Capstone Spring 2010 Leeron Franco. Elderly Obesity An interdisciplinary-based plan approach.

Capstone Spring 2010

Leeron FrancoLeeron Franco

Elderly ObesityAn interdisciplinary-based plan approachAn interdisciplinary-based plan approach

Problem StatementHow can the roles retirement facilities play in How can the roles retirement facilities play in

the obesity of their residents be changed the obesity of their residents be changed for the better?for the better?

Relevant Disciplines BiologyBiology: The science of life or living matter in all : The science of life or living matter in all

its forms and phenomena, especially with its forms and phenomena, especially with reference to origin, growth, reproduction, reference to origin, growth, reproduction, structure, and behavior.structure, and behavior.

EconomicsEconomics: The study of market forces and : The study of market forces and their effects on human behavior.their effects on human behavior.

SociologySociology: The study of society and societal : The study of society and societal interactions.interactions.

ReligionReligion: A specific fundamental set of beliefs : A specific fundamental set of beliefs and practices generally agreed upon by a and practices generally agreed upon by a number of persons/sects.number of persons/sects.

Relevant Disciplines: What roles do retirement facilities play in What roles do retirement facilities play in

the obesity of their residents?the obesity of their residents?

DisciplineDiscipline AssumptionAssumption PerspectivePerspective

BiologyBiology Genetics control ones biochemical Genetics control ones biochemical interactions of which effect obesity interactions of which effect obesity in that person.in that person.

Views obesity as a result of Views obesity as a result of Genetic predispositions to gaining Genetic predispositions to gaining weight. weight.

EconomicsEconomics Cheaper food (most likely Cheaper food (most likely unhealthy) is easier to prepare and unhealthy) is easier to prepare and serve.serve.

Views obesity in terms of goods Views obesity in terms of goods and services provided to an and services provided to an obese market.obese market.

SociologySociology The living environment has a The living environment has a strong influence on the dietary strong influence on the dietary habits of elderly people.habits of elderly people.

Sees societal influences as Sees societal influences as playing a role in the eating playing a role in the eating patterns of the elderly.patterns of the elderly.

ReligionReligion Certain religions have their own Certain religions have their own specific dietary laws that may specific dietary laws that may hinder ones health and lead to hinder ones health and lead to obesity.obesity.

Certain dietary laws must be Certain dietary laws must be followed no matter the health followed no matter the health concerns.concerns.

DisciplineDiscipline TheoryTheory InsightInsightBiologyBiology Obesity can be genetic ie. the risk of being Obesity can be genetic ie. the risk of being

obese is greatest in those whose parents obese is greatest in those whose parents were obese. The theory of ENPP1 has were obese. The theory of ENPP1 has identified that variants of ENPP1 are identified that variants of ENPP1 are associated with childhood and adult obesity associated with childhood and adult obesity of which increase the risk of glucose of which increase the risk of glucose intolerance and type 2 Diabetes.intolerance and type 2 Diabetes.

This theory recognizes the fact that there is a This theory recognizes the fact that there is a certain genetic variable that predisposes certain genetic variable that predisposes humans to being obese throughout their life. humans to being obese throughout their life. By identifying and accommodating to this factor By identifying and accommodating to this factor by whatever means possible, may help curb by whatever means possible, may help curb weight gain later in life. weight gain later in life.

EconomicsEconomics The theory of supply and demand will find The theory of supply and demand will find the most affordable way to serve the most the most affordable way to serve the most amount of people with little regards for amount of people with little regards for health concerns. health concerns.

The theory of supply and demand doesn’t work The theory of supply and demand doesn’t work in the best interest of the elderly when it comes in the best interest of the elderly when it comes to the food served in retirement facilities. to the food served in retirement facilities. Getting the most food for the lowest price is Getting the most food for the lowest price is always the goal. This usually isn’t the always the goal. This usually isn’t the healthiest choices for people. healthiest choices for people.

SociologySociology The Conflict theory is based entirely on The Conflict theory is based entirely on power and how those in power do all they power and how those in power do all they can to hold the majority of the population can to hold the majority of the population down and to keep them from gaining power, down and to keep them from gaining power, so as to secure their own position. so as to secure their own position.

