Research Korner: Cardiovascular Problems

Obesity in America: The Growing Epidemic

A REPORT ON OBESITY IN AMERICA: THE GROWING EPIDEMIC       THE RESEARCH QUESTIONS   <li class="MsoNormal" style="line-height: 200%">What are the current medical definitions of your medical entity? </li> <li class="MsoNormal" style="line-height: 200%">What is the prevalence of the medical entity in the states and counties represented by the members of your study group?   </li> <li class="MsoNormal" style="line-height: 200%">Has the prevalence of the medical entity in those states and counties changed over the last 50 years? </li> <li class="MsoNormal" style="line-height: 200%">What age groups (infants, children, teens, young adults, middle aged, or elderly) have shown the greatest increase in the medical entity in the last 10 years?   </li>   STATE AND COUNTY INFORMATION ALABAMA:   What are the current medical definitions of your medical entity?   The medical entity, obesity, is defined as any adult with a BMI above 30.  The BMI is calculated by dividing a person's weight in kilograms by his/her height in m^2.  It is thought to provide an indication of one's health concerning excess body fat (). What is the prevalence of the medical entity in the states and counties represented by the members of your study group?  In 2003, the Alabama Center for Health published a report using statistics from the Behavior Risk Factor Surveillance System, which estimated Alabama to have an obesity percentage of 24.5, ranking them in the top 7 states in the nation in obesity.  Furthermore, 37.2 percent were found to be overweight. This study also included individual county studies of obesity, which demonstrated that counties in the lower third of the state had the highest numbers of obese people.  An estimated 26.6 to 31.8 percent of people in these counties were found to be obese.  Most of northern Alabama, as well as Baldwin and Geneva counties in south Alabama, had a percentage of obesity from 21.8 to 23.0 percent (). According to a 2005 Behavior Risk Factor Surveillance System, 29 percent of adults in Alabama are obese. The percentage of overweight people is 36 percent (Alabama Department of Public Health). In a more recent report published in 2006 and distributed by "Trust for America's Health" in Washington D.C., Alabama was ranked 1st in the nation in obesity with an estimate 28.4% of the adult population being obese ().   Has the prevalence of your medical entity in those states and counties changed over the last 50 yrs? The prevalence of obesity over the past 50 years has changed dramatically.  Data collected from an article entitled "Obesity in America," a 20 year obesity statistical recording listed that from 1985 to 2005, Alabama's percentage of obese adults increased by almost 20 percent.  In 1986, the percentage of obese people in Alabama was less than 10 percent.  By 1998, the percentage increased to about 20 percent.  From 2001 to 2005, the percentage fluctuated at around 25 percent and in 2006; Alabama became the most obese state in the nation, with about 28.4 percent of the adult population being obese (). Income levels have a correlation with obesity, and can possibly be one of the main factors that one should use when considering the source of Alabama's obesity. In Alabama, the prevalence of obesity in groups with less than or equal to $15,000 was 30.9 percent. People with incomes around $75,000 were 20.8 percent obese. Education also had an impact, showing 26.3 percent obesity for adults with only a high school education. This contrasted the 18.5 percent of college graduates in Alabama that were obese ().   What age groups (infants, children, teens, young adults, middle aged or elderly) have shown the greatest increase in the medical entity in the last 10 years?   The numbers of overweight youth in Alabama are rising fast as well. Data from the 2005 Youth Risk Behavior Survey shows that among high school students, 15 percent are overweight and 18 percent are at risk for overweight ().   CALIFORNIA (SAN DIEGO COUNTY):   What are the current medical definitions of your medical entity?   For adults, obesity is defined as having a very high amount of body fat in relation to lean body mass, or Body Mass Index of 30 or higher.  BMI is a measure of an adult’s weight in relation to his or her height i.e. the adult’s weight in kilograms divided by the square of the individual’s height in meters.  For children and teens, BMI ranges above a normal weight have different labels (at risk of overweight and overweight). The BMI ranges for children and teens are defined so that they take into account normal differences in body fat between boys and girls and differences in body fat at different ages (Wood County Health Department 13). What is the prevalence of the medical entity in the states and counties represented by the members of your study group?  The rate of obesity is climbing in the state of California and is consistent with national trends.  (2001) reported that there were more than 4.7 million obese adult Californians in 2001 with Marin County having the lowest proportion of obese adults. San Diego had lower percentage of obese adults compared to the general California percentage (2). According to the 2003  (CHIS), the prevalence of obesity among adults, age 18 and older, in California was 21 percent while the prevalence of obesity among adults in San Diego County was 18 percent (). Furthermore, in 2005, 33 percent of children in California are overweight and thus, are likely to become obese when not assisted (). In 2006, a third of California children and one in every four teenagers are either overweight or obese (). Approximately 28 percent of obese California children are in fifth, seventh and ninth grades .   Has the prevalence of your medical entity in those states and counties changed over the last 50 yrs? In the last 50 years, the overall prevalence of obesity has increased in California, even doubling for both men and women from 1990 until 2003 (). According to the CDC’s Behavioral Risk Factor Surveillance System (BRFSS), in 1985 the prevalence of obesity among adults was less than 10 percent in California.  In 1988, obesity increased to 10-14 percent. In 1989, obesity dropped back to less than 10 percent. In 1991, it increased again to 10-14 percent and stayed within this range until 1997 when it increased to 15-19 percent.  