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In relation to Barton and Grant’s Health Map (2006) it is suggested that
the built environment impacts the lifestyle of individuals. With relation to
obesity, it could be discussed that the built environment and location, with
regard to food availability, can impact weight. Fraser and Edwards (2010) found
a positive correlation between proximity with fast food outlets and childhood
obesity in Leeds, this could suggest location in the UK could impact upon an
individual’s weight. As well as this, a positive correlation was found between
deprivation score and the number of fast food outlets, finding the highest
levels of obesity within the most deprived areas (Public Health England,
2017a). The presence and type of greenspace within the UK can also be seen to
impact on weight. Bell et al (2008)
found that a lower childhood BMI was associated with a greater availability of
greenspace in their environments, this could include parks, allotments, playing
fields and country side. This could suggest that greenspaces provide more
facilities to keep children active. On the other hand, there are many
inequities within types of greenspace, many affluent areas have higher amenity
greenspaces perhaps encouraging their use (Kimpton, 2017). As well as this,
deprivation and poverty were linked to lower levels of leisure-related activity
(Government Office for Science, 2007). Consequently, it could be suggested that
it is an issue of wealth, education and culture rather than just location.


This could be demonstrated through the higher levels of obesity within
unskilled manual jobs (Marmot et al, 2010). As well as this, maternal
employment in European mothers can also impact the weight of their children. Children
were more likely to have a larger waist circumference if their mothers were
unemployed, on the other hand, results also suggested that children from
mothers in part-time employment had smaller waist circumference than those of
full-time employment (Gwozdz et al, 2013). These results potentially highlight
that not only is the type of employment and education level of mothers a key
factor, but perhaps time available to prepare healthy meals or to shop for
healthy food, in an increasing obesogenic society with a greater availability of
fast food outlets. Furthermore, Brown et
al (2010) found a positive correlation between maternal working hours and
time children spent watching television, suggesting that childhood obesity may
be due to inactivity as well as dietary factors. The implications of this are
that mothers may need more education based on diet and activity when they are
expecting. Nurses, midwives and health visitors need to make this information
accessible to mothers as childhood obesity increases the risk of being obese as
an adult (Craigie et al, 2011). Education needs to be in place to teach parents
the importance of healthy and balanced diets, and barriers of lifestyle change
need to be explored and overcome to aid these changes (NICE, 2017a). This could
be a very inexpensive, preventative measure to promote healthy living and
prevent childhood obesity. This can be reflected in standardising school meals
to ensure all children, regardless of their deprivation score, are receiving
healthy, nutritious meals (Independent School Food Plan, 2016). Perhaps
national measures need to be in place to reduce the health inequality within
the UK, in Year 6 school children, 26% were obese in the most deprived areas
compared to only 12% in the least deprived areas (NHS Digital, 2017). Educational
programmes in schools may be a good starting point. However, parents need to be
educated about correct food to buy and healthy meals to cook to reduce calorie intake
of children and learn about the eat well plate to ensure a balanced diet (Food
Standards Agency, 2016).

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The health promoting
role of the nurse

the Health Belief Model (HBM)may be beneficial to nurses and patients to aid
their weight loss (Becker, 1974). It is important for nurses to find out patients
perceived seriousness, barriers and benefits are regarding weight loss. From
there, nurses can help patients to change these perceptions to gain better
results. Self-efficacy is a big factor in health behaviours according to the HBM
(Becker, 1974). This can be used by nurses to ensure patients that they can
succeed in weight loss. This could be shown through similar patient journeys to
boost their confidence as well as seeing the advantages weight loss has had on
their lives, this in turn could change their perceived benefits. This social
aspect of weight loss could be shown through reviews of weight loss apps
showing that many users like communicating with like-minded people in similar
situations (Frie
et al, 2017). This could be generalised to the social aspect of weight loss
groups. These are available nationally with groups such as Slimming World and
Weight Watchers, or locally, within Plymouth there are free programmes and
clubs available such as the 10% club, provided by Livewell Southwest, or Walk
and Talk Plymouth provided by Walking for Health, offering different length
walking groups around the local area to encourage exercise and are free, making
them more widely accessible, therefore reducing health inequalities.


well as social clubs, counselling or regular appointments with nurses or other
healthcare professionals may help adherence to weight loss, Annesi and Whitake
(2010) suggest that regular counselling to promote self-efficacy may be
beneficial to patients and increase commitment to treatment, as the HBM
suggests. If patients start to lose weight and start to feel better in
themselves, the HBM suggests their health behaviour will change. On the other
hand, if their perceived seriousness of an illness, such as diabetes, is based
on personal experiences then they may not adhere to the programme. Furthermore,
if a family member has diabetes and they only see them taking a tablet but not
the health impacts of diabetes, then they may not see issues with their own
weight. This suggests that the HBM may be beneficial to nurses in educating
patients of the impacts of obesity such as the cardiovascular risks, diabetes
and its complications and impacts it has on the body (Gottwald and
Goodman-Brown, 2012). Another benefit is planning obesity interventions around
the beliefs of the individual, as it can help gauge the behaviour of an
individual and which interventions may suit them best (Gottwald and
Goodman-Brown, 2012). On the other hand, it is limited in taking wider
determinants of health into consideration (Gottwald and Goodman-Brown, 2012).


