COMMUNITY PROJECT

OBESITY IN THE

HOMELESS

Sania A. BeckfordBoston College: William F. Connell School of NursingKeys to Inclusive Leadership in Nursing (KILN)Wednesday April 20, 2011

Oh the

Irony…

OBJECTIVESBy the end of this presentation, you will…

1. Discuss the effects of nutrition on long-term health in the population served at the Barbara McInnis House

2. Identify social disparities that places the population served at the Barbara McInnis at risk for obesity

3. Describe nursing roles and interventions to promote healthy weight & maintain good nutrition habits in the population served at the Barbara McInnis House

THE BARBARA MCINNIS HOUSEBOSTON HEALTHCARE FOR THE HOMELESS PROGRAM (BHCHP)

Boston.com; www.bhchp.org

Location: South End of Boston Established: 1984 as a pilot program funded by The Robert Wood Johnson Foundation (RWJ) &

the Pew Charitable Trusts (PCT)Mission: to provide or assure access to the highest quality health care for all homeless men,

women and children in the greater Boston areaSpecialized Services: clinics (suboxone, outpatient, transgender), dental, pharmacy, respite,

diabetes collaborative, outreach (HIV team, Street team, family team, racetrack)

MENTORSHIPPooja Bhalla

Registered Nurse (RN) Associate director of Clinical Operations 13 years at the Barbara McInnis House Multiple roles

Student nurse Clinical resource nurse Case manager

Community Project Topic Background Discussion

initiatives to control obesity of patients obesity was an issue in this population

lack of education, resources, finances Plan

list of preventative steps promote/ maintain healthy weight &

nutrition habits cost-effective & practical nfdl.k12.wi.us

PUBLIC HEALTH ISSUE: OBESITY

Food insecurity linked to poverty

Nutritional deficiencies Malnutrition

Obesity epidemic in USA Results from the 2007–2008

National Health and Nutrition Examination Survey (NHANES) 34.2% of U.S. adults aged 20

years and over are overweight 33.8% are obese 5.7% are extremely obese

(Ogden & Carroll, 2010) “the nature of nutritional risk

faced by low-income families in the US appears to be shifting from food insecurity to obesity”

(Surgeon Call, 2001; Schwarz et al.,2007)

Past Present

www.cdc.gov

FACTS & FIGURES

Poverty Homeless Low education level Underemployed/ Unemployed Family Structure

Single female head of household

Multiple morbidities Cardiovascular

Hypertension Foot ulcers Amputations

Diabetes Mellitus Mental Illness Substance Abuse

Nutritional deficiencies Malnutrition =↓ health

Illiteracy Poor management of illness/

disease status ↑ use of Emergency Room ↑ healthcare costs

Accessibility Homeless = No means for

preparing or storing food No $ = Binge on junk food

Limited hours & funding of food banks

Morbidity = ↓ activity level no job

Risk Factors Implications

NURSING ROLE PREVENTION Primary Prevention

Educate Cultural & Developmentally appropriate Learning Styles auditory, visual, kinesthetic

Assess Barriers language, access, literacy rate

Secondary Prevention Health Screenings

BMI < 24 Blood Pressure Glucose

Hemoglobin A 1 C < 7%

Tertiary Prevention Rehabilitation Long-term medication

COMMUNITY HEALTH PROJECT GOAL:

To control obesity in the population served by the Barbara McInnis House. Population: low-income and homeless individuals with co-

morbidities who utilizes services at the Barbara McInnis House

Task 1: Create a library of resources to inform the community about

signs/symptoms of illnesses Influenza Noravirus

Task 2: Create a brochure/ pamphlet educating about cost-effective

ways to control weight translated in various languages (e.g. Spanish, etc). 

=

KNOW YOUR

NUMBERS

Normal Ranges

Blood Pressure: 120/80 mm Hg

Blood Glucose: 70-110 mg/dl

Cholesterol levels: <200 mg/dl

Body Mass Index (BMI)

Normal: 19-24.9

Overweight: 25.0- 29.9

Obese: >30www.harvardpilgrim.org

Weight Management Tips Be Active

Use the stairs Go for a walk, run, etc Be active for at least

30 to 60 minutes per day 60 minutes/ 3-5x per week

Do passive range-of-motion

Choose healthy options Avoid fried food Avoid alcoholic beverages Limit sugar and salt intake Choose a variety of whole grain products Choose foods from the Food Pyramid Choose FRUITS & VEGETABLES Stay hydrated DRINK WATER

Portion control Small, frequent meals Meals should be size of fist

COMMUNITY HEALTH PROJECT (CONT’D)

REFERENCES Boston Health Care for the Homeless Program. (2010). Barbara

McInnis House- Boston Health Care for the Homeless Program. Retrieved from www.bhchp.org

Ogden, C., & Carroll, M. (2010). Prevalence of Overweight, Obesity, and Extreme Obesity Among Adults: United States, Trends 1976–1980 Through 2007–2008. Retrieved from http://www.cdc.gov/nchs/fastats/overwt.htm

Schwarz, K., Garrett, B., Hampsey, J. & Thompson, D. (2007). High Prevalence of Overweight and Obesity in Homeless Baltimore Children and Their Caregivers: A Pilot Study. Medscape General Medicine, 9(1): 48. Retrieved from http://www.medscape.com/viewarticle/551711

Stanhope, M., & Lancaster, J. (2010) Foundations of nursing in the community: Community-oriented practice, (3rd e.d.). St: Louis, MO: Mosby Elsevier.

Surgeon General. (2001). The Surgeon General's Call to Action To Prevent and Decrease Overweigth and Obesity. US Department of Health and Human Services, Public Health Service, Office of the Surgeon General, Rockville, MD.