Background And Context

Define and/or describe the health issue and community for the project clearly.

Health promotion project plan- “Adelaide Obesity prevention initiative”

The present project is focused on obesity prevention in Adelaide community in Australia. The project has the aim of reducing the prevalence rate of obesity among adults residing in the Adelaide area by 10% by the year 2020. The proposed project has a three year time frame according to which monitoring objectives and sub-objectives are included at the end of two years and three years. The total budget of the project is set at $75,000.

One of the greatest public health concerns that Australia faces at present is obesity epidemic. Obesity is the medical condition in which individuals have excess body fat accumulated to an extent that there are adverse effects on the health condition of the individual. Obesity has been proved to be caused as a result of a combination of factors such as sedentary lifestyle, genetic susceptibility and inappropriate diet (1). Obesity is a national health concern for many industrialized countries such as Australia since obesity has been repeatedly linked with different diseases such as type 2 diabetes, cardiovascular diseases, obstructive sleep apnea, depression, certain forms of cancer and osteoarthritis. The condition is a leading cause of death across the world. It is to be noted that obesity is a preventable condition that needs an amalgamation of personal and social changes (2).

Adelaide is the capital city of the state of South Australia and is one of the most populous cities of Australia. The total area is 3,257. 7 kilometer square. The total population is estimated to be 1,333,927 and more than 75 percent of south Australian population living in this area. As a result, Adelaide is the most centralized population of any state in the country (3).
Health issue justification

The prevalence of obesity and overweight has been found to increase with a speedy rate in the past two decades. The condition is not a new area for prevention on the national scale. Addressing obesity is a prime agenda at present due for achieving best outcomes of the population of the country (4).

Obesity is a serious chronic condition and the mortality rate of patients suffering from this condition is high due to the comorbid conditions. People suffering from obesity are at increased risk of suffering from the following health conditions-

• High blood pressure
• Type 2 diabetes
• Stroke
• High LDL cholesterol
• Gall bladder disease
• Osteoarthritis
• Low quality of life
• Body pain
• Mental illness (5)

Research indicates that South Australia is the fattest state in Australia. Latest government reports indicate that South Australia is known for having the highest proportion of obese and overweight individuals. In 2014-15, around 11.2 million people were obese or overweight in the country. The national rate was 63.4 per cent. Among them, 4.9 million were adults. This implied that one in four people are obese in Australia.

A summary of evidence to justify the selected health issue based on a total of five (5) criteria for priority setting.

The proportion is 73.3 per cent that follows the statistics of 71 per cent of western NSW. In Adelaide, the obesity and overweight rate has increased considerably to reach 63 per cent. When the focus is given on obese people, individuals living in eastern and central Sydney had 16 per cent chances of being obese while those living in South Australia were 38.1 per cent more likely to be obese (6).

Obesity and overweight in Australia and particularly South Australia have drastic economic consequences for the community, individuals and the government at large. As per reports, in 2003, the direct cost of obesity at a national basis was $1.3 billion per annum. South Australia accounted for $100 million per annum at the same year. In 2006, national estimate of the costs was at 3.767 billion per annum (7).

Research into the implications for rising rates of obesity highlight that obesity is related to loss of productivity and costs gained as a result of disability and sickness. Due to an increase in rate of chronic diseases as a result of obesity, the pressure on the health care system to support services is well felt (8). Increased challenges in diagnosis, increased demand for addressing complex conditions are well known. Further, there is an increased need of care professionals who are skilled enough to educate and care for patients (9).

Prevention of obesity is at present a high priority for the government of South Australia (SA) and acts as a major health reform agenda. Target had been set previously to reduce the percentage of obese individuals in the state by 2014. South Australia’s Eat Well Be Active Healthy Weight Strategy 2006-2010 (the Healthy Weight Strategy) provided an overarching framework for combating obesity and promote normal and healthy body weight. 

A number of programs have been implemented previously that aimed to integrate cooperation of national bodies into the proposed initiatives. Health department of SA provides coordination and leadership for funding of program directed at obesity prevention. Some of the notable programs are-

• Workplace Physical Activity Program
• Healthy Parks Healthy People Strategy
• Right Bite (10)

SA has different support services that are motivated to engage in addressing the selected health issue after acknowledging the importance of the same. The support services are as follow-

• Department of Health, SA
• Department for Environment and Heritage (DEH)
• Department of Transport, Energy and Infrastructure
• Department of Education and Children’s Services
• Royal Adelaide hospital with skilled and competent professionals (11)

Objective:

Changing the food environment for obesity prevention has been repeatedly highlighted in literature. The food environment has been found have an overall impact on the nutritional health of the community populations. This can be defined as the types of food accessible to an individual and the consumption of the same. Coming into discussion about obesity, access to poor nutritious food through supermarkets and other convenience stores have been linked with the increasing prevalence of the condition. At the same time, lack of access to healthy foods is also a notable cause of obesity. The relationship between food consumption and obesity has undergone a drastic change in the recent years (12).

