Running head: REDUCING OBESITY IN MIAMI-DADE COUNTY

Reducing Obesity in Miami-Dade County

Michael A. Cook
University of South Florida

REDUCING OBESITY IN MIAMI-DADE COUNTY

Reducing Obesity in Miami-Dade County

Distinct communities present with their own strengths and weaknesses in terms of
public health. Evaluating and comparing community health data provides a way to understand a
communitys specific health needs. Furthermore, these evaluations may provide insight about
potential interventions that may impact negative health trends so as to improve the health
outcomes of individuals in the community. Miami-Dade County, compared to the state of
Florida, has a higher obesity rate and a larger proportion of individuals who are qualified as
sedentary or inactive. Although this disparity may stem primarily from socioeconomic factors,
health interventions can be introduced so as to reduce the prevalence of obesity and aide and
related health outcomes.
Evaluation of Health Data for Miami-Dade County
Geography and Demographics
Miami-Dade County is a 2431 square mile region that resides at the south-eastern edge of
the Florida peninsula. According to the United States Census Bureau (USCB) (2014), MiamiDade is home to over 2.5 million of Floridas nearly twenty million residents. Miami-Dade is
also home to Floridas second largest city, Miami, which is an important cultural center for
Floridas Hispanic population, many of whom reside in the city and outlying areas.
Approximately 66.2% of Miami-Dades population qualifies themselves as Hispanic compared
to Florida at 16.8%, and over twenty percent of the population is impoverished (UCSB, 2014).
According to the Florida Department of Health (FDOH) (2014), Miami-Dades citizens also
struggle, compared to the state, with obesity, cardiovascular disease and diabetes.

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Primary Employers
The three largest private employers in Miami-Dade are Baptist Health South Florida, a
not-for-profit health care organization, the University of Miami and American Airlines,
cumulatively employing over 35,000 residents (Beacon Council, 2012). A much larger
population of Miami-Dade residents are employed through public enterprises such as the MiamiDade County government, public schools and federal government positions. These organizations
employ over 77,000 Miami-Dade residents (Beacon Council, 2012).
Educational Background
Although Miami-Dade County harbors the University of Miami, which is consistently
ranked in the top fifty for the United States, the county itself lags behind on education. When
considering individuals over the age of twenty-five, 79.5% of residents do not have a high school
diploma or equivalent certificate, whilst 26.4% have some college experience compared to state
averages of 86.5% and 26.8% respectively (UCSB, 2014). However, Miami-Dade exceeds the
state average when considering the proportion of the population with graduate or professional
degrees with Miami-Dade at 9.6% and the state of Florida at 8.9% (UCSB, 2014).
Language Influences
Due to Miami-Dades comparatively large population of Hispanic residents, there are also
language discrepancies between the county and the state. According to the United States Census
Bureau (2014), approximately 72.2% of homes in Miami-Dade County had residents who were
speaking a language other than English. This figure is over 2.5 times the state average at 27.8%.
Furthermore, 19.9% of Miami-Dade residents over the age of eighteen claim that they do not
speak English well (UCSB, 2014).
Health Strengths and Weaknesses for Miami-Dade County

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Miami-Dade presents health strengths in terms of tobacco-related disease and death, and
breast cancer screening. According to the Florida Department of Health (2014), Miami-Dade
loses approximately 166.7 of 100,000 adults over the age of thirty-five each year to forms of
tobacco-related cancer. This is 3.42% less than the state average, despite Miami-Dade being a
hub for cigar production (FDOH, 2014). Miami-Dade also shows better health figures related to
breast cancer diagnosis. Although the county does not demonstrate a lower breast cancer
incidence rate when compared to the state, Miami-Dades advanced breast cancer diagnosis rate
is 19.9% lower than the state, due to breast screening procedures catching the disease before
advanced development (FDOH, 2014).
Miami-Dade has particular health weaknesses regarding the prevalence of residents who
are overweight, obese, sedentary or do not meet the physical activity requirements recommended
by the Centers for Disease Control and Prevention. Approximately 35.4% of Miami-Dades
residents are qualified as being sedentary throughout the day, compared to the state at 25.4%, and
26.0% of Miami-Dades residents are considered obese, compared to the state at 24.1% (FDOH,
2014). These particular health weaknesses are substantial and warrant the introduction of health
interventions as these disparities are correlated to a higher risk of many disease states, including
diabetes and cardiovascular disease (Ponce-Garcia, et al., 2015).
Miami-Dade County also presents a worrisome health status in terms of diabetes and
cardiovascular complications. The countys cardiovascular disease death rate exceeds the state of
Floridas by 5.1% and the countys death rate from diabetic complications also exceeds the state
of Floridas by 7.7% (FDOH, 2014). Furthermore, Miami-Dades hospitalization rate for diabetic
individuals who received an amputation also surpasses the states (FDOH, 2014). Given that these

