Prevalence of Child Obesity
Obesity is caused by excess accumulation fat in the body to the extent that some of the body physiological functions can be greatly affected (World Health Organization [WHO], 2010). According to a health survey conducted in the UK, the research findings revealed that 19% of the female children were obese while 18% of the male children were found to be obese (Wyatt et al., 2011). For example, research has established that in UK, 64 % of the population are considered to be obese, and by the year 2050 it is revealed that 60 % of the males, 50% of the females ,and 25% of the children will be obese according to (Denford et al., 2016). Policies and interventions should focus on wider environment by involving parents and children besides teachers in the implementation of the intervention strategies (Hawkings et al., 2008).
According to (Brophy et al., 2010), children with sedentary life, whose mothers expressed high risk health behavior such as being overweight and have low education standards are high risk of developing obesity. At the same time the intervention programs should include educating the primary care givers to help in the successful implementation of the programs (Owen et al., 2010).
Prevention of childhood obesity is the international public health top priority, this has been necessitated by the fact that child obesity has significant impact on some acute and chronic disease, and the health of the general population at large. According (WHO, 2010), it is estimated that globally one hundred and seventy millions of children between the age of 0-17 years are at risk of suffering from child obesity. There is a surge in number of reported cases in developed counties. In order to develop most efficient and effective intervention strategies, there is a pressing need to fully probe the cause and outcome of childhood obesity in our communities. Due to increase in number of recorded child obesity among the population, the condition has become public health concern. High prevalence of child obesity contributes to serious health problem, obesity is known risk factor to chronic diseases such as hypertension, diabetes type 2 and other forms of cancer. For example, a cross-sectional study conducted in UK, revealed that there was close relationship between the physical activity intervention program and reduced biochemical anthropometric measurements recorded such included low-LDL and raised HDL (Owen et al., 2010; Creanor et al., 2016).
Intervention Strategies
WHO has developed intervention strategies that comprises of three different approach. The WHO strategies focus majorly on a population based approach that propagates prevention measures rather than individual clinical intervention. For example, such policies have been adopted in the UK under the Health lifestyle program (HeLP), this was a qualitative exploratory trial. The program sowed the benefit of wide sector approach by engaging children, teachers and parents in the execution and implementation of the intervention programs (Lloyd et al., 2014). The results of such research informed an evaluation process of more robust and definitive trial. One such intervention strategies by the WHO is Health promoting Schools (HPS) frame work. The key feature of this framework is the fact that it recognizes the association between role played by education and with regards to reduced cases of child obesity. Therefore, the intervention strategies developed in managing child obesity prevention should be integrated into already existing programs whose aim is to promote behavior change among the children with improved participation in physical activities and good dietary behavior as the indicators (Taylor et al., 2013; Wyatt et al., 2011). For example, some school have been able to incorporate behavior-modification education into their already existing curriculum (Haines et al 2013; Griffiths et al., 2010).
The other approach taken to tackle the high prevalence of child obesity can be classified upstream or downstream and it is purely based on the intervention point and the areas that are targeted when implementing the intervention program (Swinburn et al., 2011). The approach such that focuses on the social and environmental issues to obesity can be classified as upstream. The objective of such approach is to outline the circumstances and situations which constitute the underlying determinants of health and social equality in the society. The target of such intervention strategy is the food environment, physical activity environment and socioeconomic environment such as taxation and education, thus indirectly influences the behavior of the population. Considering school environment as the target of the intervention strategy. Schools plays key role in providing daily meals and physical activity facilities to children bearing in mind that poor nutrition and obesity can negatively impact children (Wyatt et al., 2011; Hawkins et al., 2008). Therefore, schools form the optimum settings for the implementation obesity prevention effort.
Health-Promoting Schools
There is limited available research information on the role of education and its impact on child obesity, this has been precipitated by the fact that many researchers have focused on socio-economic determinants and obesity with very few focusing on lifestyle and health problem such as child obesity (Sassi et al., 2009). There are very few studies that have established the causal effect of health education and child obesity with a few studies available showing mixed results. Evaluation of the effect of dietary educational interventions versus control on changes in BMI, prevalence of obesity, rate of weight gain and other outcomes among children under 18 years.
