DNP- Leadership for Advanced Nursing Practice

EPIDEMILOGY: PAPER TWO- ANALYSIS AND APPLICATION 1

3

EXISTING AT-RISK POPULATION

Epidemiology: Existing At-Risk Population

DNP-825-0502: Population Management

Existing At-Risk Population

Part one of population management identified that eating disorders is among key areas that benefit health practitioners through research (Rosenvinge, & Pettersen, 2015). Eating disorders are rampant cases in many people. Everyone is susceptible to having eating disorders. However, there is a group of people that are more susceptible to eating disorders than others. Adolescents are the most significant at-risk group for eating disorders. Various factors are been established to understand what make this group a more at-risk population than any other group. The factors that make this group more susceptible can be categorized into four main groups. There are social factors that are backed by the social interaction within the at-risk population’s environment, and there are biological factors that emanate from hereditary characteristics. Interpersonal and psychological factors are other dimensions. DNP- Leadership for Advanced Nursing Practice

Among the adolescent population, the group is susceptible to buckle and conform to social pressures they face. Girls face massive pressure from cultures that glorify “slimness” having a big body for girls attracts enormous stigma. As a result, girls find themselves at the cross paths of continuing their standard eating regimes that are perceived to cause lots of weight or either to practice fasting habits (DerMarderosian, Chapman, Tortolani, & Willis, 2018). In most cases, most girls choose the latter. From the boys’ perspective, society comes up with the notion that boys should have a “perfect body” (Pallotti, Tubaro, Casilli, & Valente, 2018). As a result, a group of adolescent boys are forced to conform to these ideas by having induced fasting periods in a bid to promote the “perfect body” culture (Limbers, Cohen, & Gray, 2018).

In another significant factor that leads to eating disorders, biological factors play a vital role in eating disorders. Research indicates that eating disorders are passed on through hereditary characteristics (Thornton, 2018). Adolescents with a parent who have had a history of eating disorders are likely to face the same problem (Boutelle, Braden, Knatz-Peck, Anderson, & Rhee, 2018). Recent research indicates that there is a massive contribution of genetic factors in eating disorders (Culbert, Slane, & Klump, 2018). Besides, research has shown that there is an enormous influence of biochemicals on eating disorders (Wenk, 2019). There are proofs that some chemicals, when induced, alter the brain’s ability to control hunger, appetite, and digestion (Wenk, 2019).

Interpersonal and psychological factors make adolescents more susceptible to eating disorders. At the age of twelve, many adolescent experiences many physical changes. Sometimes, these changes may take longer to occur (Avila, Park, & Golden, 2019). As a result, some adolescents may develop self-esteem. Besides, there are some adolescents who naturally have no self-esteem. This group of adolescents with natural problems of self-esteem are not considered in this regard. The problem of low self-esteem causes a ripple effect of many things, including contributing to eating disorders (Smink, 208). Adolescents are a group known for forging personal relationships by making new friends. In the middle of personal relationships, the adolescent may face a challenge such as broken relationships or difficulties in forming relationships. This phenomenon may lead to adolescents facing problems with the stress that, in turn, contribute to eating disorders. Research indicates that stress is a major course of eating disorders (Klatzkin, 2018). These suggestions from research, therefore, indicate that adolescents are the most at-risk population for eating disorders (Micali, Daniel, Ploubidis, & De Stavola, 2018).

Analysis of Population Data

There are three main types of eating disorders that face adolescents. Binge eating disorders are a problem that results from binge eating episodes. Bulimia Nervosa is characterized by eating excessive food. A persistently reduced intake of food characterizes anorexia nervosa. Binge eating disorder are also studied. Statistics indicate that there is a 1.2% prevalence among the American youth. In females, the prevalence was at 1.6%, while that of males being 0.8% (Ziobrowski, Brewerton, & Duncan, 2018). These statistics indicating that there was at least twice prevalence in females than in males. All the adolescents found to have cases of binge eating disorders were found to have impairments. 62.5 % of that population was found to have mild impairments while the rest percentage indicates significant impairments (Keski-Rahkonen, & Mustelin, 2016). This data is provided by the National comorbidity Survey Replication (NCS-R) of 2017. DNP- Leadership for Advanced Nursing Practice

Bulimia nervosa contributes to cases of eating disorders. The overall prevalence of this disorder is 0.3% among adolescents (Hessler, et al. 2019). Further statistics indicate that there is at least five times more prevalent in females than in males (Nagl et al., 2016). Results from the Sheehan disability scale suggest that 78% of adolescents facing bulimia nervosa problems indicated mild impairments (Hessler, et al. 2019). The rest 22% was reported to have severe impairments (Hessler, et al. 2019). More statistics suggest that there is a 1% chance in individuals’ lifetime to suffer bulimia nervosa. For anorexia nervosa statistics by NCS-R suggest that more than half of the adolescents suffering from the condition had previously suffered from other forms of eating disorders (Udo, & Grilo, 2018). Overall statistics reported that adolescents stated a 2.7% prevalence of eating disorders in their lifetimes. Overall statistics also suggest that there is twice more prevalence of eating disorders in females than in the male. In addition, there are indications that the incidence of eating disorders increased modestly with the increase in the age of adolescents. The statistics considered people between that age of 13-18 as the adolescent group.

