Running Head: OBESITY IN POLK COUNTY

Obesity in Polk County

Lindsey D. Willis
University of South Florida

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Obesity in Polk County

Polk County, similar to the state of Florida in which it is located, was first inhabited by
American Indians and later the Spanish. It has historically been noted as a region of cattlemen,
small farms, and orange groves since the mid 1800s. Polk County was officially established in
1861. The arrival of the rail came shortly after and brought with it the development of new towns
Lakeland, Winter Haven, and Lake Wales -- and the phosphate industry (Polk County
Historical Association, 2015). As the county continued to grow and development, along with it
came modern conveniences such as personal transportation, technological advancements, and
fast food. All of these factors bring us to one of the biggest issues in America and Polk County:
obesity.
Polk County is located in central Florida between Osceola and Hillsborough Counties
(Central Florida Development Council, 2014). It is the 9th most populous county in the state of
Florida and accounts for 3.2% of Floridas population (Office of Economic and Demographic
Research, 2015). Polk County demographics are similar to those of the state and the nation, with
the majority being of Caucasian, African American, or Hispanic origin: 73.3%, 15.4%, and
20.2%, respectively (Central Florida Development Council, 2014). As of 2012, 86% of the
county is considered an urban area and 14% rural (Office of Economic and Demographic
Research, 2015). The top three areas of employment are trade, transportation, and utilities at
24.9%; professional and business services at 17.2%; and construction at 11.4% (Office of
Economic and Demographic Research, 2015). The three major health care systems and insurers
are private insurance at 38%, Medicare at 22%, and Medicaid at 20% (Florida Department of
Health, 2014). 19% of the population is uninsured (Florida Department of Health, 2014).
According to 2014 estimates, 30.1% of Polk County residents aged 25+ are high school

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graduates compared to the state statistic of 25.4% (Central Florida Development Council, 2014).
18.20% of the population of Polk County are below the poverty level compared to 16.30% of
Floridas overall population (Florida Department of Health, 2014). Of persons aged 5 and over in
Polk County, 19.3% speak a language other than English at home compared to the state statistic
of 27.8% (Office of Economic and Demographic Research, 2015).
Strengths and Needs of Polk County Health
There are several strengths noted in the overall health profile of Polk County. First, the
county has an indigent health care program, funded by taxes, that provides care to Polk County
residents that do not qualify for private or public insurance. The program allows people to have
access to primary care, dental care, pharmacy assistance, behavioral health, and more. In 2014 it
enabled almost 50,000 people to receive care, which also relieved the burden on local emergency
departments (Florida Department of Health, 2014). Since 2010, the rate of alcohol use among
minors has declined by 4.5% and continues to do so (Florida Department of Health, 2014). Thus,
the number of alcohol related hospitalizations and deaths has been reduced (Florida Department
of Health, 2014). The rate of crime has decreased over the past several years. This has also led to
a decline violence related hospitalizations and deaths in the county (Florida Department of
Health, 2014).
There are several needs noted in the overall health profile of Polk County. Over the last
few years the rates of STDs have trended upwards in both the state and the county. STDs occur
at a rate of 68% among young people aged 15-24 in Polk County (Florida Department of Health,
2014). This is extremely detrimental to the overall health of the individual and has the propensity
to continue to increase as many individuals in this age range are practicing unsafe sex and with
multiple partners (Florida Department of Health, 2014). In 2014, the rate of 2-year-old children

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fully immunized in Polk County was below that of Floridas rate, 79.5% compared to 85.5%
(Florida Department of Health, 2014). It is imperative that children receive childhood
vaccinations as it provides them protection against many vaccine-preventable diseases, as well as
providing protection to the community. The county has also seen increasing rates of Pertussis
over the past 10-12 years (Florida Department of Health, 2014). Although births to women aged
10-19 has decreased by 20%, the rate is still higher than that of the state. Teenage births are often
accompanied by more complications, as well as premature births (Florida Department of Health,
2014).
Priority Health Issue
Polk County residents have ranked obesity as one of the greatest health risks to the
county the past few years. Statistically, Polk County has one of the highest rates of adult obesity
in the state of Florida (Florida Department of Health, 2014). In 2013, 36.9% of adults in Polk
County were rated as obese (Florida Department of Health, 2014). There is a know link between
obesity and many chronic health conditions: heart disease, stroke, diabetes, musculoskeletal
disorders, and cancer (Access to Nutrition Foundation, n.d.). Chronic health diseases are also
very costly to both the individual and the community. All of the aforementioned chronic health
conditions, aside from musculoskeletal disorders, are among the top 5 causes of death of
residents in Polk County (Florida Department of Health, 2014). Obesity is a priority health issue
among Polk County residents.
Determinants of Health
A persons health is not solely the result of their own actions and lifestyle. There are
several factors, know as the determinants of health, that affect an individuals health and the
health of a community: the social and economic environment, the physical environment, and the

