Background and Problem Description
Childhood obesity is a concern for both developed and developing countries. Overweight and obesity are induced by various social and environmental factors affecting the health and physical activity of children(1). Overweight and obese children as well as teenagers are also prone to a variety of health issues and are more susceptible to premature death in adult life; both acute and long-term risks are exacerbated by childhood and teenage obesity(1). Evidence has shown that obesity can also affect children’s development, including elevated anxiety and depression(2).The key to managing this crisis is primary or secondary prevention. In the developed countries, various adaptable best practices are available. More research is needed to identify the most successful diagnosis, prevention and treatment approaches for obesity(3). Numerous mechanisms are implicated in weight control and child obesity development including biology, biological causes (the metabolic programming or epigenetics) and environmental factors. Each of these pathways is the subject of ongoing research and is possibly of substantially varying significance across individuals and communities. With the introduction of sedentary life patterns, rapidly changing eating habits greatly increase diseases related with obesity, like resistance to insulin, type 2 diabetes mellitus and metabolic syndrome. Once obesity has been identified, the primary function of treatment is of utmost significance in the form of behavioral change approaches, food restriction and physical activity. False traditional beliefs about health and nutrition, poor awareness of diet among parents and caregivers are also leading to obesity by over-protection and forced feeding. Once, due to population growth and illegal settlements with an abundance of fast-food outlets and food areas the child’s risk of becoming obese is enhanced by reduced availabilities of fast food outlets(1).
Therefore, the proposed intervention plan in this paper is “ensuring that children between 5-10 years receive proper nutrition to prevent obesity and also ensuring that their parents are aware about the nutritional requirement of their children, thus promoting nutritional knowledge among the community to promote their health, which will be achieved within a time line of 6 months”.
The biggest threat to developing and industrialised economies from public health is obesity. Multi-strategy and multi-level community-based programs in combination with safe public policy look promising to combat obesity and many nations are researching this solution. A number of community-based obesity interventions (CBI) programs, heterogeneous in finance, pacing, target audience and context, is funded and supported by various levels of government in Australia. The occurrence of obesity in adults is increasing internationally. In 2011-12, overweight (35.3%) or obese (27.5%) is 62.8% of Australian adults and overweight (18.2%) or obese (6.9%), 25.1% of children aged 2-17(4). Evidence from the 2014 global Burden of Disease study suggests that poor diet and high body weight and obesity currently represent two major risk factors that contribute to chronic disease burden in Australia(4).
Community Description and Literature Review
According to the National Obesity summit the obesity rate of the country has been increased from 56 per cent to 67 per cent from 1990 to 2019 (5). Hence, this summit has developed some plan to control the obesity rate in the country which includes the health system reform, restricting food marketing, warning labels in unhealthy foods, physical activity regimen and diet regimen development for the people with risk of obesity, educating people for reduction of obesity and developing funding body and governing body for the reduction of the obesity (5). City and city solutions show the potential for prevention of obesity mainly in schools and should promote community engagement, commitment and capacity building, strategies, built-in structures and social marketing and community shift. Other key fundamentals of effective community-based initiatives are: (a) incorporating multiple strategies; (b) working at various levels such as human, interpersonal, corporate, and environmental and public policies in the social-ecological model; and (c) increasing community participation and ownership. C) Establishing community ownership (6).
There are specific causes accounted for the development of the obesity among people and the children of the country. Surveys and the literature reviews including the government data about the obesity rate and the most impacting factors in the obesity development would be helpful in identifying the determinants of the condition (7). It has been seen that the lack of health literacy and the high rate of junk food consumption would be the most common concern or the determinants of the obesity development among the people including children (8). Hence, the specific determinant can be identified by the government data and the literatures on this topic which are junk food consumption and the lack of literacy. However, it has also been seen that that the lack of health care access and the inequity of health are also found to be effective factor in the obesity development (9). Improving food labels and menus which provide information that helps children to make their healthy choices; reducing promotion of unhealthy products for children; and improving health resources like BMI measurements for all child care providers, and enabling more actionable messages for children food product based on the latest dietary guidelines from experts will help the community to prevent obesity(6). Other plans that can be implemented are providing healthy food in schools increasing the quality of food being delivered; enhancing the nutritional quality of other products offered in schools; improving nutrition education and an improved school environment and increasing access to good food(7).
