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Introduction: Health promotion and primary interventions... Obesity Demographic Profile of Boston Adults . . . . . . . . . . . . . . . . . . . . Guiding Principles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Target . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Timeline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Strategic Plan for the Prevention of Obesity . . . . . . . . . . . . . . . . . Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

INTRODUCTION Health promotion is the sequence of activities like education of patients, counseling e.t.c. that provides the necessary information for individuals to take health from a responsible perspective and make healthy choices for their lives. Health promotion can also be projected as concerted effort made to bring together knowledgeable effort, political will and environmental factors that are made to improve the health of individuals, groups and communities (Joint committee, 2001). Primary prevention i.e. one of the aspects of health promotion is an early anticipation to forestall the incidence of diseases, and protect oneself from injuries and accidents. These efforts are characterized by education and teaching programs which enhance exercises, healthy nutrition patterns and discouraging the use of harmful substances like drugs, alcohol and tobacco. (Hubley and Copeman, 2008). Continuous screening and checkup tests at recommended intervals to detect risk factors or vulnerabilities to certain illnesses are also a primary preventive approach to health promotion. Considering the debilitating consequences of adult obesity for the individual and the community as a whole, this proposal entails and educative strategy to greatly prevent the incidence of obesity in the city of Boston.

Obesity Demographics- Boston City The last decade has been characterized by an unabated incidence of overweight and obese individuals in Boston. The incidence of overweight and obese adults moved from below 40% and 25% respectively to approximately 60% in 2010. Sixty-four percent of adults were reported with obesity and overweight symptoms in the U.S. in 2010, with a relative incidence among the different races blacks, Latino, white and Asian having values of 33%, 25%, 16% and 9% respectively among adults. Less than sixty percent of adults had scheduled times for physical activity while less than 30% consumed about five helpings of fruits and vegetables on a daily basis. These patterns of health were sustained being relatively stable over the same decade where the average weight status showed higher values. About 15% of adults consumed a minimum of one soda daily, while adult Latino individuals showed a higher likelihood (21%) to eat at least one compared to adults of the white race (10%). More adults residing in Back Bay (73%) and South Boston (67.5%) and a lower percentage of individuals in East Boston (44%) were involved in regular physical activity compared to the overall figures for Boston.

GUIDING PRINCIPLE To utilize public health planning tools, to build a primary health intervention program to prevent obesity in Boston, using standard public health practices. TARGET: HEALTHY PEOPLE 2020 Healthy People 2020 is a national effort to project the major public health issues in the Unites States and to create the fundamental requirements for community health ideas and initiatives. It also has a central target of increasing both quality and years of life as well as decreasing health disparities. Given below are aspects of this national target that relate to obesity in adults: Increase the percentage of adults with a healthy weight status Downsize the population of obese adults Increase the number of worksites that provide nutrition and weight related counseling Increase the number of visits to physicians on nutrition and weight loss related matters Fore-stall abnormal weight gain in youth and adults. Raise the proportion of primary care health professionals who regularly measure the BMI of their patients. TIMELINE: Although the healthy people 2020 document is the underlying focus of the project, the timeline for this proposal is two years, where regular eavluations will be made to observe the efficiency of the proposed program

METHODOLOGY 1) Detailed monitoring of community health issues to identify community health problems 2) Assess and probe health issues and risk of obesity and overweight among adults (individuals above 18-years of age) in the community 3) Enlighten, educate, and equip adults with information on health issues 4) Facilitate community collaborations to identify and solve obesity-related health problems 5) Encourage by suggesting the development of policies and plans that support individual and community health efforts to political office holders 6) Enforce laws and regulations that protect health and ensure safety including banned food products unsuitable for the health of members of the community 7) Connect individuals to required and appropriate nutrition an overweight related health services and assure the provision of health-care to when otherwise unavailable 8) Assure a competent public health and personal health care workforce 9) Evaluate effectiveness, accessibility, and quality of personal and population-based health services 10) Research for new insights and innovative solutions to obesity issues and related health problems