In 2001, the prevalence increased to the 20-24 percent range. It dropped back to the 15-19 percent range in 2002. In 2003, the obesity prevalence increased to the 20-24 percent range and has remained in this range ( ). In addition, the obesity rate for men in 2003 increased by 23 percent while the rate for women recorded a 22 percent increase (). The  (NHANES) data show that the prevalence of overweight among children from 6-11 years old increased nearly four-fold between 1963 and 2000. Among adolescents from 12–19 years old, the prevalence of overweight increased more than three-fold between 1966 and 2000 ( ). In 2006, 14 percent of children in California who are between six and seventeen years old were obese, 15 percent of the same age group were overweight and 72 percent of fifth, seventh and ninth graders failed in the state standards of general physical fitness (Childhood Obesity). San Diego, which was once America’s Fittest City dropped to the 14th slot in the 2004 ranking as obesity continuous to heighten in the last 15 years - 50 percent in adults and 100 percent among children and adolescents (Obesity is Bad). Because overweight children are likely to become overweight adults, these children are more liable to suffer from cardiovascular disease, cancer, and diabetes in adulthood—all chronic, but largely preventable diseases that already account for two-thirds of all deaths in California (). The high prevalence of overweight and physical inactivity is caused by many individual, social, and environmental factors. This epidemic is perpetuated by conditions including, but not limited to, the following: increasing portion sizes, increasing consumption of fast food and soft drinks, lack of funding for nutrition and physical activity programs, availability of soda and junk food on school campuses, poor physical activity infrastructures in schools and communities, limited compliance with physical education requirements in many schools, limited access to healthy foods in low-income neighborhoods, and advertising of junk food to children and their families (3).   What age groups (infants, children, teens, young adults, middle aged or elderly) have shown the greatest increase in the medical entity in the last 10 years?   In the past 10 years, according to the Behavioral Risk Factor Surveillance System, the years 1995, 2000, 2005 in the United States revealed that the age group that has shown the greatest increase in obesity is the 30-39 age group. This group showed an increase from an obesity prevalence of 14.3 percent in 1995 to 24.4 percent in 2005 (a 10.1% increase).  Males aging between 55 to 64 years old recorded an increase of 27.2 percent in 1988-1994 and 35.5 percent in 1999-2002 while 65 to 74 year-old females had the greatest increase in obesity from 26.9 percent in 1988-1994 to 39.3 percent in 1999-2002 (). California is facing a public health crisis in the form of obesity. Californians have gained 360 million pounds in the last 10 years. More than half of the state's adults are overweight or obese and more than a quarter of California's students are overweight, placing California's rate of childhood obesity higher than the national average. Poor diet and lack of physical activity are the second leading causes of death and disability, resulting in nearly 30,000 deaths each year in California. California's economic burden as a result of this crisis was $22 billion in 2000, and is expected to rise to $28 billion in 2005. Health officials predict that if these trends continue, this generation of children will be the first to have a shorter life expectancy than their parents (). According to the  (2007) unhealthy eating habits established in childhood, adolescence and late teens carry over to adulthood. Sedentary lifestyle coupled with decreased metabolic rate. Lifestyle changes due to technology such as elevators, cars, dishwashers, televisions, power lawn mowers, etc. Decreased metabolic needs and energy expenditure coupled with the same or increased food intake.   MARYLAND:   What are the current medical definitions of your medical entity?   The  (2006) overweight and obesity are both labels for ranges of weight that are greater than what is generally considered healthy for a given height. The terms also identify ranges of weight that have been shown to increase the likelihood of certain diseases and other health problems. For adults, overweight and obesity ranges are determined by using weight and height to calculate a number called the “body mass index” (BMI). BMI is used because, for most people, it correlates with their amount of body fat: an adult who has a BMI between 25 and 29.9 is considered overweight; and an adult who has a BMI of 30 or higher is considered obese.   What is the prevalence of the medical entity in the states and counties represented by the members of your study group?  Fifty nine percent of Maryland adults were overweight or obese in 2004. Twenty-two percent of non-Hispanic white adults, 31 percent of non-Hispanic black adults, and 19 percent of Hispanic adults in Maryland are obese. Furthermore, 29 percent of low-income children between 2 and 5 years of age in Maryland are overweight or at risk of becoming overweight ().   Has the prevalence of your medical entity in those states and counties changed over the last 50 yrs? The prevalence of obesity has increased over the last 50 years. The following statistics shows the percentages from different years:   <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-autospace: none"> 1987-88: 10-14% (highest percentage range)</li> <li class="MsoNormal" style="text-autospace: none"> 1989-94: 10-14% (second highest range)</li> <li class="MsoNormal" style="text-autospace: none"> 1995-96: 15-19% (highest percentage range)</li> <li class="MsoNormal" style="text-autospace: none"> 1997-00: 15-19% (second highest percentage range)</li> <li class="MsoNormal" style="text-autospace: none"> 2001-02: 15-19% (third highest percentage range)</li> <li class="MsoNormal" style="text-autospace: none"> 2003-04: 20-24% (second highest percentage range)</li> <li class="MsoNormal" style="text-autospace: none"> 2005: 20-24% (third highest percentage range)</li> </ul>   Overall, the prevalence of obesity increased in Maryland; the numbers indicate that the prevalence tended to reach a plateau for a few years and then increased ().   What age groups (infants, children, teens, young adults, middle aged or elderly) have shown the greatest increase in the medical entity in the last 10 years?   There has been an increase of 62 percent in the number of obese adults from 1990-2002 (No Children).     NEW JERSEY:   What are the current medical definitions of your medical entity?   The  (2006) states that obesity is “the excess accumulation of body fat and a growing health problem. Obesity is a known risk factor of numerous chronic diseases, including diabetes, heart disease, high blood pressure, gall bladder disease, arthritis, breathing problems, and some form of cancer.”   