Weight problems has reached global outbreak proportions, and has become a significant health problem of out society. According to Peeters ain al. (2007), 32% or perhaps 60 mil people are today obese in the usa.
The condition grows as a result of the interaction between genetics, lifestyle behavior, and cultural and environmental impact on. Fat accumulates when more energy can be consumed than expended. The National Cardiovascular, Lung, and Blood Start (NHLBI) has adopted a classification system of body mass index (BMI).
BMI, the indirect measure of body fat, recognizes the obese and obese individuals. A BMI of 25-29 kg/m2 is considered overweight, 30-34 kg/m2 is mild obesity, 35-39 kg/m2 is usually moderate unhealthy weight, and previously mentioned 40 kg/m2 is severe obesity (Palamara, Mogul, Peterson, Frishman, 2006). Obesity develops due to high-fat, high carbohydrate diet coupled with a decline in physical exercise. Modern living conditions, eating habits, and quality of food result in over-consumption of cheap, super measured portions. More cars, tracks, and junk food restaurants at every corner, as well as quick, willing to eat microwavable dinners packed with fat, sodium, and simple carbohydrates are easier and quite often less expensive than nutritious, top quality food products.
Furthermore, the technology has made human beings rely on mechanised devices. The automated developments designed to generate life much easier, perform 1000s of tasks that in the past essential physical labor. As a result of sedentary life and over-consumption, the excessive fat gathers up in the body, and might have significant health implications. Multiple studies have says excessive fat gain increases the likelihood of diabetes, hypertension, dyslipidemia, heart disease, stroke, osteoarthritis, and many varieties of cancer.
In particular, abdominal weight problems has been recognized as strongly linked to the development of diabetes and development of heart diseases (Behn & Ur, 2006) (Chen et al., 2007) (Balkau ou al., 2007) (Despres, 2007). Due to the hazardous health risks of obesity, it really is considered a condition that requires treatment (Palamara ou al., 2006). The Centers for Disease Control and Prevention (n. d. ) estimated that medical expenditures related to overweight cost $92. 6 billion in the year 2002, and the state causes three hundred, 000 deaths per year.
Even so, prevention of the multiple wellness consequences of obesity can be done by fat loss. Bardia, Holtan, Slezak and Thompson (2007) suggested that: “Even a tiny decrease in a patient’s pounds would result in better power over multiple illnesses, enhance quality lifestyle, greatly improve a patient’s morbidity, and result in lower health care work with and medical costs”. Additionally to preventing many diseases, weight reduction can improve the already present disorders.
Research indicates that weight decrease of 4% to 8% is definitely associated with a decrease of systolic and diastolic blood pressure by simply 3 mmHg (Mulrow ainsi que al., 1998). The main weight reducing concours include: diet, exercise, psychological, behavioral, pharmacotherapy, surgery, and alternative therapies (Vlassov, 2001). However , the future effectiveness of those interventions have not proven effective, while majority of persons regain their very own weight following losing this (Biaggioni, 2008).
Guidelines to get weight reduction recommended by NHLBI involve this: initial reduction of 10% of body mass, low calorie diet (800-1500 kcal/d); thirty percent calories from fat, 15% calories from protein, and 55% calorie consumption from sugars, daily shortage of 500-1000 kcal to shed one to two pounds per week during six months, long-term weight routine service, and exercise for 35 to forty five minutes three to five days a week (Palamara et approach., 2006). Physicians are facing the elimination and supervision of a main cause of morbidity and mortality for which effective life long surgery are anxiously needed. EXAMPLE Bob is known as a 38 year old white male.
Except for hypertension, he considers himself healthy. He offers seen his family doctor 90 days ago pertaining to regular blood pressure check up, as he does just about every six months. Greg is married, has four adolescent children, and happens to be an automobile dealer for 18 years.
