Fast food restaurant Essay

The pace of modern life is fast, and nowhere is it faster than in America. We want fast transportation, fast communication, fast computers, fast photos, fast music, fast repairs, and fast service from the businesses we patronize. It is from the last of these that we got fast food. At first, it was a matter of fast service. Fountain and Fast Food Service was the title of a trade magazine, which published statements like this from 1951: â€Å"The partners have become old hands at spotting the type of conventioneer that will patronize their fast food service. † Gradually service disappeared, and in 1954 we find fast food by itself in the title â€Å"Fountain and Fast Food. † Incidentally, the trade magazine renamed itself Fast Food by 1960. In February of that year, the magazine noted, â€Å"Delicate scallops are really fast food†¦ because they come ready to cook. † And in July it remarked, â€Å"Fast food type restaurants do the lion’s share of business for breakfast and noon meals eaten out. † The fast food revolution was a quick success throughout the land, and two decades later it was conquering the world. â€Å"The U. S.outcry against infiltration from the south is matched in vehemence by our neighbors’ outcry against fast-food imperialism and the gradual Americanization of their own societies. † noted the Christian Science Monitor in 1982. Thanks to fast food, families that formerly ate home cooking now eat out or bring back take-home fast food in record numbers. Its virtue is speed, not quality. Its less than ideal nutritional value may have influenced the coining of another term twenty years later, one that also puts a four-letter epithet in front of food: junk food (1973). Gale Encyclopedia of US History: Fast FoodTop. Home > Library > History, Politics & Society > US History Encyclopedia Fast food is what one eats in the vast majority of America’s restaurants. The term denotes speed in both food preparation and customer service, as well as speed in customer eating habits. The restaurant industry, however, has traditionally preferred the designation â€Å"quick service. † For hourly wage earners—whether factory hands or store clerks—take-out lunch wagons and sit-down lunch counters appeared at factory gates, streetcar stops, and throughout downtown districts in the late nineteenth century. For travelers, lunch counters also appeared in railroad stations nationwide. Fried food prevailed for its speed of preparation, as did sandwich fare and other fixings that could be held in the hand and rapidly eaten, quite literally, â€Å"on the run. † Novelty foods, such as hot dogs, hamburgers, french fries, came to dominate, first popularized at various world’s fairs and at the nation’s resorts. Soft drinks and ice cream desserts also became a mainstay. Thus, â€Å"fast food† also came to imply diets high in fat and caloric intake. By the end of the twentieth century, the typical American consumed some three hamburgers and four orders of french fries a week. Roughly a quarter of all Americans bought fast food every day. The rise of automobile ownership in the United States brought profound change to the restaurant industry, with fast food being offered in a variety of â€Å"drive-in† restaurant formats. Mom-and-pop enterprise was harnessed, largely through franchising, in the building of regional and national restaurant chains: Howard Johnson’s, Dairy Queen, Burger King, Kentucky Fried Chicken, Pizza Hut, and Taco Tico. Place-product-packaging was brought forcefully to the fore; each restaurant in a chain variously shares the same logo, color scheme, architectural design motif, and point-of-purchase advertising, all configured in attention-getting, signlike buildings. Typically, fast food restaurants were located at the â€Å"roadside,† complete with driveways, parking lots, and, later, drive-through windows for those who preferred to eat elsewhere, including those who ate in their cars as â€Å"dashboard diners. † Critical to industry success was the development of paper and plastic containers that kept food hot and facilitated â€Å"carry-out. † Such packaging, because of the volume of largely nonbiodegradable waste it creates, has become a substantial environmental problem. In 2000, Mcdonalds—the largest quick-service chain—operated at some 13,755 locations in the United States and Canada. The company’s distinctive â€Å"golden arches† have spread worldwide, well beyond North America. Abroad, fast food came to stand as an important symbol of American cultural, if not economic, prowess. And, just as it did at home, fast food became, as well, a clear icon of modernity. Historically, fast food merchandising contributed substantially to the quickening pace of American life through standardization. By the beginning of the twenty-first century, it fully embraced mass production and mass marketing techniques, reduced to the scale of a restaurant. Chains of restaurants, in turn, became fully rationalized within standardized purchasing, marketing, and management systems. Such a system depends on a pool of cheap, largely unskilled labor, the quick service restaurant industry being notorious for its low wages and, accordingly, its rapid turnover of personnel. Bibliography Jakle, John A. , and Keith A. Sculle. Fast Food: Roadside Restaurants in the Automobile Age. Baltimore: Johns Hopkins University Press, 1999. Pillsbury, Richard. No Foreign Food: The American Diet and Place. Boulder, Colo. : Westview Press, 1998. Schlosser, Eric. Fast Food Nation: The Dark Side of the All-American Meal. New York: HarperCollins, 2002. —John A. Jakle Gale Encyclopedia of Food & Culture: Fast FoodTop Home > Library > Food & Cooking > Food & Culture Encyclopedia What is termed â€Å"fast food† in the United States today most commonly consists of hot, freshly prepared, and wrapped food items, served to customers across a counter or through a drive-up window. Known as both â€Å"fast food† and â€Å"quick-service food† in the restaurant industry, these items are routinely sold and delivered in an amount of time ranging from a few seconds to several minutes; they now vary widely in food type, encompassing virtually all kinds of meats, preparation methods, and ethnic cuisines. Inexpensive hamburgers and french fried potatoes are still the products most readily identified as fast food, but the list of items sold in the format continually increases. Fried fish and shellfish, hot dogs, chicken, pizza, roast beef, and pasta are commonly sold at quick-service outlets. In addition to these staples, many quick-service restaurants sell a broad menu of Americanized Mexican, Greek, and Chinese foods. Some fast-food outlets offer specialty items, such as sushi, clams, or ribs, and others even sell complete â€Å"home-cooked† meals over their counters. Though menus and delivery formats vary greatly, fast food’s chief common denominators include immediate customer service, packaging â€Å"to go,† and inexpensive pricing. The precise origins of fast food are vague, probably predating written history. Hungry people are as old as civilization itself, as are entrepreneurs eager to satisfy their hunger. Food vendors in ancient cities sold prepared items to passersby on the street. The actual foods varied greatly, depending on period and culture, but they generally comprised simple, inexpensive fare sold to people of modest means. Immigrants brought a variety of food styles to America, often preserving these for decades as a comforting connection with their ethnic past. Though many immigrant foodways were elaborate and ritualistic, most groups had one or two simple items that they consumed on a daily basis. As a rule, immigrant groups preferred their indigenous grains: corn from the Americas, rice from Asia, and wheat from Europe. Often these served as the basis for the â€Å"peasant† foods of their homelands. Pasta and flat breads came over with Italians; tortillas, beans, and tamales arrived with northbound Mexicans; and Germans brought dark breads, along with a variety of fatty sausages (which later mutated into the hot dog). Asian immigrants continued to eat rice as the basis of their diet. In the early twentieth century fast food remained primarily the fare of the masses. Vendors wheeled their pushcarts daily to factory gates, selling their wares to hungry workers. Often catering to the tastes of the particular factory’s dominant ethnic group, they charged customers pennies for basic items such as sausages, meatballs, or stew. Though popular among male industrial workers, this pushcart version of fast food never became mainstream cuisine. The urban diner was the transitional phase between the vendor’s pushcart and modern fast food. Most early diners were small restaurants, with limited seating, sometimes constructed out of converted railway carriages or streetcars. They served simple foods to working-class customers on a â€Å"short-order† basis, usually cooking each meal individually when ordered. Menus varied, but fried foods were common. Though diners often emphasized speed in delivering food, customers routinely lingered before and after eating. The hamburger still stands out as the single most important American fast food, though the precise origin of this meat sandwich is the subject of historical disagreement. People have eaten chopped beef throughout the ages, and it was long a fixture in many world cultures. The lineage of the American hamburger seems to point directly, as its name indicates, back to the German city of Hamburg. First appearing on American restaurant menus in the mid-nineteenth century, ground beef patties bore the title â€Å"hamburg steak. † By the century’s close, vendors regularly sold meatballs wrapped in slices of bread at county fairs and summer festivals. Regional legends attribute the invention of this snack to several different individuals, but its true originator remains a mystery. The Rise of Modern Fast Food Our modern image of the fast-food restaurant dates back to 1916, when Walt Anderson began selling â€Å"hamburger sandwiches† from an outdoor stand on a Wichita street corner. Anderson simply flattened a meatball and placed it between two halves of a bun. His sandwich quickly became popular, attracting long lines of hungry buyers. By 1921, Anderson had joined local insurance broker Edgar â€Å"Billy† Ingram to form the White Castle System. After opening several identical restaurants in Wichita during their first year, the partners quickly spread their business to neighboring cities, then to nine major urban areas throughout the Midwest and on the East Coast. What separated the White Castle System from earlier short-order restaurants was its very streamlined menu, comprising only hamburgers, coffee, Coca-Cola, and pie; a uniform architectural style; and strict standardization of food quality, preparation methods, and employee performance. By the close of the 1920s, White Castle’s aggressive marketing and rapid spread had made the hamburger one of the most popular foods in America. Other entrepreneurs soon noticed White Castle’s success in the hamburger business. Very closely copying White Castle’s products, architecture, and company name, competing new chains also thrived, carrying the hamburger craze across the nation to smaller cities and towns. The White Tower chain appeared in 1925, eventually challenging White Castle’s dominance in several northern cities. Krystal’s, opened in 1929 in Chattanooga, soon became the hamburger powerhouse of the southeastern states. White Castle’s hamburger sandwich, along with its many imitators, became a daily staple for many working-class Americans. It proved so successful, in fact, that by 1930 the president of the American Restaurant Association identified the fast-food hamburger as the most important food item in the nation. Hamburgers became even more a mainstream food during the 1930s. The larger restaurant chains began marketing their products to middle-class buyers, and even more Americans became burger lovers. Despite the harsh economy of the Great Depression, most fast-food chains continued to thrive, and in many cases grew considerably. Most continued selling the White Castle–style hamburger, but late in the decade the Big Boy chain spread east from California, introducing its new double-decker hamburger sandwich along the way. By the end of the Depression, America was a solidly hamburger-eating culture. After prospering in the Depression, however, the fast-food industry suffered a serious setback during World War II. Shortages of necessary foodstuffs, such as meat, sugar, tomatoes, and coffee, meant limited menu offerings and often a significant loss of business. Attempting to continue providing meals to their customers, fast-food