What is the prevalence of the medical entity in the states and counties represented by the members of your study group?  In 2004, obesity affected 21.9 percent of adults in the state of New Jersey. The United States national average was 23.2 percent. In 2005, New Jersey was still under the national average ().   Has the prevalence of your medical entity in those states and counties changed over the last 50 yrs? What age groups (infants, children, teens, young adults, middle aged, or elderly) have shown the greatest increase in the medical entity in the last 10 years?”   The following chart shows that in the state of New Jersey, 55 to 64-year-old individuals had the highest percentage of obesity. Almost one-third of this age group was obese ().   Moreover, the 2005  Health Survey found out that 12 percent of ninth to twelfth graders were overweight and another fifteen percent were at risk for becoming over weight. A study conducted in 2003 by the New Jersey Departments of Health and Senior Services and Education found that 20 percent of sixth graders evaluated were obese and another 18 percent were overweight. Higher obesity levels were observed among the sixth grade boys as compared to girls (). The following reports and figures are from the  (2005):     The above figures say that most students in New Jersey are “TV couch potatoes”. The figures reveal that 36 percent of New Jersey high school students spend three hours a day in front of the TV. It can also be deduced that male high school students are more likely to have obesity in New Jersey. Another interesting chart showed ethnic groups and percentages and how prevalent obesity was in each group follows:              Source: (2000). From the statistics in the figure below, it can be sorted out that there are about 385,000 New Jersey residents who are at the age of 60. From the figure above it can be said that 29 percent of this age group were obese ().     PENNSYLVANIA     TEXAS:   Total State Population:  22,859,968 (2005 estimate) Dallas County Population:  2,305,454 (2005 estimate)   What are the current medical definitions of your medical entity? According to the  (2006) overweight refers to increased body weight in relation to height, when compared to some standard of acceptable or desirable weight. Overweight may or may not be due to increases in body fat. It may also be due to an increase in lean muscle. For example, professional athletes may be very lean and muscular, with very little body fat, yet they may weigh more than others of the same height. While they may qualify as "overweight" due to their large muscle mass, they are not necessarily "over fat," regardless of BMI. The BMU of overweight people exceeds 25. Desirable weight standards are derived in a number of ways: (1) by using a mathematical formula known as Body Mass Index (BMI), which represents weight levels associated with the lowest overall risk to health. Desirable BMI levels may vary with age; and (2) by using actual heights and weights measured and collected on people who are representative of the U.S. population by the National Center for Health Statistics. Other desirable weight tables have been created by the Metropolitan Life Insurance Company, based on their client populations (). These sources are consistent with the U.S. Dietary Guidelines and with the National Heart, Lung, and Blood Institute's Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass. The amount of body fat (or adiposity) includes concern for both the distribution of fat throughout the body and the size of the adipose tissue deposits. Body fat distribution can be estimated by skin fold measures, waist-to-hip circumference ratios, or techniques such as ultrasound, computed tomography, or magnetic resonance imaging. BMI for overweight or obese is 25 or more (). According to the  (2005) obesity is a complex, multi-factorial chronic disease involving environmental (social and cultural), genetic, physiologic, metabolic, behavioral and psychological components. It is the second leading cause of preventable death in the U.S. Overweight and obesity are part of the U.S. Department of Health and Human Services' health agenda that have steadily moved away from their established targets for improvement. Today, public health leaders recognize obesity as a "neglected public health problem." This fact sheet will demonstrate the impact of overweight and obesity on millions of Americans of all ages and both genders. What is the prevalence of the medical entity in the states and countries represented by the members of your study group?             Apparently that old saying that “everything is bigger in Texas” holds true for its residents as well.  According to the  (2006) in 2005, an estimated 10.4 million or 64 percent of Texas adults were overweight or obese. Also, a report released in 2005 found that Texas reported it had the 6th highest prevalence in adult obesity in the United States. Has the prevalence of the medical entity in those states and counties changed over the last 50 years? According to the  (2006) Texas dropped its state ranking from 6th to 10th.  Unfortunately, Texas dropped in the ranking because the prevalence of obesity increased in other states, not because the state of obesity had improved in Texas. If the current trends continue, 20 million or 75 percent of Texas adults might be overweight or obese by the year 2040, and Texas costs could quadruple from $10.5 billion today to as much as $39 billion by 2040. The (2005) cites that: <ul style="margin-top: 0in; margin-bottom: 0in" type="disc"> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> There are no reports or statistics on American obesity prior to 1976.  The earliest data on American obesity was recorded between 1976 and 1980.  It was reported then that 46% of American adults were considered overweight and 14.4% were considered obese.  Since that time the percentage of overweight and obese Americans has increased dramatically.  The AOA last reported between 1999 and 2000.  At that time 64.5% were considered overweight and 30.5 were considered obese.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Early reported studies from the AOA do not give data for individual states and cities.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> In 1991 the AOA reported that 12.7% of Texas adults were obese.  In 1998 that number climbed to 19.9%.  In 2000 that number again increased to 22.7%.  The last reported statistic was in 2001 at 23.8%.</li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> In 2000 Dallas, Texas was reported as the 15th most overweight city in the United States.  