Conflict theorists would say that obesity is a Conflict theorists would say that obesity is a product of the living conditions, stress and poor product of the living conditions, stress and poor quality of food and health education that those quality of food and health education that those in power choose and enforce for those that in power choose and enforce for those that aren't in power. Those that are in power (law aren't in power. Those that are in power (law makers, company owners, etc) willingly set up makers, company owners, etc) willingly set up society so that the cheaper the good is, the society so that the cheaper the good is, the better it is for them, and so most people might better it is for them, and so most people might only be able to afford cheap, unhealthy bulk only be able to afford cheap, unhealthy bulk food and become susceptible to obesity. food and become susceptible to obesity.

ReligionReligion The Law of Koshrut, also known as the The Law of Koshrut, also known as the Jewish Dietary Law, inflicts restrictions on Jewish Dietary Law, inflicts restrictions on certain foods allowed to be eaten. certain foods allowed to be eaten.

The dietary laws of the Jewish people prevents The dietary laws of the Jewish people prevents them from eating certain foods such as selfish them from eating certain foods such as selfish and swine. Also, the food must be blessed by a and swine. Also, the food must be blessed by a Rabbi before it can officially be considered Rabbi before it can officially be considered kosher. The preparation is more thorough which kosher. The preparation is more thorough which makes the food more expensive to buy. People makes the food more expensive to buy. People opt to buy the non-kosher meats and food opt to buy the non-kosher meats and food

because it is a lot cheaper.because it is a lot cheaper.

Justification of Interdisciplinary Approach

Elderly obesity in long-term care facilities is a complex question that can Elderly obesity in long-term care facilities is a complex question that can only be resolved through an interdisciplinary approach, research, and collaboration. only be resolved through an interdisciplinary approach, research, and collaboration. In order to understand this phenomena, I began by identifying the main causes of In order to understand this phenomena, I began by identifying the main causes of obesity in the elderly, including social, religious, biological, and sociological factors. I obesity in the elderly, including social, religious, biological, and sociological factors. I believe that retirement facilities play a significant role in the obesity of the elderly and believe that retirement facilities play a significant role in the obesity of the elderly and feel that with the use of an interdisciplinary approach, this would expose these factors feel that with the use of an interdisciplinary approach, this would expose these factors contributing to it. contributing to it.

Retirement facilities have such a great impact on the eating habits of the Retirement facilities have such a great impact on the eating habits of the elderly. For example, many facilities chose to serve the cheapest food because they elderly. For example, many facilities chose to serve the cheapest food because they are catering to such a large group of people. Elderly people already face enough are catering to such a large group of people. Elderly people already face enough challenges with less mobility and the feeling of their bodies shutting down. The food challenges with less mobility and the feeling of their bodies shutting down. The food that these facilities choose to serve to their residents, is most likely the only food they that these facilities choose to serve to their residents, is most likely the only food they eat throughout the day. At this point, many of the residents don’t drive, so they spend eat throughout the day. At this point, many of the residents don’t drive, so they spend most of their time in these long-term care facilities. Along with bad eating habits, most of their time in these long-term care facilities. Along with bad eating habits, long-term care don’t always cater to the physical needs of the elderly. At this point in long-term care don’t always cater to the physical needs of the elderly. At this point in their lives, the elderly try to do whatever they can to elongate their lives as much as their lives, the elderly try to do whatever they can to elongate their lives as much as possible. possible.

By looking at this problem from the interdisciplinary perspective, taking into By looking at this problem from the interdisciplinary perspective, taking into account the social, economic, biological, and religious influences on elderly eating, I account the social, economic, biological, and religious influences on elderly eating, I feel able to add new dimension to this area of study. Elderly obesity can only be feel able to add new dimension to this area of study. Elderly obesity can only be resolved when all of these factors come together to resolve this social dilemma. resolved when all of these factors come together to resolve this social dilemma.

Analysis:The Problem With Elderly Obesity

Elderly obesity in retirement facilities has become a wide-spread societal problem, Elderly obesity in retirement facilities has become a wide-spread societal problem, affected by economic, biological, economical, and religious factors. Research has shown that affected by economic, biological, economical, and religious factors. Research has shown that genetics play a significant role in a person’s weight throughout their entire life. Geneticists have genetics play a significant role in a person’s weight throughout their entire life. Geneticists have come up with a theory stating one specific gene can predispose a person to being obese due to come up with a theory stating one specific gene can predispose a person to being obese due to its effect on their metabolic components. its effect on their metabolic components.