Major Stakeholders
Intervention plan must be developed and implemented with combined efforts of various stakeholders to lead to an effective outcome. Various stakeholders include agencies, school authority, community members, teachers, canteen authority for changing the nutritional supply for children, physical fitness trainers, educators, parents, nutritionist, healthcare professionals and interdisciplinary experts, government agencies working on the same and other associated members. Child obesity intervention program is a connective and collaborative approach towards reducing obesity and preventing the development of other related chronic diseases. Therefore, the involvement of these stakeholders is mandatory. It is also important to get the perception of every stakeholders involved in the process to get a better outcome. It can be noted that, involving various stakeholders in the strategic management for the intervention program requires an effective communication, collaboration and participation of different agencies and local communities who are involved in the administration and delivery of the services under the intervention program. It is also necessary to justify and review the strategic plans with the help of a suitable framework which will be used as a tool for monitoring the intervention process.
Childhood obesity is a major concern globally affecting a number of children and increasing the risk of developing other chronic conditions that can have lifelong implications, thus, decreasing the quality of life. Childhood obesity has become a chronic condition that poses life threatening complications and has negative impact on the physical as well as psychological wellbeing of the children 9 (3). Around 19-24% of the children in Australia are suffering from obesity. It has been reported that more than one in four children in Brisbane are overweight and this rate has been found to stabilize over the last 10 years to date and no health service has been found to be successful in preventing the obesity issues among the population(10). In Brisbane, Queensland, the fourth highest childhood obesity in the States was in 2016 and the region has no statistical difference(10).The risk factors for childhood obesity are many and have been recognised in the area of improper nutrition or diet, physical activity and other lifestyle factors. It has been found that effective weight management is required in order to prevent the development of different chronic diseases that can have lifelong implications and they act as risk factors for further complications and ultimately leading to mortality. Therefore, a combination of integrated, coordinated and a well conducted strategies are required to address the issue and prevent it facilitating early intervention, treatment, training and education and evaluation in order to induce significant reductions in the incidence of childhood obesity. In Brisbane North, Australia, the prevalence of childhood obesity has been found to continuously increase with a considerable increase in risks of the associated conditions like cardiometabolic diseases like diabetes. Childhood obesity has been reached to an alarming stage with the prevalence of associated comorbidities including diabetes, hypertension and other related conditions. Therefore, for this project the geographical area chosen is Brisbane North in Australia(8).
Aims and Objectives of the Project
The aims and objects are as follows-
Aim: To reduce and prevent childhood obesity through proper intervention plan.
Objectives:
- To plan or develop evidence based strategies for promoting health and reducing obesity in children.
- School based interventions.