In 2005 Dallas, Texas was reported as the 6th most overweight city in the United States. </li> </ul> What groups (infants, children, teens, young adults, middle aged, or elderly) have shown the greatest increase in the medical entity in the last 10 years?             The  (2006) reports the following facts: ·         Overweight and obesity are more pronounced among men, minorities and middle-aged adults. ·         The prevalence of childhood overweight was greater in Texas in 2004-2005 than the U.S. rates reported for the 2003-2004 National Health and Nutrition Examination Survey (NHANES).  The overall prevalence of overweight and at-risk for overweight in Texas schoolchildren was 42% for fourth graders, 39% for eight graders and 36% for eleventh graders in 2004-2005. ·         In 2000-2001, the percentage of overweight students in Texas was much higher among minorities, with the highest prevalence of overweight in Hispanic boys in all grade levels, Hispanic girls in fourth grade and African American girls in the fourth and eleventh grades. ·         30% of Texas high-school students are overweight or at risk of becoming overweight. ·         From 2000-2002 to 2004-2005, the prevalence of overweight increased among both eighth and eleventh graders, but slightly dropped among fourth graders in Texas from 25.6% to 23%. On the other hand, the American Obesity Association (2005) claims that about 15.5 percent of adolescents (ages 12 to 19) and 15.3 percent of children (ages 6 to 11) are obese as of 1999-2000. The increase in obesity among American youth over the past two decades is dramatic.   WEST VIRGINIA (KANAWHA COUNTY):   What are the current medical definitions of your medical entity?   Obesity is defined as an excessively high amount of body fat or adipose tissue in relation to lean body mass: BMI = [(wt in pounds)/(ht in inches)2] x 703. Obesity ranges are determined using weight and height to calculate the “body mass index” (BMI), usually a number between 18.5 and 30.  An adult BMI of 30 or higher is considered obese.   Height Weight Range BMI Considered 5’ 9” 124 lbs or less Below 18.5 Underweight 125 lbs to 168 lbs 18.5 to 24.9 Healthy weight 169 lbs to 202 lbs 25.0 to 29.9 Overweight 203 lbs or more 30 or higher Obese   Calculated BMI is age- and sex-specific and is often referred to as BMI-for-age (Overweight and Obesity: West Virginia). According to West Virginia Health Statistic Center (2005) “a single measurement that needs only two factors, weight and height, makes it possible to conduct surveillance on a worldwide basis. There are limitations to BMI, of course. It can be overestimated among persons who are very athletic and have large muscle mass, on the one hand, and underestimated among persons who have lost muscle mass, such as the ill and the elderly. It has been recommended that different BMI cutoff points be used to determine overweight and obesity in certain racial groups (25). In general, however, BMI is considered to be a reliable indication of total body fat content for most adults, regardless of sex.” Furthermore, obesity is multi-factorial, based on both genetics and behavioral factors. Obesity also can contribute to the following diseases: Type 2 diabetes, hypertension, stroke, myocardial infarction, congestive heart failure, cancer, gall stones and gall bladder disease, gout, Osteoarthritis, Sleep Apnea, and Pickwickian Syndrome (Definition of Obesity). What is the prevalence of the medical entity in the states and countries represented by the members of your study group? In 2000, the obesity rate in West Virginia was 23.3 percent, an 8.2 percent increase from 1999.  From 1990-94 the prevalence of obesity in Kanawha County was 16.9 percent, ranking the county at 19 out of 55 counties. From 1995-99 Kanawha County had a 22.5 percent prevalence of obesity moving up to the 15th obese county in the state. Mineral County has also shown prevalence of obesity with an average of 37 percent compared to the US average of 33 percent. Obesity is increasing in all counties of West Virginia, but mostly a rise is being seen in the southern and western counties (which are the poorest counties), as well as the Eastern Panhandle (Obesity in West Virginia). “In 2002, West Virginia ranked first in the nation in the prevalence of obesity (27.6%) and 42nd highest in the prevalence of overweight (36.1%). More than 63 percent of West Virginians are considered overweight or obese.” (A Need for a Healthier West Virginia) Has the prevalence of the medical entity in those states and counties changed over the last 50 years? The prevalence of obesity has changed in Mineral County, West Virginia over the past 50 years. In 1985 10 to 14 percent of West Virginians were obese with a BMI equal or greater than 30 (). According to reporter in 2005 West Virginia was considered one of the worst states in the country with obesity problems. West Virginia is consistently among the top three states in the nation for obesity, according to the Centers for Disease Control and Prevention and the State Bureau of Public Health.  The most current data, 2002, 28% of West Virginians were considered obese. West Virginia also leads the nation in hypertension and is fourth in the nation for diabetes (). What groups (infants, children, teens, young adults, middle aged, or elderly) have shown the greatest increase in the medical entity in the last 10 years?   Children, teens, and young adults have seen the most increase in obesity over the past 10 years (). For ages 18 years and above, the average weight for males and females in West Virginia has increased steadily from 1984 to 2000; the males rising from 177.2 pounds up to 194.0, and the women’s weight rising from 142.0 pounds up to 154.9 pounds (Obesity in West Virginia). The 1999 Youth Risk Behavior Study, conducted by the CDC over the telephone, shows the latest available data for the youth of WV and this age group’s obesity issues.  Using a BMI-for-age calculation formulated especially for children, whose BMI will differ according to sex and age during their developmental stages, the study showed that in 1999, 12.2% of West Virginia high school students in grades 9-12 were overweight, 15.8% being male and 8.3% being female, and that 15.9% of students were currently at risk of being overweight (Obesity in West Virginia). Sixty-four percent of West Virginia adults are obese or overweight while 29 percent of high-school students are overweight or at risk of becoming overweight. Moreover, 28 percent of low-income children between 2 and 5 years of age in West Virginia are overweight or at risk of becoming overweight (Overweight and Obesity: West Virginia).

Obesity in America: The Growing Epidemic

A REPORT ON OBESITY IN AMERICA: THE GROWING EPIDEMIC THE RESEARCH QUESTIONS What are ...