may find use of the Stages of Change Model (SCM) valuable in understanding and
changing health behaviours to aid implementation of interventions (Prochaska
and DiClemente, 1983). This could be used to understand if patients are ready
to change and lose weight. Nurses could start with assessment to see if
patients are ready to make a change, from there, nurses can tailor
interventions to suit the individual. Once patients are in the contemplation
stage, nurses can teach them about the benefits of weight loss. After this, small
changes can be implemented such as dietary changes. Once they have started on
their weight loss journey, these behaviours need to be maintained to prevent
relapse. Nurses could ensure that individuals have a strong support network
around them to aid their weight loss through positive reinforcement from
family, friends and partners. Theiss et
al (2016) found that romantic partners were ‘instrumental’ in aiding progress in weight loss and encouraging and
maintaining ‘positive attitude’ through
their weight loss journey. This could refer to practice when individuals don’t
have this network at home, nurses can offer them more support in a healthcare
setting to still reassure they are receiving positive reinforcement. The SCM
may be more useful for individuals who are losing weight without other social
support. While there are many useful applications of the model, it does carry
limitations. It does not suggest how nurses may help patients move from stage to
stage (Gottwald
and Goodman-Brown, 2012).

Furthermore, it doesn’t explicitly suggest when someone is ‘ready’ to change perhaps making it
difficult for nurses to assess when implementation should start (Gottwald and
Goodman-Brown, 2012).


Comparing the HBM and SCM there are similarities and differences. Both
models can be applied to many different situations and scenarios and are not
only useful for obesity. Both models aid identification of individual needs
(Gottwald and Goodman-Brown, 2012). SCM is a simple model, this could be seen
as an advantage or disadvantage. As an advantage, it would suggest it is simple
to use and apply to various situations and contexts, on the other hand, its
simple nature could be seen as reductionist, and too simple for the complexity
of many health situations (Gottwald and Goodman-Brown, 2012). Whereas the HBM
demonstrates the complexity of health choices and behaviours and is less of a
linear model (Gottwald and Goodman-Brown, 2012). Nurses and other healthcare
professionals may find using positive aspects from different models beneficial to
tailor care for each individual.


and equal access to health services

Nurses could create professional partnerships within healthcare to help
tackle obesity as a public health issue. Collaboration with GP surgeries
working with GPs and practice nurses will be beneficial as they are at the heart
of community healthcare and usually where patients first go with their health
concerns. Practice nurses are able to give lifestyle and dietary advice and
collaboratively work with GPs to deliver all round care, patients may be
prescribed pharmacological interventions as well as psychological treatment.

Furthermore, GPs are a good place for patients to be sign-posted to further
care such as weight management services, provided by Livewell Southwest in
Plymouth (Pryke et al, 2015). Therefore, it could be argued that practice
nurses are able to start the weight loss journey by sign-posting patients and
therefore working in partnership with other healthcare professionals such as
dietitians or weight loss clinics. A benefit of this partnership and sign-posting
patients from a GP surgery would be that patients are getting specialised,
expert care from a dietician or physiotherapist or a specialist weight
management nurse. This may be more effective than a GP or practice nurse giving
advice as patients may need a more hands-on type of care. Furthermore, GP
training and education regarding obesity is minimal, perhaps partnerships need
to evolve between specialists and GPs so informative clinics could be brought
into the primary care setting rather than sign-posting to in-hospital care
(Pryke et al, 2015).  However, this may
reduce adherence to treatment if patients are having to go elsewhere for their
care. Many obese patients are of a lower socioeconomic status and therefore may
find it hard to access the care they are being signposted to, therefore it may
be more valuable for funding to be implemented for GP education to enable
patients to access treatment in their primary care setting (Government Office
for Science, 2007).


Nurses could also create partnerships with school nurses. The health
promotion role of the school nurse is an important responsibility in educating young
people and ensure they are aware of the implications of obesity (Royal College
of Nursing, 2014). They could provide drop in clinics in schools regarding
obesity. This could again be for sign-posting as well as education. Benefits of
this would be that dietary education would be available for all, regardless of
socioeconomic status therefore reducing health inequalities. In the future,
guidance for school nurses and schools and how they can work with local
authorities and weight teams to help obese children develop a healthier
lifestyle may be beneficial to aid children to grow into healthier adults (National
Children’s Bureau, 2017). Many populations may not be accessing help in
healthcare for their obesity. Poor health education could be a barrier for
patients who are not accessing healthcare (NHS England, 2017). This could be
due to poor health education and their health beliefs, they may not understand
their weight is a problem and the impact their obesity is having on their health.

This could be due to culture, and the obesogenic nature of today’s society. As
well as this, language could be a barrier to seeking help, this could be
overcome by using online sites with language options such as NHS Choices which
has a translate option. Policy within the NHS is in place to ensure that
translation systems are accessible to ensure that fair and effective healthcare
is available to all (NHS England, 2016). Although this policy is in place, it
is still the choice of the individual whether they access the services.



conclusion, obesity is an ever-growing public health issue, causing a strain on
healthcare. The inequalities in society impact on this and although the NHS is
accessible to all, it is the health beliefs and choices of the individual
whether they access the help available to them. Nurses must respect these
individual choices, but carry on with education of the harm obesity has on the
body and its health risks (NMC, 2015). Within practice it is important for
nurses to understand the individual health beliefs of the patient to tailor
treatment to them to create a healthier society. As well as this, it is
important to encourage all patients, regardless of their weight, to lead a
healthy lifestyle to prevent obesity in the future. It is also important that
everyone is getting the same educational messages regardless of socioeconomic
status or deprivation score to reduce health inequalities. Partnerships and
collaborative working and communication within and outside of healthcare are
important to ensure all are receiving the care they need.

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