restaurants experimented with different items that were still in abundance, including soy patties, chili, and french fried potatoes. Even more damaging than commodity shortages was the very low unemployment rate, which meant that most workers bypassed the restaurant industry in favor of higher-paying work. Adjusting to this labor shortage, chains soon replaced their all-male workforce with women and teenagers, two groups who would become their most common employees. Despite attempts to find palatable alternative foods, and despite the shifts in workforce, much of the fast-food industry was a casualty of the war; by 1945, more than half of America’s restaurants had closed down, including several of the major fast-food chains. Rebuilding the fast-food industry after the war proved a slow process. No single chain emerged to claim dominance, and little innovation occurred. Individual companies struggled to restore their prewar prosperity, and new regional chains tried to gain a foothold. Suffering the effects of escalating costs and still under the threat of continued shortages due to unstable food supplies in war-torn countries, fast-food restaurants often had to double prices to remain in business. As population shifted from America’s cities to suburbia during the 1950s, the fast-food industry quickly followed. Early chains such as White Castle and White Tower, resisting moving to the suburbs, were quickly eclipsed by upstart franchised chains. Burger King and McDonald’s outlets became common fixtures at suburban crossroads, selling burgers, fries, and shakes to hungry families. Burger King’s Jim McLamore and McDonald’s Ray Kroc each sought to build one of his restaurants in every American town, and they opened hundreds of new Burger Kings and McDonald’s each year in the 1960s. To accomplish this rapid expansion, they relied heavily on franchise investors, enforced strict product uniformity throughout their chains, and aggressively advertised in every newly opened territory. With McDonald’s and Burger King’s success, Burger Chef outlets soon appeared nearby. Arby’s, Kentucky Fried Chicken, and Taco Bell were not far behind. By the late 1960s, fast food no longer meant just hamburger restaurants, but had diversified to include quick-service pizza, roast beef, chicken, and tacos. To give an idea of the dimensions to which the fast-food industry has grown, in 1999 Americans consumed over 26 billion pounds of beef, much of it as hamburgers. In that year McDonald’s alone had more than ten thousand restaurants in the United States, from which it grossed in excess of $13 billion in revenue. Criticism of Fast Food Despite the widespread popularity of fast food in modern American culture, critics abound. Since the 1930s, articles and books have condemned the industry, exposing allegedly poor sanitary conditions, unhealthy food products, related environmental problems, and unfair working conditions. Whether it warrants the attention or not, the fast-food industry is still regularly cited for exploiting young workers, polluting, and contributing to obesity and other serious health problems among American consumers. American beef consumption, and more specifically the fast-food hamburger industry, is often blamed for the burning of the Amazon rain forests to make way for more grazing lands for beef cattle. Early foes of fast food cited the deplorable filth of many hamburger stands, in addition to claiming that the beef ground for their sandwiches was either spoiled, diseased, or simply of low quality. In fact, many critics maintained that much of the meat used in fast-food hamburgers came from horse carcasses. The high fat content of fast food was also controversial. Despite deceptive industry claims about the high quality and the health benefits of their products, in the 1920s and 1930s concerned nutritionists warned the public about the medical dangers of regular burger consumption. This distrust and criticism of fast food continue today, extending even further to include dire warnings about the industry’s use of genetically modified and antibiotic-laden beef products. Most major chains have responded to recent attacks by prominently posting calorie and nutritional charts in their restaurants, advertising fresh ingredients, and offering alternatives to their fried foods. Despite a few more health-conscious items on the menu, fast-food chains now aggressively advertise the concept that bigger is better, offering large â€Å"super-size† or â€Å"biggie† portions of french fries, soft drinks, and milkshakes. Critics point to this marketing emphasis as a reason for an excessive and greatly increasing per-capita caloric intake among fast-food consumers, resulting in fast-growing rates of obesity in the United States. Increased litter is another problem that critics have blamed on the fast-food industry. Selling their products in paper wrappings and paper bags, early outlets created a source of litter that had not previously existed. Wrappers strewn about city streets, especially those close to fast-food restaurants, brought harsh criticism, and often inspired new local ordinances to address the problem. Some municipalities actually forced chains to clean up litter that was imprinted with their logos, but such sanctions were rare. Fast-food wrappers became part of the urban, and later suburban, landscape. Since bags and wrappers were crucial in the delivery of fast food, the industry as a whole continued to use disposable packaging, superficially assuaging public criticism by providing outside trash receptacles for the discarded paper. Years later, environmentalists again attacked the industry for excessive packaging litter, criticizing both the volume and the content of the refuse. By the early 1970s, the harshest criticisms focused more on the synthetic materials used in packaging, and less on the carelessly discarded paper. Critics derided the industry’s use of styrofoam sandwich containers and soda cups, claiming that these products were not sufficiently biodegradable and were clogging landfills. Facing mounting opposition from a growing environmental movement, most of the major chains returned to packaging food in paper wrappings or small cardboard boxes. Labor activists have criticized fast-food chains’ tendency to employ inexpensive teenage workers. Usually offering the lowest possible wages, with no health or retirement benefits, these restaurants often find it difficult hiring adults for stressful, fast-paced jobs. Many critics claim that the industry preys on teenagers, who will work for less pay and are less likely to organize. Though these accusations may have merit, the industry’s reliance on teenage labor also has inherent liabilities, such as a high employee turnover rate, which result in substantial recruiting and training costs. Companies have countered criticism about their use of teenage workers with the rationale that they offer young people entry-level work experience, teaching them: both skills and responsibility. Despite the relentless attacks, hundreds of millions of hungry customers eat fast food daily. The media constantly remind American consumers about its supposed evils. Most are conscious of the health risks from fatty, greasy meals; most realize that they are being served by a poorly paid young worker; and if they choose to ponder it, most are aware that the excessive packaging causes millions of tons of trash each year. But they continue to purchase and eat fast food on a regular basis. Fast food remains central to the American diet because it is inexpensive, quick, convenient, and predictable, and because it tastes good. Even more important, Americans eat fast food because it is now a cultural norm. As American culture homogenized and became distinctively â€Å"American† in the second half of the twentieth century, fast food, and especially the hamburger, emerged as the primary American ethnic food. Just as the Chinese eat rice and Mexicans eat tamales, Americans eat burgers. And fast food has grown even beyond being just a distinctive ethnic food. Since the 1960s, the concept has extended far beyond the food itself, with the term becoming a common descriptor for other quick-service operations, even a metaphor for many of the negative aspects of mainstream American life. Theorists and pundits sometimes use the term â€Å"fast food† to denigrate American habits, institutions, and values, referring to them as elements of a â€Å"fast-food society. † In fact, â€Å"fast-food† has become a frequently used adjective, implying not only ready availability but also superficiality, mass-produced standardization, lack of authenticity, or just poor quality. In the last two decades of the twentieth century, fast food gained additional economic and cultural significance, becoming a popular American export to nations around the world. Some detractors claim that it is even deliberately used by the United States, as a tool of cultural imperialism. The appearance of a McDonald’s or Kentucky Fried Chicken restaurant on the streets of a foreign city signals to many the demise of indigenous culture, replacing another country’s traditional practices and values with American materialism. In fact, the rapid spread of American fast food is probably not an organized conspiracy, rather more the result of aggressive corporate marketing strategies. Consumers in other countries are willing and able to buy fast-food products, so chains are quick to accommodate demand. Thought of around the world as â€Å"American food,† fast food continues its rapid international growth. Bibliography Boas, Max, and Steve Chain. Big Mac: The Unauthorized Story of McDonald’s. New York: Dutton, 1976. Emerson, Robert, L. Fast Food: The Endless Shakeout. New York: Lebhar-Friedman, 1979. Halberstam, David. The Fifties. New York: Villard Books, 1993. Chapter 11 discusses the origins of the McDonald’s empire. Hogan, David Gerard. Selling ’em by the Sack: White Castle and the Creation of American Food. New York: New York University Press, 1997. Jakle, John A. , and Keith A. Sculle. Fast Food: Roadside Restaurants in the Automobile Age. Baltimore: Johns Hopkins University Press, 1999. Langdon, Philip. Orange Roofs, Golden Arches: The Architecture of American Chain Restaurants. New York: Knopf, 1986. McLamore, James, W. The Burger King: Jim McLamore and the Building of an Empire. New York: McGraw-Hill, 1998. Mariani, John. America Eats Out. New York: William Morrow, 1991. Schlosser, Eric. Fast Food Nation: The Dark Side of the All-American Meal. Boston and New York: Houghton Mifflin, 2001. Tennyson, Jeffrey. Hamburger Heaven: The Illustrated History of the Hamburger. New York: Hyperion, 1993. Witzel, Michael Karl. The American Drive-In: History and Folklore of the Drive-In Restaurant in the Car Culture. Osceola, Wisc. : Motorbooks International, 1994. —David Gerard Hogan AMG AllGame Guide: Fast FoodTop Home > Library > Entertainment & Arts > Games Guide Release Date: 1989 Genre: Action. Style: Maze Random House Word Menu: categories related to ‘fast food’Top Home > Library > Literature & Language > Word Menu Categories Random House Word Menu by Stephen Glazier For a list of words related to fast food, see: Cuisines, Meals, and Restaurants – fast food: cheap, mass-produced dishes served quickly at walk-in or drive-in outlets; convenience food Wikipedia on Answers. com: Fast foodTop Home > Library > Miscellaneous > Wikipedia For other uses, see Fast food (disambiguation). A typical fast food meal in the United States includes a hamburger, french fries, and a soft drink. Pictured here are burgers from In-N-Out Burger McDonald’s, Kentucky Fried Chicken and Pizza Hut fast food restaurants in the United Arab Emirates Fast food is the term given to food that can be prepared and served very quickly. While any meal with low preparation time can be considered to be fast food, typically the term refers to food sold in a restaurant or store with preheated or precooked ingredients, and served to the customer in a packaged form for take-out/take-away. The term â€Å"fast food† was recognized in a dictionary by Merriam–Webster in 1951. Outlets may be stands or kiosks, which may provide no shelter or seating,[1] or fast food restaurants (also known as quick service restaurants). Franchise operations which are part of restaurant chains have standardized foodstuffs shipped to each restaurant from central locations. [2] Contents 1 History 1. 1 Pre-modern Europe 1. 2 United Kingdom 1. 3 United States 2 On the go 2. 1 Filling stations 2. 2 Street vendors and concessions 3 Cuisine 3. 1 Variants 4 Business 5 Employment 6 Globalization 7 Criticism 8 See also 9 References 10 Further reading 11 External links History.

