Health Promotion Program To Prevent Childhood Obesity In South Australia

PUBH 2104 Health Policy, Planning and Management

Aim and Significance

The aim of this grant application is to propose a Health Promotion Program for preventing obesity among young children by the promotion of health eating in South Australia. The main rationale for focusing on the prevention of childhood obesity is the high incidence of obesity in children in Australia. Obesity and overweight has been identified as a major public concern in Australia as it affects health and well-being and school performance of children . Due to impact of obesity on other health outcomes, it also increases the health-care costs (Bell et al., 2019).  In the year 2011-2012, one in every four children was found with overweight or obesity. In addition, the statistics for obesity in the year 2017-2018 revealed that 25% of children aged 2-17 years were overweight and 8.2% were obese.  It shows that the prevalence rate has remained stable since the year 2007-2008 (Australian Institute of Health and Welfare, 2020). Prioritizing obesity prevention by means of correcting eating habit is considered important as excess body weight can lead to endothelial dysfunction and increase the risk of chronic diseases such as stroke, hypertension and stroke. Changing diet or eating habit is an important priority as poor eating habits such as high-fat and high-energy food increases the risk of obesity (Sun et al., 2020). Hence, it is planned to propose a grant application for promoting healthy eating behaviour in youths.

The above program relates with the State Public Health Plan 2019-2024 for South Australia as the plan focus on the prevention of chronic disease in the community and the prevention of obesity is one of the priorities. The plan proposes that taking actions on unhealthy eating alone can prevent chronic disease and lead to around $6 billion savings annually (Government of South Australia, 2020).   

The grant application proposed a health promotion program that gives education on healthy eating to young children and parents. The program in the above area is considered important to prevent the adverse consequences of obesity.  Various research evidences have reported about the incidence and consequence of the burden of obesity in children globally and in Australia. According to Di Cesare et al. (2019), excess weight during childhood is an important global health issue. It has been estimated that 40 million children under age of 5 years and 330 million aged 5-19 years were obese in the year 2016. Because of the global crisis posed by the increase in weight in children, the World Health Organization proposed no increase in child overweight by 2025. Target childhood obesity prevention is considered important because of many short and long-term consequences too. In Australia, the rate of pediatric obesity has been found to triple in the next decades. In the year 2015, the total cost due to obesity was found to be around $43 million (Black, Hughes & Jones, 2018). The short-term effects are risk of psychological comorbidities such as depression, anxiety and low self-esteem. The long-term consequences of obesity are increase in the risk of cardiovascular diseases, diabetes, cancers and muscoskeletal disorder in adulthood. It can reduce the risk of disability and premature death (Black et al., 2018).  

Background

Di Cesare et al. (2019) gave the insight that obesity has reached epidemic level in many countries and the highest incidence rate has been found in developing countries. One of the widely accepted causes of obesity is the imbalance between energy intake and expenditure. The ecological models suggest physical activity, sedentary habits and dietary intake as some of the important risk factors of obesity. The impact of the above risk factors is further moderated by age and gender. According to Larsen (2018), family characteristics such as parenting style and lifestyle of parents   play a role in influencing eating habits and weight gain issues for children. Evidences from survey reveal that food parenting practices such as developing food and coercive control (food restriction and praise) has effect on food eating habits of children. General parenting styles may have impact on self-control and internalizing symptoms and it may interact with food parenting practices too. Due to the above reasons, interventions focusing on lifestyle as well as parenting styles are more successful.

Poor lifestyle is identified as the primary factor behind the increase in incidence or overweight or obesity issues in Australia.  The number of obese and overweight children has increased because of poor eating habits such as poor intake of vegetables and fruits and consumption of high calorie snacks. Canadian children aged 4 years and above have been found to consume higher daily snack calories from foods such as chocolate bars, soft drinks, syrup, fats and oil (Roblin, 2007). Thus, lifestyle is identified as the main cause behind obesity in Australia. Improper eating behavior contributes to excess amount of energy and calorie-rich foods are mostly devoid of important nutrients for proper development (Ku?bicka & Racho?, 2013). Positive association has been found between fruit juice consumption and weight gain issues. Higher intake of free sugars such as monosaccharides and disaccharides increase the risk of weight gain issues.  For this reason, targeting eating habits and choice of food is a crucial factor to prevent obesity. Considering the complexity of the condition, integrated multi-component approach to prevention is crucial too (Verduci et al., 2021).

The literature review on interventions targeting childhood obesity has mostly focused on physical activity intervention and dietary intervention. A systematic review by Pereira and Oliveira (2021) on dietary interventions to prevent childhood obesity revealed that many school-based interventions have been implemented. A cluster randomized trial implemented intervention such as physical activity (PA) program, lessons on nutrition, media use and sleep. After four months, increase in aerobic fitness was found. Another study referred in the study was a school-based trial done in Netherlands. The intervention mainly consisted of educational components such as healthier food options, restricting access to vending machines and decreasing portion sizes in the canteen. After twenty months follow-up, reduction in body composition measures were found. Similarly, clinical trials also targeted eating habits in a comprehensive intervention for childhood obesity. According to Xu et al. (2020), nutritional education and physical activity intervention was carried out in 38 primary schools in two semesters. The intervention had no effect on overall dietary diversity, but positive effect on food consumption was found. 