The purpose of this study therefore will be to assess the role of health education in battling cases of children obesity and to disseminate the information to contribute to the understanding of such a relationship and the implication of the findings to health and education policy on child obesity.
Research question- what is the roles of health education in reducing child obesity?
Problem describes patients with children with obesity. Intervention school, represents intervention strategy, health education intervention is implemented in the selected school. Control school, there is no implementation of the intervention strategy for example no health education taught in the school. The reduction in number of child obesity reported cases represents the measured outcome of the strategy.
Problem- child obesity
Intervention- health education
Control- no health education
Outcome- reduced cases of child obesity
A cluster randomised control trial will be used, the clusters will be at the level of school. The data collection instrument will be a semi-structured interviewer-administered questionnaire. The questions will be administered to the 100 purposely selected obese children who shall be duly registered students at the school that will be randomly selected using the cluster sampling method. The health education intervention program will be implemented on intervention school. At the same time a control school will be selected and the school will not implement the health education intervention program. The health education intervention program will consist of health education promotion programs that including nutrition education lectures, individual counselling and education on good dietary practices by a trained nutritionist. The information on the program will be passed to the student using banners with information on benefits of eating fruits and vegetables. At the same time the educational materials will be distributed to the parents.
Social and Environmental Factors
A total of (n =100) children of age between 4- 17 years will be recruited into the study, they will be purposely sampled from the cluster of schools selected from the district and they will comprise of both female and male students and all races will be included into the study. The inclusion criteria will include having measuring Body Mass Index (BMI), which can be calculated according to the following: BMI = Weight (kg) / (Height) (m2). The BMI will be rounded to the nearest hundredth unit and thereafter plotted on the BMI for age charts for boys and girls.
The data from the study will be collected using interviewer-administered questionnaire. The anthropometric measurements of each of the child recruited in the school with intervention program will be taken and recorded. For example the BMI of each of the participant child will be calculated from the height and weight. Each the child will be asked questions contained in the semi-structured questionnaire, parent of a child with a special need will be allowed to fill some questions on their behalf. The student’s age will be categorized as 2-5, 6-9, 10-13, and 14-17 years. 2.5 Data Analysis
Data obtained from the questionnaire will be coded and entered in SPSS v.20.The data will be cleaned up before generating frequencies. For data presentation, continuous variable was summarized using frequencies. The student t-test will be used to calculate the mean within the group. While ANOVA will also be used to compare the mean between the two or more groups.. The data results on the prevalence child obesity will be presented using bar graph while box and whisker will be used to present the difference in mean between the groups. For correlation and regression, used least square method and scatter plot will be used to present the result that showed the outcome of the type of relationship between health education and reduced cases of child obesity.
The children who will be recruited into this study will be treated with respect and dignity besides there will be high level of confidentiality. Written and signed consent will be obtained from the participants, for the younger participants the consent will be signed on their behalf by their mothers. The real names of all the children participants will not be written on the questionnaire but they will be given unique codes for identification. The children will be assured highest level of confidentiality during and after the study.
Study Design
Research question: What is the role of Health education in reducing obesity in children?
The literature search was started by identifying most relevant peer reviewed journal articles in my library using CINAHL database searched using EMBOSCO platform. I filtered my search by specifically searching for quantitative research and qualitative research papers. I was interested in a full text of the journal article. The research question was broken down into the main topic this was done to attain the most get the most effective key words to perform the journal search. In this search I was looking for peer reviewed journal articles with most relevant information and findings that could help me get answers to my research that will be looking into roles of health education in reducing the child obesity.
Using PICO strategies I was able to breakdown the research question as follows:
Population- Children with Obesity
Intervention- Health Education
Control- No Health Education
Outcome- Reduced child obesity
First I searched for articles about children obesity. Thereafter I searched for article about health education. Then I searched for articles about reduced child obesity. Finally, thereafter I searched the three combined key word using the AND button. This process then lead to one set of articles with articles that contained all your topics together.
I used Boolean operators to combine the research question key words. For example, I used AND + OR. Looking at the search history I was able to identify the searches on the key word about the role of health education, thereafter I was able to highlight all of them and finally I achieved journal article containing information on my research topic that is the role of health education in reducing child obesity.