A critical literature review of evidence used to develop each of the project goals, objectives, and sub-objectives on how the health issue has been addressed before.

Sub objective:

Whether consumption of fresh fruits and vegetables reduce the chances of obesity has been discussed in studies. A number of epidemiological studies have indicated that fruit and vegetable intake has beneficial effects on diseases such as stroke, cancer and heart diseases. The results of studies assessing effect of fruit and vegetable consumption on health are positive in relation to hypertension, chronic obstructive pulmonary diseases and cataracts. The underlying concept is that nutrients present in fruits and vegetables work in a synergistic manner to reduce risk of poor health conditions through healthy body weight (13). 

Sub objective:

Though increased fruit and vegetable intake acts as a significant aspects of obesity prevention, research indicates that this strategy is to be applied in adjunct with the decreased consumption of fast food and those that are high in fat and sugar content. The link between fast food consumption has been attributed to four main factors; unhealthy ingredients, larger portions, and convenience. Fast food has less content of vitamins and minerals, with large amount of fats and sugars. These have a direct connection with increased weight. The ingredients present in fast food are aggravated with larger portion sizes growing parallel to the body weight of a person. Since fast foods are easy to access and are cheaper, those from the lower-income group are at more risk of developing obesity (14).

Objective:

Obesity is a result of distinct energy imbalance, meaning excess energy consumption and minimal energy expenditure. The most easily modified yet most viable factor for obesity is the amount of activity carried out by individuals. Maintaining an active lifestyle instead of a sedentary one ensures that the BMI of the individual is maintained at an appropriate level. Physical activities refer to the body movements responsible for burning of calories. Exercise can be referred to the class of physical activity referring to planned and structured activities aiming at bringing improvement in the physical health (15).

Sub objective:

A number of literatures suggest that differences in built environment for physical activity. Cardiovascular exercise such as jogging and cycling is known to be a part of an effective weight loss and obesity prevention program. These activities act by burning calories, increasing the aerobic capacity and decreasing the resting heart rate, thereby maintaining a suitable body weight. Cycling is a non-weight bearing exercise and can be undertaken by individuals of all age groups. Jogging is however a weight-bearing exercise and thus need to be done considerately. Regular engagement in these exercises promotes optimal body functioning through appropriate body metabolism (16).

Identify the health promotion model/s used to guide the development of the project plan and explain how you used it.

Sub objective:

Contribution of parks and open spaces to physical activity is noteworthy. Parks are the places where one can experience nature and engage in physical activities. In the contemporary era, increased urbanization has pushed the provision of open parks and spaces to the bottom edge. The environment has a primitive role in the promotion of energy expenditure and such opportunities are to be taken for addressing sedentary behaviors. Increasing population-level physical activity would be requiring extensive changes in the environment. Public parks facilitate physical activity as they provide spaces for walking, jogging and other sports activities and exercises. Parks are to be built as the places where receptive recreation can be combined with exertive activities. The link of physical activities to prevention of obesity has been understood already (17).

Health promotion planning models act as suitable tools for achieving the aim of outlining promotion strategies. The development of the health promotion plan is based on the PRECEDE-PROCEED model. Interventions and preventive strategies based on the PRECEDE-PROCEED model programs have the potential to decrease the prevalence of obesity and overweight. The model is a suitable framework that considers factors that influence the health outcomes. In addition, a structure for health needs assessment, program design and implementation, and program evaluation can be understood (18).  Social, epidemiological, environmental, behavioral, educational, ecological, and administrative and policy assessment are encompassed into the framework. The significance is that enabling, reinforcing and predisposing factors can be accurately identified.

 Figure: contributory factors to obesity prevalence

Stakeholder

A vast pool of literature bring into focus that the potential of community based obesity prevention programs is immense. Advocacy and suggestions in this regard are welcomed from diverse theoretical standpoints so that the implementation of the initiatives is backed by a strong rationale. Stakeholder engagement is important for enabling better project outcomes. The inputs from the different stakeholders ensure that there is increased exchange of opinions and ideas the amalgamation of which is crucial (19). Actions for the proposed project would be a part of the movement led by the health sector and non-health sector for improving the overall wellbeing of the community.