Paramedicine Essay

Paramedicine is a unique field of practice that represents the connection between public health, health care, and public safety. The idea of paramedicine originally featured in the EMS Agenda, which expands the idea of traditional emergency medical services to emergency response system. It brings together responsibilities and roles that are associated with paramedics and at the same time represents the highest level of practice, which is witnessed out of a hospital medicine and cared by non-physicians. This means that paramedicine is a health profession that focuses on assisting families, individuals, and communities to attain, re-attain and at the same time maintaining optimal health, that usually results from sudden onset or acute result that emerges due to medical, and or traumatic events. This type of profession is common and practiced mostly in the out of hospital setting (Adrian 2006, pp. 56). The practice that is associated with paramedicine is usually art, and is based on the sciences of physiology, human anatomy, and pathophysiology. The aim of paramedicine is to promote best possible quality of life, as defined in philosophy of persons and families, which is common throughout their life expectances, which ranges from the care that occurs between birth and death. Paramedicine Profession The profession practice that is used in a paramedicine setting includes a complex and at the same time independent decision making, which is evident in the face of incomplete, ambiguous, and the information that is obtained maybe conflicting. The common decisions making that comes in practice includes readiness and response, patient assessment, scene management, emergency vehicle operations, clinical problem solving, planning, leadership, therapeutic communications, patient education, disposition decisions, and resource coordination. Hence, it involves the application of concepts of medical care at the same time in an uncontrolled, challenging, and austere condition. John’s research paper on Paramedicine World (2006), sums up the natural condition of a professional paramedicine expert, â€Å"People who are in the field of paramedicine should have a wide knowledge and at the same time are supposed to be experienced in issues that are related with complex and fast decision making capabilities without external pressures† pp. 23. Moreover, a part from the idea or portion of practice, paramedicine involves the routine use of medical skills, and tasks, which are controlled by the law. For the different regulated tasks e. . administering a medication, starting an IV, and performing invasive task, requires the practice of paramedicine to be dependent (Adrian 2006, pp. 55). The dependent portion that is present in practice of paramedicine is usually based on a collaborative relationship that has a physician medical director who is charged with provision of medical oversight. The contemporary philosophy that is in medical oversight involves provision of treatment that is common in the physician protocols in encouraging clinical problem solving and in decision-making. Hence, the decision that regards the protocol that is implemented is based on the formation of a specific paramedic diagnosis. Paramedicine bases on the emerging concept of paramedic theory, this theory is based on the study and analysis of three pillars of paramedicine; public health, medicine or health care, and public safety, which interact and intersect. It is stated in the IoM Report EMS at Crossroads (2006), that EMS is currently fragmented and at the same time largely separated from the general and overall health care system. Major emphasis in the theory of paramedic is the integration of emergency medical services, both extra-professionally and intra-professionally. Extra-professional study takes care of integration of EMS with the current nation’s emergency care and the health care system. Intra-professional integration bases on the study of distribution, resource allocation, efficiency and deployment. Other areas that are involved in paramedic theory are response planning, emergency response, inter-facility transfer, community education and response or disaster preparedness. Example of skills of paramedicine staff In different parts of the world, e. g. Canada, United States, United Kingdom and Australia have different tasks that they are supposed to undertake with specified qualifications. However, some skills that they are supposed to be performed include; †¢ Emergency vehicle response †¢ Emergency operations †¢ Mass casualty staging and triage †¢ Patient rescue and extrication †¢ Patient transportation †¢ Notifications and Radio Communications †¢ Life Support (Basic, advanced) †¢ ACLS – Advanced Cardiac Life Support †¢ Pharmacological treatment and electric cardiac arrest †¢ Medical administration and at the same time fluid resuscitation The emergency medication that is offered varies in terms of individual medication, and depends on the preference of the physician medical director, the law and at the same time the standard of the care. The individual medication drugs may include Adenocard and Atropine, which monitors the speed of the heartbeat. At the same time, they treat anxiety and crisis conditions and perform RSI. They may at times be permitted to administer pain relievers, and monitors vomiting. Experts who are in the field of paramedicine should have a wide knowledge of pharmaceuticals and the dugs that aid in life support. Paramedics are supposed to have a wide knowledge on drugs that can save and salvage a situation, and at the same time minimize the effects of side effects† (Richard 2006, pp. 78). As written by James in his article Paramedicine Vision (2006), he states that, â€Å"The field of paramedicine depicts different level of emergency containment, and any service that is administered depends on the laws of that specified region, the advice from the physician in charge and the nature of incident† (pp. 45). Qualified Paramedicine Place of Work They are usually employed by different organization, with varied operations distinctions. At the same time, they can be employed by the government agencies in public hospital, part of fire department and municipal EMS service. There presence is common in private sector organizations e. g. private ambulance companies, private hospitals, mines, corporations, racetracks and air ambulance services. At the same time they can work in voluntary sector which they do not offer monetary compensation e. g. community response units or Volunteer Fire Department. Paramedicine in United States Paramedicine is practiced different and the qualifications that are required differ between states. An example is the United States, a paramedic is a person who is qualified in paramedicine field and responds to treatments and medical emergencies and trauma that is common in outside of hospital settings. They provide treatment on the scene and during the transportation to a hospital emergency department. People from this profession also treat patients who do not require hospitalization, such as large events and public gathering. They obtain the legal authority to practice pre-hospital medical care in the said field, and they obtain license from physician medical director who are specialized in the field of Emergency medicine. In this scenario, they serve in out-of-hospital extension of the emergency services, which are offered by medical doctors in the hospital emergency sector. The medical doctors are qualified, and have great amount of experience and directs the functions that are performed by EMTs and other medical responders. There are different ways that the paramedics as stipulated by National Highway Traffic Safety Administration (NHTSA) are classified – EMT – B (basic), EMT – I (Intermediate), EMT – P (Paramedic) and the First Responders. In the United States, paramedics who work independently, and are under the direction of emergency medical control physicians, and they provide the most advanced emergency level for public outside hospital settings. Nevertheless, there are exceptions to those physicians who operate with air ambulance and jurisdictions that honor CCP – Critical Care Paramedic courses, which are not accepted by the state but are required during hospital ICU to hospital ICU transfers. In general, this means that depending on the region where the department is situated, their ability depends on the states or region conditions. There may be rules and conditions that are supported in the United States and are not eligible in United Kingdom or Australia. At the same time the technology and support that such institutions receive differs a lot, which results in different levels of success in their operations. Paramedicine is an important field in maintaining the state of human life. The demands that are required by different level of populations: individual, family and community are completely different. People who are involved in paramedicine have to understand all socio-ethical, traditional, and legal jurisdiction. The field of paramedicine has various issues that are brought into focus. These issues should be merged in certain way that it does not cause any conflict and they include public health, health care and public safety. Hence, combines different categories to yield paramedics. It is able to combine features that are seen in physiology, human autonomy, and pathophysiology to give birth to a conclusive field of practice. Its operability is some how demanding since it is dependent and at the same time requires stringent decision-making tasks. All this are based in the field of paramedic theory, and brings issues that are related with extra profession and intra-profession, The different fields that are required are used differently depending on the nature of the situation and conditions that are set. This means that it is a collaborative work between different governmental, private and volunteer groups.

Impact of Immigration on American Society Research Paper

Impact of Immigration on American Society - Research Paper Example The fear of the negative impact of immigration has led to passage of Acts. These acts restrict the inflow of immigrants to the main parts of America. Moreover, after Second World War, American soldiers married foreign women from 50 different countries. This paper will discuss the impact of the positive as well as negative impact of the immigration and the controversy revolving around the war brides of the American servicemen. Additionally in this paper, the negative impact of immigration will provide justification of the passage of Acts that intended to limit large scale immigration.1 Some level of immigration has been continuous throughout American history. There have been two epochal periods: the 1880 to 1924 Age of Mass Migration, primarily from Southern and Eastern Europe, and the Post 1965 Wave of Immigration, primarily from Latin America and Asia. In 21st century the impact of the immigration is relatively less than that in the 20th century with the American population reaching a total of 300 million. 2 Therefore, Acts were passed to limit the amount of foreigners intending to settle in America because of the fear that the Americans won’t conform to the typically â€Å"American way of life†. The first law that caused the prevention of Immigration was the Immigration Act of 1882. Congress passed a new Immigration Act that stated a 50 cents tax would be levied on all â€Å"aliens â€Å"landing at United States ports. It was an act in which the State Commission and officers were in charge of checking the passengers upon incoming vessels arriving in the U.S. The passengers were examined by a set of exclusionary criteria. Upon examination passengers who appeared to be convicts, lunatics, idiots or unable to take care of themselves were not permitted to land. The Immigration Act of 1891 was a revised version of the aforementioned Act and it declared that certain classes of individuals are considered unfit to become American citizens. 3 Moreover, the Immigration Act of 1917 excluded diseased people as well as prostitutes from immigrating to America. Also, the Immigration Act of 1924 set quotas that limited annual immigration from certain countries. â€Å"The 70 million immigrants who have arrived since the founding of the republic (are responsible for the majority of the contemporary American population (Gibson 1992: 165).† 3These Acts were passed because of the concern of the natives over immigrants polluting the American society or bringing negative sides of their heritage to America. In addition, in the years between 1942 and 1952, servicemen started the tradition of marrying women where they waged wars. In addition, 100000 war brides were British, 150,000 to 200,000 hailed from continental Europe, and another 16,000 came from Australia and New Zealand. There were brides from non-Allied countries, too. Military estimates indicate that 50,000 to 100,000 servicemen wed women from countries of the Far East, including Japan, and immigration records show that by 1950, 14,175 German brides of American servicemen had entered the United States. 4These statistics show the diversity with regards to the nationalities these brides belonged to. Interestingly so, foreign women were willing to marry these soldiers on the mere basis of their proximity, generosity and opportunity. British women, in particular saw the American soldiers as a breath of fresh air and the continental European pictured

Interpreting New Media Essay Example | Topics and Well Written Essays - 1000 words

Interpreting New Media - Essay Example As the paper stresses the significant contribution of Twitter towards citizen journalism is unquestionable. Platforms such as Twitter have become sources of information that can be regarded as ‘world changing’ and gaining legitimacy and respect in the provision of up-to-minute news. With increased wireless connectivity and rapid consumption of modern technology, mobile phones have become a means of data transfer systems and portable digital media production. The move has resulted to increase in some citizen journalists who are also eye witness reports. According to the essay findings citizen journalism on Twitter platforms is also challenging the practice and image of journalism in that the public is no longer solely depending on journalists to offer accurate reports. In the recent coverage of Hurricane Sandy in the United States of America, Live eye witness messages were instantly uploaded online sharing the results of the natural disasters from a subjective point of view. Even though these are valid representations of the individual news report, they lack structure, shape, and professional journalistic meaning. Twitter has played an important role in citizen journalism. Citizen journalism has gained much significance through its inclusion and incorporation in mass media report packages and has led to a restructuring and re-evaluation on how journalists network. Modern technology has changed and transformed journalism as a profession.

Biography of presidential candidate Barack Obama Essay

Biography of presidential candidate Barack Obama - Essay Example As for his personal life, his parents got separated when he was merely 2 years old and they divorced at a later stage. His mother remarried and moved to Indonesia in the year 1967 where Obama attended local schools at Jakarta and then returned to Honolulu to spend his time with his grandparents as he attended school from the fifth grade onwards. He graduated from high school in 1979. (Curry, 2004) Obama went ahead towards Los Angeles where he got enrolled at Occidental College and then made his way towards New York City to transfer his educational qualifications at the Columbia University. Barack Obama majored in political science and his specialization was within international relations subject. He worked at Business International Corporation and later switched to New York Public Interest Research Group. He also taught constitutional law at the University of Chicago Law School for a period of 12 years and became a lecturer for another 4 years. After this, he was appointed as Senior Lecturer for 8 years. He is also a member of a number of companies and sits at the board of governors/directors for them. Some of these companies include Public Allies Chicago, Woods Fund, The Joyce Foundation, Chicago Annenberg Challenge, Chicago Lawyers’ Committee for Civil Rights Under Law and a few others. The dominating impression about Obama is that he will bring about a change and this is the aspect that he is highlighting the most. He has awakened a new sense of energy within the people through his refreshing and innovative ideas. Critics seem to think of him as an immature President to-be but then again some are supporting him for the mere reason of change that Obama has clung on to for so long now. Obama supports the basis of a free market for America as well as encourages the widespread economic security basis all over the world. Obama is of the view that terror can only be curtailed if the perspective of the terrorists could be

Anti-Realism Essay Example | Topics and Well Written Essays - 1000 words

Anti-Realism - Essay Example For instance, no one has ever seen black holes including the scientists, but phenomena predict that black holes exist. The major support for this realism impression is that scientific information must be considered as almost true, since science determines the truth of how things are. A realist is an individual who believes that the purpose of scientific phenomena’s is to describe the biosphere as it is. The realists argue that if it is sensible to agree to a certain philosophy, then it is equally sensible to trust in the reality of the theoretic objects brought about by such a philosophy, despite the fact that such theoretic objects cannot be directly seen. On the other hand, realism may be believed as a phenomenon about the purpose of science: scientific theories are designed to tell individuals the reality around the world. Therefore, it is an axiological philosophy concerning science that states the main goal of science is to find the truth regarding the essence of Realism. Anti-realism is defined in disagreement with realism; it is any position that is comprised of either the renunciation of an unprejudiced reality or the renunciation that verification-hypothetical assertions are false or true. The two reasoning’s of Verification-hypothetical assertions according to anti-realism are varied but very clear. To begin with, the first type refutes that other minds do exist, and the realist involved in this type is referred to as solipsist. The second type argues that whether or not there are other unobservable minds, no aspect of the situation is existent. The second anti-realist can be referred to as logical behaviourists. In short, an anti-realist is an individual who does not consider scientific phenomena’s to aim at the truth, rather he considers its purpose on experimental suitability. The major support of anti-realism is that scientific theories cannot be considered as the truth, since they are not visible and