Literature Review

The significance of the study by Ek et al. (2019) was that it implemented a more and less  (ML) program which aimed to modify parenting practices and support them to acquire positive reinforcements and limit setting. Apart from evidence-based parenting practices, the program targeted education on healthy food habits, PA and techniques to regulate emotional control. However, it was a protocol based study and the result of the intervention is not known yet. Yu et al. (2020) reported about the implementation of a school-based nutrition education and PA intervention in Wuhan, China. In the intervention, three things were targeted. Firstly, a supportive school and family environment was created. Secondly, a compulsory daily exercise and lifestyle modification program was implemented. Nutritional education can promote intake of healthy food and promoting dietary habits. PA education involved increasing PA and decreasing sedentary behaviour. It involved setting multiple goals such as decreasing fruits and vegetables consumption and decreasing the duration of screen viewing. To control the intervention quality, the study used strategies such as training for project members, immediate revising intervention and diversification of the forms of intervention. The findings revealed improvement in anthropometric indicators, cardiovascular risk profile and mental health. Thus, nutritional intervention has been identified as a major part of lifestyle intervention for children with obesity. 

The goal of the program is to prevent weight gain issues and obesity in children by implementing a school-based nutritional intervention. Through this intervention, the purpose is to increase awareness about healthy foods among children and encourage parents to make healthy food choices for children. The primary reason for targeting parents is that they exert a strong influence on children’s diet. Some parents like to over-indulge their children in rich and energy dense food thus contributing to weight gain. These program targets children aged 6-12 years so that behavior can be modified at early stage (Lopez et al., 2018).

As the program will be implemented in school setting, it is planned to include young children, teachers, school champions, dieticians, parents and school coordinator in the health promotion program.

The key input for the program will include initial educational session with parents, introduction of good quality children’s lunch boxes, weekly message on nutrition information and eventually dietary assessment by 24 hour recall. The purpose of educational session is to facilitate positive reinforcement about the health message. It can ensure adherence to the intervention and facilitate implementation of diet related change in home based settings too. The target output for the program is change in parenting style, improvement in eating habits and anthropometric measures of children, awareness about healthy foods and interest in healthy food eating habits.

Program Plan and Program Logic

The outcome for the program is reduction in number of children with weight gain and obesity issues and decrease in consumption of unhealthy food items among young children.

The school-based dietary program will be arranged into four stages. The first step will involve dietary education session with dieticians, health promotion staffs, parents and teachers. All the parents will be invited to take part in the session by the distribution of flyers in school setting and by direct invitation via call or email. In this educational session, the dietician will introduce parents and teachers to the important of healthy eating habits among children. The advantage of early nutritional education is that it can improve parent’s attitude towards healthy eating and this would facilitate gradual change in behaviors Gato-Moreno et al. (2021). The key topics that will be covered by the dietician will include a brief introduction to nutrition, healthy eating habits and healthy food options, ways to design healthy food menus for children and attract children towards fruits and vegetables. The initial session will be followed by a second follow-up session were confusion of parents will be addressed and their understanding about healthy food options will be evaluated.

The second step will involve introducing children to healthy food by asking them to bring healthy food and give names of healthy food items in their lunch boxes. The teachers will applaud children who have a healthy lunch box and the teachers will discuss about the benefits of fruits and vegetables. In this way, children will get involved in healthy eating behavior and they will develop the interest to continue with healthy food eating habits.  In addition, parents will be provided with dietary guidelines and some healthy menus that they can provide to their children at school. The above intervention area is important as Nathan et al. (2019) highlighted that lunchboxes in primary schools contain excess of sweet and savoury discretionary snacks. The implementation of nutritional intervention can increase the inclusion of core food items such as fruits and vegetables, whole grain cereals and lean meats.

The third stage will involve weekly message on nutrition and the skills of teachers will be important in this regard. It will involve planning innovative strategies so that children learn about healthy foods through drawing, role-plays and art sessions. Such nutritional education programs have been found to have a major impact on the knowledge and dietary habits of children (Cotton et al., 2020).

Goal and Assumptions

The last stage will involve dietary assessment of children and it will be done after three months and after six months. It involves provided parents with a nutrition booklet and portion size. The advantage of the dietary intervention is that parents can give feedback about changes in diet and portion size among children. It can also help to estimate portion size among children. By means of feedback process, parents can be given feedback about ways to modify food and drink choices. The parents will be encouraged to report about positive outcomes post the intervention in terms of weight gain, BMI as well as attitude towards healthy food among young children (Pérez-Rodrigo et al., 2015).

