Description and Analysis of the Program to Combat Childhood Obesity - Essay Example

? Obesity of children is a global health issue which has developed into a pandemic. Concerted action and combined strategies of government, healthcare and research are critical for the implementation of prevention and correction management for childhood obesity. Policy changes are essential for the creation of environments of low obesity. The problem of schoolchildren becoming more obese than their predecessors has to be solved. The reduction of the ten percent of the children who were known to be overweight will be the target of the universal efforts (Lobstein et al, 2004). From the overweight children, 25% had been classed as obese and prone to chronic disease and disabilities. The likelihood of obesity having multiple predictors for illness is high. The escalation of Type 2 diabetes, heart disease and a variety of other co-morbidities before or during early adulthood is expected to interfere with the normal life of the obese child. Sleep apnoea, arthritis and other disorders of bones, joint disorders and cancer have also been associated with obesity. Low self-esteem is another significant problem and may require appropriate psychological approach. A shorter life expectancy is inevitable in addition. The issue having become a global one, it is really urgent that measures are taken to prevent overweight and obesity. A collaborative effort on a war footing needs to be undertaken to find a rational solution. Where previously the issue was descriptive of children from wealthy families, recent discovery has been made that economy and geography have little to do with the obesity. With all this in mind, I opted to join MEND, a program working for reversing the child obesity issue on an international basis. Epidemiology The problem is caused by a “mathematical” difference in the intake of energy as calories and expenditure of energy. Increased intake could be more than the needed requirement for the bodily functions. This could cause obesity. Similarly if the expenditure of energy in the form of exercise is not possible, an accumulation of fat again occurs in the body. This accumulating fat causes obesity and overweight. Either the intake has to be reduced or the expenditure increased to balance the calories being utilized in the body. The obesity is measured as the BMI or body mass index in the project. This is the ratio of the weight in kilograms to the square of the height in metres. Overweight and obesity have been defined as leading health indicators by the Healthy People 2010. This programme intended to reduce the childhood obesity incidence by 5% in the US. The significance of the issue in Wales Wales has had its fair share of the problem following the recession. The Welsh Health Survey had indicated that 3% in children under 16 were classified as obese. (Brindley, 2010). Wales held a high position in the childhood obesity league, with nearly one in five children being classed as obese. As a possible result of the recession, more families were looking or switching to cheaper foods which tended to be more processed and contained high levels of salt, fat and sugar (Brindley). The number of adults classed as overweight or obese had been increasing gradually over the last ten years. These results were from the annual survey. Health experts in Wales were raising concerns over children’s long-term health should obesity continue to rise unchecked (Brindley). The significance of the issue in Wales had motivated the government to plan strategies for containing the problem. For all of these reasons, the UK government set up the MEND program to decrease the incidence of these problems and protect the children’s health so that they live a healthy life. Furthermore, it was in the financial interest of the government to fund these health promotion programs as preventive work with childhood obesity was far cheaper in the long run. Dealing with the costs of health care of obesity-related health conditions could be expected to show shocking skyrocketing figures. Health promotion included activities which were set up in order to assist in preventing diseases, improving health and increasing general well-being (Naidoo & Wills, 1998). Health Promotion as envisaged by Tannahill Health promotion had been explained in a variety of ways by different researchers. Tannahill’s model is being highlighted here. This model is broad in its views and discusses the good and bad or advantageous or disadvantageous aspects of health. In addition there is a political dimension too (Tannahill, 1985). Three overlapping spheres of activity, which are health education, health protection and ill-health prevention make up Health Promotion as indicated in page 4. Health Education: This was done via communication activities which concentrated on improving well-being and aiming to stop ill health, which was done by changing the knowledge, beliefs, attitudes and behaviour