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disease states are correlated with obesity, community-directed obesity interventions may help
reduce the prevalence of these disparities.
Obesity as a Priority Health Issue
Miami-Dade exceeds the state average in terms of population of overweight or obese
individuals, and in levels of physical inactivity and sedentary behaviors (FDOH, 2014). These
issues are of particular concern because the physiological burden and malfunctioning that can
occur as a consequence of obesity and physical inactivity can lead to diabetes and cardiovascular
disease, which is the leading cause of death in the United States (Centers for Disease Control and
Prevention, 2014). Furthermore, this health disparity warrants prioritization not only because of
its serious impact on health risks and well-being, but also because there are population-wide
interventions that can be implemented so as to help Miami-Dade trend in a positive direction.
Applications of Community Health Models
The Determinants-of-Health model is a model that aims to evaluate and analyze the
health status of particular populations by recognizing and discussing the factors that contribute to
that status. Some of these factors include: income and social status, education levels, physical
environment, social support accessibility, genetic background, access to health services and
lifestyle choices.
Lifestyle factors. Lifestyle choices are often a substantial determinant when it comes to
obesity or weight difficulties, although biological and genetic predispositions can also be crucial
to consider. According to the Florida Department of Health (2014), 67.3% of Miami-Dade
residents are inactive at work, and 35.4% are qualified as living sedentary lifestyles, compared to
the state at 25.4%. Furthermore, only 29.2% of Miami-Dade residents meet moderate physical
activity recommendations from the Centers for Disease Control and Prevention, and an even

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smaller proportion of the population meets vigorous physical activity recommendations (FDOH,
2014). Not only do the majority Miami-Dade residents not meet these recommendations, the
county continues to rank far below the state average. This lack of physical activity may
contribute to the obesity problem in Miami-Dade as regular physical activity is a part of a
healthy lifestyle and aids in burning excess calories and building lean muscle mass, which
metabolizes an appreciable quantity of fat at rest.
Compounding this lack of physical activity is the dietary situation in Miami-Dade. Only
23.1% of Miami-Dade residents consume at least five servings of fruits and vegetables a day,
compared to the state at 26.2%, and only 24.3% consume three or more servings of vegetables
alone per day (FDOH, 2014). These dietary disparities may also contribute to the obesity
problem as fruit and vegetable recommendations are formulated based on the knowledge that
these dietary categories are often low in fat and calories, especially vegetables, but high in
vitamin and mineral content.
Environmental factors. The Florida Department of Health (2014) suggests that this
disparity may stem from environmental factors as the summer and fall months in Miami-Dade
are exceedingly hot and not conducive to outside exercise and activity. Although Floridas
temperature is relatively homogeneous due to the high humidity throughout most of the state,
there is some evidence to support the Health Departments claim. Monroe county, for example,
which shares a latitudinal border with Miami-Dade also houses a sedentary population that is far
above the state average at 46.6% (FDOH, 2014). These environmental conditions may deter
residents from engaging in physical activity thus contributing to a more sedentary lifestyle.
Biological factors. Obesity is a complex disease in terms of physiology as there are
constant interactions between an individuals genetic background, physiological states and

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environmental components such as dietary intake and activity levels. Despite the complexity,
there are known single gene modifications that can increase the risk of an individual becoming
obese, and there are dozens of other autosomal genetic modifications that increase obesity risk
by altering energy homeostatic pathways (Rao, Lal, & Giridharan, 2014).
Population Diagnosis
For Miami-Dade adult residents, obesity is a particular risk. Compared to the state, this
population is more likely to be overweight or obese, live a sedentary lifestyle, fail to consume
recommended daily fruit and vegetable servings, and fail to meet the CDCs physical activity
recommendations (FDOH, 2014). These risks are not as prevalent in the Miami-Dade youth
population, which continues to remain under the national average for childhood obesity.
Community/Population-based Interventions
Primary Level of Prevention. For Miami-Dade adult residents, the obesity disparity
may improve if particular risk factors that are contributive to obesity are modified. A particular
modifiable risk factor is the level of physical inactivity amongst adults, which the FDOH
suspects is partially due to the seasonally harsh environmental conditions, in terms of heat and
humidity (FDOH, 2014). A potential intervention is to promote the proliferation of community
walking groups in local parks that have ready access to shade, water fountains and indoor
meeting areas. This intervention is geared toward all adults in the community who may suffer
from obesity or sedentary lifestyle. The funding for this intervention would minimally include
the cost pamphlets, signs and announcements about the introduction of such walking groups by
the health department or local parks and recreation departments. Ideally, funding could be put
forth to schedule monthly Walk-in-the-Park events where resources such as beverages and health
snacks would be available. These events may incentivize community members to form their own