The management of the program will be done by school coordinators, dieticians and health promotion staffs. They will be involved in deciding the resource needed for the programs, developing flyers, nutritional guidelines and designing nutrition based activities for children. The health promotion staff will be involved in the above activities. In addition, dieticians will play a role in implementing dietary interventions and designing lunch box menus for children. In contrast, school coordinators will manage administrative functions and recruitment of staffs for the project. They will take care of funding arrangements for the project too. The logic diagram for the project is given below:

It is expected to complete the above program within two years. The time table of activities that will be completed in two years are as follows:

Apart from the above timeline of activities, the project will also involve expenditure in various areas. Some key expenditure will be in the area of office equipment, pamphlet and flyers, recruitment cost, salaries and wages, travelling cost and development of guidelines and menus.

References 

Australian Institute of Health and Welfare (2020). Overweight and obesity among Australian children and adolescents. Retrieved from: https://www.aihw.gov.au/reports/overweight-obesity/overweight-obesity-australian-children-adolescents/summary

Bell, L., Ullah, S., Leslie, E., Magarey, A., Olds, T., Ratcliffe, J., … & Cobiac, L. (2019). Changes in weight status, quality of life and behaviours of South Australian primary school children: results from the Obesity Prevention and Lifestyle (OPAL) community intervention program. BMC Public Health, 19(1), 1-14.

Black, N., Hughes, R., & Jones, A. M. (2018). The health care costs of childhood obesity in Australia: An instrumental variables approach. Economics & Human Biology, 31, 1-13.

Cotton, W., Dudley, D., Peralta, L., & Werkhoven, T. (2020). The effect of teacher-delivered nutrition education programs on elementary-aged students: An updated systematic review and meta-analysis. Preventive medicine reports, 20, 101178.

Di Cesare, M., Sori?, M., Bovet, P., Miranda, J. J., Bhutta, Z., Stevens, G. A., … & Bentham, J. (2019). The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC medicine, 17(1), 1-20.

Ek, A., Nyström, C. D., Chirita-Emandi, A., Tur, J. A., Nordin, K., Bouzas, C., … & Nowicka, P. (2019). A randomized controlled trial for overweight and obesity in preschoolers: the More and Less Europe study-an intervention within the STOP project. BMC Public Health, 19(1), 1-13.

Gato-Moreno, M., Martos-Lirio, M. F., Leiva-Gea, I., Bernal-López, M. R., Vegas-Toro, F., Fernández-Tenreiro, M. C., & López-Siguero, J. P. (2021). Early Nutritional Education in the Prevention of Childhood Obesity. International Journal of Environmental Research and Public Health, 18(12), 6569.

Government of South Australia (2020). State Public Health Plan 2019-2024. Retrieved from: https://www.sahealth.sa.gov.au/wps/wcm/connect/90d6826d-7584-432f-8a7c-8083477798bd/Draft+State+Public+Health+Plan+for+consultation.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-90d6826d-7584-432f-8a7c-8083477798bd-mlGtIDH

Ku?bicka, K., & Racho?, D. (2013). Bad eating habits as the main cause of obesity among children. Pediatr Endocrinol Diabetes Metab, 19(3), 106-110.

Larsen, J. K., Sleddens, E. F., Vink, J. M., Fisher, J. O., & Kremers, S. P. (2018). General parenting styles and children’s obesity risk: changing focus. Frontiers in psychology, 2119.

Lopez, N. V., Schembre, S., Belcher, B. R., O’Connor, S., Maher, J. P., Arbel, R., … & Dunton, G. F. (2018). Parenting styles, food-related parenting practices, and children’s healthy eating: A mediation analysis to examine relationships between parenting and child diet. Appetite, 128, 205-213.

Nathan, N., Janssen, L., Sutherland, R., Hodder, R. K., Evans, C. E., Booth, D., … & Wolfenden, L. (2019). The effectiveness of lunchbox interventions on improving the foods and beverages packed and consumed by children at centre-based care or school: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 16(1), 1-15.

Pereira, A. R., & Oliveira, A. (2021). Dietary Interventions to Prevent Childhood Obesity: A Literature Review. Nutrients, 13(10), 3447. https://doi.org/10.3390/nu13103447

Pérez-Rodrigo, C., Escauriaza, B. A., Bartrina, J. A., & Allúe, I. P. (2015). Dietary assessment in children and adolescents: issues and recommendations. Nutricion hospitalaria, 31(3), 76-83.

Sun, M., Hu, X., Li, F., Deng, J., Shi, J., & Lin, Q. (2020). Eating habits and their association with weight status in Chinese school-age children: a cross-sectional study. International Journal of Environmental Research and Public Health, 17(10), 3571.

Xu, H., Ecker, O., Zhang, Q., Du, S., Liu, A., Li, Y., … & Ma, G. (2020). The effect of comprehensive intervention for childhood obesity on dietary diversity among younger children: Evidence from a school-based randomized controlled trial in China. PloS one, 15(7), e0235951.

Yu, H. J., Li, F., Hu, Y. F., Li, C. F., Yuan, S., Song, Y., … & He, Q. Q. (2020). Improving the metabolic and mental health of children with obesity: a school-based nutrition education and physical activity intervention in Wuhan, China. Nutrients, 12(1), 194.

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