of the community (Tannahill, 1985). Health Protection: This referred to policies and codes of practice which were geared at stopping ill-health or improving well-being, for instance, no smoking in public places. Prevention: This looked at the first occurrence of disease, and also to the progress of the disease and then the final outcome (Tannahill, 1985). Tannahill Model of Health Promotion (Tannahill, 1985). As the next generation of adults appeared after the present childhood obesity epidemic went into adulthood, the health problems they faced were greater. The health problems found in the young adult populations could include higher rates of heart disease, diabetes, certain cancers, gall bladder disease, osteoarthritis, endocrine disorders and other obesity-related conditions. Treatment for these conditions could potentially last for the remainder of their lives. As a consequence, the financial inflictions to the health services, the losses to society and the concerns affecting the individuals could be greater (Lobstein et al., 2004) Why MEND (Mind, Exercise, Nutrition and Do it) MEND was a project that worked with obese children aged 7-13 and their families within Swansea. This project promoted healthy eating and physical activities for the obese children and their families. MEND was set up as a part of a National Initiative funded by the Welsh assembly Government until March 2011. I had chosen this project because I was interested in playing a role in the battle against childhood obesity. My Bachelor degree in Nutrition and food Science had influenced me in the matter. Being partially equipped, I joined a movement that meant well and could make an indent in the statistics. Furthermore, I felt that the issue that MEND was tackling was a serious and growing issue within children not just in the UK but worldwide and that needed to be solved. Presently the strain on the health services due to childhood obesity was too huge to be recorded (Lobstein et al., 2004).This was due to the fact that childhood obesity caused a large amount of health problems, such as hyperinsulinaemia, poor glucose tolerance and a raised risk of type 2 diabetes, hypertension, sleep apnoea, social exclusion and depression and these in turn toppled the morbidity and mortality statistics. My initial approach When I initially went to my placement within MEND, I felt apprehensive as it was a new environment that I was not familiar with. The meeting with the staff helped ease my tension. The short induction led me to understand more clearly what the aims and objectives of the organisation were. I was given an overview of the organisation and how the sessions ran. The workers explained the structure of the sessions so I was well prepared for the service users when they arrived. The placement MEND (Mind, Exercise, Nutrition...Do it!) was set up in 2004, as a social enterprise in Great Ormond Street. History had revealed that the Hospital for Children and the University College London Institute of Child Health worked in partnership to formulate the MEND program. The mission was to offer healthy lifestyle programmes for children and their families, as well as obesity management training for front-line staff facilitated self-help programmes for adults and class room resources. The running times for Swansea MEND were fixed for every school term, twice-weekly, for 3 months and were currently located in Bishop Gore Comprehensive School (City and Country of Swansea, 2011). Each session Each session ran on a similar pattern. There was an hour long workshop for the children and their parents. Then while the children went through an hour of exercise, the parents had an adult discussion. The overweight child was measured before and after the programme. The contact with the children and the families continued in the form of newsletters and reunion events. Enquiries and doubts were cleared through telephone support. Funding was by the Welsh government and the service is free (Welsh Assembly Government, 2010). Referral of a child The local obesity care pathways worked through the participation of the GPs, school nurses and other health professionals. They made the referrals of obese children between the ages of 7 and 13 to participate and enjoy the benefits of the MEND programme. The families needed to consent to the inclusion in the programme. Long-term health outcomes at the 12th month were the targets. The indicators measured were the BMI, waist circumference, increased participation in and uptake of physical activity and reduced sedentary behaviour, as well as improvement to self confidence and self-esteem. BMI was calculated with the measurements of weight in kilograms and height in metres. Children with serious illnesses, congenital and developmental illnesses, physical disabilities or psychiatric conditions were excluded (City and County of Swansea, 2010). The MEND Project Team This project delivered 400 programmes on a worldwide basis with the