Economics plays a role in what food is being served in these facilities. Facilities try to Economics plays a role in what food is being served in these facilities. Facilities try to find the cheapest food to buy to serve such large amounts of people. Being that pasta is very find the cheapest food to buy to serve such large amounts of people. Being that pasta is very cheap and easy to prepare makes it a prime candidate for most of the dishes being served. cheap and easy to prepare makes it a prime candidate for most of the dishes being served. Consuming such high amounts of carbohydrates and not burning off the calories greatly affects Consuming such high amounts of carbohydrates and not burning off the calories greatly affects the health of the elderly.the health of the elderly.

Social research has shown that elderly living in these types of facilities are more Social research has shown that elderly living in these types of facilities are more prone to infection and obesity. Long-term care facilities try to cater to the needs of their prone to infection and obesity. Long-term care facilities try to cater to the needs of their residents, however they are a business and must make a profit as well. Because of this, they try residents, however they are a business and must make a profit as well. Because of this, they try to feed the residents with the cheapest, not always the healthiest, types of food. This includes to feed the residents with the cheapest, not always the healthiest, types of food. This includes foods high in calories, fat, and carbohydrates. Unfortunately having a salad bar is hard to foods high in calories, fat, and carbohydrates. Unfortunately having a salad bar is hard to maintain because produce is considered expensive and doesn’t last as long as other food maintain because produce is considered expensive and doesn’t last as long as other food groups. These facilities also don’t always go out of their way to offer physical activities, such as groups. These facilities also don’t always go out of their way to offer physical activities, such as ay to offer physical actay to offer physical actiivities, such as yoga and aerobics because of the costs. These types of vities, such as yoga and aerobics because of the costs. These types of decisions make a difference in the lives of the residents living there.decisions make a difference in the lives of the residents living there.

Religion plays a slightly smaller role in the foods the elderly consume. There are Religion plays a slightly smaller role in the foods the elderly consume. There are retirement facilities that cater to elderly of a specific religion. For example, Jewish retirement retirement facilities that cater to elderly of a specific religion. For example, Jewish retirement facilities need to offer a Kosher Menu because the Jewish People follow a strict dietary law, facilities need to offer a Kosher Menu because the Jewish People follow a strict dietary law, called Kashrut, that prohibits them from consuming certain foods such as shellfish. Also, the called Kashrut, that prohibits them from consuming certain foods such as shellfish. Also, the actual process of “kosherizing” the food is lengthy and expensive. This is were decisions need to actual process of “kosherizing” the food is lengthy and expensive. This is were decisions need to be made so the facility doesn’t end up losing money.be made so the facility doesn’t end up losing money.

Due to these factors affecting the weight of the elderly, the solution has become Due to these factors affecting the weight of the elderly, the solution has become complex as the problem. All the factor’s in a person’s life (that they have control over) need to complex as the problem. All the factor’s in a person’s life (that they have control over) need to change in order to avoid further complications with obesity and other health problems. The change in order to avoid further complications with obesity and other health problems. The solution proposed needs to be an integrated effort of these disciplines so as to be most effective.solution proposed needs to be an integrated effort of these disciplines so as to be most effective.

ConflictsStudies have shown that both nature and nurture influence obesity later in life. Many

scientists are for one or the other in terms of which has a greater influence on obesity in the elderly. With this in mind, more scientists are leaning towards genetics being the

greater factor in obesity because it is based on factual evidence. In other words, some people are predisposed to being obese even before they are born and allow their

environment to have any kind of influence on them.

Biology- NatureBiology- Nature As a result of one specific gene, nature As a result of one specific gene, nature

makes people more susceptible to makes people more susceptible to being obese later on in life. being obese later on in life.

Apparently, the offspring of two obese Apparently, the offspring of two obese parents will inevitably become obese parents will inevitably become obese themselves no matter what actions are themselves no matter what actions are taken to avoid this. taken to avoid this.

