Obesity Case Study Concept: Health Promotion

Obesity Case Study Concept: Health Promotion Throughout this cold and wet winter, you haven’t had much of an opportunity to visit with your neighbors in the cozy neighborhood where you live. Shortly before Thanksgiving, a family moved in across the street from you. It appears to you that this is a grandmother and her grandson of around 3 years old. You notice that the grandmother is morbidly obese and the child is rather plump himself. One spring afternoon you meet the grandmother for the first time at the locked mailboxes that serve your neighborhood. Your first surprise is that she is not a grandmother at all – the extra weight made her look older from afar but now you realize she is not past her early 30’s. She appears shy and doesn’t meet your eyes, but as you talk with her a bit you notice a Southern accent. You learn that her name is Alice and her son’s name is Travis. Her husband, Kenny, is in the Army deployed to the Middle East. Alice surprises you by telling you that she just discovered she is pregnant with her second child. You chat a bit more before you must leave to get ready for clinical. As the weather improves, the neighbors start to come out to work and play in their yards and children are everywhere. You notice that you rarely see Alice or Travis outside, usually only getting in and out of their car. One afternoon you run into Alice at the mailboxes again. You ask her how she has been doing, and she replies that she hasn’t been getting out much. She says she doesn’t really know anybody here and hasn’t felt like exploring the neighborhood. She and Travis just spend time inside watching TV and playing video games. You ask about the pregnancy, and she immediately lowers her eyes but tells you she has been to see a doctor who she didn’t like at all. Alice tells you “she was really a mean lady and I’m going to find me a different doctor. All she wanted to do is scold me for weighing too much and tell me what I can/can’t eat and how I should be getting more exercise. Then she tried to scare me by telling me all these things that could go wrong with my pregnancy and baby. She just doesn’t understand that I’m just a big girl. She even said that I am ‘repeating the cycle’ with Travis. What kind of talk is that? He may have a little baby fat but he is a good boy.” Alice then asks, “You’re a nurse, aren’t you? You explain that you are almost a nurse and will be finishing school soon. “Well”, Alice continues, “if you don’t mind, and if you’re not too busy, would you come for supper on Sunday and talk to me about all of this? All of my people are big girls and my momma and aunties never had any problems having babies. This really scares me but I don’t know what to do…I want to do right by Travis and the baby. I’ve always been big but I guess I did get bigger after Travis was born and it just seems like I keep getting bigger now that Kenny’s gone.” At dinner on Sunday Alice serves a lot of fried food smothered in gravy. She tells you that she has thought about it…she wants to do things right but she doesn’t think she needs to make a lot of changes in her life. Her mother reinforces everything will be okay and that the doctor is just trying to get her to come back to the clinic more often since she has good insurance through Kenny’s military service. When you try to talk to her about her and Travis’ diet, she immediately changes the subject and admits she has considered getting in better shape but voices resistance to any type of exercise regime. You mention that just getting outside and taking short walks with Travis would help. She reluctantly agrees to try it but only if the weather is okay…she doesn’t like to walk if it gets too hot, cold or rainy. You see Alice and Travis a few months later. While you don’t think it looks like either has lost any weight, you have noticed them outside more and want to provide positive reinforcement for that life style change. You comment that it has been good to see her and Travis outside more often and ask her about the pregnancy. Alice shares that she is really afraid for her new baby. Every doctor that she has seen (total of 4) has told her that she is approximately 200# over weight and that it could mean negative outcomes for her baby. To top it off, she tells you that the longer Kenny is gone; Travis has been getting increasingly sadder. When you ask what she does for him when he is sad to make him feel better, she brightens and says that she knows ‘how to make him happy’…she soothes him with his favorite treats just like her mom did for her when she would get sad as a little girl. You see Alice’s expression change and then she questions whether that is the right thing to do but admits she doesn’t know anything else to do. Besides “Kenny likes me & Travis just the way we are”, she adds with a smile. But soon the smile fades and she again comments on wanting to do right by herself, Travis and the baby. She remembers that you are a nursing student and asks if you can give her additional information on the subject. She confides that she doesn’t’ really understand what the doctors mean when they call her obese and tell her that it is an ‘epidemic’. She starts to cry and asks you for help. “I’ve gained a lot of weight since Kenny left…what if he doesn’t like how big I’ve gotten? Everyone says I’m supposed to cook healthier foods for Travis…I don’t even know how to cook anything healthy. Besides, fruits and vegetables are expensive…I can’t afford that unless I go on food assistance and I don’t want to do that”. After reading the case study – 1. Identify the health care issues for Alice and Travis. 2. What strategies can be used to prevent the development of the identified health concerns? 3. What are the primary, secondary and tertiary prevention strategies to assist the family in this case study? 4. Which health promotion model could be used for planning and disseminating health information for Alice and Travis? 5. How can you use the Health People 2020 goals to assist this family? Be sure to refer to the grading rubric!!! General Instructions: For question #4, choose one of the following Health Promotion Models: Arjzen, Fishbein – Theory of Reasoned Action; Planned Behavior Bandura – Self-Efficacy DiClemente and Prochaska – Transtheoretical or Stages of Change Model Edelman and Mandle – Holistic Health Model Maslow – Hierarchy of Needs Dorothea Orem – Self-care Deficit Theory Nola Pender – Health Promotion Model Rosenstoch – Health Belief Model Identify each section by the Question number. References used must be cited in paper and listed on a separate reference page.