P (child obesity) OR (over weight child) NOT (adult obesity). At the same time I used AND
P (child obesity) AND I (health education). The final PICO strategy was then inserted into the search box in the CINAHL database. Through my search of the database I found 5 relevant journal articles (Table 1, appendix), which I used for my literature review.
I used * is used to truncate words and find different word endings. For example, Obes * the result included obesity, obese among others.
Methodology
Discuss the inclusion/exclusion criteria in detail.
The study participants should be children of school going age (2-17) they should be of any gender. For example the children should be in either primary or secondary school. The one of the study objectives should be to determine the association of the health education and reduced child obesity cases. The study should focus on the health promotion intervention programs that promote healthy dietary behavior among the children. The study should focus on the roles of schools as institutions in dealing with child obesity.
The journal article that do not measure the role of health education as determinant. For example, the articles that focused on the role of physical education alone without health education in reduction of child obesity were excluded. At the same time the journal articles that did not have children as the study participants were also exclude in the literature search process. Moreover journal articles that were not peer reviewed or unpublished were also not included as part of the literature. Journal articles published more than 10 years were excluded. The articles that did not have conclusion and the impact of the research findings on the study area of child obesity were excluded
The article will be previewed by reading through the article abstract to determine how relevant it is to the subject area. This will be achieved by looking at the tittle, aim of the study, the study population, the methodology used in obtaining data and the research findings and the outcome. The identified journal articles will be primary source only. Thereafter a more critical and systemic review will be undertaken by reading through the article to enable full understanding of the article content.
There is positive relationship between health education and healthy well-being of individuals according to. For example, results from a cohort study in the UK conducted by Brophy et al. (2009), revealed that there was a relationship between level of education and occurrence of obesity. The study registered obesity ODD ration of 0.63. However, this may be contradicted by the findings from other parts of the world, where findings of such results have concluded that established causal relationship is still subject of research (Jelalian et al., 2017; Devaux et al., 2011). The research findings on the positive relationship between health education and reduction of number of reported obesity cases have also been supported by the findings from cluster randomised controlled trial that was conducted in the UK by (Creanor et al., 2016). The association was attributed to accessibility to health education and information on healthy dietary practices. According to (Lloyd et al., 2012; Wyatt et al., 2011), schools offers good settings for implementation and promotion of health education intervention programs through teaching good dietary behavior and provision of healthy diet. It has been established that more researcher have focused a lot on the increasing physical activities as an intervention measure to attain reduced number of obesity cases among the children. It has been established that health education intervention curriculum developed to tackle cases of child obesity differs from one school to another and also from one country to another. Therefore, this has necessitated the need for more research to be carried out develop more uniting intervention this was according to the recommendation from a study conducted in the UK on the accessibility and feasibility of intervention programs in UK by (Creanor, 2010). The approach of using health education as an intervention strategy towards child obesity prevention has been used by European Union through EU- school fruit scheme it has been described as a wide voluntary scheme whose main objective is to provide fruits and vegetables to children aged 6 to 10 and the strategies involved in the implementation of the scheme include health education and awareness- initiatives (WHO, 2012). According to (Wyatt et al., 2008), after implementation of the health education intervention program in the schools for two years, the study findings revealed that it there was decrease of obesity cases to 22% in the intervention schools while in the control school cases were at 32 % . It is therefore very clear that there is an association between health education intervention and reduction in child obesity based on the consistency in the findings by different researchers. However, some of the findings from the discussed studies can raise fundamental issues. For example, the study by (Lloyd et al., 2008), very minimal data is provided on staff training and hours on delivery of nutritional education, besides the methodology of the study is not elaborate.
Study Participants
It has been established that among the children aged between 9-10 years, there is significant decrease in the prevalence of obesity (Lloyd et al., 2012). According to (Lloyd et al., 2012), there is established significant difference between the prevalence of child obesity due in the intervention schools and control schools. The intervention school children recorded decreased anthropometric measurements, the children consumed less energy snacks and spent less time on watching screen whereas, the control school did not register the same outcome. According to research conducted in the UK by (Brophy et al., 2009), on the prevalence of child obesity among the children from a minority communities in living in the UK, it was established that improved socio-economic status is a risk factor to child obesity. The children of Asian origin had obesity ODD of 1.3 while the children of African origin had ODD obesity ODD of 1.7, the findings also revealed that cultural believes plays a key role in the development of child obesity.