Sociology- NurtureSociology- Nurture People who are predisposed to being People who are predisposed to being

obese because of their parents, may obese because of their parents, may avoid being obese themselves avoid being obese themselves because of certain actions they can because of certain actions they can take (ie. Eating healthy foods and take (ie. Eating healthy foods and exercising).exercising).

People brought up this way tend to People brought up this way tend to remain a normal weight because of remain a normal weight because of outside forces.outside forces.

The environment is a determining The environment is a determining factor when it comes to obesity, this factor when it comes to obesity, this may be a good or bad thing. may be a good or bad thing.

Common Ground The field of epigenetics studies other factors aside from genetics The field of epigenetics studies other factors aside from genetics

that can affect a person’s genome and phenotype (physical that can affect a person’s genome and phenotype (physical appearance). This gives credibility to the theory of the environment appearance). This gives credibility to the theory of the environment (nurture) having some kind of influence on obesity. (nurture) having some kind of influence on obesity.

Epigenetics helps bridge hard and soft sciences (objective vs. Epigenetics helps bridge hard and soft sciences (objective vs. subjective subjects) such as biology and sociology by unifying them subjective subjects) such as biology and sociology by unifying them into one theory. It accepts theories and perspectives of these into one theory. It accepts theories and perspectives of these individual disciplines and combines them into a unified theory. individual disciplines and combines them into a unified theory.

Common Ground Vocabulary EpigeneticsEpigenetics- the approximately stepwise process by which genetic - the approximately stepwise process by which genetic

information, as modified by environmental influences, is translated information, as modified by environmental influences, is translated into the substance and behavior of an organism. into the substance and behavior of an organism.

Hard science-Hard science- any of the natural or physical sciences, as chemistry, any of the natural or physical sciences, as chemistry, biology, physics, or astronomy, in which aspects of the universe are biology, physics, or astronomy, in which aspects of the universe are investigated by means of hypotheses and experiments. investigated by means of hypotheses and experiments.

Soft science-Soft science- any of the specialized fields or disciplines, as any of the specialized fields or disciplines, as psychology, sociology, anthropology, or political science, that psychology, sociology, anthropology, or political science, that interpret human behavior, institutions, society, etc., on the basis of interpret human behavior, institutions, society, etc., on the basis of scientific investigations for which it may be difficult to establish scientific investigations for which it may be difficult to establish strictly measurable criteria. strictly measurable criteria.

**All definitions courtesy of Dictionary.com****All definitions courtesy of Dictionary.com**

A new approach… The connection between hard and soft The connection between hard and soft

sciences (in relation to elderly obesity) is sciences (in relation to elderly obesity) is becoming more evident. An becoming more evident. An interdisciplinary approach is necessary to interdisciplinary approach is necessary to handle the convergence of these handle the convergence of these disciplines to propose a solution. disciplines to propose a solution.

My experience gained through My experience gained through volunteering at Kinneret has helped shape volunteering at Kinneret has helped shape my proposed solution, hoping to integrate my proposed solution, hoping to integrate numerous disciplines.numerous disciplines.

An interdisciplinary proposal to address elderly obesity via

Kinneret

My ObservationVolunteering at Kinneret’s dining services has opened my eyes to the foods Volunteering at Kinneret’s dining services has opened my eyes to the foods

being offered to the residents. To start off, each resident is giving bread with butter being offered to the residents. To start off, each resident is giving bread with butter along with a small side of pasta salad. The meal following this appetizer depends on along with a small side of pasta salad. The meal following this appetizer depends on the day, especially if it happens to be a holiday. On one occasion, I happened to the day, especially if it happens to be a holiday. On one occasion, I happened to volunteer on Chinese Night. The menu included egg drop soup, fried rice, egg foo volunteer on Chinese Night. The menu included egg drop soup, fried rice, egg foo yong, and chicken with vegetables. To top this off, the residents were given either a yong, and chicken with vegetables. To top this off, the residents were given either a cookie or slice of fruit for dessert. The food for that night was high in cholesterol, fat, cookie or slice of fruit for dessert. The food for that night was high in cholesterol, fat, carbohydrates, and sodium. carbohydrates, and sodium. On On another occasion, I happened to have volunteered on the Sabbath. Being that another occasion, I happened to have volunteered on the Sabbath. Being that Kinneret is a Jewish retirement facility, this night called for a more festive menu Kinneret is a Jewish retirement facility, this night called for a more festive menu including matzo ball soup, salad, baked chicken or salmon, and mashed potatoes. including matzo ball soup, salad, baked chicken or salmon, and mashed potatoes. This is a typical menu for any Jewish family on a Friday night.This is a typical menu for any Jewish family on a Friday night.