'Am I more of a transformational or transactional leader Essay

'Am I more of a transformational or transactional leader - Essay Example The evaluation exercise involved responding to prompts in the questionnaire. The responses were categorical data on a scale of 0 to 4 where zero indicated poorest scores while four indicated highest scores. Based on a model that grouped different prompts into seven factors that were independent and mutually exclusive, scores were evaluated for each factor, total scores compared, and the factor with the highest scores defined the most suitable leadership model. Results from my analysis identify inspirational motivation factor as the best match my leadership characteristics. The factor describes a leader who offers a vision to people and assists the people in concentrating on their work from which they can derive self-utility. These features correspond to characteristics of transformational leaders who create awareness among their followers and develop focus on collective objectives. Transformational leaders also promote intrinsic utility among people, develops vision and â€Å"help people understand need for change,† features that are identifiable with the inspirational motivation factor (Dubrin, 2012, p. 84). Full range leadership model is relevant to my future practice because it identifies a need to posses diversified leadership styles that can be applied in different situations. Its scope that identifies features of transactional and laissez-faire styles also offers a basis for identifying development goals and formulating a strategy for implementing the goals (Sosik, Jung and Jung, 2012). Based on my lower scores on features of transactional leadership style, I plan to improve on my ability to establish standards and enforce them. Developing this ability will diversify my leadership potential and ensure effectiveness in conditions that requires immediate but satisfactory results. My specific goal for development is therefore to gain the ability to enforce developed standards on my

Maintenance Awareness in Design Essay Example | Topics and Well Written Essays - 2500 words

Maintenance Awareness in Design - Essay Example Findings: The findings of this paper indicates that systems always fail due to miss management and poor planning on the part of managers, companies and all individuals involved in any specific project. Moreover, it further indicates that designers can learn from various failures and they can minimize the risk factors by taking several measures. System failure, basically, stands for any situation when a system stops working and fails to achieve desired objectives. It further lacks in smooth functioning of an overall system which is very much required for any successful design and project. Nowadays, it is common trend that people prefer to use new systems and advanced technology rather than old ones. They feel themselves more compatible with latest technology just because of demand and trend. Projects are usually driven just to replace the old trends and architecture. Old systems are extensively replaced with new ones having new technology. However, it is very essential to understand that there are several important aspects and stages involved in any good design. All of these stages should be accessed if you want a successful design. It is not wise option to go just for modern and trendy designs. Essential stages should be kept in mind. These generally include, If we look at technical side of the modern projects, we will observe that nowadays projects are built with a goal of offering multiple functions that was not possible in recent past. Currently, systems become the integration of various sub systems. Some additional constraints are also getting involved day by day with changing needs and demands of various people. Now people are more concerned about reliability and security systems offer within a design. Nowadays, we can also observe that the success rate is continuously decreasing and most of the large projects of engineering are less satisfactory. Many of the projects are getting failed and end up in failures and great risks. However, it is also a

Major Environmental Issues That Are Associated With Staging Music Essay

Major Environmental Issues That Are Associated With Staging Music Events - Essay Example Music can put forth powerful substantial effects; can create deep and thoughtful emotions within us, and produce substantially subtle variations of articulateness by skilled com- challenge and performers (Besser, 2000). Playing pleasant-sounding music in the innate environment can be therapeutic because it supports people to reconnect and accord them with nature.   This leisure interest can assist us increase greater responsiveness and high opinion for the environment, together with the rocks, trees, rivers, animals, skies birds, et cetera. Which are all complete the four basics of air fire, earth and water.   Basically play a harmonious instrument or resonate, hum or screech out in the surroundings, focus on the environment, calm down into the experience and scrutinize ourselves and the innate world’s activities. Dorothy conducted research of the special effects of music on vegetation and exposed that their strength and growth flourish when constructive, pleasant-sounding music was performed to them (Todd, and Cody, 2000).   In dissimilarity, the findings established that plants worsened and ultimately died when serious rock music was performed to them.   She further defines the term constructive music as unfamiliar to a number of people. When she uses the term constructive to portray music, they are describing music that has advantageous qualities and is expressively and spiritually inspiring, maybe even curative. In

Organizing and Controlling are Related Essay Example for Free

Organizing and Controlling are Related Essay Functions of management consist of organizing, planning, controlling, staffing, delegation and leading. (Koontz Weihrich, 2000). These functions work together simultaneously as one can assist in the functioning of the other hence all managerial functions are important for the function. By this the opinion is that the function of organizing and controlling are related. These functions are implemented in the same direction. In order to show the relation between organizing and controlling, it is important to look into the functions of both of them. Organizing function comes into play when people work together in groups to achieve goals. They must have roles that they play. These roles are developed by people, are defined and structured by the organization to make sure what is contributed is a group effort. What workers do has a definite purpose and they know how their job objective fits into group effort hence the organization gives their authority, tools, information to accomplish the task. Organizing is that part of managing that involves establishing a structure of roles for people to fill in an organization. The purpose of an organization structure is to help in creating an environment for human performance. (Gareth, 2003). A structure will define the tasks to be done, the role established looking at abilities and motivation of the people available. The organization structure make it easy for managers to organize workers’ activities hence it will be easy to control them as each one know the role they should play, which makes supervision of work less, which saves time as well as resources of the organization. By organizing, the organizations must identity and clarify required activities, group activities necessary to attain objective, assign each group to a manager with authority necessary to supervise it and provision for coordination on the same level and among departments in the organization structure, which make controlling of activities manageable. Organization structure should clearly state who is to do what tasks and who is responsible for what results to eliminate difficulties while exercising control function because difficulties can be caused by confusions and uncertainty of assignment. The structure must reflect objectives and plans because activities come from them. It must also reflect the authority available to an enterprise management. It must be designed to work to permit contributions by members of a group and to assist people gain objectives effectively in the future, which is changing. An organization is staffed with people, the groupings of activities and the authority relationships of an organization structure must take into account people’s limitations and customs to be able to control their roles so as to know if the organization goals are being achieved. The organization process consists of establishing enterprise objectives, formulating supporting objectives, policies and plans, which are of planning. Also identifying and classifying the activities necessary to accomplish these, grouping activities in the light of the human and material resources available and the best way, under the circumstances, of using them, delegating to the head of each group the authority necessary to perform the activities and tying the groups together horizontally and vertically through authority relationships and information flows. Koontz Weihrich, 2000). The span of management is influenced in two ways, narrow span where a great deal of time is spent with subordinates, which is related to little training, inadequate authority delegation, unclear plan of non-repetitive operations, fast changes in external and internal environment, complex task, use of poor communication techniques, ineffective meeting. (Black Porter, 2000). The wide span is where little time is spent with subordinates and is related to thorough subordinate training, clear delegation to undertake well-defined tasks, well defined plans for repetitive operations and slow changes in external and internal environment, simple task and effective meetings. If the organization wants to use the controlling function effectively, it can use the wide span management. Delegation of authority, if it is poor, it will affect the span of management due to unclear authority hence organizing can be difficult, which can make the controlling function difficult as they function simultaneously. If a manager delegates authority clearly for a task to be undertaken, a well trained subordinate can get it done with the manager little supervision, but if the task is not clearly defined, then the subordinate does not have the authority to undertake it, which can lead to the staff not doing it and hence the manager spending a lot of time supervising it. Staffing is done by identifying workforce requirements, getting the required people who are available and recruiting them, selecting, placing, appraising, compensation, planning the careers and training. (Preble, 1992). If staffing is done effectively, the candidates will be developed as the current jobholders to be able to accomplish their tasks effectively and efficiently. If the candidates are given the right roles hence it will be through controlling that managers compare actual performance against goals, identify any significant deviations and take necessary corrective action. Leading assists in influencing people so that they contribute to organization and group goals. Managers can say that their problems arise from people, their desire, attitude, and behavior. (Robbins Coulter, 2002). Since leadership implies followers hip and people tend to follow those who offer a mean of satisfying their own needs, wishes and desires. Leading involves motivation, leadership styles and communication. With no effective leading in an organization it can be very difficult to organize the employees and this will affect the controlling function as reports, statement produced to access control might have mistakes. Planning involves selecting mission and objectives and the actions to achieve them. It requires decision-making that is, choosing future causes of action from among alternatives. Jones George, 2003). Plans range from plans of overall purposes and objectives to the most detailed action to be taken. Before a decision is made, only what exists is a plan study or a proposal not a real plan. Controlling activity relate to the measurement of achievement. Some mean of controlling like the budget, inspection records, each measure and show whether plans are working out making organizing easy. Compelling events to confirm to plans means locating the persons who are responsible for results to differ from planned action and taking necessary step to improve performance. These results are controlled by what people do. Control is where performance is measured and corrective action is taken to ensure the accomplishment of organization goals. Control also coordinates various activities, decision-making related to planning and organizing activities and information from directing and evaluating each worker’s performance. Control is concerned with records, reports, organizational progress toward aims as well as effective use of resources. Control uses evaluation and regulation. These reports are what assist in assigning roles to employees. Control uses evaluation and regulation. It can be separated into mechanical and sociological elements. There are three stages of control. The mechanical elements are predetermined definition of standards for a level of performance; measurement of current performance against the standards and corrective action when indicated is the sociological element. If an organization uses the three stages of control, it will have a flexible organization structure. The best approach of control will contain time, a high degree of mutual support, open and authentic communication, clear understanding of objective, utilization of resources and a supportive environment. These approaches will lead to conflict resolution, charged beliefs and attitudes, genuine innovation, commitment, strong management and prevention of consequence of control, which were unintended. A good control system has the following characteristics; it must reflect the nature of the activity, should report errors promptly, should be forward looking, it should point out exceptions at critical points, should be objective, flexible, reflect the organization pattern, economical, understanding and should indicate corrective action. With these conditions adhered to, it will be fast to organize people in the organization so as to meet the organization goals. Controlling mechanisms include procedures, evaluating devices, reports, inspection, audits, which all require planning and organizing hence the function must be performed simultaneously. For controlling to occur, there must be directing. All functions of management go together as if one of the functions lacks or does not follow the proper channel then the organization goals can fail to be achieved. Control can be used as a management tool to measure the degree to which predetermined goals are achieved and of applying necessary corrective actions to improve performance, policies, and procedure as standards. Among the controls are rules that are needed to let employees know what is expected of them and how functions are coordinated. Self-control includes being up to date in knowledge, giving clear orders, being flexible, helping others improve increasing problem solving skill, being able to handle pressure and planning ahead. Delegation is often viewed as a major means of influence and therefore, it can be grouped as an activity in leading rather than controlling. Delegation include assigning responsibility to an employee to complete a task granting the employee sufficient authority to gain the resource to do the task and letting the employee decide how that task will be carried out. This will make the organization decide which goals to pursue and course of action to adopt so as to attain the organization goals and how to allocate organization resources to attain those goals. Once the organization has established goals and associated strategies, funds are set aside for the resources and labor to the accomplishment of goals and tasks. As the money is spent, how it was spent and what it obtained. Review of financial statements is one of the more common methods to monitor the progress of programs and plans. In the organizing process, the key issue in accomplishing the goals identified in the planning process is structuring the work of the organization. The purpose of the organizing function is to make the best use of the organization’s resources to achieve organizational goals. Organizational structure is the formal decision-making framework by which job tasks are grouped and coordinated. The organizing function deals with all those activities that result in the formal assignment of tasks and authority and a coordination of effort. The supervisor staffs the work units, trains employees, secures resources and empowers the work group into a productive team. The first step in the organizing process is departmentalization. Once jobs have been classified through work specialization, they are grouped into manageable units and can be controlled. An organization chart displays the organization structure and shows job titles, lines of authority and relationships between departments. The nature and scope of the work needed to accomplish the organization goals needed to determine work classification and work unit design, so as to have control. Work process requirements and employee skill level determine the degree of specialization. Placing capable people in each job ties directly with productivity improvement. In order to maximize productivity, the organization must have the required resources and be able to control its expenditure by auditing its reports. Supervisors must match employee skill levels with task requirement to achieve organization goals. Teamwork is achievable if people can work together cooperatively and effective if they know the part they are to play in the team activity and the way their roles relate to each other hence making the control function attainable. By designing and maintaining these systems of roles is organizing. Koontz, 1958). The effort spent on improving predictions and forecasts are spent on increasing control, learning not only will the need for predicting and forecast be reduced, but managers’ ability to get what they want to increase. By organizing managers can design and create an organization structure, which is flexible to enable the function of control to be handled properly. Control aspects are emphasized on the basis of observation of the control process in terms of feedback or adaptive control. (Hitt Mathis, 1986). Feedback is always introduced as one of the controlling functions, hence managers encourage that the feedback system be used a lot in the organization so as to know which organization goals have been achieved. Feedback is a type of control that takes place after a work activity is done. Managers can implement controls before an activity begins and after the activity has been completed. In order to measure whether plans of the organizations are being followed it is necessary for managers to compare planned performance with actual performance. (Ishikawa Smith, 1972). Feedback can be used to give information in this area, as it is the forward and backward flow of information hence the supervisor will be able to know how the performance of a certain employee is. This will enable the supervisor check on the targets he sets for the employees if they have all been achieved or if they have been partly achieved and see the gap created. (Dixon, 2003). The actual performance and the planned performance show the gap. This will make it easy for the organization to determine which employees require training so as to get more skills and by this the organization will eliminate the gap. Plans cannot be effective unless managers monitor how well planned actions are matching actual achievements as implementation processes. Therefore, plans should not be just laid aside while being on the process or even after being decided on. Managers are responsible not only for making plans for the organizational goal but also for watching the plans to the end. Hence, to make sure that plans are organized the control function has to be effective to make sure that organization goals are achieved. If managers do not control, they would have no way of knowing whether their goals and plans were on target and what future actions to take. The plan can be meaningless if it did not help to accomplish the organizational goals. This can be avoided by controlling because the manager organizes and compares the actual performance against the goals, identify any significant deviations and take any necessary corrective action. Controlling provides the answers to whether or not the current performance of the organization should be continued or what corrections might be needed to make the performance satisfactory. Controlling cannot be implemented unless there is some resource hence the organization should have a structure, which takes this into consideration. There must be some organization and control on how resources will be allocated. Without an organization goal, no management functions can be put into practice. If the manager does not know which direction the company is going, they cannot choose what course of action to take hence controlling will be difficult. It seems that controlling is regarded as looking back considering the main role of controlling, which are feedback and monitoring. Managers can put controls when an activity begins. If the actual performance of employees in an organization is not as expected then plans and goals have to be set so that they are put in the right way. For control to work if the plans put in place by the organization are going in the wrong directions the manager needs to indicate the problem and also suggest how to solve it. The manager should also explain how the plan should be proceeded and guide toward the right direction. This will make it easy for the person organizing activities of the workers as workers will be given the roles they are able to achieve hence making organization goals attainable. The main role of planning is choosing appropriate goals and courses of action and controlling is monitoring systems to evaluate how well the organization has achieved its goal. Planning process steps include deciding which goals the organization will pursue, deciding what courses of actions to adopt to attain these goals and deciding how to allocate organization resources to attain these goals. Considering that organizing process looks at accomplishing goals identified in the planning process it will be good for an organization to evaluate the performance of employees so as to check if the goals are being attainable and if they do not look attainable performance assessment should be carried out as well as regulation of other activities, which can be time consumed due to lack of skills by the employees should be eliminated. In conclusion if managers are keen on the organization structure that the organization adopts be it flat, tall, product, geographical to make sure that the one implemented caters for the organization goals as well as objectives. The control function can be used to generate reports and audits will be done effectively in less time. This shows that control and organizing function has to work parallel for the effective achievement of organization goals.