The role of the government would be fundamental for allocation of resources. Concerted actions from the government’s end would be classified into four distinct areas; leadership, advocacy, development of policies and increased funding. The sectors and agencies that would made a part of the obesity prevention project are as follows-

• Health Promotion commission
• South Australia government department and agencies mainly the Department of Aboriginal and Torres Strait Islander Partnerships, Department of National Parks, Department of Transport and Main Roads, Department of Infrastructure, Local Government and Planning and Public Service Commission.
• Australian Government departments and agencies, mainly the Department of Health, Department of Human Services, Department of Industry, Innovation and Science, and Australian Bureau of Statists.
• Primary health networks
• Hospitals
• Health research networks
• Non –government organizations
• Training, education and academia sectors

Stakeholders

Goal

The goal of the project is to achieve reduction in the prevalence rate of obesity among adults residing in the Adelaide area by 10% by the year 2020.

Objectives and Sub-objectives

References

Opie CA, Haines HM, Ervin KE, Glenister K, Pierce D. Why Australia needs to define obesity as a chronic condition. BMC public health. 2017 Dec;17(1):500.

Avsar G, Ham R, Tannous WK. Factors influencing the incidence of obesity in Australia: a generalized ordered Probit model. International journal of environmental research and public health. 2017 Feb 10;14(2):177.

Duckett S, Willcox S. The Australian health care system. Oxford University Press; 2015.

Agbaedeng T, Mahajan R, Munawar D, Elliott A, Twomey D, Khokhar K, Lau D, Sanders P. Obesity Associates with Increased Risk of Sudden Cardiac Death: A Systematic Review and Meta-Analysis. Heart, Lung and Circulation. 2017 Jan 1;26:S186.

Da Luz FQ, Sainsbury A, Mannan H, Touyz S, Mitchison D, Hay P. Prevalence of obesity and comorbid eating disorder behaviors in South Australia from 1995 to 2015. International Journal of Obesity. 2017 Jul;41(7):1148.

[Internet]. Myhealthycommunities.gov.au. 2018 [cited 27 May 2018]. Available from: https://www.myhealthycommunities.gov.au/Content/publications/downloads/AIHW_HC_Report_Overweight_and_Obesity_Report_December_2016.pdf?t=1508889600026

[Internet]. Health.gov.au. 2018 [cited 27 May 2018]. Available from: https://www.health.gov.au/internet/preventativehealth/publishing.nsf/content/E233F8695823F16CCA2574DD00818E64/%24File/obesity-jul09.pdf

Bolton KA, Kremer P, Gibbs L, Waters E, Swinburn B, de Silva A. The outcomes of health-promoting communities: being active eating well initiative—a community-based obesity prevention intervention in Victoria, Australia. International Journal of Obesity. 2017 Jul;41(7):1080.

Hayes AJ, Lung TW, Bauman A, Howard K. Modelling obesity trends in Australia: unravelling the past and predicting the future. International Journal of Obesity. 2017 Jan;41(1):178.

Nichols M, Reynolds R, Waters E, Gill T, King L, Swinburn B et al. Community-based efforts to prevent obesity: Australia-wide survey of projects. Health Promotion Journal of Australia. 2013;24(2):111-117.

[Internet]. Health.qld.gov.au. 2018 [cited 27 May 2018]. Available from: https://www.health.qld.gov.au/__data/assets/pdf_file/0020/663050/health-wellbeing-strategic-framework-obesity.pdf

Steeves EA, Martins PA, Gittelsohn J. Changing the food environment for obesity prevention: key gaps and future directions. Current obesity reports. 2014 Dec 1;3(4):451-8.

Welker E, Lott M, Story M. The school food environment and obesity prevention: progress over the last decade. Current obesity reports. 2016 Jun 1;5(2):145-55.

Hawkes C, Smith TG, Jewell J, Wardle J, Hammond RA, Friel S, Thow AM, Kain J. Smart food policies for obesity prevention. The Lancet. 2015 Jun 13;385(9985):2410-21.

Ewing R, Meakins G, Hamidi S, Nelson AC. Relationship between urban sprawl and physical activity, obesity, and morbidity–update and refinement. Health & place. 2014 Mar 1;26:118-26.

Gonçalves IO, Passos E, Rocha-Rodrigues S, Torrella JR, Rizo D, Santos-Alves E, Portincasa P, Martins MJ, Ascensão A, Magalhães J. Physical exercise antagonizes clinical and anatomical features characterizing Lieber-DeCarli diet-induced obesity and related metabolic disorders. Clinical Nutrition. 2015 Apr 1;34(2):241-7.

Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N. Contribution of public parks to physical activity. American journal of public health. 2007 Mar;97(3):509-14.

Rezapour B, Mostafavi F, Khalkhali HR. School-based and PRECEDE-PROCEED-model Intervention to promote physical activity in the high school students: Case study of Iran. Global journal of health science. 2016 Sep;8(9):271.

Leslie E, Magery A, Olds T, Ratcliffe J, Jones M, Cobiac L. Community-based obesity prevention in Australia: background, methods and recruitment outcomes for the evaluation of the effectiveness of OPAL (Obesity Prevention and Lifestyle).

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