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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

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Health Promotion Proposal, Part 2

Adult Obesity

Student’s Name: Yulexis Moreda

Institution: Florida National University

Instructor: Nora Hernandez Pupo

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

Date: October 15, 2025

HEALTH PROMOTION PROGRAM PROPOSAL

Introduction

Based on the aforementioned evidence-based point, this proposal proposes a multicomponent community-based lifestyle intervention that will be used to improve the obesity and overweight conditions of urban, low-income, 35–60-year-old adults. Healthy Living for Life (HLL) is the name of the program, which is a health promotion initiative that includes dietary changes, physical activity, and theoretical counselling. Through at-risk, culturally sensitive, and nurse-led interventions that are easily accessible and feasible to implement in urban community-based settings, HLL aims to promote weight loss and a healthier lifestyle.

The stages of the program

Phase 1 (Months 1–3: Preparation and Enrollment): The recruitment will be conducted by the advanced practice nurse (APN) within this period to recruit via neighborhood clinics, community centers, and places of worship.  The baseline assessments based on validated instruments will be conducted to record blood pressure, weight, BMI, waist circumference, dietary and physical activity habits.  Besides getting culturally relevant educational content on the subject of physical activity and nutrition, the participants will be oriented on the expectations and the organization of the program.

Phase 2 (Months 4–12: Active Intervention): Weekly 90-minute group sessions involving behavioural counselling, instruction, and supervised physical exercise will be part of this stage. Each session will consist of 30 minutes of moderate physical activity (dance classes, walking clubs, resistance training), 30 minutes of group counselling using motivational interviewing and problem-solving techniques, and 30 minutes of nutrition education. 

Phase 3 (Months 13–18: Maintenance and Follow-up): To sustain lifestyle changes, the participants will change their monthly group meetings and continue virtual coaching.  Biometric checks carried out by the nurse practitioner after every three months will be used to assess the progress and pinpoint the barriers, whereas peer mentors, who are trained community volunteers, will be available to provide support throughout the process.

Resources and Personnel

Some of the resources that are needed when implementing the HLL program include a multidisciplinary team and community infrastructure.  The team will consist of two community health workers, a certified fitness instructor, a registered dietitian, and a nurse practitioner (program lead).  The job description of the nurse practitioner will involve clinical examination, behavioral counselling, health education, and coordination.  Physical resources may include access to a community center where they can hold weekly meetings, exercise equipment (e.g., resistance bands and mats), written materials, and online tools e.g., an SMS system or smartphone app, where participants who do not have smartphones can access the sessions.  The relationships with the local farmers' markets will enable access to lower-cost produce.

With the way it aligns with the nursing competencies in community partnership, preventing chronic diseases, and promoting health, there is a high probability that this intervention can be implemented by an advanced practice nurse.  Some of the skills advanced-role nurses possess are patient education, motivational interviewing, and holistic care, which are essential to facilitate long-term behavior change.  The digital tools, coupled with community-based support in the form of the intervention, make it cheaper and more accessible, and it is scalable to similar urban populations.

Intended Outcomes

The SMART goal for this intervention is: Within 1.5 years, according to validated biometric and behavioural measures, at least half of the low-income urban adults (35-60 years of age) will lose 5 percent of their initial body weight and show improved eating and physical exercise patterns.

  The exact intended outcomes are the following:

Weight Loss: By month 18, the participants will have lost a measurable average of 5 percent of their initial weight.

Physical Activity: By the program conclusion, 70 percent of the participants will have engaged in at least 150 minutes of moderate-intensity physical activity each week.

Improved Dietary Intake: By the end of the 12th month, the participants will record taking an additional two servings of fruits and vegetables in a day, and a reduction of sugar-sweetened drinks by half, continuing the same up to month 18.

Improved Self-Efficacy and Knowledge: Using a validated behavioural self-efficacy scale, participants will show increased self-efficacy scores in relation to weight management.

Decreased Clinical Risk Factors: Participants will show decreased blood pressure, fasting glucose levels, and waist circumference, all of which point to a lower risk of cardiometabolic disease.