participation of local, regional and national partners. The United Kingdom had the benefit of 350 programs within one school term. Fifteen thousand families had benefited from these programs (MEND, 2010). A programme manager led and coordinated the project. Apt skills, confidence and impressive personality described the successful manager. The leaders were those who conducted the actual sessions and were in direct contact with the children and families. The manager occasionally participated as a leader. Each session had a theory leader and an exercise leader who were supported by a programme assistant. The Swansea MEND team which I joined consisted of 2 managers, and 3 leaders who ran the sessions. The Swansea MEND program had successfully engaged with 30 families since the project had started. More about the Project Activities Children with weight above the healthy range for their age and height were selected for the project. Their families were also included because the success of any project with children as beneficiaries required the cooperation of their families and peers for total success. The children enjoyed the programmes which were instilled with fun for the main purpose of keeping them entertained and interested for the whole length of the programme. Without making it too obvious the children were assisted to manage their overweight and live healthier lives. Child health experts had made this program successful. Research had indicated that the MEND had indeed been easily accessible to families. Obesity and a variety of risk factors linked with obesity were reduced resulting in obvious improvement at the completion of the 3rd month (Sacher et al, 2005). Sacher’s study had the limitation that a control group was not included in the study. The program had helped the children and families learn the methods of improving consumption of proper food in the right proportion. The children gained the support of families or carers in the process of improving their health, keeping themselves fit and their notions about their own bodies. The children learnt the importance of nutrition and balanced diets. The significance of keeping to a balanced diet was impressed upon them. The MEND leaders also conveyed the benefits of being active and exercise in their daily lives. Tips were also provided on how to remain motivated. Support was provided to the families to make alterations in their habits slowly and realistically as the targets were long-term. Altering their mentality towards food and exercise so that they ended up healthier and happier was the basic instruction to the families. The families and their children were taught to read food labels and understand their content and proportions of ingredients, to discard some and to take healthy foods. In all they learnt how to make their weekly shopping healthier. Physical activity sessions filled with fun were part of the program. The children were taught swimming, dancing and ball games; all means of “expenditure of calories”. Folders were maintained for children and families separately. The folders contained different information about healthy eating, choice of healthy food and ideas of physical activity they could follow for achieving better health and in the meantime lose weight. A website had been set up for providing lots of useful tips for parents and children. Leaders with MEND used small targets for motivating and encouraging children to become more active. They asked the child to do one hour of exercise and also eat 2 pieces of fruit daily. During the weekly sessions the leader checked on their assigned targets to assess what they had achieved. If satisfactory progress had been made, the child would be rewarded with a sticker. The children looked forward to these stickers. Different targets were thus set and assessed. The leaders in the session also spent time with the parents, reading through the information more in-depth than if they had read it by themselves. The leader also took care to explain the link between marketing and the buying of food and how these marketing strategies affected the purchase of food. The right kind of food to fit the balanced diet theory could be purchased using the right attitude towards the purchase. Strategy and Operational Working A 20-year research partnership between Great Ormond Street Hospital for Children NHS Trust and University College London Institute of Child Health had been undertaken to ensure the steady execution of the program. MEND monitored the achievements of each service user. They also evaluated the success of each program through a secure online system. This information was then reviewed and analysed in order to make improvements and assist with the implementation of new services and programs. The City and County of Swansea and Abertawe Bro Morgannwg University Trust both managed the project in partnership. Other partners in the project were the Swansea Public Health team, the University of Texas School of