Previous medical history: hypertonie, obesity, hyperlipidemia Allergies: non-e to prescription drugs, latex, pets, foods, or environmental Hospitalizations / surgeries / traumas: tonsillectomy in childhood Medications: lisinopril 20mg orally daily Family health background: mother and brother with hypertension Interpersonal history: lives with better half and children, all very supportive of each and every other, get along well, beverages 2 glasses of whiskey socially on week-ends, denies smoking cigarettes or dubious substance employ Physical activities: taking walks on treadmill machine for 20 minutes once or twice a week, sometimes plays football with family on week-ends Daily consumption patterns: lunch break – four sandwiches with cheese and ham; lunchtime – organic soup, cooked or toast sausage; meal – salad, lots of potatoes, 2 servings of steak or meatloaf or chicken, pickled fruit and vegetables; supper – pasta with sauce or pizza; treats – potato chips, cookies, chocolate, pretzels and fruits, all throughout the day; liquids – 8 glasses of soda, juice, normal water or milk. Review of devices: unremarkable, zero complaints.
Pounds: 280 pounds, Height: 6’3?, Waist circumference: 52?, BMI: 35kg/m², BP: 150/90 mmHg Most recent abnormal laboratory assessments: total cholesterol – 230, triglycerides – 310 All the other results including glucose, bloodstream count, BUN, creatinine, and liver enzymes were within normal range. Bob confessed that weight loss has been one of the greatest challenges for him. His a lot of previous efforts at fat loss have been defeated.
He portrayed willingness and readiness to try again, but was worried that he would not be able to stick to the plan long term. Bob’s family was incredibly supportive, and willing to help along with his weight loss attempts. To identify the health risks of obesity, and also to determine interventions to reduce those risks, analysis articles were examined. The search for relevant studies was conducted applying OVID MEDLINE, PUB MEDITERRANEAN SEA, CINAHL, and COCHRANE directories. SUMMARY OF LITERATURE Dietary interventions form the fundamental element of the supervision of overweight.
There is a wide variety of possible diet plans, but simply no consensus on which is the most powerful for weight reduction. A review simply by Noakes and Clifton (2004) compared the effects of a low carbs diet and a low body fat diet. General, the studies revealed that an extremely low carbohydrate diet triggered significantly more fat loss than reduced fat diet in the short to medium term. On the other hand, a moderately low carbohydrate diet plan resulted in related weight loss being a low fat diet plan.
Moreover, the low and moderately low carbohydrate diets have been found to more effectively reduce triglyceride, and increase high density lipoprotein (HDL) amounts compared to zero fat diet. Again, comparison between the low carbohydrate and zero fat diets was performed by Lecheminant et al. (2007). In a quazi-experimental design, 102 participants had been assigned either to a low carbohydrate (LC) or a low-fat (LF) group.
Both groupings followed a really low energy diet and lost significant body weight (LC 20. four kg, LF 19. you kg) and waist circumference. The differences between the two groupings were not statistically significant. Besides the diet, all participants were involved in fast walking 300 minutes a week, and all had been issued pedometers to screen their improvement. Also, the two groups had been equally good at preventing fat re-gain over six months, and both groups were found to have a lowered blood pressure due to weight loss. Similarly, a systematic assessment by Pirozzo, Summerbell, Cameron j. and Glasziou (2002) compared the effects of a minimal fat diet to low calorie diet and low carbohydrate diet plan.
Six randomized controlled tests with a total of 594 participants had been analyzed over a period of six to eighteen months. Overall results demonstrated nonsignificant differences in weight-loss, weight maintenance, serum lipids, and blood pressure between each of the diets examined. Moreover, a single year randomized trial by simply Dansinger, Gleason and Griffith (2005) in comparison Atkins, Zone, Weight Watchers, and Ornish diets.
A single centre randomized trial assigned 160 participants among the four diet plan groups. After one year, every diet groupings were identified to have significantly reduced weight and waistline size, without significant dissimilarities between groupings. Similarly to previous studies, low carbohydrate diets reduced triglycerides and diastolic blood pressure, every except Ornish diet group increased very dense lipoprotein (HDL), and all other than Atkins diet plan group lowered low density lipoprotein (LDL). In addition to energy restriction through the diet, energy spending may boost weight loss.
Within a meta-analysis by Shaw, Gennat, O’Rourke and Del Mar (2006), forty one randomized controlled clinical trials were analyzed to look for the effects of exercise in over weight and obese adults. The multiple exercise interventions included walking, exercising, cycle ergometry, weight training, aerobic exercises, treadmill, stair stepping, grooving, ball video games, calisthenics, drinking juices, and aqua jogging. The 3476 members exercised three to five days weekly for a typical duration of 45 minutes each day.