It was found that the majority of treatments concentrated on both nutritional and physical activity behaviour, while some focused exclusively on food behaviour, after an evaluation of previous interventions (11). Around half of the approaches were based on the behavioural theory. Teachers have carried out most of the interventions almost all initiatives, except some which distributed free fruit and/or vegetable items, have a curricular component (11). In addition to curricular guidelines, some programs also used the participation of parents and families. Many programs have used environmental and policy changes. Most of the approaches have a primary school focus, because eating habits are more palatable in this age group, and transforming patterns into healthy ones can go a long way toward dealing with the problem of overweight and obesity in the childhood. In high school there was only 1 intervention (11). This could be exacerbated by the emphasis on higher-level academics. Throughout high school, safe dieting is important as teens are often obese, and follow unhealthy eating habit including, eating junk food, missing breakfasts, limiting the intake of fresh vegetables and fruits, drinking sweetened drinks, and consumption of unhealthy snacks. Potential initiatives should also be aimed at secondary school students. Some approaches centred on habits in terms of both food and physical activity while some concentrated only on activities in the diet (12). Solely a few adiposity markers as the BMI were assessed by those interventions and few of them indicated a decrease in fatty levels.The topics included: nutritional knowledge of food groups, food label reading, information about the food pyramid, self-monitoring of food consumption, ways to increase fruit and vegetation consumption, healthy eating in fast-food restaurants, self-control of food intake, self-esteem, environmental change, building self-efficacy in healthy weight. Future curricula can concentrate on certain or all these areas of childhood obesity prevention programs to establish a dietary aspect. Certain events included the participation of parents and grandparents, the organisation of fairs and markets, the encouragement of visits to their households, food sampling, opportunities to promote healthiest food at school stalls, adjustment of school meals, competitions, creation of nutritive programs, the social marketing of healthy foods, etc. in addition to providing nutritional information in the classroom. This is a quite exhaustive list of potentials to be included for prospective intervention planners Parental and social participation that has been used in multiple approaches and has the potential to influence eating habits is of particular importance (12).
Intervention Plan
Children’s diet today is rich in processed carbohydrate, added fat, sugar and salt, especially in low income, undeserved urban populations. Sugar intake is a primary risk factor for chronic metabolic disorders, for example overweight and obesity, type 2 diabetes and reduced dental health. The latest cohort study meta-analysis of children revealed that one or more sugar-sweetened beverages (SSB) dietary amounts were shown to be substantially higher risk of excessive weight or obesity. While the intake of SSB in recent decades has decreased marginally, the consumption is still high especially in young people, reaching 10-15% of the total amount of calorie. However, a new nationally representative study reported no decrease in the percentage of total caloric intake of additional sugar in US children (at 14% of the total daily energy supply (calorie)) in foods as well as beverages. Such findings indicate that the added sugar in the diet of children is essential for items such as grain sweets, candy and other snacks. Children with higher intakes of sugar drinks are more likely to snack than those who drink less (13).Dietary patterns of a person’s dietary environment are strongly influenced. Food and unhealthy food advertisements target low-income minority communities disproportionately. Earlier studies have shown the possibility of bad dieting and obesity in low-income areas where there is limited access to healthy foods (13). Individuals with low revenue are more likely to live in small food markets with less healthy food quality and greater access to low-nutritional high-energy products and larger portion sizes (12).
Proposed strategies and evaluation plan-
Interventions including diet along with physical activity have found to reduce the risk of obesity in young children aged between 0 to 5 years as the childhood obesity is one of the most prominent factors (4). There is no strong evidence supporting the fact that dietary interventions are beneficial alone. The strategy of the prevention of this mal condition would be mostly focusing on the dietary education providence including warning and spreading awareness about the junk food consumption. Moreover, the inclusion of the physical activity plans for the children would also be effective in the knowledge development regarding obesity prevention would be effective strategy (10). Therefore, the first strategy is to modify their diet plan by giving their parents proper education through educational campaigns.
It has been found that interventions focusing only on physical activity alone are not very effective in the children at this age. On the contrary, interventions that focus on diet and nutrition combined with physical activity are found to be effective in these children (11). For obese children, it is necessary that they maintain a healthy diet followed by proper physical activity. Children with obesity must follow a proper diet plan covering all the necessary requirements of the body. Therefore, the intervention plan for this project is based on nutritional and diet changes appropriate for obese children to meet the nutritional need of the body and prevent obesity. Therefore, approaches will be taken to educate the children and their parents about nutrition and the food that should be avoided to promote their health (10).