To reduce the incidence of chronic illnesses by curtailing the prevalence of obesity in Boston

This is hope to be achieved on a solid footing of leadership, data, and partnership coordination, obesity prevention efforts. Progress towards these goals and objectives will be reviewed annually with revisions or updates as needed. A comprehensive review of the Plan will be conducted in annually with subsequent re-prioritizing and reframing of goals and objectives to suite prevailing conditions at that time. STRATEGIES a) Standardize and improve statistical gathering and data acquisition from all districts of health centres in the Boston state b) Facilitate data sharing agreements between all stakeholders and partners. c) Ensure timely access to and dissemination of obesity related information including the most current, solid, scientific information on physical fitness, nutrition, breastfeeding, and the prevention of obesity. d) Facilitate partnerships between state agencies (including health divisions and districts, welfare, transportation, agriculture, economic development, tourism, recreation, and education), obesity coalitions, businesses, local programs, and others to coordinate obesity prevention efforts, pool resources, lobby for funds, and decrease bureaucratic burden.

e) Disseminate information to the business community regarding the direct and indirect costs of obesity as well as return on investment for workplace wellness programs. f) Raise public awareness of the benefits of weight maintenance, weight loss, proper g) nutrition, physical fitness, and wellness through media, social marketing, and educational institutions. Strategies for Individuals: individuals will be educated to participate in frequent and appropriate physical activity let your daily fruit and vegetable intake not be less than five Desist from frequent and unrestrained addictive television and other sedentary involvements Lobby for zoning requirements to improve access to opportunities for physical activity Strategies for Communities: communities will be educated on Creating safe and unhindered walking and bicycle paths Providing a greater number of opportunities for all to engage in physical activity (recreation unit, rental of bicycles, post-school hour programs for children, dance sessions, martial arts, etc.) Creating or supporting farmers markets to increase accessibility of fresh, locally grown, healthy farm produce How to modify residential neighborhoods, workplaces, and shopping districts to promote physical activity Strategies for employers: Employers will be educated on Providing worksite-friendly physical activity and wellness programs Allowing negotiable work itinerary to allow staff to exercise or attend weight-control routines Altering or modifying worksite to promote physical activity (e.g. clean stairwells, availability of showers/lockers, bike racks) Provision of healthy food choices in official gatherings or meetings, vending machines and worksite canteens Strategies for community health care services increase the use of clinical settings for effective communication around obesity developed tools to improve provider communication with patients on obesity related issues JUSTIFICATION Economic costs of obesity Medicare- consumes bulk of tax payers fund Medicaid- consumes bulk of tax payers fund Out of pocket expenses

Private insurance- Health insurance expenditures made up the bulk of the costs, but sick leave, life insurance, and disability insurance accounted for nearly 39% of the total Negative impact on businesses- significant costs such as lost productivity or absenteeism.

CONCLUSION The escalating incidence of overweight and obese individuals has taken a dramatic turn in recent times a trend pervading across different age groups of the Boston community including adults. Physical activity, nutrition and breastfeeding have been shown to positively impact weight management and thus should be encouraged. Also residents of Boston city should be encouraged participate in the recommended amount of physical activity (Healthy People 2020) and eat the recommended amount of fruits or vegetables. Considering the economic costs and impact of this disease, efforts at encouraging weight control is a worthwhile venture. And while researchers and the medical community continue the search for treatment options, members of the Boston community must identify and implement obesity prevention and weight maintenance measures to slow the epidemic. In essence taking action to address overweight and obesity in the Boston communities will have tremendous, positive public health effects.

REFERENCES Finkelstein, EA, Fiebelkorn, IC, Wang, G. National medical spending attributable to overweight and obesity: How much, and whos paying? Health Affairs 2003; W3; 219226. World Health Organization. Physical status: The use and interpretation of anthropometry. Geneva, Switzerland: World Health Organization 1995. WHO Technical Report Series. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual Medical Spending Attributable to Overweight and Obesity: Payer- and Service-Specific Estimates. Health Affairs, 28 (5): w82231, 2009.