Introduction

Obesity is skyrocketing world-wide with between 16% to 33% of all adolescents (ages 12 to 19) being obese as of 2008 (AACAP, 2008). In addition to the physical complications of obesity in children of this age, obesity may connect to psychological issues including low self esteem and depression (Hagarty & Schmidt, 2004). In addition, obesity in the U.S. costs an estimated $100 billion in healthcare costs each year—and that number is growing as the obese population numbers grow. There are few community health problems with as much potential to impact the lives of those affected as adolescent obesity.

This project will consider a community health program to address the problem of adolescent obesity in an urban area of a mid-sized city. The target population will be adolescent girls between 12 and 19 who are members of the local Boys and Girls Club, with the goal of reducing overall body mass index (BMI) ratios in this cohort and thus attempting to reduce depression in this group. The health issue that will be addressed by this project is the prevention of obesity and obesity-linked depression within this group of adolescent girls.

Significance of the Problem

Obesity has come to national attention as an epidemic in the U.S. and is a leading cause of rising healthcare costs, as well as a leading cause of death due to a wide variety of metabolic complications, including type 2 diabetes, and heart disease (Hagarty & Schmidt, 2004).  Compared to national statistics in which the 1963-1970 National Health and Nutrition Evaluation Survey (NHANES) found that 5 % of adolescents were obese. In the 1999-2000 NHANES, 15.5% of adolescents were obese (Ibid.).  These numbers are, at best, alarming because health problems that begin so early in life are likely to continue throughout life.

It is believed that factors such as sedentary lifestyles and consumption of high-calorie foods play a major role in adolescent obesity; when combined with school districts that have dropped mandatory physical education classes, the impact has been significant (Ibid.).

The medical impact of obesity is also significant. It is likely that obese adolescents will have greater risk of cardiovascular disease (CVD); in at least one study, 60% of overweight adolescent already demonstrated 3 of 5 risk factors for CVD (Ibid.).  Furthermore, overweight in adolescents is strongly linked to development of insulin resistance, which in turn may be a significant precursor to type 2 diabetes. Other clinical manifestations linked to adolescent obesity include hypertension, atherosclerosis (even in teenagers), dyslipidemia, polycystic ovary syndrome (PCOS) in girls, sleep apnea and many other complications (Ibid.).

In addition to the physical problems associated with obesity, a second type of problem associated with obesity are psychological problems. In particular, a number of studies link depression with obesity in adolescents (Dragan & Akhtar-Danesh, 2007; Boutelle et al., 2010; Merten et al., 2008; Stice et al., 2005). As a single example, one study showed a significant link between obesity and depression in adolescent girls; a similar link was not found for adolescent boys Merten et al., 2008).

These facts clearly define a problem of great importance in communities. By helping adolescents avoid the pitfalls of obesity, a substantial number of future healthcare problems can be avoided. The specific problem linked with adolescent obesity that this project will address is depression.  The proposed project will thus address the twin issues of obesity and depression specifically in adolescent girls who are in the “overweight” category  based on the latest NIH BMI charts for girls between the ages of 12 and 19.

Because this is a nationwide epidemic and because obesity and obesity-linked depression sets young girls up for lifetime health consequences, it is important to prevent the development of obesity as much as possible in this population. For this reason, the primary focus in the proposed project will be on girls who are above normal weight. While the project will be open to all girls in the target population (i.e., girls between 12 and 19 who are members of the Boys and Girls Club in this city), activities and projects will be primarily directed at girls who are in danger of developing obesity.  If healthy lifestyle and healthy eating habits can be created in the teenage years, there is an opportunity to stave off the long-term health impacts of obesity and obesity-linked depression.

Community Significance, Assets and Challenges

The importance of this issue to adolescent girls is clear. Obesity at this young age sets up this population for a lifetime of health complications, including cardiovascular disease and type 2 diabetes at extraordinarily young ages. The impact on their lives of ill health and lifestyle restrictions that can result from such  medical complications rivals only smoking in its potential to negatively impact lives.

On the other hand, if effective community health projects can assist in turning the trend around, significant positive impacts could be achieved and significant healthcare improvements for the overall community attained.

Working with teenagers is challenging for a number of reasons. Teenagers tend to listen more to peers than adults. They may have a sense of their own immortality, making them less likely to heed warnings about future health problems years (or decades) in the future. For a teenager an effect that may not appear in their lives for another ten years can seem like it won’t happen until “forever.”  Looking that far ahead is often something they cannot or will not do.

In addition, when the subject population of adolescent girls is not only at risk for obesity but also for depression (though it’s not clear which of the two is the causal agent), communication and other psychosocial issues can complicate getting the message across to the subject population.