Obesity: History, BMI Classification, Determinants and Effects

Obesity: History, BMI Classification, Determinants and Effects OBESITY Obesity is fast becoming a serious epidemic in the United States due partly to eating habits and physical inactivity amongst Americans. According to the Centre for Disease Control, Seventy-three percent of adults and 43 percent of all children in the United States are overweight or obese. Among African-Americans 20 years and over, more than two-thirds are overweight or obese (Gaines, 2010). Generally, the rate of overweight and obesity are higher for African-American and Hispanic women than Caucasian women, higher in the south and Midwest and increases with age (Ogden et al., 2014; Gregg et al., 2009; Sherry et al., 2010). According to the World Health Organization, body mass index (BMI) of an obese person has a value greater than or equal to thirty. Type 2 diabetes and high blood pressure are two diseases that ultimately affect African Americans and this is predominantly caused by an increase in weight as those extra pounds predisposes a person to these diseases (Gaines, 2010). Obes ity is one of the primary risk factor for heart diseases, diabetes and a number of cancers and these are major causes of death in American today. The health implication of obesity and the complications associated with it is increasingly becoming more detrimental than cigarette smoking and has therefore become one of the major preventable causes of death worldwide. This investigation paper focuses on the brief history of obesity; this will take obesity from its discovery over 2000 years to this present day. An understanding of the BMI classification, aetiological determinants, pathophysiology and health effects is important if obesity prevalence will be curtailed. Furthermore, the socio economic impact of obesity management on the United States economy will be looked into. Finally, its treatment options, prevention and trends of the disease will be discussed. HISTORY OF OBESITY The Ancient Greeks were the first to acknowledge obesity as a health disorder and this was further recognized by the Ancient Egyptians in a similar way. According to Hippocrates, corpulence is not only a disease itself, but the harbinger of other diseases (Haslam & James, 2005). Hippocrates which was the Ancient Greek Father of Western medicine acknowledged obesity in his work and details of various diseases including diabetes was first given by him. Another Indian surgeon Sushruta, also discovered the association between obesity, diabetes and heart diseases and he was the first person to find out the significant signs, symptoms, causes and health implications. In the Ancient days, man always strived for food due to scarcity or famine and this resulted in obesity being regarded as a sign of wealth and good fortune in the middle age. However, all this changed when the scientific society of the 20th century revealed the medical implications of obesity (Caballero B., 2007) With the inception of the industrial revolution, body size and strength of soldiers and workers became pertinent as this was attributed to the military and economic power of Nations (Caballero, 2007). The increase in the average body mass index from underweight to the normal on the BMI charts played an important role in the development of industrialized societies (Caballero, 2007).   Therefore in the 19th century, there was an increase in weight and height generally. However, during the 20th century, the genetic potentials for height was reached and this resulted to weight increasing more than height in this century and thus resulted in the average increase in BMI (Caballero, 2007). In human evolution, for the first time, the number of adults with excess weight exceeded the number of those who were underweight which further led to obesity (Caballero, 2007). The perceptions of the public as regards healthy body weight varied from those regarded as normal in the western society, but this perception was changed in the beginning of the 20th century. There was a reduction in the weight seen as normal since 1920s and this was evident by the 2% increase in average height of the Miss America pageant winners and a 12% decrease in weight between year 1922 and 1999 (Rubinstein & Caballero, 2000). Also, the perception of most people as regards healthy weight has changed, for example in Britain the weight at which people regarded themselves to be overweight was considerably higher in 2007 than in 1999 (Johnson & Wardle, 2008). Obesity is still regarded as an indication of wealth and well-being in many parts of Africa and this has become more widespread since the HIV epidemic began (Haslam & James, 2005). BODY MASS INDEX (BMI) CLASSIFICATION According to the World Health Organization, Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, normal weight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2) (W.H.O. 2004). For example, an adult who weighs 60kg and whose height is 1.65m will have a BMI of 22.0. BMI = 60 kg / (1.65 m2) = 60 / 2.72 = 22.04 LEAN BODY MASS Lean Body Mass is a component of body composition, it is calculated by subtracting body fat weight from total body weight. Total body weight is lean plus fat. In equations: LBM = BW − BF Lean Body Mass equals Body Weight minus Body Fat LBM + BF = BW Lean Body Mass plus Body Fat equals Body Weight Lean Body Weight (men) = (1.10 x Weight(kg)) 128 ( Weight2/(100 x Height(m))2) Lean Body Weight (women) = (1.07 x Weight(kg)) 148 ( Weight2/(100 x Height(m))2) Ideal Body Weight (men) = 50 + 2.3 ( Height(in) 60 ) Ideal Body Weight (women) = 45.5 + 2.3 ( Height(in) 60 ) Body Mass Index = Weight(kg) / Height(m)2 The table below further explains the classification of BMI in relation to the weight and height of an individual. Table 1: The International Classification of adult underweight, overweight and obesity according to BMI Source: Adapted from WHO, 1995, WHO, 2000 and WHO 2004. BMI values are age dependent and are the same for both males and females (WHO, 2000). The health risks associated with increasing BMI are many and the interpretation of BMI values in relation to risk may vary for different populations in different geographical locations (WHO, 2004). AETIOLOGY DETERMINANTS OF OBESITY Obesity is a heterogeneous group of conditions with numerous causes, it is not merely a single disorder and it is predominantly expressed phenotypically (Susan A.J, 1997). Obesity is hereditary, but the genetic component does not follow simple Mendelian principles and the effect of the genotype on the aetiology of obesity may be decreased or increased by factors that are non-genetic (Susan A.J, 1997). Several factors determine the body weight, and these are interactions of genetic, environmental and psychosocial factors which are in relation to the amount of energy consumed and the amount of energy expended and the resulting acting through the physiological mediators Table 1: The International Classification of adult underweight, overweight and obesity according to BMI of energy intake and energy expenditure and the resulting equilibrium between both (Susan A.J, 1997). ENDOCRINE AND HYPOTHALAMIC DISORDERS Certain endocrinological disorders may lead to obesity, but this applies to a very small percentage of the total number of cases (Susan A.J, 1997). The endocrinological determinants of obesity have been reviewed recently (Bouchard C., Perusse L., Leblanc C., Tremblay A, & Theriault, 1988). The single disorder that causes obesity in this group is hypothyroidism in which increased weight occurs largely as a result of reduced energy expenditure (Susan A.J, 1997). Other endocrinological factors contributing to obesity include Cushing’s syndrome and disorders of corticosteroid metabolism, where weight gain is typically accompanied by a distinctive prototype of fat deposition in the trunk, sex hormone disorders including hypogonadism in men and ovariectomy in women, insulinoma and growth hormone deficiency (Susan A.J, 1997). The key causes of weight gain in these cases are the amount of energy intake. Certain hypothalamic tumors or damage to the hypothalamic part of the brain as a result of excessive exposure to radiation, infectious agents or head trauma can also lead to obesity with defect in appetite control and hyperphagia (Susan A.J, 1997). A hypothalamic disorder is also believed to be the foundation of a number of congenital abnormalities which could also result in obesity, e.g. Prader-Willi syndrome, which is an abnormality that could be a primary cause of obesity (Susan A.J, 1997). GENETIC INFLUENCE At a population level, the genetic influence of obesity is expressed in terms of heritability (Susan A.J, 1997). This refers to the percentage of the total difference in a character which is attributable to genetic factors (Susan A.J, 1997). The heritability of obesity may be considered either in terms of the total fatness of an individual or the distribution of body fat in an individual (Susan A.J, 1997). Several discoveries have been made over the years regarding the influence of genetics on chronic diseases like cardiovascular disease and obesity (R. C. Whitaker, J.A. Wright, M.S. Pepe, K.D. Seidel, &W.H. Dietz., 1997). Recent reports indicate that at least 32 genes contribute to common forms of obesity. Many of these genes are thought to be related to the development of obesity through the deregulation metabolic hormones in the body (Susan A J, 1997).   The obesity related variant in the fat mass and obesity-associated protein also known as alpha-ketoglutarate-dependent dioxygenase FTO, has aroused interest in pediatrics due to its relationship with increased weight and ponderal index at 2 weeks of age (A. Lopez-Bermejo, C.J. Petry, M. Diaz, et al., 2008). FTO is located on the long arm of the chromosome 16 and is expressed in the brain, specifically the hypothalamic nuclei (Khung E. Rhee et al. 2012). Those who are homogenous for the at-risk allele have been found to be 3kg heavier than those who do not have the allele (T.M. Frayling, N. J. Timpson, M. N. Weedon et al. 2007). This weight gain is likely due to the gene’s involvement in the regulation of energy intake (Khung E. Rhee et al. 2012). According to recent studies, individuals carrying the at-risk allele prefer dense energy foods (J.E Cecil, R. Tavendale, P. Watt, M. M. Hetherington, & C.N.A Palmer, 2008), have reduced feeling of satiety (J. Wardle, S. Carnell, C.M.A. Haworth, I.S. Farooqi, S. O’Rahilly, & R. Plomin, 2008), display loss of control over eating (M. Tanofsky-Kraff, J.C. Han, K. Anandalingam et al. 2009), consume more fat and calories (even after adjusting for BMI) (N. J. Timpson, P.M. Emmett, T.M. Frayling, et al. 2008) and display a greater tendency towards consuming palatable foods after eating a meal (J. Wardle, C.Llewellyn, S. Sanderson, & R. Plomin, 2009). Therefore, FTO isn’t associated with energy expenditure, but it increases the susceptibility of individuals to higher calorie consumption and decreased satisfaction. A meta- analysis of 45 studies found that adults who were physically active attenuate the odds of obesity associated with FTO by almost 30% (T.O. Kilpelainen, L. Qi, S. Brage, et al. 2011). Thus carrying a gene for obesity does not necessarily predestine one to be obese (D. Meyre, K. Proulx, H. Kawagoe-Takaki et al. 2010), but rather increases the risk in the face of an obesogenic environment (Khung E. Rhee et al. 2012). Numerous studies in different ethnic groups suggest that the familial correlation in the total body fatness, expressed as body mass index, (BMI; kg/m2) from parent to offspring is about 0.2 and for sibling-sibling relationships about 0.25 (Bouchard C, Perusse L, Leblanc C, Tremblay A, Theriault G. 1988). As would be expected, studies of twins show a much higher concentration, particularly in monozygotic pairs (Susan A.J, 1997). However, these findings do not segregate the independent effects of genetic transmission and a shared environment (Susan A.J, 1997). Further studies of twins reared apart attribute 50-70% of the difference in BMI in later life to genetic factors (Stunkard A, Harris J, Pedersen N, McClearn G. 1990). Adoption studies, where an individual is compared both to their biological parent and their adopted parents, have also demonstrated the importance of genetic influences (Susan A.J, 1997). There is a strong relationship between the BMI of the adoptee and their biological parents across the entire range of