Spa Therapy

Spa Treatment Introduction             Throughout the history, people have been interested in the medicinal value of water. The medical world has viewed water with different opinions, from very enthusiastic to extremely critical, and from beneficial to harmful. As early as 500 BC, the Greeks are reported to indulge in a variety of social baths. The Romans were also keen in the medicinal value of the water and spas were a major place for relaxation social interaction in ancient Rome. The history of the Spa industry is colorful and the interest in water has fluctuated from century to century and from nation to nation. Today, spa therapy is receiving renewed attention from medical specialties and health tourists, and having a revival. The modern spa has hit mainstream and gaining global renown. Different types of spas are emerging to meet the demands and wants of the ever-changing market. Modern spas are not only seen as a place where one can experience the medical benefits. Modern spas have become a great place for people to make lifestyle changes. They are also excellent places for education, and at times, places of instant change. The medical field and the spa field are becoming intertwined. Consumers want the expertise of the medical community but they love the spa environment. The spa industry has made a huge impact on different industries such as the tourism, hospitality and the medical field.       History and Development             The term Spa is believed to be derived from the name of a Belgian town – Spa. In the 14th century, a curative, thermal spring was discovered in Spa. Spa is also believed to be derived from the Latin word “spagere” which means to scatter, sprinkle, and moisten) or it may be an acronym of the Latin phrase “sanitas per aquas” which means health through water. Ancient Greece and the Roman Empire             In classical times, taking the waters used to be a popular treatment for a wide range of diseases. The Greeks loved to bathe in fresh water from natural resources. Initially, bathing was confined to the more wealthy people in private baths, but public baths were soon opened. Spas were considered sacred and were dedicated to some deities. Initially bathing only served cleansing and hygienic purposes but soon it became popular for its health benefits and its ability to cure some diseases. Hippocrates proposed the hypothesis that the cause of all diseases lay in an imbalance of bodily fluids. He advised that in order to regain the balance, a change in habits and environment is needed. This included bathing, perspiration, walking, and massages. Because of the Greeks’ influence, the Romans also built thermal baths located at mineral and thermal springs. Spas served as recreation centers for soldiers. In contrast with the Greeks, who took the waters after intensive physical exercises, the Romans considered the baths more important than gymnastics alone. The Roman baths served as a center for relaxation, socializing, cleansing and a place where one can find medical treatment. The Roman Spa treatment can come as application of water to afflicted parts of the body, immersion of the whole body in the water, and drinking excessive quantities of water. There were three type of baths that developed in ancient Rome, home baths (balnea), private baths (balnea private), and public baths (balnea publica) that were run by state. Thermae was developed along with the introduction of the aqueducts. Thermaes are large impressive edifices that can hold thousands of people. Baths were truly a place of social interaction. Many Romans built baths in newly conquered lands all over Europe. Throughout the years, the roman bathing gradually changed towards a place for relaxation and pleasure, rather than for medical treatment, although this was still provided. The Romans preferred to use the baths and very hot waters for renewing their appetites and thirst, and the baths became, rather, centers for various sexual practices. The Roman baths became a place for sexual pleasures and deterioration of morals became evident. Dark and Middle Ages             Bathing culture became disreputable during the collapse of the Roman Empire and as a result, bathing became prohibited. The rise of Christianity added to the decay of the bathing culture. Faith in cure through worship and praying was regarded as more important than a medicinal bath. Baths were redeveloped as churches although some aristocrats who were not affected of the Church’s decrees continued to enjoy baths.       Renaissance             In the 16th century, baths were considered a source of contagious diseases such as syphilis, plague, and leprosy. It also became a dangerous meeting place for political and religious dissidents. Baths became expensive and majority of people who have been impoverished by wars cannot afford it anymore. But affluent people continue to visit the baths, although they preferred to go to baths from natural sources with warm, mineral water instead of the public baths. The new bathing culture that had developed in Italy gradually spread over other parts of Europe. There were two types of spa that developed during this period. Once was hot springs that are for drinking and bathing and the other was cold springs which were for drinking cures only. Medical Doctors created spas not as a center for leisure but as centers for treatment. Much attention was paid to purging, drinking cures, eating well balanced diets and bathing. 19th and 20th Centuries             Interest in the bathing grew around 1800. Mineral water was examined and tested to unlock the secrets of its curative values. Doctors believed that nature has a cure for every disease and the key lies in the analysis of the water’s components. Individual treatments were prescribed, based on the composition and temperature of the water. Also, combinations of treatments were developed consisting of hot and cold baths, herbal baths, mud packs, active physical exercises, massages, and diets. The development of guesthouses and hotels that use mineral waters became a major change in Europe and North America. Spa resorts became not only a place for the elite society to meet but also a place where one can find people from different walks of life. Spas became creativity centers for painters, writers and composers. In the past decades, a big shift in the use of mineral water for treating diseases have taken place in continental Europe. The medical benefits of bathing were acknowledged by medical professionals that caused the flourish of spas in Europe. Bathing was normally combined with different treatments such as physical exercises, hydrotherapy, and mud packs. Development of Modern Spas             The United States became one of the centers of spa innovation in the world beginning 1850s. Several famous people visited spas like New York’s Saratoga Springs. In 1910, Elizabeth Arden introduced the first day spa – Red Door Salon in Manhattan. The day spa offered manicures, facials and the signature “Arden Wax”. Another innovation was introduced by Deborah Szekeley when she opened the first destination spa in Baja, California in 1958. She also pioneered the first Golden spa in California, which offered individualized weight loss and fitness programs and aerobics. In 1974, the first fitness spa also opened in California. Medical spas were introduced by innovative US doctors in 1997. They combined Western and holistic medicine in a luxurious, spa-inspired environment alongside spa services.             