A great benefit about living at Kinneret is the keeping of Kashrut, also A great benefit about living at Kinneret is the keeping of Kashrut, also known as the Jewish dietary laws. This puts restrictions on what they can not serve known as the Jewish dietary laws. This puts restrictions on what they can not serve including shellfish and swine. This means only kosher meat is being offered. Kosher including shellfish and swine. This means only kosher meat is being offered. Kosher meat is prepared in a much cleaner environment then non-kosher meat which is why meat is prepared in a much cleaner environment then non-kosher meat which is why it is much more expensive. Because of this and budget cuts, the rest of the menu is it is much more expensive. Because of this and budget cuts, the rest of the menu is filled with cheaper, unhealthy dishes. The breads, pastas, and rice being offered are filled with cheaper, unhealthy dishes. The breads, pastas, and rice being offered are not the best choices for the elderly living there. Eating these types of foods all day not the best choices for the elderly living there. Eating these types of foods all day everyday puts a strain on their health. everyday puts a strain on their health.

I also noticed vending machines offering unhealthy snacks (for example I also noticed vending machines offering unhealthy snacks (for example Snickers and Kit Kats) and sodas outside of the main room where the residents Snickers and Kit Kats) and sodas outside of the main room where the residents spend most of their time. By doing this, the elderly are tempted to purchase these spend most of their time. By doing this, the elderly are tempted to purchase these snacks that only hurt them later on.snacks that only hurt them later on.

Education Have nutrition-trained staff to educate Have nutrition-trained staff to educate

the residents on making healthy the residents on making healthy choices and portion control when it choices and portion control when it comes to the food options being comes to the food options being offered to them.offered to them.

Offer healthy cooking workshops to Offer healthy cooking workshops to show the residents different dishes that show the residents different dishes that are easy to prepare, healthy, and are easy to prepare, healthy, and affordable. affordable.

Have weekly meetings with a Have weekly meetings with a Nutritionist/Dietician to evaluate the Nutritionist/Dietician to evaluate the residents and explain to them certain residents and explain to them certain foods they should avoid or eat more of foods they should avoid or eat more of so as to live a longer, happier, so as to live a longer, happier, healthier life. healthier life.

Have pamphlets filled with healthy Have pamphlets filled with healthy eating choices and recipes availableeating choices and recipes available

Meal Plan Offer meal plans that provide Offer meal plans that provide

more options that are low in fat more options that are low in fat and sodium.and sodium.

Incorporate fresh fruits and Incorporate fresh fruits and vegetables into every dish being vegetables into every dish being prepared. This makes the plate prepared. This makes the plate both colorful and healthy.both colorful and healthy.

Feature heart-smart items such as Feature heart-smart items such as

grilled fish, salads, and nuts.grilled fish, salads, and nuts. Offer healthy snacks throughout Offer healthy snacks throughout

the day that help with memory and the day that help with memory and focus, especially in the vending focus, especially in the vending machines.machines.

Emphasize grilled, baked, or raw Emphasize grilled, baked, or raw goods rather than fried. goods rather than fried.

Physical Education Encourage the residents to get as much Encourage the residents to get as much

exercise as they're capable of doing, even if exercise as they're capable of doing, even if it's simply walking around the facility.it's simply walking around the facility.

Providing well-lit sidewalks for them to use Providing well-lit sidewalks for them to use throughout the day or night. throughout the day or night.

Offer exercise classes everyday that help Offer exercise classes everyday that help build strength and prevent the residents build strength and prevent the residents from becoming weak and frail. Classes that from becoming weak and frail. Classes that aren’t as intense such as yoga are great and aren’t as intense such as yoga are great and don’t require expensive machines.don’t require expensive machines.