fatness, but no relationship between the adoptee and their adoptive parents (Stunkard A, Sorensen T, Hanis C. et al. 1986). Studies of fat distribution have considered both the ratio of subcutaneous to total fat mass and the distribution of subcutaneous fat in the trunk relative to the limbs (Susan A.J, 1997). Data from the Quebec Family Study, suggest that the size of the internal fat stores are more strongly influenced by genetic factors than subcutaneous depots (Bouchard C., Perusse L., Leblanc C., Tremblay A, Theriault, 1988). Familial clustering suggests that genetic factors may account for 37% of the variance in the trunk to extremity skin fold thickness ratio (Rice T, Bouchard C, Perusse L, Rao D. 1995). These combined evidence from these genetic analysis suggests that obesity is a polygenic disorder and that a considerable proportion of the variance is non-additive (Susan A.J, 1997). This would explain the higher correlations between siblings than those between parent and offspring, and the 2-fold greater correlation between monozygotic than dizygotic twins (Susan A.J, 1997). These genetic influences seem to operate through susceptible genes; the occurrence of the gene increases the risk of developing a characteristic but not essential for its expression nor is it, in itself, sufficient to explain the development of the disease (Susan A.J, 1997). Unlike animal models, where a number of single genes can lead to obesity, no human obesity gene has yet been characterized, but the heterogeneous nature of human obesity does not preclude the identification of small number of individuals with a single defect which leads to obesity (Susan A.J, 1997). In man, a number of genetically determined conditions result in excess body weight or fatness (e.g Prader-Willi syndrome or Bardet-Biedl syndrome), but these account for only a very small proportion of the obese population (Susan A.J, 1997). PHYSIOLOGICAL MEDIATORS Energy expenditure Studies in animals have postulated that at the time of overfeeding, a remarkable increase in metabolic rate may deplete the excess energy thus reducing the rate of weight gain below theoretical values (Rothwell N., Stock M., 1983). Genetically obese animals tend to gain more weight than their lean controls even when they are pair-fed, thus implying a greater metabolic rate (Thurby P., Trayhurn P., 1979). One possible explanation for this effect is the decrease in diet-induced thermogenesis which is lessened in animal models of obesity due to a decrease in the sympathetic activation of brown adipose tissue (Rothwell N., Stock M., 1983). These unequivocal effects on energy expenditure in obese animals contrast with the paucity of evidence in humans (Susan A Jebb, 1997). Susan A.J (1997) stated that in obese humans, there have been constant reports of abnormally low energy intake which indirectly imply that there must be a defect in energy expenditure. There are three basic elements to energy expenditure which have each been the focus of extensive research. Basal Metabolic Rate In 1997, Susan A Jebb defined basal or resting metabolic rate as the energy expended by an individual at rest, following an overnight fast and at a comfortable environmental temperature in the thermo neutral range. Several studies of basal metabolic rate have concluded that obese subjects have a higher BMR compared to their lean counterparts. Researchers like Swinburn B. & Ravussin E, reported that approximately 80% of the inter- individual variance in BMR can be accounted for by age, fat-free mass, fat mass and gender. Nevertheless, this still gives room for some likelihood that inter-individual difference in BMR which may influence individuals with a relatively low BMR to become obese (Susan A. Jebb, 1997). Diet induced thermogenesis A number of studies have suggested that the post-prandial increase in energy expenditure is attenuated in obese subjects, perhaps due to decreased Sympathetic Nervous System activity (Astrup A. 1996). Similar effects have also been demonstrated in the post-obese. However this is not a consistent finding, even among studies from the same laboratory. A recent review by Ravussin E. & Swinburn B. (1993) identified 28 studies in favour of a defect in thermogenesis in humans and 17 against. However, since thermogenesis accounts for only a fraction of total energy expenditure (approximately 10%), the potential for a significant effect on total energy expenditure is insufficient (Susan A. Jebb 1997). Physical activity The most significant component of energy expenditure is physical activity which may represent 20-50% of total energy expenditure. Studies of fidgeting movements in Pima Indians within a whole-body calorimeter have shown significant inter-individual variations in the daily energy cost of these actions from 400-3000 kJ/day, with low levels predictive of subsequent weight gain at least in males but not females (Zurlo F., Ferraro R., Fontvielle A. et. al. 1988). However, in free-living conditions, the freedom to undertake conscious physical activity or exercise increases the inter-individual variability even further (Susan A Jebb). Research in this area has been hampered by imprecision in the methods to measure physical activities which have included various actometers, heart rate monitoring, activity diaries and direct observation (Susan A. Jebb, 1997). The energy requirements of an individual encompass the summation of basal expenditure, thermogenesis and physical activity. A whole-body calorimeter can be used to measure the total energy expenditure of an individual. The analysis of total energy expenditure in 319 obese subjects clearly demonstrates a significant increase in energy expenditure with increasing body weight such that individuals with a BMI in excess of 35 kg/m2 have energy expenditure approximately 30% higher than those with BMI less than 25 kg/m2 (Susan A Jebb, 1997). The outstanding difficulty with these studies , as stated by Susan A. Jebb in 1997 is that the increase in energy expenditure seen in obese subjects as a result of their increased body size may mask pre-existing metabolic defects in the pre-obese state which exposes the individual to excessive weight gain. However, in experimental overfeeding researches, there is no remarkable difference in the degree of weight gain between lean and obese subjects when matched for their excess energy intake (Diaz E. Prentice A. M et. al. 1992).   Studies of total energy expenditure in post-obese subjects have not arrived at a definite conclusion; some studies show no difference in energy expenditure in the post-obese relative to never-obese controls (Goldberg G.R., et. al. 1991), whilst others show a modest suppression of energy expenditure (Geissler C. Miller D., Shah M. 1987). In general, there is little evidence to support the hypothesis that human obesity may be due to a specific defect in energy expenditure in predisposed individuals (Susan A Jebb, 1997). Susan A Jebb further stated that advocates of a metabolic basis to obesity, argue that only very small differences in energy expenditure are neccessary to produce significant weight gain over many years, and this difference may be lower than the limits of precision of even the most advanced methodology. Energy Intake The failure to identify a defect in the metabolic control of energy expenditure and the contrary observation of high levels of energy expenditure, and the contrary observation of high levels of energy expenditure in obese subjects has led to a focus on food intake to explain the aetiology of obesity (Susan A Jebb, 1997). The increase in energy expenditure associated with the development of obesity should automatically help to prevent continued weight gain; hence the failure of this auto-regulatory system suggests that there must be a considerable error in the regulation of food intake (Susan A Jebb, 1997). Furthermore, habitually lean individuals are able to regulate intake to match energy requirements over a wide range of energy requirements yet those who become obese seem unable to achieve this balance (Susan A Jebb, 1997).   Breakthrough in discerning the role of energy intake in the aetiology of obesity has been critically disconcerted by under-reporting which is now largely recognized as a feature of obesity (Susan A Jebb, 1997). Comparisons of energy intake and energy expenditure indicate consistent shortfalls in self-reported intake, averaging approximately 30% of energy requirements in obese subjects (Prentice A.M., Black A.E., Coward W.A., 1986; Lichtman S., Pisarska K., Berman E., et al., 1993). This phenomenon also extends to post-obese subjects and to others who may be very weight conscious (Susan A Jebb, 1997). Under-reporting may be cause by several factors and it is natural for individuals to change their eating pattern when they are to record their food intake.   This is usually associated with a reduction in intake as subjects consciously or sub-consciously adopt a self-imposed ‘diet’. (Susan A Jebb, 1997). Therefore they might give accurate results about their intake for that duration, but it may not be a true representation of their habitual pattern. Forgetfulness, underestimation of meal size and lack of basic knowledge of food consumption can also lead to under-reporting. Although, it is possible to have falsification and fabrication of dietary records, there are also instances of self-deception or deliberate manipulation of dietary records. Recent research into the appetite control system by Blundell J.; Bouchard C., Bray G. (1996), has identified a network of synchronous interactions which govern eating behavior. These effects are mediated through the central nervous system particularly the hypothalamus, where a number of neuropeptides appear to regulate feeding behavior via effects on hunger and satiety (Susan A Jebb, 1997). Laboratory studies of feeding behavior by Spiegel T., et al., in 1989, proposed that, following a convert energy preload, obese subject may be less able to accurately compensate for the energy content of the preload at a subsequent meal than lean subjects. However, these studies are usually of short duration in laboratory settings and may not accurately reflect eating behavior in a naturalistic setting, where knowledge of foods consumed and conditioned learning may invoke other regulatory processes (Susan A Jebb, 1997). There is also significant evidence that the individual macronutrients (protein, fat, carbohydrate and alcohol) have different influences on eating behavior, majorly due to their effects on satiety (Stubbs R., 1995). Experimental studies of manipulated foods and retrospective analyses of dietary records suggest that protein is the most satiating (DeCastro J., 1987; Hill A., Blundell J., 1990). Carbohydrate is also an efficient inhibitor of later food consumption, at least in the short terms, meal-to-meal context (Rolls B., et al. 1994). Fat seems to have a satiating capacity (Lawton C., Burley V., 1993). Fat hyperphagia occurs during a single meal due to subjects overeating high fat foods and is also known as passive over consumption. In 1994, Poppitt S., stated that fat has two times the energy per gram of carbohydrate or protein which may be due to the level of energy density and not necessarily a characteristic of dietary fat. Appetite is said to be stimulated by alcohol and according to DeCastro J & Orozco (1990), in free living circumstances, alcohol consumption with meals is associated with higher energy intakes, but this may also reflect that alcohol is more likely to be consumed on special occasions which in themselves are associated with increased food intake. Basically, taste preference can have an effect on the amount of food consumed and the kind of food.   