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distinct walking groups and schedule their own group routines. Community nursing contributes
to this intervention by providing education and resource information about nutrition and activity
recommendations and their contribution to overall current and future health.
Secondary Level of Prevention. Screening would be another advantageous intervention,
wherein individuals can participate in a dietary and activity level screening that provides them
with an understanding about how their particular dietary regimen and activity levels contribute to
their risk for particular disease states in the future, such as cardiovascular disease and diabetes.
These screenings can be directed towards any interested community member and requires little
funding as only staffing and basic educational information may be necessary. Community
nursing contributes to this intervention in an educational role, and nurses may also be helpful in
acquiring basic physiological data for the screening process.
Tertiary Level of Prevention. Adult individuals in Miami-Dade who are currently
qualified as being obese can prevent further impact on their health by monitoring their own
nutritional intake and activity levels via a health application for mobile devices. Dozens of
applications are available for mobile devices, regardless of operating system, that allow
individuals to readily track their nutritional intake and activity levels, and provides a way to
monitor trends and establish health goals. Funding for this intervention could be virtually
unnecessary as these applications are already available on the market, and many are free. If the
health department wanted to create their own application that also provided information about
county-wide community-health goals, this could potentially cost thousands of dollars for basic
development. The community health nurse could be involved in this intervention by educating
about county-wide health disparities, as well as potential interventions for modifying specific
health goals tracked in the application.

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Reflections and Synthesis of Health Policy

Health policy is integral to health care because it allows for community-wide
interventions to be implemented based on specific community health needs. These policies
reflect a communitys unique strengths and weaknesses and can help provide funding for these
implementations. The Walk-in-the-Park intervention for obesity is a project aimed to increase the
number of community-driven walking groups in public parks that are known for shade
abundance, safety and local resources. This project could be initiated by hosting walking events,
perhaps monthly, sponsored in part by the health department where community members are
attracted to participate in social walking, and are provided basic nutritional resources. A funding
concern is that it may take several of these sponsored walking events before community
members form their own social groups and independently develop their own regimens and
routines.
The first step is to identify potential parks with adequate resources and aesthetic appeal,
quantifying the cost of resources and staffing, manufacturing signs, and advertising the event.
The health department of Miami-Dade would be approached first as they have published
materials about the obesity issue in the county and publicly advocate for improvement on this
issue. This project enhances the health of the population by reducing their risks of health
cardiovascular complications and diabetes, which are already prevalent in the county compared
to the state (FDOH, 2014).
Conclusion
Obesity is a primary health concern for individuals in Miami-Dade County because the
proportion of obese individuals exceeds the state and this health status is correlated to several
negative outcomes, including cardiovascular disease and diabetes (Ponce-Garcia, et al., 2015).

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This disparity may be diminished if community-driven walking groups were formed where
individuals could congregate to socialize and exercise in parks with adequate shade, resources,
safety, and aesthetic appeal. This paper is relevant to my nursing career because obesity is a
common health status and I feel a strong obligation to reduce the risk for negative outcomes
associated with obesity. Considering this issue on a community level, and generating
community-based interventions helps to apply nursing interventions to scales that affect more
individuals, and that is valuable.

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References
The Beacon Council (2012). Employment and labor. Retrieved from
http://www.beaconcouncil.com/meet-miami-dade-county/employment-and-labor
Center for Disease Control and Prevention (2014). National diabetes statistics report. Retrieved
from http://www.cdc.gov/nchs/data/hus/hus15.pdf#019
Florida Department of Health (2014). County-state profile. Retrieved from
http://www.floridacharts.com/charts/SpecReport.aspx?RepID=7200&tn=25
Ponce-Garcia, I., Simarro-Rueda, M., Carbayo-Herencia, J. A., Divisn-Garrote, J. A., ArtigaoRdenas, L. M., Botella-Romero, F., & ... Gil-Guillen, V.F. (2015). Prognostic value of
obesity on both overall mortality and cardiovascular disease in the general population.
Plos ONE, 10(5). doi:10.1371/journal.pone.0127369
Rao, K. R., Lal, N., & Giridharan, N. V. (2014). Genetic & epigenetic approach to human
obesity. Indian Journal Of Medical Research, 140589-603.
The United States Census Bureau (2014). County and population profiles. Retrieved from
http://www.census.gov/did/www/saipe/downloads/estmod14/est14_FL.txt