Several of the studies in contrast exercise to diet both alone or in combination with work out. The results revealed that work out alone resulted in marginal weight loss, but when combined with diet created significant weight-loss. Moreover, assessing the powers of the various types of exercise activities, it had been found that both everywhere intensity exercises were associated with weight loss. non-etheless, high intensity induced only more weight reduction than low power, but when the diet component was added, the between everywhere intensity has not been significant. Additionally , the conclusions revealed that systolic blood pressure lowering was loved by diet above exercise, and diastolic blood pressure was lowered equally likely by exercise as by diet.
Furthermore, exercise did not reduce hypercholesteria levels, unfortunately he found to reduce triglycerides evenly well since diet. Individuals involved in the physical exercise trials improved diastolic blood pressure, triglyceride, very dense lipoprotein, and glucose levels no matter whether they dropped weight. Probably the most difficult areas of weight loss strategies is constant adherence to exercise. A meta-analysis by Richardson ain al. viewed the effects of jogging in weight reduction (2008).
307 participants in 9 interventional studies were supplied with pedometers to monitor stage count. Pedometers served because motivational equipment to do it yourself monitor and reach the goals of walking. The participants logged the daily recorded steps, and examined their effects during conferences. On average about 0. 05 kg was lost a week after strolling two thousands of to four thousand methods per day.
Even though the amount of weight shed in the studies was small , adherence to walking applications and raising step count according to preset desired goals is important to get the beneficial effects on overall health. The exercise reduced the risk of cardiovascular situations, lowered stress, and helped maintain lean body mass of the participants. The research have shown the use of measuring device is helpful in monitoring the progress of physical activity, which is a good way to motivate continued embrace walking.
An additional meta-analysis as opposed different mental interventions and their effects about weight reduction (Shaw, O’Rourke, De Mar, Kenardy, 2005). thirty-six randomized controlled clinical trials including 3495 participants were assessed. The majority of studies assessed the consequence of behavioral concours on fat loss. The life long clinical connection with the members ranged from several to 80 weeks, with sessions lasting 60 minutes regular. The techniques included stimulation control, goal setting, and self-monitoring.
The solutions enhanced nutritional restraints by giving adaptive diet strategies, and by increasing determination for activities, and to preserve adherence for the healthier lifestyle. Behavioral therapy was successful by decreasing weight as a stand-alone strategy (2. 5 kg), and even higher weight reduction was attained once combined with shedding pounds (4. being unfaithful kg).
Several evaluated research also evaluated cognitive therapy, psychiatric therapy, relaxation therapy, and hypnotherapists, but the outcomes of these either did not disclose significant weight-loss, or triggered weight gain. In addition, a number of studies found the weight loss was associated with reductions in systolic and diastolic blood pressure, serum cholesterol, triglycerides, and fasting plasma blood sugar. These studies once again confirm the important health rewards of reducing weight. Overall, the study suggests that most diets happen to be equally good at weight reduction.
There are multiple basically popular diets known, and according to Dansinger ou al. (2005), more than one thousands of diet literature are now attainable. Instead of looking for the best obtainable, obese individuals should be suggested that any kind of diet would be more effective than the one they may be currently consuming. Moreover, diet plan modification has been shown to be more effective than exercise, but the two are beneficial in reducing heart risk factors.
Exercise does not have to be strong, and jogging in most times of the week is sufficient intended for risk lowering when continuing long term. Finally, addition of behavioral affluence may enhance motivation and self monitoring, and boost weight loss maintenance. INTERVENTIONS AND RESULTS Frank was presented with the materials findings upon health risks and health promotion, and was encouraged to lose weight by diet plan, and involvement in more physical exercises. He was introduced with the feasible options, and it was advised that this individual participates in designing his weight loss plan.
That way Bob could have more control over the surgery, and was able to incorporate his preferences. Frank identified his perceived great things about losing weight while: improved body image, mood, physical fitness and agility, reduced stress, and lowered risk of comorbidities. The main boundaries were mainly the capacity eliminate favourite foods, and occasional apathy to perform physical exercises. Instead of beginning one of the multiple popular diet plans, Bob chosen to reduce his portion sizes in the beginning by 30%, substitute an evening meal and snack foods by vegatables and fruits, and eliminate soda and juice. To assure smaller section sizes, Greg was urged to use a more compact plate than usual.
