Obesity as a serious health concern
Obesity is a disease characterized by excessive body fat. It is a serious health concern that can lead to other medical conditions such as diabetes, hypertension, heart diseases, and certain types of cancer. It occurs when an individual’s body mass index (BMI) is greater than 25. It results from consuming more calories than are burned by regular physical activities. In England too, obesity poses a threat to the nation’s health with both adults and children in the country being much affected by it. National Health Survey shows that 14.4% of children aged 4 and 5 are obese while a further 13.3% in the same age group are overweight. Out of children between the age of 10 & 11, 25.5% are obese while 15.4% are overweight. It is also noted that children who live in deprived areas are more susceptible to obesity with children from both age groups (4-5 and 10-11) from most deprived areas being twice as likely to be obese as children from least deprived areas. The rate of obese children in most deprived areas is 4 times higher (Baker, 2022). The purpose of this essay is to discuss the problem of childhood obesity in England and the importance of addressing this. The essay will also explore two approaches to managing obesity including school interventions and family interventions. These two approaches will be conferred in relation to the Trans-Theoretical model of health. In this respect, the pros and cons of the approaches will be explored and finally, the better approach of the two will be identified.
Figure 1
Source: (Baker, 2022)
Every child grows differently so a child cannot be classified as obese if he/she looks larger than their peers. Children are considered overweight if they have a BMI equal to or more than 85 percentile and below 95 percentile for children of the same age and sex while a child with BMI above 95 percentile will be considered obese. It is important to address the issue of childhood obesity because obesity can cause a variety of problems (more specifically in children) including sleep apnea, asthma, joint or bone problems, early puberty, hypertension, type 2 diabetes, and orthopaedic issues. Moreover, overweight or obese children are more vulnerable to social isolation, bullying, depression, eating disorders, lower self-esteem, and learning and behaviour issues (JohnsHopkins Medicine, 2022). Furthermore, individuals who are obese in childhood are very likely to remain so in adulthood as well furthering their risks of other health conditions (Vieira and Carvalho, 2018). This issue is very much prevalent in the UK but there is an inequality in numbers with data showing that 9.1% of children from least deprived areas aged 4-5 are obese in comparison to 19.7% from most deprived areas and 15.5% of children from least-deprived areas aged 10-11 are obese in comparison to 32.1% from most deprived areas. The prevalence of obesity is severe in Wales as well with approximately 1 in 8 children being affected by it (Beynon and Bailey, 2019). Data also shows that boys are slightly more susceptible to obesity than girls. The difference is below 1 percent in children aged 4-5 but more pronounced (8.5%) in children aged 10-11 (Baker, 2022). Obesity is generally caused by poor lifestyle (poor diet, lack of regular physical activity), genetics (Prader-Willi Syndrome), medical conditions (Cushing’s syndrome, hypothyroidism), and certain medications (corticosteroids, antidepressants) (NHS, 2017).
Prevalence of childhood obesity in England
There are many social and environmental factors that contribute to obesity in children. The prevalence of obesity is associated with a person’s racial-ethnic identity, sex, and socio-economic status. An important factor is food availability in areas with a low economic status where energy-dense and high-calorie food is considered more affordable by people. In addition, areas with a low social status that suffer from deprivation, high crime, and disorders have also been shown to have a high prevalence of obesity (Brehm and D’Alessio, 2019). People from deprived areas are also less physically active because they face many limitations to an active lifestyle as shown in figure 2. This shows that a person’s low economic and social conditions determine his/her likeability of being obese to a large extent (Moreno-Llamas, García-Mayor and De la Cruz-Sánchez, 2020).