The individual preference for certain meals would make them more likely to consume more of that meal. Therefore, sensory preferences plays a role on energy balance since is it associated with energy intake. According to Witherley S, Pangborn R & Stern J (1980), several reports of sensory preferences for particular food groups in association with obesity, but inter-subject variability is so great as to obscure any underlying obese-lean differences. The relationship between sensory preference for fat versus sugar and BMI was pinpointed by Drewnowski in 1992. Obese women had preference for foods with high fat to sugar ratio while women with low BMI had preference for high sugar to fat ratio, therefore increase in weight is closely related to increase for fatty foods. Eating frequency has effect on weight gain, because people who eat several small meals at intervals have less weight than those that eat fewer meals in larger quantity and therefore large quantity of food consumed at a time may be a risk factor for obesity, however, studies as regards this, showed no remarkable relationship (Bellisle F, McDevitt R, Prentice A.M. 1997). Research in this area is contradicted by under-reporting of food consumption in obese subjects and by post-hoc variations in eating patterns as a result of obesity and efforts to control weight (Susan A Jebb, 1997). Eating frequency in obese subjects is however an unreliable blueprint to the eating patterns involved in the aetiology of obesity (Susan A Jebb, 1997). ENVIRONMENTAL INFLUENCE Obesogenic environment which was first coined in the 1990s, in a bid to explain the present obesity epidermic. According to King D (2007), obesogenic environment is the sum of the influences that the surroundings, opportunities or conditions of life have on promoting obesity in individuals and populations. This encompasses the cultural, social and infrastructural conditions that affect the ability of a person to embrace a healthy lifestyle. Individuals in a population respond to unhealthy environment and the more urbanized the environment, the more individuals are pressurized to adopt unhealthy habits. The pressure from the surrounding makes it difficult for individuals to change their lifestyle and practice healthy habits when the environment itself is unhealthy. Environmental factors may have a critical effect in the development of obesity by unmasking genetic or metabolic susceptibilities (Susan A.J, 1997). Environmental influences on diet involve a wide range of factors including accessibility to food and high calorie drinks. Eating habits are commonly influenced by the availability and accessibility of unhealthy food, which is an important consideration in the effect on obesity. Studies in the United States recommend that the availability of high quality, affordable ‘healthy’ food is limited for people who reside in low-income communities and such scarcity is associated with unhealthy diet and obesity (White 2007) .However despite several epidemiological studies that shows environmental influences play an important role in the aetiology of obesity, it is a fact that some people within the same ‘unhealthy environment’ still managed to maintain a healthy weight (Susan A.J, 1997). PSYCHO-SOCIAL INFLUENCES Food is sometimes used as a coping mechanism by individuals with weight issues, especially when they are unhappy, nervous, stressed, bored and depressed. In many obese individuals there seems to be a perpetual cycle of mood disturbance, overeating, and weight gain (Jennifer C. Collins & Jon E. Bentz 2009). When they feel frustrated, they rely on food for comfort, even though this coping mechanism may pacify their mood, the resultant weight gain that results may cause a dysphoric mood due to their inability to control their stress (Jennifer C. Collins & Jon E. Bentz, 2009). Eventually a guilty feeling may restart the cycle and might steer a habitual pattern of eating food to get comfort. This habitual pattern is specifically significant if there is a genetic risk factor for obesity or an ‘obesogenic’ environment where foods high in calorie & density are readily accessible and sedentary lifestyle is present. Regrettably, these situations are popular in America. In addition to depression and anxiety, other risk factors include problematic eating behaviors such as â€Å"mindless eating,† frequent snacking on high calories foods, overeating, and night eating (Glinski J., Wetzler S., Goodman E.2001). American Psychiatric Association has currently included Binge eating disorder (BED) in an appendix of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and is characterized by: recurrent episodes of eating during a discrete period of time (at least 2 days a week over a 6 month period); eating large quantity of food than majority of the people would eat at the same time; a feeling of loss of control during the episodes; and guilt or distress following the episodes (Jennifer C. Collins & Jon E. Bentz, 2009). According to Wadden T.A., Sarwer D. B., Fabricatore A. N., Jones L., Stack R., & Williams N.S (2007), BED is estimated to occur in approximately 2% of the general population and between 10% and 25% of the bariatric population. An important differentiation pointed out by the American Psychiatric Association, between BED and bulimia/anorexia is that BED is not associated with any regular compensatory behaviors, such as purging, fasting, or excessive exercise. It can therefore be implied that the majority of individuals with BED are overweight. Night eating, which was first identified in 1955 as another disorder that can lead to remarkable weight gain, though night eating syndrome (NES) is not currently recognized by the American Psychiatric Association as a distinct diagnosis in the DSM-IV-TR. Night eating syndrome is characterized by excessive late night consumption (> 35% of daily calories after the evening meal), unhealthy eating patterns, â€Å"morning anorexia,† insomnia, and distress (Stunkard A. J., Grace W. J. & Wolff H. G. 1955). NES occurs in approximately 1% of the general population and an estimated 5-20% of the bariatric population (Wadden T.A., Sarwer D. B., Fabricatore A. N., Jones L., Stack R., & Williams N.S. 2007). More recently, NES has been seen as a disorder of circadian rhythm that includes a delay of appetite in the mornings and the continuation of appetite and over consumption of food during the night (Jennifer C. Collins & Jon E. Bentz, 2009). PATHOPHYSIOLOGY OF OBESITY There are several possible pathophysiological mechanisms involved in the advancement and prolongation of obesity. This field of research had been almost unapproached until the leptin gene was discovered in 1994 by J. M. Friedman’s laboratory (Zhang, Y., Proenca, R., Maffei, M., Barone, M., Leopold, L., Friedman, J.M., 1994). These researchers proposed that leptin was a satiety element. However, soon after J. F. Caro’s laboratory could not ascertain any mutations in the leptin gene in humans with obesity. In 1995, Considine, RV; Considine, EL; Williams, CJ; Nyce, MR; Magosin, SA; Bauer, TL; Rosato, EL; Colberg, J., & Caro, J.F. proposed a contrary view that Leptin expression was increased, postulating the possibility of Leptin-resistance in human obesity. Since the discovery of leptin, insulin, ghrelin, orexin, cholecystokinin, adipokines, peptide tyrosine tyrosine, as well as many other mediators have been researched. The adipokines are intermediators produced by adipose tissue; their action is thought to revise many obesity-related diseases. Leptin and ghrelin are considered to be interrelated in their effect on appetite, with ghrelin produced by the stomach regulating short-term appetitive control (i.e. hunger pangs when the stomach is empty and satiety when the stomach is stretched). Leptin is created by adipose tissue to signal fat storage reservoirs in the body, and mediates long-term appetitive controls (i.e. to eat more when fat storages are low and less when fat storages are high). Although administration of leptin may be effective in a small subset of obese humans who have deficiency in leptin, most obese humans are considered to be leptin resistant and have been found to have high levels of leptin (Hamann A., & Matthaei S. 1996). This resistance is thought to explain in part why administration of leptin has not been shown to be effective in suppressing appetite in most obese people (Flier J.S. 2004). Leptin and ghrelin act on the hypothalamus and are produced peripherally. They control appetite through their actions on the central nervous system. They act on the hypothalamus, a region of the brain central to the coordination of food consumption and energy expenditure. There are several circuits within the hypothalamus that contribute to its performance in integrating appetite, the melanocortin pathway being the most well understood (Flier J.S. 2004). The circuit starts with an region of the hypothalamus, the arcuate nucleus, that has outputs to the lateral hypothalamus (LH) and ventromedial hypothalamus (VMH), the brains feeding and satiety centers, respectively (Boulpaep, Emile L., Boron, & Walter F. 2003). According to Flier J.S. (2004), the arcuate nucleus contains two distinct groups of neurons; the first group co expresses neuropeptide Y (NPY) and agouti-related peptide (AgRP) and has stimulatory inputs to the LH and inhibitory inputs to the VMH and the second group coexpresses pro-opiomelanocortin (POMC) and cocaine- and amphetamine-regulated transcript (CART) and has stimulatory inputs to the VMH and inhibitory inputs to the LH (Flier J.S. 2004). Consequently, NPY/AgRP neurons stimulate feeding and inhibit satiety, while POMC/CART neurons stimulate satiety and inhibit feeding (Flier J.S. 2004). Both groups of arcuate nucleus neurons are regulated in part by leptin. Leptin inhibits the NPY/AgRP group while stimulating the POMC/CART group (Flier J.S. 2004).   Researches done by Flier J.S., 2004, thus concluded that a deficiency in leptin signaling, either via leptin deficiency or leptin resistance, leads to overfeeding and may account for some genetic and acquired forms of obesity. EFFECT ON HEALTH Obesity is a severe medical condition and a chronic health issue worldwide. The association between body weight and mortality is a subject of concern, especially in regards to the optimal weight for longevity (JoAnn E. Manson, M.D., Walter C. Willett, M.D., et al, 1995). The significance of understanding the true relationship between weight and mortality is underlined by the increasing prevalence of obesity in the United States (Kuczmarski RJ, et al, 1994) especially women (Harlen WR, et al, 1988). Obesity is a major risk factor for cardiovascular diseases (e.g., heart disease, stroke and high blood pressure), diabetes (e.g. type 2 diabetes), musculoskeletal disorders (e.g., osteoarthritis), some cancers (e.g., endometrial, breast, and colon cancer), high total cholesterol or high levels of triglycerides, liver and gallbladder diseases, sleep apnea and respiratory problems, reproductive health complications such as infertility and mental health conditions (WHO, 2012). Obesity and Cancer Obese people are more vulnerable to cancer and their prognosis is extremely worse when diagnosed. Men that are obese are 33% more likely to die from cancer and obese women also have a 50% higher likelihood of dying from breast cancer (Weight Management Centre, 2010). Additional to obesity, cancer has recently been linked to diet and physical activity status (Bray 2004, Barnard 2004, Wiseman 2008). The cancers most significantly associated with obesity in women are cervical, uterine, kidney, breast and endometrial cancer and in men are colon, pancreatic and liver cancer (Calle, Rodriguez, Walker-Thurmond & Thun 2003). One study, using National Cancer Institute Surveillance, Epidemiology, and End Results data, estimated that in 2007 in the United States, about 34,000 new cases of cancer in men (4 percent) and 50,500 in women (7 percent) were due to obesity. The percentage of cases attributed to obesity varied widely for different cancer types but was as high as 40 percent for some cancers, particularly endometrial cancer and esophageal adenocarcinoma (National Cancer Institute, 2012). Obesity and cardiovascular disorders Cardiovascular disease (CVD) is one of the major cause of death in U.S. Obese people are more liable to die from CVD largely due to accelerated atherosclerosis, hyperlipidaemia, loss of glyceamic control and hypertension. Until recently the relationship between obesity and coronary heart disease was viewed as indirect, i.e., through covariates related to both obesity and coronary heart disease risk (Lew E.A., Garfinkel L., 1979) including hypertension; dyslipidemia, particularly reductions in HDL cholesterol; and impaired glucose tolerance or non–insulin-dependent diabetes mellitus. Insulin resistance and accompanying hyperinsulinemia are typically associated with these comorbidities (Reaven G.M., 1988). Although most of the comorbidities linking obesity to coronary artery disease increase as BMI increases, they also relate to the total distribution of body fat. Long-term longitudinal studies, however, indicate that obesity as such