OBESITY IN POLK COUNTY

persons individual characteristics and behaviors (World Health Organization, 2016).

Furthermore, these factors are influenced by the amount of money, power, and resources
people have access to (Bryant, Hess, & Bowen, 2015, p. 220). By using this model, nurses are
able to increase obesity awareness through screening, treatment plans, and advocating for
healthier diets (Bryant, Hess, & Bowen, 2015). Some of the key factors contributing to obesity in
Polk County are lack of access to both affordable and healthy food, lack of grocery stores in the
area, unhealthy eating habits, and physical inactivity (Florida Department of Health, 2014). The
primary population diagnosis for Polk County, in regards to obesity, is as follows: population at
risk of developing chronic health conditions and complications due to a high prevalence of
obesity, as evidenced by 36.9% of adult Polk County residents were considered obese in 2013
(Florida Department of Health, 2014).
Interventions
Community gardens have been used throughout the U.S. to provide low income residents
access to fruits and vegetables in a convenient and affordable manner (Bryant, Hess, & Bowen,
2015). Community gardens allow us to teach people through health promotion about healthy
food habits and the importance of eating fruits and vegetables to prevent obesity and as a means
of weight management (Bryant, Hess, & Bowen, 2015). One community garden in Alabama has
community residents lease 4x8 plots for $25, on a revived plot of land, to garden during the
spring and summer time. By charging the residents $25, this allowed the garden to sustain itself
(Bryant, Hess, & Bowen, 2015). It is likely that the use of community gardens would require
additional startup money from the county, but should be able to maintain with little to no
required funding thereafter. The aforementioned community in Alabama saw a large increase in
vegetable consumption: residents with a family member participating in the community garden

OBESITY IN POLK COUNTY

were 3.5 times more likely to consume vegetables than those without a family member
participating in the community garden (Bryant, Hess, & Bowen, 2015). This intervention would
require participation from a community nurse to help teach the residents about healthy eating, as
well as following up after a predetermined amount of time to evaluate the effectiveness of the
intervention. One study that used a community garden for prevention of obesity in children,
measured the height and weight of the children before and after the program. The data was then
used to calculate the childrens BMI, as a way to evaluate the effectiveness of the program
(Castro, Samuels, & Harman, 2013). 17% of children who were considered obese or overweight
improved their BMI and 100% of children with a normal remained within a healthy range
(Castro, Samuels, & Harman, 2013).
The basis of secondary prevention is screening. Screening can also be used to prevent and
detect obesity (Mackey, Olson, DiFazio, & Cassidy, 2016). Due to the increasing prevalence of
obesity in the U.S., its association with comorbid conditions, and increased risk of death, the
U.S. Preventive Task Force recommends screening all adults for obesity (Moyer, 2012). By
screening for individuals that are obese or have an increased risk, we can apply targeted
behavioral interventions and medical treatment to those that need it most (Moyer, 2012). Nurses
in primary care or community health settings can obtain and gather this data, as well as
participate in motivational interviewing of those most at risk. Motivational interviewing has been
shown to promote a readiness to partake in positive behavioral modification (Mackey, Olson,
DiFazio, & Cassidy, 2016). It is also important for them to discuss the associated health
problems with overweight or obese individuals (Mackey, Olson, DiFazio, & Cassidy, 2016).
Screening for obesity can be done during an individuals routine doctors visit. For those that lack
access to care, it would be beneficial to provide community screenings at reduced or no cost