He also agreed to beverage at least two liters of drinking water a day, particularly with meals, to succeed in satiety quicker. He was motivated to keep a journal of his daily intakes of food and drink to monitor his diet, and to identify a lot of hidden types of excess consumption. Moreover, in order to avoid excess consuming, Bob was instructed to eat at the table, and also to not let family members to have any foodstuff while seated on the couch or before the computer.
He also chose to become more physically active, and his selection of daily workout was jogging. Bob was encouraged to purchase a pedometer to monitor progress in physical activity, aiming for at least two thousand steps each day. Richardson ainsi que al. (2008) informed a two 1, 000 step walk was predicted to equivalent one mile.
Bob was also prompted to set weekly walking desired goals, slowly increasing his stage count. Bob’s family was also involved with his make an effort to lose weight. To aid him obtain his goals, family members designed to show support for Bob’s exercise simply by joining him. Furthermore, Bob was encouraged to identify scenarios of everyday living providing chances for more physical activities, for example parking further away from the entrance at the office and supermarket. Weekly conferences evaluated Bob’s progress, and discussed about difficulties of following the strategy.
Bob continued to be strongly determined throughout the eight weeks of intervention, and successfully come to most of his weekly nutritional and physical exercise goals. Servings of his meals decreased steadily right up until no more than 50 percent of first food intake was reached, plus the snacks included fruits and vegetables only. Daily stage count reached up to half a dozen thousand ways on some days, and daily walks through the recreation area with his partner became a pleasurable routine. To everyone’s shock, during the third week Joe decided to accompany his sons to the fitness center twice a week, where he swam in the pool area for one hour.
He portrayed feeling stimulated after any physical activity. Many small slips back were documented when Frank missed a couple of days of jogging, and could certainly not resist eating high calorie or large fat food. At the end of eight several weeks of surgery, Bob provides lost 9 pounds, reduced his BODY MASS INDEX to thirty-three. 9 kg/m², and his stomach circumference lowered by 1 ) 25 in .. Also, his systolic and diastolic blood pressure was a little bit reduced.
However, the effect within the blood lipid level has not been tested. In conclusion, during just eight weeks Bob converted from relatively obese to mildly obese, and remained motivated to carry on the weight loss plan. DISCUSSION Research has revealed that any diet, as long as caloric intake is restricted, will result in fat loss. It has been worked out that to lose one pound a week, speculate if this trade to restrict diet by five-hundred kcal each day. Patients frequently get discouraged by the slow effects of weight loss.
However, studies point that “more restrictive diet plans have decrease compliance prices and increased weight regain” (Palamara ain al., 2006). Unfortunately, burning off the weight is usually not the greatest challenge. What folks mostly are unsuccessful at is definitely maintaining the reduced excess weight. Effective fat maintenance needs not only lessening energy intake and raising energy expenses, but also modification of behaviors that predispose to weight gain.
Joe monitored his daily dietary intake, and avoided conditions leading to overindulging. Also, the pedometer monitored the amount of going for walks, and served as a mindset tool. Furthermore, intrinsic determination for physical exercises, as described by Teixeira et ing. (2006), may be the satisfaction by participating in a task, while extrinsic motivation identifies the desire of slimmer physical appearance, and weight reduction. The experts presented that the extrinsic purposes correlated with short-term weight loss, whereas intrinsic causes predicted long-term results.
Frank expressed enjoyment of daily moves through the recreation area, which correlates with intrinsic motivation, and so he is likely to continue above longer period of time. It is important that diet or exercise is maintained pertaining to the enjoyment and great feelings caused by the activity. IMPLICATIONS OF RESULTS FOR MEDICAL PRACTICE The continuing within obesity and related risk factors, and failure of maintaining long-term weight loss bring about increasing prevalence of comorbidities. Health care costs related to treating ailments resulting from obesity is going to continue to rise, except if health care providers make use of more effective actions to deal with the situation.
Promoting healthy nutrition and lifestyle early on may prevent the introduction of obesity. It is a great challenge to get nurse practitioners to aid patients preserve their fat. Although the recommended compositions of varied diets incorporate specific levels of fats, sugars, and protein, the research revealed that it is the total caloric articles that is responsible for weight loss, in spite of nutrient partitioning. Once the sufferer is willing to commit, the treatment strategy should be created together.