These results are in line with the SMART framework because they are time-bound within 18 months, relevant to lowering the risks associated with obesity, measurable using validated tools, specific to quantifiable behavioural and biometric goals, and achievable based on previous research.

Evaluation Plan

Focus groups and participant interviews will be used for qualitative evaluation in order to gauge opinions regarding the program's value, obstacles faced, and contentment with the nurse-led approach. To assess viability and acceptability, attendance data, digital platform engagement levels, and retention rates will also be monitored. Pre- and post-intervention outcomes will be compared using paired t-tests and descriptive statistics, and qualitative responses will be subjected to thematic analysis (Golan et al., 2022). After every cycle of data collection, the advanced practice nurse will create evaluation reports with the help of a research assistant to direct continued program enhancement.

The program will incorporate a follow-up evaluation at 24 months (six months after completion) to make sure the evaluation accurately reflects effectiveness in the real world. The sustainability of the results more especially, the maintenance of weight loss and lifestyle changes, will be ascertained by this prolonged evaluation (Golan et al., 2022). The findings of this follow-up will be shared with local public health departments and community partners to promote funding or integration into long-term community health programs.

Barriers and Challenges

There are several possible obstacles to successful program implementation of the Healthy Living for Life. The first is economic and environmental, where program members from low-income inner-city neighborhoods might not have frequent access to healthy foods, safe places to exercise, or available time to get to sessions due to work or caregiving responsibilities. In an effort to offset such hindrances, the program shall launch collaborations with local food banks and farmers' markets to disperse produce vouchers and begin group-based exercises in public areas or schools in the evening hours (Gooey et al., 2022). Evening and weekend session provisions will further suit diverse work timetables.

The second major hindrance pertains to digital disparity and computer illiteracy. While adding a mobile or SMS element increases scalability, participants who have lower access to the internet or smartphones may be excluded (Anazco et al., 2024).

In addition, financial constraints may become an obstacle to ongoing program activity and staff assistance. The nurse practitioner will apply for grant funds from local public health authorities, community benefit programs of hospitals, and philanthropic organizations to offset expenses (Miranda-Peñarroya et al., 2022). In partnership with schools of nursing or universities, there would also be research grants and student volunteers to assist in data delivery and collection. Sustainability in the long run will depend on integrating the HLL program into such community health systems, such as federally qualified health centers, where nurse practitioners already practice within preventive care models (Gooey et al., 2022).

Finally, cultural and language diversity among participants could affect understanding and engagement. To prevent this, materials will be culturally adapted and translated into commonly used local languages, and cultural competency training will be offered to the staff to guarantee respect and inclusivity in honoring participants' beliefs and food and body image issues (Gooey et al., 2022).

In conclusion, This intervention plan offers a potential, evidence-based, nurse-led approach to reducing adult obesity in urban low-income residents. Healthy Living for Life is in a position to significantly impact the fight against obesity and enhance the health of vulnerable adults by fusing the strength of behavioural science with the reach of community-based nursing practice. While the Social Ecological Model is applied to ensure that the intervention addresses both individual behaviour and environmental determinants of health, digital support tools are used to increase engagement and scalability.

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

Golan, M., Tzabari, D., & Mozeikov, M. (2022). The Impact of Delivering School-Based Wellness Programs for Emerging Adult Facilitators—A Quasi-Controlled Clinical Trial. International Journal of Environmental Research and Public Health, 19(7), 4278. https://doi.org/10.3390/ijerph19074278

Gooey, M., Bacus, C., Ramachandran |, D., Piya, M., & Baur, L. (2022). Health service approaches to providing care for people who seek treatment for obesity: identifying challenges and ways forward. Public Health Research & Practice, 32(3). https://doi.org/10.17061/phrp3232228

Miranda-Peñarroya, G., Vallejo-Gracia, M., Ruiz-León, A.-M., Saenger-Ruiz, F., Sorio-Fuentes, R., Izquierdo-Pulido, M., & Farran-Codina, A. (2022). Development and Validation of a Short Questionnaire on Dietary and Physical Activity Habits for Patients Submitted to Bariatric Endoscopic Therapies. Obesity Surgery, 32(1), 142–151. https://doi.org/10.1007/s11695-021-05754-7

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