Evaluation Plan
Obesity is a nutrition related disorder generally caused by an imbalance between dietary energy intake and energy expenditure. The root cause of obesity is consumption of fast food, which have a higher fat content, higher energy density and high amount of fiber have been found to be related with obesity. Evidences have also shown that a higher consumption of carbohydrates, particularly those which are in more refined form (5). There are many evidences showing that an increase in the consumption of carbohydrates upsurges the obesity in children, thus, in order to reduce obesity, intervention plan should be developed and implemented targeted to this area. Therefore, necessary measures will be taken to ensure consumption of healthy nutrients and avoid consumption of foods that are rich in carbohydrates (6).
The creation of innovative preventive and pre-school education services is perceived to be a vital step in the life cycle against the childhood obesity (11). The overall objective of the present project is to assess the efficacy of healthy eating and prevention of childhood obesity. As child obesity is a multi-determined condition, researchers argue now that over-weight and obesity determinants of child risk factors must be influenced by obesity prevention and intervention strategies (i.e. increasing high calorie, poor nutrient consumption, sedentary behaviours, and physical lack as well as parenting behaviours). Therefore, the intervention plan developed aims to promote safe dietary habits and early-age behaviours. It is a highly structured social system that will encourage parents to develop healthy behaviours and make changes in healthy behaviour (12).
Children will be provided with posters and leaflets containing information with pictures to educate them on the importance of diet and nutrition and maintain healthy eating habits. They must be encouraged to practice healthy eating with the help of colourful posters or pictures (13).
The family is the main entity affecting preschool children; thus, many of the possible evolving determinants in pre-school years of risk factors for overweight and obesity will have family roots (13). Positive correlations have been recorded between certain facets of child wellbeing and pre-choice childhood overweight / obesity: parental activities and the attitudes promoting such policies, including maternal eating habits such as limiting access to food and insisting on food; decreased parental support for health promotion strategies (e.g., fewer pro-health funding) (14).
Project success
The Children’s Eating Questionnaire will be used for the evaluation of childhood eating habits, particularly in terms of fussiness and satiety response a semi-quantitative analysis of the food level produced for Australian Brisbane preschool children will be used as a framework for determining average consumption for children and their parents. The questionnaire will be based on eating and physical activities and will be a document specifically dealing with foods related to literary obesity-especially beverages, fruits and vegetables, packaged snack foods and food for takeaway (1). Quantities according to household measurements in general which apply either to their corresponding day or to their typical consumption and their serving proportions will be based on the Australian Healthy Eating Handbook. Awareness about child nutrition will be measured with the Nutrition Knowledge Questionnaire sub-scales (5). The key outcome of this intervention is the intake of eating habits of children. Significant factors include the expected health effects of the method and the uncertainty in the primary outcome calculation. For the consumption of food, improvements in the sample size will be needed in conjunction with other nutritional results, such as sweet drinks, packaged treats (e.g. popcorn, chocolate bar), sweets / cookies and fruit depending on sample size studies. Sample size checking will be appropriate (7).
Sustainability Plan
The evaluation will be focused on the women empowerment and also impacting over the children food behaviour. The community based program will be focusing on the 0 to 5 years old children and the mother and other elder women of the families of the community. This project will be inclusive of the community children and the family members as these will help in the development of the awareness and the acceptance (9).
The impact of the program will be seen in the change of rate of the obesity among the children of the community. Moreover, the grandmother and the mother awareness change can also be achieved by this project. The community acceptance of the change and the positive attitude development of the people of the community regarding the obesity reduction can also be the impact of the project (15).
Knowledge and attitude change long with the change in the rate of the obesity among children and the community people will be the expected outcome of the project. The knowledge specifies the knowledge about the diet and the effects of the negative practices over the body. The factor of the development of the program will be considering the awareness of the community people regarding the obesity (16).
Conclusion
Based on the above discussion it can be concluded that the obesity of the people and the children of Australia is higher due to lack of education and junk food consumption. Hence, the development of the program for the reduction of the obesity by the development of the education rate and the awareness of the community people will be very much effective. Hence, the literature review and the survey regarding this topic should be considered more effectively. On this context it can also be stated that project for the obesity reduction should be focused on the social determinants of health and the reduction of these causes effectively.
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