Considering that the variety of diet plan options have already been shown to possess similar effects, the nurse practitioner can help match the nutritional plan with patient’s diet preferences. Even though diet was found being more effective in weight reduction than exercise, individuals with heart risk factors should be educated about some great benefits of physical activities. It is important to inspire continuous participation in work out, even when zero reduction of weight is observed.
Changes in lifestyle can be hard to sustain intended for the patient, consequently continuous support and inspiration by a nurse practitioner are necessary. The interventions need dedication of both, the individual and the nurse practitioner. Also, guidance patient’s friends and family, and encouraging to get involved in liked one’s have difficulty through weight loss and weight maintenance may possibly provide extra support, and contribute to long-term behavior adjustments.
Behavioral tactics such as encouraging setting ideal goals, personal monitoring and evaluation may increase the chance of success. Patient’s satisfaction with all the choice of diet and physical activity, and effective long term adherence are the best predictors of ongoing weight routine service. CONCLUSION The comorbidities associated with obesity substantially lower the individual’s quality lifestyle, and are also turning out to be an enormous burden on medical. Successful treatment and prevention of obesity can decrease the occurrence of its difficulties.
Dieting is definitely resented by most individuals, it is therefore necessary to help patients to find appropriate and motivating affluence that can be successfully followed long term. Patient’s motivation to commit to a long term faith is essential to permanent changes in lifestyle. It is a long and difficult journey from choosing to lose weight towards the successful long term results, although even tiny losses of weight can produce important health improvements. REFERENCES Bardia, A., Holtan, S. G., Slezak, M. M., Thompson, W. G. (2007, August). Diagnosis of overweight by principal care doctors and influence on obesity management. _Mayo Clinic Proceedings, 82_(8), 927-32.
Retrieved February several, 2008, via OVID MEDLINE database. Behn, A., Your, E. (2006, July). The obesity outbreak and its heart consequences. _Current Opinion in Cardiology, 21_(4), 353-60. Gathered February six, 2008, from OVID MEDLINE database. Biaggioni, I. (2008, Feb).
Should we concentrate on the sympathetic nervous program in the take care of obesity-associated hypertension? _Hypertension, 51_(2), 168-71. Retrieved April some, 2008, by OVID MEDLINE database. Chen, L., Peeters, A., Magliano, D. L., Shaw, L. E., Welborn, T. A., Wolfe, Ur., Zimmet, S. Z., Tonkin, A. Meters. (2007, December). Anthropometric measures and absolute cardiovascular risk estimates in the Australian Diabetes, Obesity and Lifestyle (AusDiab) Study. _European Journal of Cardiovascular Elimination & Treatment, 14_(6), 740-5.
Retrieved March 7, 2008, from OVID MEDLINE repository. Dansinger, Meters. L., Gleason, J. A., Griffith, L. L., ain al. (2005).
Comparison of the Atkins, Ornish, Weight Watchers, and Zone diets for weight loss and heart disease risk reduction. _Journal of American Medical Association, 293, _ 43-53. Retrieved Feb . 5, 08, from Digital Journals. Centers for Disease Control and Prevention (CDC). (n. d. ). _Overweight and obesity: Economic consequences, 2007. _ Retrieved March 7, 08, from http://www.cdc.gov/nccdphp/dnpa/obesity/economic_consequences.htm Despres, M. P. (2007, June). Heart problems under the influence of excessive visceral fat. _Critical Pathways in Cardiology: A Diary of Evidence-Based Medicine, 6_(2), 51-9.
Recovered February 5, 2008, via OVID MEDLINE database. Lecheminant, J. D., Gibson, C. A., Sullivan, D. K., Hall, S i9000., Washburn, 3rd there�s r., Vernon, M. C., Curry, C., Stewart, E., Westman, E. C., Donnelly, J. E. (2007, November). Comparison of a low carbs and low fat diet intended for weight routine service in obese or overweight adults enrolled in a specialized medical weight management system. _Nutrition Log, 6, _ 36. Recovered February several, 2008, by PubMed database.
Mulrow, C. D., Chiquette, E., Angel, L., Cornell, J., Summerbell, C., Anagnostelis, B., Manufacturer, M., Grimm, R. Junior. (1998). Diets to reduce body weight for managing hypertension in adults. _Cochrane Hypertonie Group. Cochrane Database of Systematic Reviews, (4), _ CD000484. Recovered February 5, 2008, by COCHRANE database.