Researchers have established that there is higher acceptability of the health education intervention strategy towards reducing child obesity among all the stakeholders (Kipping et al., 2008; Langford et al., 2015). This finding can be supported by the research finding conducted by (Brug et al., 2010), 90% of the children reported that they would like to continue with the health education promotion programs because they enjoyed it. This was supported by the findings by (Hoppu et al., 2012) who generally reported the feedback form the children as positive. For example, use of fliers with health education information on the highlighting the benefits of eating fruits and vegetables was highly rated among the student as most effective strategy (Sawaya et al., 2010). In another study conducted by (Kipping et al., 2008), the study received high level of support from the school community. According to (WHO, 2010), report on population-based approaches to child obesity prevention, engagement with multi-sector and environment has been cited as a key component of successful implantation of intervention strategy against the child obesity (Wyatt et al., 2011).
It is very clear from the literature available that there is an association between health education and reduction in child obesity cases. However, the successful implementation of the intervention program is dependent on other factors. The findings from the literature has provided the evidence of effectiveness of health education intervention towards child obesity reduction. For example, the findings from the study conducted by (Wyatt et al., 2011), revealed reduced cases of child obesity to 22%. At the same time research conducted by (Lloyd et al., 2012), also revealed the same results. Many of the findings from the five journal articles have provided the answer to the research question on roles of health education in reducing child obesity. The purpose of this research is to determine the role of the health education in reducing child obesity. At the same time the reviewed literature have proved the hypothesis on the association between health education and reduced cases child obesity. Therefore there is sheared objective of this research and the available literature in the subject area.
Health education plays a key role in changing knowledge, behaviour and skills leading to improved delivery of child obesity prevention intervention with and as a result reduced cases of child obesity.
The reviewed journal article were very in-depth. The methodology was well described indicating how the study participants were recruited, sample size, data collection methods and tools used to collect the data. The results were well presented using descriptive statistics and inferential statistics. For example in a study conducted by (Wyatt et al., 2011), Mean and standard deviation were used to present the result on the fidelity of the study, whereas, in a study conducted by (Lloyd et al., 2012), rates and odd ratio were used to generalize the study finding to the general population. Therefore the study results among the reviewed journal were clear and easy to understand. The studies contributed immense information on the role of education in reducing child obesity. First by proving the hypothesis of association between the two. Secondly, by proving the current statistics on the child obesity with regards to socio-demographics. However, there is a need for more studies to be done focusing on different races and geographical distribution. Such studies will validate the research results and enable accurate and reliable statistical inferences to be made.
Policy and institutional environment this refers to policies that have been developed to counter the negative effect of child obesity. The target of such intervention polies is the food environment, physical activity environment and socioeconomic environment such as taxation and education, thus indirectly influences the behavior of the population. Considering school environment as the target of the intervention strategy (Hawkins et al., 2008; 2013). Schools plays key role in providing daily meals and physical activity facilities to children bearing in mind that poor nutrition and obesity can negatively impact children. According to (WHO, 2012), the strategy to tackle the rising cases of child obesity should include priority- setting processes at both national and local level of government , the objective of such initiative should be geared towards addressing health education on diet and physical activity.
Studies have highlighted lack of support from the relevant government institution and competing priorities as the one of the challenges affecting effective implementation of intervention programs. For example, some of the cited changes facing implementation of health education intervention program is failure of teachers to deliver lessons on health education due to absenteeism and high turnover of teachers (Kipping et al., 2008; Wyatt et al., 2011).
Based on the findings from the reviewed literature more studies on the role of health education in reducing child obesity should be conducted with wide scope by focusing on different geographical areas and inclusion of different race in the study.
Conclusion
There is consistence in the reported high prevalence rate of child obesity and the findings have revealed no significant changes over the year, it is therefore important for more research to be conducted on the prevalence of child obesity and modalities on implementing health education intervention. The data from the literature revealed the success of health education intervention strategy in reducing child obesity, therefore more research conducted in the subject area will help in highlighting the challenges and barrier in implementation of this intervention approach.
Reference
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