OBESITY IN POLK COUNTY

from county funding. Although this would lead to increased spending for the county initially, the
the comorbid conditions associated with obesity heart disease, diabetes, cancer require
increased use of services and costs in the long run (Moyer, 2012).
At the level of tertiary prevention, we are working towards preventing further progress of
the disease and the development of comorbidities (Center for Disease Control and Prevention,
2013). For the patient with obesity this means lifestyle modification and risk reduction of the
following comorbidities: type 2 diabetes, hypertension, dyslipidemia, and coronary heart disease
(McKinney, Skolnik, Chrusch, & American Academy of Family Physicians, 2013). There are
several things that need to be include in an obesity management program: nutritional counseling
and dieting, moderate physical activity, resistance training, behavior therapy, motivational
interviewing, goal setting, and self-monitoring (Caballero, Finglas, & Toldr, 2015). Using these
components in conjunction has led to a greater amount of weight loss and significantly greater
rates of maintaining that weight loss (Caballero, Finglas, & Toldr, 2015). It is also important to
view obesity as a chronic disease that requires continuous management and support for the
success of the individual and the maintenance of long term weight loss. (obesity management)
For those suffering from severe obesity, pharmacotherapy and bariatric surgery may be needed
(Caballero, Finglas, & Toldr, 2015). Severe obesity is classified as those with a BMI 40 or a
BMI > 35 with 2 or more obesity-related comorbidities (Caballero, Finglas, & Toldr, 2015, p.
129).
Health Policy Proposal
Due to the high prevalence of obesity, the goal is to reduce obesity in the adult population
in Polk County. In order to accomplish this new policy, screening for obesity should be part of
the routine check-up or physical (McKinney, Skolnik, Chrusch, & American Academy of Family

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Physicians, 2013). This screening procedure should be covered by insurance or paid for by
county funds for the uninsured. It is important to educate the public, as this will require
additional money from tax payers and may meet some opposition. Obesity, and its associated
health problems, account for significant healthcare spending in the U.S.: $147 billion in 2012
(McKinney, Skolnik, Chrusch, & American Academy of Family Physicians, 2013). Screening for
obesity can significantly impact the health of the public by reducing the prevalence of obesity
related diseases. Thus, saving the county money overtime by preventing increased healthcare
spending on the chronic health conditions associated with obesity: stroke, diabetes, heart disease,
and more.
Conclusion
I believe community health and preventative health policy implementation are an
important part of nursing, and one that we are severely lacking in the United States. I hope as a
future nurse, I can help educate the population on the importance of community and preventative
health to improve the overall quality of life for our population. Not only would this lead to
decreased healthcare spending, but unneeded suffering related to preventable diseases and
illness.

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References
Access to Nutrition Foundation. (n.d.). Obesity and diet-related chronic diseases. Retrieved from
https://www.accesstonutrition.org/obesity-and-diet-related-chronic-diseases
Bryant, P. H., Hess, A., & Bowen, P. G. (2015). Social Determinants of Health Related to
Obesity. The Journal for Nurse Practitioners, 11(2), 220-225.
Caballero, B., Finglas, P., & Toldr, F. (2015). Encyclopedia of Food and Health. Academic
Press.
Castro, D. C., Samuels, M., & Harman, A. E. (2013). Growing healthy kids: a community
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medicine, 44(3), S193-S199.

Center for Disease Control and Prevention. (2013). The concept of prevention. Retrieved from
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Central Florida Development Council. (2014). Polk county demographic report. Retrieved from
http://cfdc.org/CentralFlorida/media/Central-Florida/Economic%20Reports/Polk-CountyDemographic-Report-Update-Website_1.pdf

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Florida Department of Health. (2014). Polk County 2015 Community Health Assessment. Bartow,
FL.: Author.
Mackey, E. R., Olson, A., DiFazio, M., & Cassidy, O. (2016). Obesity Prevention and
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McKinney, L., Skolnik, N., Chrusch, A., & American Academy of Family Physicians. (2013).
Diagnosis and management of obesity. American Academy of Family Physicians.
Moyer, V. A. (2012). Screening for and management of obesity in adults: US Preventive Services
Task Force recommendation statement. Annals of internal medicine, 157(5), 373-378.
Office of Economic and Demographic Research. (2015). Polk County. Tallahassee, FL.: Florida
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