Alongside with these developments and innovation, the spa which was originally available for rich women seeking to lose weight became a relevance in the society that is increasingly focusing on prevention, healthy lifestyles, fitness, spirituality and relaxation. The spa is now a place for diverse people with different lifestyle pursuits. Spas have become a place where one can engage in medical and spiritual programs. Modern spas also have facilities for outdoor adventures and exotic travel. Spas have gone global, located virtually at every world region. The spa aesthetic has also influenced everything from fashion and cosmetics, to architecture, home décor, and cuisine. Medical Benefits of Spa Treatment             Thermal bath spas, like the ones located in the English city of Bath, are famous for curing different illnesses. Bath was famous for curing paralysis, even in those patients who were regarded as incurable. The treatment consisted of bathing, drinking cures, diet, and purges. Patients who are sick with paralysis and already been treated elsewhere but still could not find cure go to Bath. Many of these patients were cured after staying in Bath for months. In the past decade several randomized controlled trials have studied the effects of spa therapy in rheumatoid arthritis and osteoarthritis. Patients were randomly allocated to receive spa therapy. Overall, the results showed positive effects lasting for three to nine months.             Hydrotherapy is effective in helping people with soft tissue injuries, arthritis and other joint related illnesses. Many people enjoy the medical benefits of hydro massage on sore muscles, stiff joints and circulation. Hydro exercise has been found by medical experts as a way to enhance mood and it can improve self-esteem and a sense of accomplishment. Hot water can also help in reducing pain by stimulating the body to release endorphins. The massage action of spa’s warm bubbles further helps to relax tense muscles by relieving pressure in surrounding nerve groups. Spa treatments can also aid in weight loss and alleviating stress. Relaxing and soaking in warm water is also beneficial for people with sleep problems. Popular Spa Services and Treatments 1. Therapeutic Massage             Therapeutic massage involves the manipulation of the muscles of the body. Massage has a calming effect on the nervous system and aids in promoting relaxation and well-being. It can also reduce tension and anxiety. Massage can also improve blood circulation. Massage can prevent muscle cramps and spasms. 2. Facial             Another popular spa treatment is the facial. Facial includes analysis of the skin, deep cleansing, massage, toning, and moisturizing. 3. Body Treatments             Body treatments are facials for the whole body. One of the popular body treatments is body scrub, an exfoliating treatment that rubs off dead skin cells. Body scrubs are often combined with a detoxifying or hydrating body wrap. 4. Reflexology             Reflexology is treatment that targets the feet. The theory behind reflexology is that there are reflex points in the feet, hands and ears that relate to specific organs and glands in the body. Reflexology has a relaxing effect that can be felt all over one’s body. 5. Body Wrap             Body wrap originally targeted weight loss by wrapping the body tightly with bandages or plastic wrap. Today body wraps are usually treatments that uses a body mask commonly made of algae, seaweed, mud, clay, lotion or cream. Body wraps aid in detoxification and helps in eliminating toxins from the body through metabolic stimulation. Some body wraps can also aid in hydrating the skin and making the skin smooth and soft. 6. Thai Massage             Most spas offer Thai massage. Thai massage is one of the newest and hottest massages today. It was developed by Buddhist monks in Thailand as a healing technique. Thai massage targets the energy line of the body to increase flexibility, alleviate the tension of the muscles and joints and aids in balancing the energy systems of the body through passive stretching and gentle pressure. 7. Hot Stone Massage             Smooth and heated stones are used in this kind of massage. The stones that are being use are mostly basalt. Basalt is a volcanic rock that is black in color and has the ability to absorb and retain heat. This massage is deeply soothing and relaxing. It aims to release tight muscles using heat. 8. Spa Manicure and Pedicure             Spa manicure and pedicure includes an aromatic salt rub, or hydrating mask or paraffin dip that can make it last longer and feel more luxurious.       Types of Spa 1. Resort and Hotel Spas             Resort and hotel spa offers a wide selection of different recreational activities and facilities that includes full-service spa. Included activities are golf, tennis, horseback riding, skiing, and different water sports. Resort and hotel spas also offer dining options for the customers. The spa treatment often compliments the stay of the guests in the resort or hotel. 2. Destination Spas             All guests can participate in the full-immersion spa experience that a destination spa provides. Customers experience personalized spa experience that includes fitness programs, body treatments, spa cuisine and wide array of therapeutic spa treatments. Destination spas provide spa style treatments with accommodation or spas within accommodation environments. 3. Connoisseur Spas             Connoisseur Spas often cater to affluent markets. They offer extraordinary ambiance, luxurious accommodations, top of the line equipments and exceptional spa services. Connoisseur spas also offer outstanding cuisines. 4. Casino Spas             Casino spas offer different gaming facilities alongside with relaxing spa treatments. Vacationers need not live the premises if they choose to participate in a game of chance. This type of spa caters to vacationers who seek excitement and spa luxury at the same time. 5. Day Spas             Day spas offer simple and flexible ways of incorporating spa experience into your busy daily life. Day spas offer customers with the best breaks from their daily routine that often includes massages that soothes both the body and mind, beautifying facials and body wraps that seek to rejuvenate the body. Day spas provide professionally administered spa services that are offered to clients on a daily basis with appropriate day spa facilities. 6. Cosmetic Medical Spas             Cosmetic medical spas are often supervised by a licensed healthcare professional. Cosmetic medical spas integrate both the atmosphere of clinical-grade aesthetic enhancement and spa treatment concepts. Cosmetic Medical Spas offer cosmetic medical procedures, beauty and spa therapies. 7. Wellness Medical Spas             Wellness and preventive care are some of the major offerings of this spa type. Wellness medical spas often combine western medical concepts and complementary philosophies. 8. Dental Spas             Dental spas offer a spa luxury by incorporating spa elements into the dental practice. A dental spa integrates dental therapy with spa services. 9. Mobile Spas             Mobile spas offer services such as facials, massages, manicures and pedicures at the customer’s home or office. 10. Natural Bathing Spas             Natural bathing spas operate within a retreat location, offering extensive use of communal bathing in naturally occurring waters or mud pools with a full range of Spa services may or may not provide on site guest accommodation. A. Mineral Spring Spa                                             B. Hot Spring Spa C. Natural Mud Spa                                                 D. Sea Water Spa 11. Salon Spas             Salon Spas are beauty therapy and/or hair businesses with minimal water facilities and minimal guest amenities, which offer body therapy treatments. This type of spa aspires to provide high spa level of service and present a spa style holistic approach. 12. Spa Retreat             Spa retreat is an accommodation-based facility, offering spa and body treatments, with some water based therapy. It also offers spa cuisine or healthy food option. 