Figure 2
Source: (Moreno-Llamas, García-Mayor and De la Cruz-Sánchez, 2020)
Early childhood presents a valuable opportunity for establishing healthy lifestyle behaviours like a healthy diet, regular physical activity, and limited sedentary time that will ultimately contribute to promoting better health and reducing the risk of obesity. This is because treating obesity in adulthood is more difficult than trying to change lifestyle habits in early childhood. The interventions can be implemented at various levels with many groups and people playing a crucial role in helping to reduce obesity prevalence in children (figure 3). One approach to managing and preventing obesity in children is through interventions implemented by schools. Schools can play a key role in improving children’s behaviour to prevent childhood obesity. This is because (1) primary education is compulsory in most countries and has an outreach to all children including those from low socioeconomic backgrounds; (2) children spend much of their daily life in schools with one or two meals per day; (3) most schools have physical education classes and provide separate time for physical activity during breaks; (4) schools have a proper structure environment which makes it easy to implement interventions; (5) intervention implementers can reach a larger number of children in a short time; (6) the teaching staff can facilitate the intervention delivery which improves the sustainability of the delivery (Lambrinou et al., 2020).
Figure 3
Source: (Narayanan et al., 2019)
Another approach is family intervention since parents and caregivers play a crucial role in providing kids with a positive environment that fosters healthy eating and physical activity. Research suggests that kids who do not learn about healthy eating from parents, who fail to understand the importance of healthy habits in childhood, and whose parents do not encourage a healthy lifestyle are more at risk of developing obesity (Moore, Wilkie and Desrochers, 2017). In this approach, health professionals can work with parents and help them develop parenting skills to help them support healthy behaviour in their children. These skills include monitoring their children’s behaviour, reinforcing positive behaviour, and providing children with a nurturing environment (Chai et al., 2019).
The Transtheoretical model provides a suitable framework for conceptualizing and measuring behavioural changes in children. It is also helpful to facilitate strategies that are customized and can be easily adapted. The TTM includes 5 stages of change (pre-contemplation, contemplation, preparation, action, and maintenance), self-efficacy (person’s confidence in his ability to change), and decisional balance (weighing barriers and enablers of change) (Liu et al., 2018). The model has been widely utilized to understand the behaviour of physical activity in individuals, hence it would be useful to design strategies for interventions to prevent childhood obesity.
Associated health conditions and risks
Figure 4
Source: (Pope, Lewis and Gao, 2015)
Applying TTM to school interventions to reduce and prevent obesity in children involves strategies through which schools evaluate the stage of change at which the children are and then design appropriate interventions to encourage a positive change in the children. (Ham et al., 2016), in their study applied the TTM through 8 exercise counselling sessions provided by two trained nurses who gave personal counselling to children after school hours. These sessions included (1) providing the children with basic information about obesity (causes/problems) and the benefits of exercise; (2) assessment of the children’s self-image (active or inactive); (3) identifying unhealthy behaviour and what problems it results in; (4) strategies to surmount exercise barriers; (5) change commitment through written pledge; (6) home exercise assignments to perform with parents; (7) discussing efforts that overcoming the barriers take; (8) self-reflection of the efforts invested and interveners’ feedback. The results showed that there were positive modifications in the change stages, self-efficacy, decisional balance, BMI, lipid profile, and glucose tolerance of obese or overweight children who received TTM based exercise counselling (Ham et al., 2016).
In applying the TTM to family interventions, it is important to first assess the level of change that both the child and parents are at in order to provide individualized interventions. Parents’ perception of their child’s weight is important to ensure that they provide their children with an environment at home that encourages healthy eating and regular physical exercise. Family interventions based on TTM will aim at reducing the child’s BMI and helping the parents to participate in the reduction process. Applying TTM to family intervention might involve activities like discussing between parents and children the advantages and disadvantages of having an unhealthy weight, taking the parents and kids to their favourite fast-food restaurant where they would identify foods with high fat and calorie content and offer healthy substitutes to them, and encouraging both parents and kids to separately identify and then evaluate their feeling on their own body weights (figure 5 and 6).
