Preventing Obesity In Children And Youth: A Community-Based Intervention Strategy

• Childhood obesity is a global epidemic in both developed and developing countries

• The prevalence of childhood obesity has increased in magnitude by 5 times during the last decade

• Shortages in the number of obesity prevention programs at school and at the community levels is increasing the rate of childhood obesity

• Proper involvement of the stakeholders and application of the proper public health promotion framework with long term goals might help in bringing effective change in childhood obesity

• The aim of this presentation is to

• Develop a health promotion program targeted towards the reduction of childhood obesity

• The development of the health promotion program will be done based on the principle of the Ottawa Charter Health Promotion Framework by WHO

• The health promotion program will be structured based on planning, community engagement, implementation, management, evaluation and recommendations

• At the end an approximate budget for the implementation of the health promotion program will be illustrated

• According to the Australian Institute of Health and Welfare (2019):

• One out of four children in Australia are obese (2017 -18)

• Childhood obesity has increased to 31% by 19% burring the last two decades in Australia

• Childhood obesity is the leading cause of mortality and morbidity among the children

• Excess body weight increases the risk of developing cardio-vascular disease, type 2 diabetes mellitus and other musculoskeletal diseases during later stages of life

• According to the Ottawa Charter of Health Promotion Framework proposed by the World Health Organization, three basic strategies for health promotion are:

• Advocate: Advocacy for health

• Enable: Equity in health by ensuring the availability of equal healthcare access for all while promoting supportive environment for equitable health access

• Medicate: Proper co-ordination between all the stakeholders for comprehensive health promotion

• Ottawa Charter (OC) for Public Health Promotion is a gold standard for health promotion

• This health promotion framework create opportunity for the bringing change in the health literacy level

• OC public health promotion also facilitates the development supportive environment and promotes skill building in order to improve

• Priority areas for health promotion as per the Ottawa Charter

• Building healthy public policy: Deals with the analysis of the obstacles for the adoption of the childhood obesity prevention policy

• Create supportive environment: Promoting supporting environment for comprehensive health promotion among children: The supportive environment for the prevention of childhood obesity will be in the school

• Strengthening community based action: Continuous availability of the information along with funding for the implementation of the policy. For prevention of the childhood obesity, funding must come from government along with collaboration from schools

• Community-based action and its importance to the health promotion is also proposed by Laverack’s model proposed in the year 2007

• Other priority areas for health promotion as per the Ottawa Charter

• Development of personal skills: The personal skill development for the prevention of the childhood obesity will be focused towards the education of the parents and the teachers (primary care givers of children)

• Reorientation of the health services: Reorientation of the healthcare services through professional education and training of the parents and school teachers under the guidance of the childhood nurse

• School level health promotion program

• Interventions

• (i) Increasing health literacy among parents and teachers

• (ii) Promotion of the physical activity sessions during the recess hours under trained physical-fitness expert

• (iii) Changing the diet plan in order to make the children physically active

• Meta-analysis conducted by Tidwell, Hung Hall, M. (2016) stated that 12-month-based physical activity sessions among the children between the age group of 5 to 13 years is helpful in reducing childhood obesity

• Meta-analysis also suggested that at the school level education for healthy lifestyle also helps in reducing the chances of developing childhood obesity

• Burgermaster et al. (2017) stated that there is a positive relationships between the program outcomes and the level of student’s satisfaction. Thus indicating that the outcome of the program will vary with the degree of satisfaction of the student

• According to Keya et al. (2019):
• Primary prevention: Helps to limits the incidence of the disability or disability among the population by eliminating the factors the negatively affects health. Elimination of obesity helps to reduce the associated disability of childhood like diabetes, cardiovascular disease and musculoskeletal disorder

• Secondary prevention: Helps to prevent the disease progression by early implementation of interventions. Early implementation of the obesity prevention interventions helps to prevent the progression of several diseases like asthma and hypertension among children

• Tertiary prevention: Aims to reduce the consequences of established diseases. Childhood obesity prevention aims to decrease the negative consequences of the obesity like social exclusion, poor body image and lack of self-confidence

• Totura et al. (2015) stated that obesity prevention interventions depends on the supportiveness of the school climate

• Lack of proper funding for the implementation of the interventions create a barrier in achieving the positive health promotion outcomes in-spite of having supportive environment

• The main stakeholders for the implementation of the childhood obesity prevention programs are:

• Teachers

• Community healthcare nursing professionals

• Parents of the children

• School administrative board

• Physical education trainer

• Teachers: Teachers will help to assist parents and children to indulge in obesity prevention activity by

• Community healthcare nursing professionals they will help in strengthening community based action and personal skill building of the other stakeholders like teachers, parents and children

• Parents of the children: They will assist children at home with physical activity and proper diet

• School administrative board: They will provide proper fund for program implementation and thus helping to re-orient the healthcare services

• Physical education trainer: Framing customized physical activity for the children that is engaging yet helpful in reducing weight

• Dietician: Framing of the diet plan so that the children remains active during the physical activity sessions

• The promotion of the leadership development will be done with the help of the nursing professionals