13. Health Spa             Health spas operate within a retreat location, offering a full range of spa services and wellness programs that address the client’s health and lifestyle needs, providing on site guest accommodation.   Spa Equipments 1. Vicky shower – an important equipment fro a spa that is used for washing clay wraps, salts scrubs away quickly while giving the client with soothing hydro massage. 2. Wet table – a self-draining table that makes wet body treatments more easy to perform. 3. Massage chair – a massage chair that has an adjustable face cradle and chest support are being used to provide better access to the thoracic and scapular regions. Massage chairs must be versatile and at the same time comfortable. 4. Lomi Lomi tables – combination of features from other tables make lomi lomi table makes it suitable for different kinds of treatments and therapies. It has different features that will truly increase client comfort. 5. Rainbar Vicky shower – suspended from the ceiling with a flexible hose connection that allows the versatility of wet table being placed in any part of the room. 6. Lagoon wet table – makes wet body treatments like mud masks and salt scrubs easy to perform. The large draining hole that is located at the foot of the table makes drainage easier and keeps water and other materials away from the client’s head. 7. Scotch hose – a jet hose that projects water. This equipment is used to speed up the metabolism of the client by direct contact of hot and cold pressurized water to the points of pressure of the client. 8. Hydrotherapy tub – used to relieve tension in muscles and joints by providing underwater body massage. A hydrotherapy tub combines water with air jets. 9. Hot towel cabinet – used to hold towels at around 160 degrees. Commonly used for hygienic purposes. 10. Swiss shower – has a number of showerheads that are adjustable for the direction of water flow and pressure of the water.   Spa Facilities 1. Sauna 2. Steam Room 3. Spa Pool 4. Hot Tub 5. Plunge Pool 6. Relaxation Room / Lounge 7. Spa Restaurant 8. Atrium Pool 9. Physical Fitness Center    Spa Etiquette 1. Advance booking is important because some resort and hotel spas often fill up fast. 2. Be sure to inform the therapist or booking agent if you have any type of medical condition because some treatments may not be advisable for you. 3. On the day of the treatment, avoid exposure to the sun and don’t take any alcoholic beverages. 4. Don’t bring your valuable and jewelry with you to the spa. To avoid all worries and stress leave them in the hotel or resort’s safe. 5. Always try to arrive early so you can enjoy an unhurried transition into the spa. After the treatment, it is customary to vacate the room within five to ten minutes. You can spend your relaxation time ate the spa’s waiting or relaxation room. 6. On the day of the treatment, try not to take any food an hour before your schedule. Avoid consuming alcoholic beverages. Drink plenty of water. 7. Don’t smoke inside the spa premises. 8. Be sure to communicate your preferences to the therapist or personnel. Feel free to make inquiries and ask explanations about the treatment’s aspects that you do not understand.   Communication and Contraindications 1. Exfoliation             The spa therapist must explain the various methods of exfoliation to the customer. The therapist must explain the method of application for various methods of exfoliation at the point in the treatment plan in which they should be used. The therapist must also explain the contraindications of exfoliation. Total Contraindications 1. Any form of infection, disease or fewer 2. Under the influence of recreational drugs or alcohol 3. Diarrhea and vomiting 4. With medical, GP or specialist permission in circumstances – where written permission cannot be obtained, clients must indemnify their condition in writing prior to treatment. Pregnancy; Cardio vascular conditions; Hemophilia; Any condition already being treated by a GP or another complementary practitioner; Arthritis; Nervous or Psychotic conditions; Osteoporosis; Epilepsy; Recent operations; Diabetes; etc. 2. Steam and Sauna             The spa therapist must be able to explain the therapeutic effects of steam and therapeutic effects of steam and sauna treatments and must be able to explain the differences between wet and dry heat. The therapist must also explain the safety procedures required for each treatment. The therapist must explain the contraindications to Steam and Sauna. Total Contraindications 1. Any form of infection, disease or fewer 2. Under the influence of recreational drugs or alcohol 3. Diarrhea and vomiting 4. With medical, GP or specialist permission – in circumstances where written medical permission cannot be obtained clients must indemnify their condition in writing prior treatment. Pregnancy; Cardiovascular conditions; Hemophilia; Any condition already being treated by a GP or another complementary practitioner; medical edema; Any dysfunctions of the nervous system; Bells Palsy; Inflamed Nerve; Cancer; Postural deformities; Kidney infections; etc. 3. Body Masks/Wraps             The therapist must explain and ensure appropriate client care at all times. It is the therapist’s responsibility to explain and select a suitable mask for the area to be treated. The therapist must be able to explain the ingredients and their function in accordance with the manufacture’s details, The masks or wraps must be appropriately applied and demonstrate thorough removal after treatment time has elapsed. The therapist must update the client’s records accordingly. The Clients must also understand the contraindications to wraps and masks. Total Contraindications 1. Any form of infection, disease or fewer 2. Under the influence of recreational drugs or alcohol 3. Diarrhea and vomiting 4. With medical, GP or specialist permission – in circumstances where written medical permission cannot be obtained clients must indemnify their condition in writing prior treatment. Pregnancy; Cardio vascular conditions; Hemophilia; Any condition already being treated by a GP or another complementary practitioner; Arthritis; Nervous or Psychotic conditions; Osteoporosis; Epilepsy; Recent operations; Diabetes; etc. 4. Sea Water and Seaweed Treatments             The therapist must explain the different types of seaweed and their uses. The therapist must be able to explain effectively the benefits of seaweed treatments. The therapist must be able to explain the application of seaweed treatments and give background information about the history of seaweed treatments. Total Contraindications 1. Any form of infection, disease or fewer 2. Under the influence of recreational drugs or alcohol 3. Diarrhea and vomiting 4. With medical, GP or specialist permission in circumstances – where written permission cannot be obtained, clients must indemnify their condition in writing prior to treatment. Pregnancy; Cardio vascular conditions; Hemophilia; Any condition already being treated by a GP or another complementary practitioner; Arthritis; Nervous or Psychotic conditions; Osteoporosis; Epilepsy; Recent operations; Diabetes; etc. 5. Water Treatments             The therapist must explain the various ways in which water is treated to maintain hygiene. The therapist must explain how the treatment of the water may affect the hydrotherapy treatment. The changes that will occur to the body once it is immersed in water must be thoroughly explained. 