Public Health, Baylor College of Medicine, RTI International and Duke University. The partners met on a regular basis in order to watch over the development of the scheme and to ensure that every program met the aims of MEND and its funding partners. ‘Project management was the skill of successfully balancing time, quality, and resources in order to produce a particular change or product’ (Pencheon, 2001). From my experience in MEND I believed that the organization followed the recommendations from the above quote of Pencheon. I felt that they were able to manage their time well; the quality of service and resources were excellent. They were able to extract the maximum out of what they had available. The evidence-based work that MEND carried out was thus highly effective. It was reported that Professor Atul Singhal, paediatrician and head of clinical trials in the Childhood Nutrition Research Centre at University College London Institute of Child Health (ICH) stated appreciatively that: “These results suggest that the MEND program helps overweight and obese children lose weight. They also show that child weight management programs have a positive effect on a child’s health and so could help to address the rising obesity problem in children.” (Business Wire, 2010). Presently MEND is carrying out a second, larger Randomised Control Trial, which is being done at the Institute of Child Health. This trial aims at monitoring families for longer periods to see their progress two, five and ten years after starting the Programme. Health Promotion Approaches Health promotion played a vital role within the new public health movement (Bunton, Macdonald, & NetLibrary, 2002). The aims of the MEND program were to enhance the health and well-being of communities, which included children and families, to support them in their unmet health needs. Simultaneously national and local targets were to be achieved on a variety of issues including childhood obesity and health inequalities (MEND, 2010). The program was initially set up due to obesity becoming an area of concern for health and non-health related organisations. It was also set up in order to meet local area agreements (MEND, 2010). MEND worked by looking at ways in which to promote sports and health within the community. It supported local authorities and sport/leisure providers to increase the number of people using leisure facilities (MEND, 2010). The MEND program supported families on the journey of weight management by looking at the three parts necessary for individual-level behavioural change; (i) education (ii) skills training, and (iii) motivational enhancement. This was done whilst keeping an understanding of the need to engage multiple, interacting systems of influence within the family context (Sacher et al, 2010). A social approach was applied to health education. Tones and Tilford attributed this approach as being appropriate as the attempt was to alter attitudes, knowledge and behaviour via education. Social issues in these three entities were addressed in this approach. Health education therefore included social change and radical models to motivate the service users (Draper et al., 1980). Ottawa Charter (WHO 1986) defined Health promotion as mainly being concerned with giving control to people to manage their health and so therefore included a variety of strategies to strengthen communities, develop supportive environments and inform and educate about health issues (Naidoo & Wills, 2005). This meant the service user must be motivated to bring about changes in behaviour and attitudes by being armed with new knowledge. In order for people to feel empowered, it was necessary for the person not only to feel passionate about wanting to change their circumstances but also to feel well equipped to change it by having information, support and skills to do this (Naidoo & Wills, 2005). MEND was doing exactly this. They were providing new knowledge and realisation about the dangers of obesity. New information was being provided by way of interaction at the sessions. Children were motivated to change their dietary habits and introduced to physical activity or exercise as a means of overcoming the obesity or overweight. Evaluation The success of the MEND program had been evidenced by independent studies. These studies showed that after attending the MEND program children lost weight (specifically body fat), increased their physical activity levels and self-esteem and reduced their sedentary behaviours. The independent study conducted by a team at University College London Institute of Child Health (ICH) showed the positive results of the weight management program that MEND offered for overweight and obese children and their families. The MEND Program worked to the international recommendations, which requested paediatric obesity programs to involve the whole family and include nutrition education, behaviour modification and promotion of physical activity (The Hindu, 