Provide incentives for active residents such Provide incentives for active residents such as cheaper rent or better meal options. as cheaper rent or better meal options.

Make the facility vibrant with flowers and Make the facility vibrant with flowers and trees to add a sense of positive ambiance trees to add a sense of positive ambiance when walking around.when walking around.

Take weekly trips to places such as parks Take weekly trips to places such as parks and beaches that encourage exercising.and beaches that encourage exercising.

Set up residents with individual exercise Set up residents with individual exercise programs ran by a hired trainer.programs ran by a hired trainer.

Get involved with the community and Get involved with the community and participate in Walk-A-Thons that fight participate in Walk-A-Thons that fight different health diseases such as cancer and different health diseases such as cancer and diabetes. diabetes.

Have on-site active competitions that involve Have on-site active competitions that involve the residents and their families. This builds the residents and their families. This builds strength and memories to last forever!strength and memories to last forever!

Further Insight Into The Plan Education:Education: The more we educate the elderly are about their food intake, the better The more we educate the elderly are about their food intake, the better

off their personal health will be. Many of the residents at Kinneret come from different off their personal health will be. Many of the residents at Kinneret come from different backgrounds but if there was someone there to show them how to make healthy food backgrounds but if there was someone there to show them how to make healthy food choices, they’d all be on the same page and feel more comfortable. This will also get choices, they’d all be on the same page and feel more comfortable. This will also get the seniors excited when it comes to eating. Training the staff can be a cheaper the seniors excited when it comes to eating. Training the staff can be a cheaper alternative to hiring a dietician. alternative to hiring a dietician.

Meal Plan:Meal Plan: Most elderly people want to live long and happy lives. In order to live a Most elderly people want to live long and happy lives. In order to live a long life, they must watch what they eat. Foods high in fat and cholesterol make the long life, they must watch what they eat. Foods high in fat and cholesterol make the elderly prone to infections and sickness. However, by adding more vegetables and elderly prone to infections and sickness. However, by adding more vegetables and fruits to their menu, Kinneret will help build the immunity of their residents at fighting fruits to their menu, Kinneret will help build the immunity of their residents at fighting off diseases. By changing the menu weekly to the vegetables that are on sale that off diseases. By changing the menu weekly to the vegetables that are on sale that week, will help reduce the costs of Kinneret substantially.week, will help reduce the costs of Kinneret substantially.

Exercise:Exercise: Physical activity is very important as a person grows older because if not, Physical activity is very important as a person grows older because if not, their body begins to turn frail. By adding exercise programs, this encourages the their body begins to turn frail. By adding exercise programs, this encourages the residents to work out and keep their bodies in shape. This is also a great way for the residents to work out and keep their bodies in shape. This is also a great way for the seniors to get involved with the communittee and socialize with others. They will feel seniors to get involved with the communittee and socialize with others. They will feel a sense of personal accomplishment and connection towards others. Making these a sense of personal accomplishment and connection towards others. Making these activities fun helps when being associated with food. By exercising with equipment activities fun helps when being associated with food. By exercising with equipment already available (ex. chairs), Kinneret is saving money on buying high-tech gym already available (ex. chairs), Kinneret is saving money on buying high-tech gym machines. Also, walk-a-thons are both for a good cause and free. machines. Also, walk-a-thons are both for a good cause and free.

The Bottom Line

Research has shown that genetic predispositions, economical, Research has shown that genetic predispositions, economical, sociological, and religious factors account for obesity in elderly sociological, and religious factors account for obesity in elderly residents in retirement facilities.residents in retirement facilities.

These factors are being studied by disciplinarians who look to find a These factors are being studied by disciplinarians who look to find a solution to this problem by incorporating the different disciplines solution to this problem by incorporating the different disciplines together.together.

Studies have shown that obesity in elderly is not solely due to their Studies have shown that obesity in elderly is not solely due to their genes but also the environment in which they live in, i.e. theory of genes but also the environment in which they live in, i.e. theory of Epigenetics. Epigenetics.

By applying an interdisciplinary approach to the problem, the By applying an interdisciplinary approach to the problem, the solution will be more successful because it integrates numerous solution will be more successful because it integrates numerous disciplines problems into one. disciplines problems into one.

The End