6. Hydrotherapy             The benefits of hydrotherapy must be thoroughly explained to the customer. The therapist must explain the procedure for each treatment and all the safe precautions that must be taken. The therapist must be able to explain the contraindications to hydrotherapy treatment. Total Contraindications 1. Any form of infection, disease or fewer 2. Under the influence of recreational drugs or alcohol 3. Diarrhea and vomiting 4. With medical, GP or specialist permission in circumstances – where written permission cannot be obtained, clients must indemnify their condition in writing prior to treatment. Pregnancy; Cardio vascular conditions; Hemophilia; Any condition already being treated by a GP or another complementary practitioner; Arthritis; Nervous or Psychotic conditions; Osteoporosis; Epilepsy; Recent operations; Diabetes; etc.   Spa Health, Safety and Hygiene Maintenance Steam and Sauna 1. Ensure the cabinets are wiped out with sterilizing solution after every treatment 2. Ensure the benches are covered with clean paper towels for each client 3. Ensure the clients showers before entering the cabinet and that swimwear or similar is worn 4. Ensure that the treatment is explained to the client before commencement 5. Ensure the correct temperature is adhered to 6. Check temperature gauge 7. Ensure the client stays in the sauna/steam room for maximum of ten minutes 8. After ten minutes they should take warm shower or plunge in a warm pool 9. Ensure the clients drink plenty of water 10. Ensure that the client rests in the rest area and allows the body temperature to return to normal before leaving the spa       Body Masks/Wraps 1. Check consultation and contraindications 2. Explain the treatment to the client 3. Use appropriate protective sheets for the couch and floor area 4. Help the client onto the couch protecting the client’s modesty at all times 5. Apply the mask/wrap in accordance with manufacturer’s instruction 6. Wrap the client in sheets/blankets/thermal blanket, whichever is most appropriate to the treatment 7. Remove the mask/wrap at the end of the treatment Hydrotherapy 1. Ensure safety handles are available to ensure clients do not slip 2. Check the temperature gauge 3. Never leave the client unattended 4. Ensure a panic button is available 5. When using the hydrotherapy bath, ensure that half the water is drained before the client attempts to get out 6. Ensure clients shower then relax until the body temperature returns to normal before dressing 7. Ensure the water is at the right temperature for the treatment 8. Ensure the water has been treated appropriately 9. Ensure the entire spa are complies with health safety and hygiene regulations     Marketing and Promotion             One of the most powerful promotional and marketing tools today is the internet. Distance promotion can be effective in attracting the spa’s clients. The spa can also use leaflets that can be distributed to different Tourist Information Centers. The spa must be located strategically to the place where the target market can easily access the spa. Effective branding is also helpful in attracting the target market. Attractive signage must be installed. Due to the importance of the internet as a marketing and advertising tool, a website must be created be become more competitive and visible. Promotional marketing through e-mail can be useful for the business. For the clients that reside near or around the premises, mail advertising may be effective.   Conclusion             Recent innovations and developments of the spa industry have change the way people see spas. Different treatments and various facilities and equipments have been introduced to offer better service to the growing spa market. Different spa types target different customers. The spa industry now caters to different people from all walks of life with diverse interests. Today’s spa is no longer for the affluent. It has gone mainstream, and the varieties of treatments are increasing. Modern spas are places of renewal for body, mind and spirit. Modern spa targets not only the physical wellness of customers but also consider the mental, emotional and spiritual dynamics. Spas have become a place for healing and rejuvenation. Spas can be found virtually everywhere. There is a flavor for every taste. People are looking for ways to counter the stresses and pressures of everyday life. With less time available for rest and regeneration, people are looking for places where they can relax, unwind and gain relief from overindulgence and overwork. Modern spas aim to treat the mind, body and soul of each client by offering them different treatments. The treatments that modern spas offer range from wet treatments such as hydrotherapy, to dry treatments like massage and body wraps, to wellness therapies and beauty treatments. Modern spas still bring renewal and well-being, as well as allowing the clients to relax, reflect, revitalize, and rejoice.                  Pictures: Types of Spa Resort/Hotel Spa   Destination Spa       Health Spa   Hot spring Spa         Casino Spa   Day Spa Connoisseur Spa     Mobile Spa         Dental Spa       Spa Equipments   Wet Table   Vicky Shower   Massage Chair   Lomi Lomi Tables           Lagoon Wet Tables   Rainbar Vicky Shower         Scotch Hose   Hydrotherapy Tub   Hot Towel Cabinet     Spa Treatments   Therapeutic Massage Facial   Body Treatments   Reflexology   Body Wrap   Thai Massage       Hot stone Massage     Spa Facilities Sauna   Steam Room   Spa Pool   Hot Tub     Relaxation Room / Lounge   Spa Restaurant         Spa Treatment TABLE OF CONTENTS                                                                                                   Page Number Introduction                                                                                                 1 History and Development                                                                        2 Ancient Greece and the Roman Empire                                               2 Dark and the Middle Ages                                                                        3 Renaissance                                                                                               4 19th and 20th Centuries                                                                           4 Development of Modern Spas                                                                5 Medical Benefits of Spa Treatment                                                       6 Popular Spa Services and Treatments                                                            7 Types of Spa                                                                                               9 Spa Equipments                                                                                         11 Spa Facilities                                                                                               13 Spa Etiquette                                                                                               13 Communication and Contraindication                                                 14 Spa Health, Safety and Hygiene Maintenance                                   18 Marketing and Promotion                                                                        20 Conclusion                                                                                                  20     Pictures: Types of Spa                                                                                               21 Spa Equipments                                                                                         27 Spa Treatments                                                                                          32 Spa Facilities                                                                                               36 Bibliography                                                                                                39

Spa Therapy

Spa Treatment Introduction Throughout the history, people have been interested in the medicinal value of water. The medic...