Propose a health promotion program using an evidence-based intervention found in your literature search to address the problem in the selected po

1

Health Promotion Proposal, Part 1

Adult Obesity

Student’s name: Yulexis Moreda

Instructor: Nora Hernandez Pupo

Course: Health Promotion & Role Development in Adv. Nursing Practice

Date: September 24, 2025

ADULT OBESITY

Obesity is a complex, chronic, and relapsing multiple-factor disease, which is witnessed to be a pandemic across the world and classified by excess body fat that disrupts health. Obesity is a condition that has been increasing at an alarming rate in the world. More than 890 million adults worldwide, or 16 percent of the global adult population, were obese in 2022, a 220-fold increase from 1990 (Khani et al., 2025). In the United States, obesity has been on a constant increase. In the United States, most adults are now obese (more than 40%): 27 percent of women and 56 percent of men are obese as compared to 1999 (Cohen et al., 2022). The middle-aged adults are disadvantaged: the incidence among 40-59-year-olds is close to 46 percent, and there is a high probability of type 2 diabetes, cardiovascular disease, hypertension, sleep apnea, and different kinds of cancers in obese patients, not to mention that the healthcare cost occupies quite an impressive share of the expenses, and the quality of life deteriorates. The target audience for the proposed intervention will comprise low-income urban adults aged between 35 and 60 years who are currently obese (BMI 30), as the burden is not equally distributed. The initial, practical, and quantifiable outcome of the program is that at least 50 percent of the participants will achieve a 5 percent weight reduction, which is clinically significant during the first 18 months. The second measurable outcome included the increase of moderate physical activity that exceeds 150 minutes per week and the improvement of the diets, measured by quantifiable increases in the intake of two portions of vegetables and fruits per week and the quantifiable decrease in the intake of sugar-sweetened beverages, measured by validated questions and periodic biometric indicators.

The Vulnerable Population

The intended audience to be covered during this intervention is middle-aged adults (35-60 years) residing in low-income urban communities across the United States. It will indubitably build structural and environmental inequity in such communities, which will raise the likelihood of becoming obese. Among them, the problem of food access is particularly notable, where urban low-income areas are often referred to as food deserts/food swamps, characterized by a scarcity of healthy and affordable foods and an abundance of low-nutritional value and high-calorie options. The dietary trend is characterized by an abundance of calories and low nutritional value. Even the nature of the constructed environment is an issue; the low pavements, open fields, and security concerns surrounding the facility restrict access to any form of physical activity. Additionally, the difficulty of commuting or holding low-paying jobs restricts the time one can spend exercising or cooking.

These are environmental restrictions that disrupt socioeconomic and demographic factors. Among adult populations of Blacks and Hispanics, obesity is more prevalent than in White adult populations. It is caused by economic deprivation, poor access to preventive health care, systemic stressors, and cultural and social determinants of health. The results of one of the researchers showed that the Black respondents were better placed to be obese, diabetic, and physically inactive (79.6, 94.5, and 28.4, respectively; p<0.001) than the white ones. There is also less viability in practicing traditional weight-loss interventions due to reduced health literacy, economic barriers to accessing organized weight-management interventions, and conflicting life demands such as caregiving. All these risk factors involve overlapping of environmental, economic, social, and behavioral groups, and the intervention they need should target not only the individual but also the environmental barriers.

A Review of Literature

Multicomponent behavioral interventions on adult obesity have a strong evidence base. Multicomponent interventions, which combine dietary advice, organized physical activity, and behavioral interventions such as self-monitoring, stimulus control, and problem-solving, have been shown to result in statistically significant weight loss and may also prevent the development of type 2 diabetes (Sasako et al., 2023). The strength of the review is that it summarized high-quality trials to offer clear-cut criteria of what an effective intensive program is (frequency of contacts, various behavior-change interventions). Nonetheless, the most significant limitation is that most trials were conducted in resource-enriched environments or among participants who volunteered for the research; therefore, the findings may not be generalizable to underserved urban groups, where retention and access issues are prevalent.