Noakes, M., Clifton, S. (2004, February). Weight loss, diet composition and cardiovascular risk. _Current Opinion in Lipidology, 15_(1), 31-35. Retrieved February 5, 08, from OVID MEDLINE repository. Palamara, K. L., Mogul, H. Ur., Peterson, S i9000.
J., Frishman, W. L. (2006). Overweight: new perspectives and pharmacotherapies. _Cardiology for reviewing, 14_(5), 238-58. Retrieved Feb 7, 2008, from OVID MEDLINE data source.
Peeters, A., O’Brien, P. E., Laurie, C., Anderson, M., Wolfe, R., Flum, D., MacInnis, R. L., English, Deb. R., Dixon, J. (2007, December). Significant intentional weight-loss and fatality in the severely obese. _Annals of Surgery, 246_(6), 1028-33.
Retrieved February 7, 2008, from OVID MEDLINE data source. Pirozzo, S., Summerbell, C., Cameron, C., Glasziou, S. (2002). Guidance on low-fat diets for obesity. _Cochrane Metabolic and Endocrine Disorders Group. Cochrane Database of Systematic Testimonials, (2), _ CD003640.
Gathered February 5, 2008, by COCHRANE data source. Shaw, E., Gennat, H., O’Rourke, P., Del Scar, C. (2006). Exercise pertaining to overweight or obesity. _Cochrane Metabolic and Endocrine Disorders Group. Cochrane Database of Systematic Reviews, (4), _ CD003817.
Recovered February your five, 2008, by COCHRANE repository. Shaw, K., O’Rourke, G., Del Mar, C., Kenardy, J. (2005). Psychological concours for obese or unhealthy weight. _Cochrane Metabolic and Endocrine Disorders Group.
Cochrane Database of Methodical Reviews, (2), _ CD003818. Retrieved February 7, 08, from COCHRANE database. Teixeira, P. M., Going, S i9000. B., Houtkooper, L. B., Cussler, At the.
C., Metcalfe, L. L., Blew, R. M., Sardinha, L. N., Lohman, Capital t. G. (2006, Jan). Work out motivation, ingesting, and body image variables as predictors of weight control. _Medicine & Research in Sports activities & Workout, 38_(1), 179-88. Retrieved The spring 4, 08, from OVID MEDLINE repository.
Vlassov, Sixth is v. V., (2001). Weight reduction for reducing mortality in weight problems and overweight. _Cochrane Metabolic and Endocrine Disorders Group. Cochrane Database of Methodical Reviews, (3), _ CD003203.
Retrieved Feb 5, 2008, from COCHRANE database.
Promoting Health Internationally Essay
Developing countries are beset with health downturn to a greater extent than their even more developed alternative. The lack of solutions and the existence of numerous challenging needs triggers the ...
The video game console wars Essay
1 . Compare Nintendo’s web marketing strategy for the Wii with Sony’s strategy for PS3. Right at the end of 06\, two video game console sector giants, Manufacturers and Sony ...
Labour Law & Industrial Relations Essay
If the objection not achieved satisfactorily DOL may reject the application Thinking of the BEKV?M shall be last Any party aggrieved by judgement of Labour Courtroom may opt to appeal ...
Global Perspective on Health Policy Essay
The questionable issue of healthcare insurance coverage for all individuals is an ethical and moral issue that Us citizens struggle with as socially aggressive as they are my own are ...
Sdlc with Example Essay
The SDLC has become a part of the THAT community since the inception in the modern digital computer. A course in Systems Analysis and Style is required in most Supervision ...
Ways to Reduce Global Warming Essay
Around the world refers to the gradual increase in the Earth’s temperature due to the growing concentration of human caused green house gases which are co2, chlorofluorocarbons and hydro fluorocarbon ...
MG420 DLC Labor Relations Essay
1 ) Define the word “collective bargaining” and list and illustrate four issues that are mandatory components of a collective bargaining agreement. Efficiency, equity, and voice, they are the three ...
A New Work Ethic Essay
The following questions are to support us evaluate and maybe possibly understand exactly where business in America is going, especially with a capitalist culture. 1 . Explain how typical the ...
Legal Safety and Regulatory Requirements Essay
Human resources was created to make sure the corporation reaches their goals, which is to maximize returns on investment from the organization’s human capital and lessen financial risk, providing the ...