Obstacles Facing Prevention and Promotion of Health Activities Concerning Eating Disorders

Preventing eating disorders faces significant challenges, especially for adolescents. The major challenge facing prevention is stigma. Adolescents face social stigma as they go to school or when they engage themselves in other activities (Leme, Philippi, Thompson, Nicklas, & Baranowski, 2019). There is a common problem, especially with weight. Girls considered being “plus-size” face several issues. Among them is the rejection they face in the social space. This rejection makes it a challenge convincing a girl that it is a health practice to develop good eating habits. On another hand, the cultural expectations of perfect bodies make the task of preventing cases of eating disorders. DNP- Leadership for Advanced Nursing Practice

The promotion of heath for eating disorder patients is also faced with several obstacles. First, patients live in denial that they are facing problems that require medical attention (Hernandez, & Hewitt, (Eds.). 2014). As a result, patients fail to attend clinics and other avenues where they can get help. Besides, some patients refuse to take advice or medications that is prescribed to them. There is also a significant challenge associated with the collaboration of stakeholders to promote health. Parents being the primary stakeholder in the treatment of their adolescent kids, fail to coordinate with medical practitioners in various ways. This failure results in adverse effects of treatment outcomes for eating disorder patients. It is, therefore, critical to note that the treatment of eating disorder patients faces several obstacles.

Stakeholders That Need to Collaborate in Issues of Eating Disorders

Several stakeholders need to come on board for collaboration to prevent and promote health in issues about eating disorders. The National Eating Disorder Association is a crucial entity. The association should collaborate with health facilities in the promotion of health. Activities such as raising awareness on eating disorders will only be harnessed through a collaboration between the two entities (Graham et al., 2019). This collaboration will go a long way in the sensitization of different people how the eating disorder is a real problem that requires medical intervention.

The second set of stakeholders that need to collaborate of formed by a triangle of four stakeholders. The first stakeholder is the doctor. A doctor is necessary for providing advice as well as performing formal treatments on patients. Teachers also have an essential role to play. Teachers are required to give formal advice on eating habits as well as encourage better eating habits. The teacher is supposed to coordinate with the adolescent students and the parent for prevention and promotion of health. The adolescents are central to the collaborative partnership, and they are required to collaborate will all the stakeholders in the partnership. Finally, the parent plays a significant role in the promotion of excellent eating habits as well as ensuring adolescents get advice and medical attention when necessary. This collaboration would be efficient in the prevention and promotion of health in the eating disorder space. DNP- Leadership for Advanced Nursing Practice

References

Avila, J. T., Park, K. T., & Golden, N. H. (2019). Eating disorders in adolescents with chronic gastrointestinal and endocrine diseases. The Lancet. Child & Adolescent Health, 3(3), 181. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/30638841

Boutelle, K. N., Braden, A., Knatz-Peck, S., Anderson, L. K., & Rhee, K. E. (2018). An open trial targeting emotional eating among adolescents with overweight or obesity. Eating disorders, 26(1), 79-91. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10640266.2018.1418252.

Culbert, K. M., Slane, J. D., & Klump, K. L. (2018). Genetics of eating disorders. In Annual Review of Eating Disorders (pp. 35-50). CRC Press. Retrieved from https://www.taylorfrancis.com/books/e/9781315380063/chapters/10.4324/9781315380063-9.

DerMarderosian, D., MD, Chapman, H. A., MD, Tortolani, C., PhD, & Willis, Matthew D., MD, MPH. (2017). Medical considerations in children and adolescents with eating disorders. Child and Adolescent Psychiatric Clinics of North America, 27(1), 1-14. doi:10.1016/j.chc.2017.08.002

Graham, A. K., Wildes, J. E., Reddy, M., Munson, S. A., Barr Taylor, C., & Mohr, D. C. (2019). User‐centered design for technology‐enabled services for eating disorders. International Journal of Eating Disorders, 52(10), 1095-1107. doi:10.1002/eat.23130

Hernandez, L. M., & Hewitt, M. (Eds.). (2014). Implications of health literacy for public health: Workshop summary. National Academies Press. Retrieved from https://books.google.com/books?hl=en&lr=&id=vYmcBAAAQBAJ&oi=fnd&pg=PT16&dq=Hewitt,+M.,+%26+Hernandez,+L.+M.+(2014).+Implications+of+health+literacy+for+public+health.&ots=qMmopUVa-9&sig=Vqm7fP4dRYbEc9RmDjGjS2c5U2c#v=onepage&q=Hewitt%2C%20M.%2C%20%26%20Hernandez%2C%20L.%20M.%20(2014).%20Implications%20of%20health%20literacy%20for%20public%20health.&f=false

Hessler, J. B., Heuser, J., Schlegl, S., Bauman, T., Greetfeld, M., & Voderholzer, U. (2019). Impact of comorbid borderline personality disorder on inpatient treatment for bulimia nervosa: analysis of routine data. Borderline personality disorder and emotion dysregulation, 6(1), 1. Retrieved from https://bpded.biomedcentral.com/articles/10.1186/s40479-018-0098-4.

Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current opinion in psychiatry, 29(6), 340-345. Retrieved from https://journals.lww.com/co-psychiatry/Abstract/2016/11000/Epidemiology_of_eating_disorders_in_Europe_.5.aspx

Klatzkin, R. R., Gaffney, S., Cyrus, K., Bigus, E., & Brownley, K. A. (2018). Stress-induced eating in women with binge-eating disorder and obesity. Biological psychology, 131, 96-106. Retrieved from https://www.sciencedirect.com/science/article/pii/S0301051116303374.

Leme, A. C. B., Philippi, S. T., Thompson, D., Nicklas, T., & Baranowski, T. (2019). “Healthy habits, healthy girls-brazil”: An obesity prevention program with added focus on eating disorders. Eating and Weight Disorders: EWD, 24(1), 107-119. doi:10.1007/s40519-018-0510-5

Limbers, C. A., Cohen, L. A., & Gray, B. A. (2018). eating disorders in adolescent and young adult males: prevalence, diagnosis, and treatment strategies. Adolescent health, medicine and therapeutics, 9, 111. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6091251/.

Micali, N., Daniel, R. M., Ploubidis, G. B., & De Stavola, B. L. (2018). Maternal Prepregnancy Weight Status and Adolescent Eating Disorder Behaviors: A Longitudinal Study of Risk Pathways. Epidemiology, 29(4), 579-589. Retrieved from https://journals.lww.com/epidem/Abstract/2018/07000/Maternal_Prepregnancy_Weight_Status_and_Adolescent.20.aspx

Nagl, M., Jacobi, C., Paul, M., Beesdo-Baum, K., Höfler, M., Lieb, R., & Wittchen, H. U. (2016). Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European child & adolescent psychiatry, 25(8), 903-918. Retrieved from https://link.springer.com/article/10.1007/s00787-015-0808-z.

Pallotti, F., Tubaro, P., Casilli, A. A., & Valente, T. W. (2018). “You see yourself like in a mirror”: the effects of internet-mediated personal networks on body image and eating disorders. Health communication, 33(9), 1166-1176. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/10410236.2017.1339371.

Rosenvinge, J. H., & Pettersen, G. (2015). Epidemiology of eating disorders part III: Social epidemiology and case definitions revisited. Advances in Eating Disorders, 3(3), 320-336. Retrieved from: https://www.tandfonline.com/doi/abs/10.1080/21662630.2015.1022197

Smink, F. R., van Hoeken, D., Dijkstra, J. K., Deen, M., Oldehinkel, A. J., & Hoek, H. W. (2018). Self‐esteem and peer‐perceived social status in early adolescence and prediction of eating pathology in young adulthood. International Journal of Eating Disorders, 51(8), 852-862. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/eat.22875.

Thornton, L. M., Munn-Chernoff, M. A., Baker, J. H., Juréus, A., Parker, R., Henders, A. K., … & Kirk, K. M. (2018). The anorexia nervosa genetics initiative (ANGI): Overview and methods. Contemporary clinical trials, 74, 61-69. Retrieved from https://www.sciencedirect.com/science/article/pii/S1551714418302751

Udo, T., & Grilo, C. M. (2018). Prevalence and correlates of DSM-5–defined eating disorders in a nationally representative sample of US adults. Biological psychiatry, 84(5), 345-354. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S0006322318314409.

Wenk, G. L. (2019). Your brain on food: How chemicals control your thoughts and feelings. Oxford University Press. Retrieved from https://books.google.com/books?hl=en&lr=&id=QPiFDwAAQBAJ&oi=fnd&pg=PP1&dq=chemicals+that+lead+to+brains+ability+to+control+hunger&ots=S4CUW87DHr&sig=kM48cp-y1Goqoou1h11lUOJAj_I#v=onepage&q=chemicals%20that%20lead%20to%20brains%20ability%20to%20control%20hunger&f=false

Ziobrowski, H., Brewerton, T. D., & Duncan, A. E. (2018). Associations between ADHD and eating disorders in relation to comorbid psychiatric disorders in a nationally representative sample. Psychiatry Research, 260, 53-59. doi:10.1016/j.psychres.2017.11.026

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