• Nursing professionals will educate the teachers about the approaches of the childhood obesity prevention

• Teachers post their education and training under the nurses will help to conduct the activity sessions with the children

• Crowne et al. (2017) stated that leadership training given by the nursing professionals help in the development of the emotional intelligence among the trainee and thus help in proper promotion of the health promotion

• The delivery of the educational material will be done by the nursing professionals and physical exercise trainer along with dietician

• Physical exercise trainer will train the game teacher of the school in order to guide them with the physical exercise training process of the students during recess period

• The dietician will help to train and educating the parents about the healthy diet plan that must be followed in order to keep them physically active so that they can take part in physical activity

• The management of the budget and finances will be performed by the school authority

• Additional help can he taken from the healthcare professionals like the community level nurses in order to highlight the gaps in practice and thus helping in cost-effective policy planning for promoting comprehensive health outcomes

• Community level nurses (3 hours of training) : 200 dollars per day
• Dietician: 1 hour of educational training: 50 dollars per day

• Physical exercise trainer: 1 hour of training: 100 dollars per day

• Cost of human resources per day: 350 dollars

• Cost of human resources for 1 week of training and development: 350 x 7 = 2450 dollars
• Other resources

• Over-head projector for power-point presentations

• Different gaming equipments like football, badminton, table tennis
• These resources are already present in schools and thus excluded from budget list

• Planning: Planning of the health promotion program under the strict participation of the community level nurses, dietician, physical trainer and school administrative authorities

• Community engagement: Community engagement will be done by the community level nursing professionals who will educate the teachers and the parents about the importance of healthy lifestyle promotion for obesity prevention

• Implementation: The implementation of the program will be done by the nurses, teachers, physical exercise trainer along with dietician

• Management: Management of the program will be done by the school teachers and the administrative authorities of the school

• Evaluation: Evaluation will be done post 6 months of program implementation through comparing the present weight of the children with the base line data

• Further engagement of the stakeholders by child psychologists can prove to be helpful for improving the outcome of the health promotion interventions

• The role of the child psychologist will be promote self-awareness among the children about obesity by implementing person-centered counseling approach

• Flook et al. (2015) stated that presence of the child psychologist in the childhood health awareness program helps in understanding the actual thought process of the child and thus helping to implement customized approach

Conclusion

• Childhood obesity prevention program will be school based

• Main stakeholder will be: community health nurses, teachers, parents, school administrators, dieticians and physical trainers

• The average budget of the human resource per week is 2450 dollars

• The evaluation of the effectiveness of the program will be done post 6 months of implementation

References

Amini, M., Djazayery, A., Majdzadeh, R., Taghdisi, M. H., & Jazayeri, S. (2015). Effect of school-based interventions to control childhood obesity: a review of reviews. International journal of preventive medicine, 6.

Australian Institute of Health and Welfare. (2019). Overweight & obesity. Access date: 7th of November 2019. Retrieved from: https://www.aihw.gov.au/reports-data/behaviours-risk-factors/overweight-obesity/overview

Burgermaster, M., Gray, H. L., Tipton, E., Contento, I., & Koch, P. (2017). Testing an integrated model of program implementation: the Food, Health & Choices school-based childhood obesity prevention intervention process evaluation. Prevention Science, 18(1), 71-82.

Crowne, K. A., Young, T. M., Goldman, B., Patterson, B., Krouse, A. M., & Proenca, J. (2017). Leading nurses: emotional intelligence and leadership development effectiveness. Leadership in Health Services, 30(3), 217-232.

Flook, L., Goldberg, S. B., Pinger, L., & Davidson, R. J. (2015). Promoting prosocial behavior and self-regulatory skills in preschool children through a mindfulness-based kindness curriculum. Developmental psychology, 51(1), 44.

Flynn, M. A. T., McNeil, D. A., Maloff, B., Mutasingwa, D., Wu, M., Ford, C., & Tough, S. C. (2006). Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’recommendations. Obesity reviews, 7, 7-66.

Keya, T. A., Leela, A., Habib, N., & Rashid, M. (2019). Childhood Obesity: Role of Population-based Preventive Approaches.

Lavarack, G. (2007). Health Promotion Practice: Empowered communities. Open University, London.

Thompson, S. R., Watson, M. C., & Tilford, S. (2018). The Ottawa Charter 30 years on: still an important standard for health promotion. International Journal of Health Promotion and Education , 56(2), 73-84.

Tidwell, D., Hung, L. S., & Hall, M. (2016). A meta-analysis of randomized controlled school-based programs demonstrates improvement in childhood obesity prevention. Journal of the Academy of Nutrition and Dietetics, 116(9), A42.

Totura, C. M., Figueroa, H. L., Wharton, C., & Marsiglia, F. F. (2015). Assessing implementation of evidence-based childhood obesity prevention strategies in schools. Preventive medicine reports, 2, 347-354.

Victoria State Government. (2019). Ottawa Charter for Health Promotion. Access date: 7th of November 2019. Retrieved

from: https://www.betterhealth.vic.gov.au/health/ServicesAndSupport/ottawa-charter-for-health-promotion