Even more current trials have been done on modalities of delivery. Anazco et al. (2024) examined the differences between traditional in-person lifestyle programs and digitally enhanced lifestyle interventions. They found that the digital arm of the study resulted in better weight loss and improved body composition. Scalability and flexibility are the key advantages of digital tools, as participants can receive coaching, engage in self-monitoring, and access educational modules remotely, thereby minimizing the limitations imposed by transportation and time constraints. However, the trial's weakness lies in its dependence on the availability and ease of use of digital technology among participants. In urban communities with low incomes, digital literacy and internet access may decrease the trial's reach and equity.

In a synthesis of the literature, two themes are evident: first, multicomponent behavioral strategies are consistently more effective than single-strategy interventions; second, the delivery innovation in the form of digital improvements enhances access and engagement, but may leave behind individuals without satisfactory access and abilities. The strengths in the literature include a rigorous trial design and consistent evidence demonstrating that behaviorally based programs can provide clinically significant weight loss. These include the variability in the intensity of intervention, a high rate of short follow-up in most studies, which restricts the evidence on long-term maintenance, and a relative lack of studies that directly examine culturally adapted, community-based models specific to low-income urban adults (Anazco et al., 2024). The issue of sustainability and adaptation to the socio-environmental context is an area of concern.

Appropriate Health Promotion/Disease Prevention

The most appropriate conceptual framework that this proposal can be applied to is the Social Ecological Model (SEM) that integrates the constructs of the Social Cognitive Theory (SCT) because it clearly acknowledges the fact that individual behaviors are affected by different levels of factors interacting with each other: individual, interpersonal, organizational, community, and policy (Holmes et al., 2021). On a personal level, the program will be based on self-monitoring, nutritional literacy, goal setting, and motivational interviewing to enhance self-efficacy. This SCT construct is key to long-term behavior change. At the interpersonal level, the participants will be organized in peer-support groups and buddy schemes to foster accountability, behavior change, and social encouragement.

At the organizational level, the intervention will collaborate with community clinics, faith-based organizations, and local employers to establish group sessions, provide short-term counseling, and offer screening and referral services. It will be community-level (enhance local food/physical-activity environment) strategies, which will be coordinated with local farmers markets, local gardens, and safe-walking programs, and policy-level actions, which will involve advocacy of structural-level provisions, such as fresh-produce subsidies or local policies to discourage local concentration of unhealthy food establishments (Holmes et al., 2021). The incorporation of SCT into SEM enables the relationship between both the social and environmental contexts (self-efficacy, outcome expectations, observational learning) and the inner-world processes (self-efficacy, outcome expectations, observational learning), providing a coherent and multilevel approach to addressing obesity among underserved city adults.

References

Anazco, D., Espinosa, M. A., Cifuentes, L., Kassmeyer, B., Schmidt, T. M., Fansa, S., Campos, A., Tama, E., Harmsen, W. S., Hurtado, M. D., Hensrud, D. D., & Acosta, A. (2024). Efficacy of in-person versus digital enhanced lifestyle interventions in adults with overweight and obesity. Obesity Pillars, 12, 100133–100133. https://doi.org/10.1016/j.obpill.2024.100133

Cohen, S. A., Nash, C. C., Byrne, E. N., Mitchell, L. E., & Greaney, M. L. (2022). Black/White Disparities in Obesity Widen with Increasing Rurality: Evidence from a National Survey. Health Equity, 6(1), 178–188. https://doi.org/10.1089/heq.2021.0149

Holmes, A. U., Golman, M., Wiginton, K., & Amuta, A. (2021). Examining Social Cognitive Theory and Social Ecological Model in Reversing Predictors (Family Meals, Sleep, Media Use) of Childhood Weight Status within the Home Environment. TWU Student Journal, 1(1), 68–75. https://doi.org/10.1016.j.pcad.2018.06.002

Khani, M., Afsahi, R., Nasab, A. E., Bi’aragh, S. H., Rasouli, K., Ahangar, M. H., Soltani, A. S., & Pourahmad, R. (2025). Addressing the challenge of obesity in primary care: a review of effective interventions and implementation strategies. Diabetology & Metabolic Syndrome, 17(1). https://doi.org/10.1186/s13098-025-01925-z

Sasako, T., Yamauchi, T., & Ueki, K. (2023). Intensified Multifactorial Intervention in Patients with Type 2 Diabetes Mellitus. Diabetes & Metabolism Journal. https://doi.org/10.4093/dmj.2022.0325