not only relates to but independently predicts coronary atherosclerosis (Manson J.E., et al., 1995; Garrison R. J., et al. 1985; Rabkin S.W., 1977). Messerli F. H. (1982) stated that left ventricular hypertrophy is mostly seen in patients with obesity and is related to systemic hypertension and may be related to the severity of obesity. Hypertension is approximately three times more commonly found in obese individuals than normal-weight persons (Van Itallie T.B., 1985). This relationship may be directly related such that when weight increases, there is an increase in blood pressure (Kannel W.B., Brand N., et al., 1967) and when weight decreases, blood pressure also decreases (Reisin E., Frohlich E.D., et al., 1983). Obesity and mental health Individuals diagnosed with obesity tend to be less favorable on all levels of the psychological assessment and may exhibit several symptoms ranging from mere sadness to chronic depression. Evident are more episodes of mood swings, anxiety, personality and eating disorders, basically related to or associated with obesity experienced by individuals with obesity (Pickering, Grant, Chou, Compton 2007). Obesity may be an inception of psychiatric manifestations and vice versa and is related to psychosocial deterioration and bias based on weight. This comprises of loss of self-worth, and reduced self-esteem associated with stigmatization. Stigmatization can further lead to desolation and withdrawal and thus many obese individuals seek solace in binge eating, thereby gaining more weight. Based on reports from Roberts, Deleger, Strawbridge & Kaplan 2003; Herva, Laitinen, Miettunen, Veijola, Karvonen & Lasky 2006; Kasen, Cohen, Chen &Must 2008, concern, shame and guilt associated with low self-worth, which is finally related to excessive food consumption completes the obesity-mental disorder circle. There is bias and discrimination associated with obesity. They generally report reduced quality of life and functional wellbeing, collectively called Health-related quality of life (HRQOL) (Puhl & Brownell 2001; Wadden & Phelan 2002). This relationships is majorly expressed by women (Fontaine 2001) and for people with severe obesity (Hudson, Hiripi, Pope & Kessler 2007; Scott, Bruffaerts, Siomn, Alonso, Angermeyer, de Girolamo et al. 2008). Obesity and diabetes Diabetes is usually a terminal illness. i.e. it is a lifelong chronic disease characterized by high levels of sugar in the blood. One of the major risk factors for diabetes is obesity. Obesity is directly associated with Diabetes 2. The association between obesity and type 2 diabetes are firmly established and without the intervention of a healthy diet and proper exercise, obesity can lead to type 2 diabetes over a very short period of time.   In fact, obesity is believed to account for 80-85% of the risk of developing type 2 diabetes, while recent research suggests that obese people are up to 80 times more likely to develop type 2 diabetes than those with a BMI of less than 22 (National Health Service, 2014). It is a known fact that obesity carries a greater risk of developing type 2 diabetes, especially if you have excess weight around your abdomen. Studies postulates that abdominal fat causes fat cells to releases ‘pro-inflammatory’ chemicals, which can reduce the body’s sensitivity to the insulin, this can also disrupt the function of insulin responsive cells and their ability to react to insulin. This is known as insulin resistance   which is a primary activator for type 2 diabetes. Excess abdominal fat is a major high-risk form of obesity. SOCIO-ECOMOMIC/ FINANCIAL COST OF OBESITY In 1999-2000, nearly 65 percent of U.S. adults were either obese or overweight. Obesity accounts for $117 billion a year in direct and indirect economic costs. Obesity is associated with 300,000 deaths per year, and is fast becoming the leading cause of preventable deaths† (Mancino, Lin, and Ballenger, 2004). Certainly, obesity has become a large problem in America. Recent increase in meal portions and reduction in availability of natural food production may propose why people find it challenging to maintain a healthy diet. Although, certain People have been successful at maintaining a healthy nutritional status and avoiding this unhealthy situation. Gary Becker’s human capital theory is a groundwork that helps to clarify the effect of weight status on the economy in terms of the labor market outcomes for the individual. Human capital is the educational qualification, job experience/training, and the health condition that workers devote their time in to boost their capacity and skills to be â€Å"rented out† to employers (Ehrenberg and Smith, 2005). Healthy weight status in relation to labour is a type of human capital investment. According to Robert Pindyck and Daniel Rubinfeld (2004), â€Å"When an investment decision is made, the investor commits to a current outlay of expenses in return for a   stream of expected future benefits.† These stated costs for a healthy weight may include buying of food with high nutritional values and creating time for physical activities. As an investment, the individual sacrifices money, time and other resources to attain a healthy weight to become more productive in the future and, hence, earn higher income. Obese workers miss more days of work and inflict more cost on employers especially in medical and disability claims and also workers compensation claims. As a result, firms end up with extra costs associated with obesity, this is one of the economic effects of obesity. Obesity places significant burden on the society through health care expenditures and disability payments combined through group health insurance and public programs. The estimated annual medical cost of obesity in the U.S. was $147 billion in 2008 U.S. dollars; the medical costs for people who are obese were $1,429 higher than those of normal weight (CDC, 2011). Obesity there has direct and indirect effect on the Nation’s resources, as more money is spent on the obese due to the high risk of comorbidity with other life threatening diseases like type 2 diabetes, osteoarthritis and cardiovascular diseases. TREATMENT There are several weight-loss schemes available but many are ineffectual and short-term, especially for those who are morbidly obese. The strategies for weight loss with non-surgical programs usually involve a combination of diet modification, behavior modification therapy and appropriate exercise. Dietary Modification Dietary modifications for obesity are designed to create a negative energy intake-energy expenditure balance (i.e., calories consumed < calories expended) by reducing daily energy intake below the required level. The required energy varies by weight, sex and level of physical exercise such individuals with higher weights, more activity have greater energy needs, including men (Melanson K. & Dwyer J. 2002). Uniformly, higher energy deficits results in higher weight losses. Low calorie diet is recommended for obese individuals and they are advised to check calorie content of meals before consumption. Very low calorie diet is recommended for morbidly obese individuals with little or no success in low diet consumption. Behaviour Therapy The oldest report of the use of behavioral therapy in the management of obesity occurred in 1967. Since then, it has been widely used in the management of obesity (Gupta R. & Misra A. 2007). Behavior therapy involves setting out goals and principles to patients to aid their adherence to the diet modification and activity goals for weight loss. Conventional tactics include self-monitoring of food intake and exercise, reduced portion of meals and number of times of food intake, intellective restructuring, problem solving, and prevention of regression. The primary aim of behavior modification therapy is to change eating pattern and exercise practices to promote weight loss (CDC, 2011). Components of behavioral therapy Self-monitoring: This is one of the main elements of behavior therapy in obesity. Self-monitoring includes maintaining food dairies and activity logs (Guare J.C., et. Al., 1989).Stimulus Control: This is the second key element in behavior therapy. In this element, focus is placed on altering the environment that initiates eating and modifying it to help prevent overeating. Stimulus control includes proper purchase of food items, excluding energy-dense processed food and introducing more fruits and vegetables (Wing R.R., 2004) Slower eating: Reducing the speed of eating so as to allow signals for fullness come into play.Goal setting: Setting realistic goals for one’s self or setting goals for patients as appropriate (Bandura A. & Simon K.M., 1977). Behavioral contracting: Reinforcing of successful outcomes or rewarding good behaviors plays a key role (Volpp K. G., et. al., 2008).Education: Nutritional education is a necessary component of a successful behavior therapy for obesi ty. A structured meal plan in conjunction with consultation with a dietician will be helpful (Pedersen S. D., et. al., 2007).Social support: Behavioral modification is more sustainable in the long term when there is social support. Enhancing social support is essential for behavioral therapy (Avenell A. et. al., 2004). Physical activity Physical activity is the third component of non-surgical weight loss interventions and lifestyle modification. The advantages of physical activities include promoting negative energy balance by maximizing calorie expenditure, preserving fat-free part during weight loss, and improving cardiovascular fitness. Physical activity, however, is ineffective in weight loss in the absence of diet modification. The greatest benefit of physical activity is in facilitating the maintenance of weight loss (Pronk N.P & Wing R.R. 1992). Case studies have shown that people who exercise regularly are more successful in maintaining weight losses than are those who do not exercise. Kayman S., Bruvold W., Stern J.S. 1990; Klem M.L., Wing R.R., McGuire M.T., Seagle H.M., Hill J.O.1997). Additional evidence comes from randomized trials. Participants who receive diet plus exercise maintain greater weight losses 1 year after treatment than do those who receive diet alone, although the differences are not always statistically significant (Wing, R.R. 1999). PREVENTION Obesity is a long-lasting medical condition, which is linked with several debilitating and life-threatening conditions. The increasing rate of obesity globally is a public health concern (Srinivas N., et. al., 2004). Hence an effective way to control obesity requires strategies that would tackle the major issues relating to prevention (Srinivas N., et. al., 2004). The treatment and prevention of obesity are interrelated. The prevention of obesity involves several levels i) Primary ii) Secondary iii) Tertiary (Timothy P.G., 1997). Primary prevention: The goal of primary prevention is to reduce the number of new cases. Diet modification/ healthy diet habits is a primary way of preventing obesity. Sedentary life style which is one of the causes of obesity can be prevented by appropriate exercises and activities that help burn out excess calories in the body and also prevent accumulation of fat. Simple habits ranging from 30 minutes walk in a day to weekly work out at the gymnasium can go a long way in maintaining a healthy weight. Health education is also very important in this aspect because some individuals in the community are unaware of the health implications of their habits. Appropriate health education programs should be organized to increase awareness. Accessibility to healthy food is also an important factor in the prevention of obesity. Formulations of policies that would facilitate healthy eating habit should be adopted by the Government; this would go a long way in reducing the economic effects of ob esity and the burden on the Nation’s resources. Policy and environmental approaches that make healthy choices available, affordable and easy can be used to extend the propagation of strategies designed to raise awareness and support people who would like to make healthy lifestyle changes (CDC, 2011).Secondary prevention: Secondary prevention is to lower the rate of established cases in the community (Srinivas N., et. al., 2004). Secondary prevention includes strategies to diagnose and treat an existing medical condition in its early stage to avoid complications. (Jeffery G.K., 2014). 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