Introduction What is the definition of obesity?  Obesity according to the Centers for Disease Control (CDC) is, “Weight that is higher than what is considered as a healthy weight for a given height is described as overweight or obese” (p 1).  To determine whether you are obese related to your height and weight you will use a Body Mass Index calculator. According to the CDC, “Body Mass Index (BMI) is a person's weight in kilograms divided by the square of height in meters. A high BMI can be an indicator of high body fatness. BMI can be used as a screening tool but is not diagnostic of the body fatness or health of an individual” (p 1). CDC, 2015.

3. Population In Kalkaska County Kalkaska County: 16,891 residents (2009 estimate) < 5 years old: 6.2% < 18 years old: 22.3% 65 years old and over: 16.4% Females: 49.9% Caucasians: 96.9% High school graduates age 25+(2000 estimate): 80.% Bachelor’s degree or higher age 25+: 9.7% Median household income (2008): $40,618 Persons below poverty (2008): 15.0% U.S. Census Bureau, 2014.

4. How Kalkaska Compares to the State The poverty rate of residents in Kalkaska is higher than the state of Michigan, as evidenced by Women, Infants, and Children (WIC), free/reduced lunches, and Medicaid participants. Incidence of heart attack, stroke, and diabetes are all higher in Kalkaska than Michigan 39.0% Kalkaska residents are considered obese, in comparison to the state of Michigan’s 31.3%. District Health Department #10, 2014.

5. The Socio-Ecological Model Approach East Carolina University, 2015 Each layer is affected by the next... positively or negatively! Strengthening part of one layer will ripple the effects to the layer below. Ultimately strengthening, or weakening, the INDIVIDUAL!

6. Analysis Strengths: Kalkaska has a slightly lower incidence rate of cancer than the state of Michigan. Fewer residents of Kalkaska are considered overweight than state of Michigan. These factors are positive, but are not adequate in offsetting the fact that Kalkaska tops the state in rate of obesity, diabetes, and heart disease. District Health Department #10, 2014.

7. Analysis Challenges 39.2% of Kalkaska get no physical activity, compared to Michigan’s 23.8%. 36.9% Kalkaska residents have no access to health care related to cost compared to 15.7% of Michigan resident going without. A greater percentage of Kalkaska residents have an inadequate diet since fewer eat recommended number of fruits & veggies as compared to the state of Michigan. District Health Department #10, 2014.

8. Analysis Challenges Kalkaska has limited choices for fitness opportunity. One public gym. The Kaliseum, which houses a pool, ice rink, activities such as swim lessons, indoor cycling, dance classes and a walking path. Kalkaska Memorial Health Center’s cardiac rehabilitation gym is not open to general public for use. Kaliseum Recreation Complex, 2015.

9. Who Can Help? Physicians, nutritionists, Schools, Northwest Community Health Department, Kaliseum Recreation Complex, Weight Watchers How can community nurses help Assessment CollaborationPlanning Education Nurses promote healthy behavior in many settings in the community, provide continued support and integrate family for increased success. Ingram & DeCelle, 2012.

10. Community Health Nursing Diagnosis Risk for: imbalanced nutrition: more than body requirements Among: Kalkaska residents Related to: obesity and lack of physical activity As demonstrated by: increased disease mortality rates, lack of healthcare access due to inadequate numbers of primary care physicians (PCPs), and inability to afford healthcare to see a physician

11. Causative Factor: Obesity District Health Department #10, 2014.

12. Causative Factor: No Physical Activity District Health Department #10, 2014.

13. Issue of Concern: Health Indicators Between 2012-2014 Kalkaska consistently had higher mortality rates (per 100,000 people) when compared with the state of Michigan as a whole for:  Cancer  Cardiovascular disease  Diabetes related District Health Department #10, 2014.