2010). The independent study involved 116 children aged between 8 and 12 years. These children participated in the study, which consisted of taking part in a nine-week MEND program, which was then followed by 12 weeks of free family swimming between January 2005 and January 2007. All the children in this study reported a loss of weight, lowered their BMI (Body Mass Index) and waist circumference, improved their self-esteem and physical activity levels. The children’s general health, including cardiovascular fitness, also improved (The Hindu, 2010). Research further indicated that young people and children participating in the MEND program showed long-term health improvements, just 12 months after starting the Programme. Random participants were assigned to start the program immediately (intervention group), or receive the intervention six months later (control group). At initial assessment, waist circumference, BMI, body composition, physical activity level, sedentary activities, cardiovascular fitness and self-esteem were recorded and then again at 6 and 12 months. From these assessments it was found that all measures improved at 6 months and were maintained at 12 months. One of the strengths of the MEND program was its suitability to families. All the children who enrolled in the program completed it (Health Disease Treated, 2007). Conclusion I realised that I was fortunate to participate in this programme which addressed a global health issue of childhood obesity. Thoroughly enjoying my time at MEND, I found it hugely beneficial at being able to see theory being applied in practice. In all I completed 3 sessions with MEND associating myself with my co-workers, other staff and service users. I am impressed; the program offers an invaluable service greatly needed at the moment to society. The experience convinced me that such programs which had sincere targets and well-implemented plans could be far-reaching and success would be sure. References: Brindley, M. (2010). Recession fuels new rise in child obesity across Wales. Wales: Wales News. Bunton, R., Macdonald, G., & NetLibrary, I. (2002). Health promotion: Disciplines, diversity, and developments (2nd ed.). London: Routledge. Business Wire ( 2010) New Study Shows Effectiveness of the MEND Program (Mind, Exercise, Nutrition, Do it!) in Prevention and Treatment of Pediatric Obesity. Available at: http://www.businesswire.com/news/home/20100201005595/en/Study-Shows-Effectiveness-MEND-Program-Mind-Exercise (Accessed: 8 March 2011). City and Country of Swansea (2010) How can I register / refer a child?. Available at: http://www.swansea.gov.uk/index.cfm?articleid=36078 (Accessed: 1 March 2011). City and Country of Swansea (2011) MEND - Mind, Exercise, Nutrition...Do it!. Available at: http://www.swansea.gov.uk/index.cfm?articleid=36077 (Accessed: 1 March 2011). Draper, P.,Griffin, J., Dennis, J., and Popay, J. (1980) ‘Three types of health education’, British Medical Journal 281: 493-5. Health Disease Treated (2007) New Study Shows Effectiveness of the MEND Program in Prevention and Treatment of Pediatric Obesity. Available at: http://www.aamedya.com/HealtH-177941-new-study-shows-effectiveness-of-the-mend-program-mind-exercise-nutrition-do-it-in-prevention-and-treatment-of-pediatric-obesity/new-study-shows-effectiveness-of-the-mend-program-mind-exercise-nutrition-do-it-in-prevention-and-treatment-of-pediatric-obesity (Accessed: 8 March 2011). Lobstein, T., L. Baur, R. Uauy. (2004)’ Obesity in children and young people: a crisis in public health’, Wiley, vol 5 (Suppl. 1), 4–85. MEND. (2010). The mend partnership working model; A case study. London: MEND. Naidoo, J., & Wills, J. (2005). Public health and health promotion: Developing practice (2nd ed.). Edinburgh: Baillie?re Tindall. Naidoo, J., & Wills, J. (1998). Practicing health promotion: Dilemmas and challenges. London: Bailliere Tindall in association with RCN. Pencheon, D. (2001). Oxford handbook of public health practice. Oxford ; New York: Oxford University Press. Sacher, P.M., Chadwick, P., Wells, J.C., Williams, J.E., Cole, T.J., Lawson, M.S. (2005). Assessing the acceptability and feasibility of the MEND Programme in a small group of obese 7-11-year-old children. Pub Med: 18(1):3-5. Sacher, P.M., Kolotourou, M., M, Paul, Chadwick, J, Tim., Cole, Lawson, M.S., Lucas, A., and Singhal, A. (2010). Randomized Controlled Trial of the MEND Program: A Family-based Community Intervention for Childhood Obesity. 1930-7381. Tannahill, A. (1985).What is health promotion? Health Education Journal. 44(4):167-8. The Hindu (2010) MEND program effective in child obesity prevention. Available at: Lawson, M.S. http://www.thehindu.com/health/fitness/article99419.ece?service=mobile (Accessed: 8 March 2011). Welsh Assembly Government (2010) Childhood obesity in Wales tackled with fun-filled programme. Available at: http://wales.gov.uk/newsroom/childrenandyoungpeople/2010/mendprogrammes/?lang=en (Accessed: 7 March 2011). Read More