Figure 5
Source: (Mason et al., 2008)
Figure 6
Source: (Mason et al., 2008)
The pros of using school interventions based on TTM include the opportunity to address the different levels of readiness of children and help them to adapt to healthy behaviour (regular physical exercise) along with their peers. Additionally, learning in the school environment promotes discipline and social support. It is easier to teach kids the importance of a healthy weight by trained nurses under the supervision of teachers which will help them to move from the pre-contemplation and contemplation stages and commit to change. Schools can initiate sports programs and promote healthy meals for free (the meals that students eat at school- breakfast and lunch) to encourage children to eat balanced diets and be more physically active. Sports programs that are designed specifically for overweight children might be helpful to introduce inactive children to team sports and an active lifestyle. This will help children to grow in the stages of preparation, action, and maintenance. However, there are certain limitations to school interventions as well. One such limitation is that since there are many children in a school setting and every one of them is at a different stage of change, it becomes difficult to help each one of them through individualized interventions. Moreover, children are at school for a limited time which is why their behaviour cannot be monitored all the time which might lead to a failure at the maintenance stage. There are also some concerns that school-wide programs for obesity interventions can increase body image concerns among children and create more underweight children (Bhadoria et al., 2015).
Social and environmental factors
The pros of family interventions based on TTM include (1) it focuses on behavioural changes in both parents and kids which promote better health outcomes; (2) it helps to encourage parents to promote a healthy environment at home by purchasing more healthy foods and monitoring their kids’ behaviour; (3) parents can become role models to their kids to follow healthy behaviour; (4) family interventions can be more personalized in nature which aligns with TTM. The cons of family interventions include the limitation that the success of the intervention is possible only when parents themselves are aware of the problems that obesity poses for their children. Studies show that 50% of parents have a propensity to underestimate their obese or overweight children (ScienceDaily, 2014). Moreover, parents must be educationally, socially, and economically empowered to facilitate healthy eating habits in kids (proper diet with all the required nutrients along with adequate levels of physical exercise) (Scaglioni et al., 2018).
Comparing both school and family-based interventions, it can be said that the focus of both approaches is to manage childhood obesity through the promotion of healthy eating behaviours and regular physical exercise in kids. In schools, nurse interveners can work with teachers to give exercise counselling to kids to help them through various stages of change in TTM and schools can organize sports programs and policies of free healthy food to kids to reduce and prevent obesity issues. Family interventions assume parents to be the change agents for their kids and involve interactions between parents and kids on healthy behaviour, parents providing their kids with a balanced diet, and parents monitoring their kids’ behaviour and reinforcing the right habits. As per the TTM, the better approach out of the two for the pre-contemplation and contemplation is the school intervention because this stage is basically concerned with teaching the kids to make them aware of the issue of obesity and school is a suitable environment for education and learning. For the maintenance stage, regular monitoring and reinforcing are required which is better done by the parents. Moreover, it is to be noted that for children below the age of 12, family interventions are more effective (Kothandan, 2014). The school interventions also acknowledge the importance of family involvement in managing obesity. It includes giving children homework assignments for physical exercise to be performed with parents. Furthermore, as per the transtheoretical model, strategies are made according to the stage of change at which the individual is. This makes it a more personalized model to influence health behaviours. According to this, family interventions are better as they can be designed as per the individual needs of the children while in school interventions, there is an involvement of many children which makes it difficult to make customized strategies for every child. Family interventions help to provide children with a supportive environment that encourages lifestyle modifications in household setting (Liu et al., 2019).
To conclude, obesity is a major health issue that affects the entire country of the United Kingdom. The disease is characterized by excessive body fat. The problem must be addressed in early childhood the medical problems that obesity cause. Moreover, individuals who are obese in childhood are more likely to remain so in adulthood causing more social and medical issues for them. Obesity is caused by poor lifestyle, genetics, medical conditions, and certain medication.
Two approaches to managing obesity
Schools can play a crucial role in this because they have an outreach to most children and the teaching staff can facilitate the delivery of interventions to enhance their sustainability. Another approach to preventing childhood obesity is through family interventions because parents play a crucial role in shaping a child’s personality and can provide them with a positive nurturing environment.
School interventions based on TTM would include providing exercise counselling, organizing sports programs, and implementing policies of free healthy meals while family interventions based on TTM would involve counselling both the parents and the kids, assessing the stage of change that they are at, and then implement cognitive and behavioural interventions strategies for them.
As per the TTM, school interventions are helpful in the pre-contemplation and contemplation stages while family interventions are helpful in the maintenance stage. An important part of school interventions is family involvement. Furthermore, kids below 12 can show better results through the family approach. This approach also helps to provide kids with a more personalized obesity management program.
Reference list
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