14. Causative Factors: Access & Affordability Kalkaska County had the following numbers of residents per primary care physician:  2011 – 2,857  2012 – 5,714  2013 – 2,448  2014 – 2,451 Kalkaska also had approximately 16% of the population that had no access to healthcare due to cost in years 2011-2013. This number rose to 36.9% in 2014. District Health Department #10, 2014

15. Indicators Needed for Successful Intervention Provide affordable healthcare Increase the number of primary care physicians in the Kalkaska community Marketing the community to physicians for employment opportunities

16. Goal and Mission Statement Goal- To better understand, prevent and treat obesity to improve the lives of those affected in Kalkaska through research, education and advocacy. Mission Statement –Educating the population of Kalkaska with the understanding of the causes, consequences, prevention and treatment of obesity.

17. Planning Target population: Kalkaska County residents Goal: Decrease obesity among population Solutions: Educate the community of Kalkaska to assure they understand the causes, consequences, and preventive measure and available treatment for obesity. Resources Needed: Financial Support Educational material for residents such as information on eating healthy and physical activities available in their area Access to current trends in the area

18. Health Belief Model TAKING PREVENTIVE ACTION Likelihood of health-related behavioral change to take preventive action INDIVIDUAL PERCEPTIONS Perceived susceptibility and perceived severity MODIFYING FACTORS Age Gender Socioeconomic Personality Spiritual beliefs LIKELIHOOD OF ACTION perceived benefits vs. perceived barriers CUES TO ACTION Illness of family member Health provider visit Media campaigns CUES TO ACTION Illness of family member Health provider visit Media campaigns Health Belief Model. (2013). Adapted from http://currentnursing.com/nursing_theory/health_belief_model.html

19. Interventions  Prevention – Free blood pressure screenings at the health department.  Behavioral Interventions – Local government can work to create healthier restaurants, limit future fast food restaurants and create more recreational facilities for physical activity  School-Based Programs – Making healthier foods available in the schools, providing education on healthy eating, changing curriculum to include physical fitness for all grades.  Worksite Programs – Weight Watchers, wellness programs with cost incentives for health insurance, reduced membership rates for The Kaliseum.

20. Interventions  Prevention – Free blood pressure screenings at the health department.  Behavioral Interventions – Local government can work to create healthier restaurants, limit future fast food restaurants and create more recreational facilities for physical activity  School-Based Programs – Making healthier foods available in the schools, providing education on healthy eating, changing curriculum to include physical fitness for all grades.  Worksite Programs – Weight Watchers, wellness programs with cost incentives for health insurance, reduced membership rates for The Kaliseum.

21. Evaluation Conclusion Limited healthcare resources Health fitness resources are limited Multiple fast food restaurants Increased prevalence of obesity in Kalkaska county Lack of educational resources within the community Compared to Michigan obesity rates Kalkaska’s obesity rates have increased over the years according to statistics Increase health resources in the community that will benefit everyone. Be proactive within your community!

22. References Bryant, P.H., Hess, A., Bowen, P.G. (2015). Social determinants of health related to obesity. The Journal for Nurse Practitioners, (11)2, 220- 225. doi: 10.1016/j.nurpra.2014.10.027 Centers for Disease Control and Prevention (CDC). (2015). Adult obesity causes and consequences. Retrieved from http://www.cdc.gov/obesity/adult/causes.html Centers for Disease Control and Prevention (CDC). (2015). Defining adult overweight and obesity. Retrieved from: http://www.cdc.gov/obesity/adult/defining.html District Health Department #10. (2014). Kalkaska Country Chartbooks Summary: 2011, 2012, 2013, 2014. Retrieved from http://dhd10.org/chartbooks East Carolina University. (2015). Office of health access. Retrieved from http:// www.ecu.edu/cs-dhs/healthaccess Harkness, G.A. & DeMarco, R.F. (2016). Community and public health nursing: evidence for practice. (2nd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott, Williams & Wilkins. Ingram, R.R & DeCelle, G. (2010). Obesity: Managing an emerging health crisis. Nursing Management, 43(7), 26-33. doi: 10.1097/01.NUMA.0000415490.97707.2c Kaliseum Recreation Complex. (2015). Programs and classes. Retrieved from: http://www.kaliseum.com/content/?q=classes U.S. Census Bureau. (2014). District health department #10: Kalkaska county health profile. Retrieved http://dhd10.org/images/Kalkaska_Co_profile_2010.pdf doi:10.1016/j.nurpra.2014.10.027