The Problem of Obesity Among the Children of the Kingdom of Saudi Arabia - Article Example

Health Promotion Programme for the Obese Children of Saudi Arabia [Name of the Student] [Name of the University] TABLE OF CONTENTS Health Promotion Programme for Obese Saudi Arabian Children 3 Letter 3 Background 4 Causes of Obesity 6 Identifying the Priority Needs 6 Primary Age Group for Commencing Prevention 7 Objectives of this Programme 8 Planning a Health Promotion Programme to Reduce Obesity among Saudi Children 9 Evaluation Planning 12 Lay Theories 14 Implicit Theories 16 Conclusion 18 References 20 Health Promotion Programme for Obese Saudi Arabian Children Letter Place: Riyadh. Date: 31 December 2013. To: Dr. /////// Head of the Pædiatric Clinic, University Hospital, //////, Kingdom of Saudi Arabia. Dear Sir, Your recent letter regarding the development of a health education programme, with respect to obesity in the children of the Kingdom of Saudi Arabia, is to hand. It provides me with the utmost of pleasure to furnish the following guidance, suggestions to you, in this regard. My advice will concentrate upon the significance of arriving at an adequate and efficient plan; identifying the requirements, priorities, resources necessary for implementing the programme, tangible and latent impediments; and evaluation of the programme. After taking due cognisance of the importance of the programme, I have thought it fit to provide exhaustive references to the authoritative sources cited. In addition, I have provided a reference list of these sources, at the end of my letter. This will enable you to peruse the information to a much greater depth, if necessary. Background As you are well aware, contemporary childhood obesity constitutes a grave risk to public health and it has assumed alarming proportions, across the world. There has been a corresponding interest among parents, scientists and health professionals to address this pressing and seemingly intractable issue. In fact, the World Health Organization (WHO) has identified obesity as one of the most disregarded diseases that have substantial importance for public health (Koukourikos, Lavdaniti, & Avramika, 2013, p. 129). As of the year 2010, it had been estimated that there were around 42 million obese children, aged less than five years. Obesity constitutes an influencing factor for several chronic diseases, such as asthma, cancer, cardiovascular disease, Type 2 diabetes and hypertension (Jurdak & Kanarek, 2012, p. 134). Over the years, the terms overweight and obesity have undergone change. At present, it is described as an excess of body fat. However, there is no unanimity regarding the level of excess fatness for determining the presence of obesity or overweight among adolescents and children (Dehghan, Akhtar – Danesh, & Merchant, 2005, p. 24). For instance, Williams and other researchers had measured the thickness of the skin fold in 3320 humans, in the age range of 5 to 18 years. Thereafter, they categorised children with a minimum body fat of 25% for males and 30% for females as fat (Williams, et al., 1992, p. 359). Those who belonged to the 95th or higher percentile of body mass index for age, were defined as overweight by the Centre for Disease Control and Prevention (Dehghan, Akhtar – Danesh, & Merchant, 2005, p. 24). Individuals in the 85th to 95th percentile of body mass index for age were described as being at risk for overweight. The obese were defined as the individuals at or above the 95th percentile of body mass index (Arroyo & Herron, 2013, p. 6). Furthermore, obese children are at an increased risk of contracting Type 2 diabetes, which has only recently been discerned in this age group. Previously, it has always been associated with adults. The American Diabetes Association published a consensus report, which discloses that 85% of the children diagnosed with Type 2 diabetes are obese or overweight (Lobstein, Baur, & Jackson – Leach, 2010, p. 9). Liver steatosis or non – alcoholic fatty liver disease is another major complication in pædiatric obesity. A study involving a seven year old boy, has shown that non – alcoholic fatty liver disease could develop into hepatocellular carcinoma (Nobili, et al., 2013). Causes of Obesity Moreover, in the Kingdom of Saudi Arabia, obesity and overweight among children are well established. The extent of this malaise is akin to that found in the developed nations (Amin, Al – Sultan, & Ali, 2008, p. 317). Some of the reasons conjectured, in this context are; unhealthy dietetic habits, inadequate food choices and socio – economic disparities (Amin, Al – Sultan, & Ali, 2008, p. 318). Identifying the Priority Needs As such, obesity and overweight in adolescents and children have been discerned as the risk factors for the diseases with increasing incidence among the obese adolescents and children. Some of the diseases believed to be intimately associated with obesity are hepatic disease, Type 2 diabetes mellitus, impaired glucose tolerance, mental disorders and cardiovascular ailments (El Mouzan, Al Herbish, Al Salloum, Al Omar, & Qurachi, 2012, p. 130). As a consequence, it is imperative to be on the lookout for the presence of obesity and overweight, from an early age. In addition to the national prevalence data, regional disparities have to be considered during the surveillance of obesity and overweight. In the Kingdom of Saudi Arabia, such information tends to be scarce (El Mouzan, Al Herbish, Al Salloum, Al Omar, & Qurachi, 2012, p. 130). Consequently, health professionals should possess the knowledge and skills to support patients and their families and to change their behaviours. The objective of such transformation, being the prevention of weight gain, and the initiation and preservation of weight loss. Behavioural change, does not necessarily ensue from increasing knowledge. In order to make certain that children experience healthy growth and development, it is essential to meticulously supervise weight loss (Lobstein, Baur, & Jackson – Leach, 2010, p. 7). An increase has been detected in the child obesity levels of nations with emerging and less developed economies. This phenomenon has been marked among the urban populace, where the necessity for physical activity is lesser. Furthermore, in the urban areas sedentary behaviour tends to become the norm, and this is accompanied by better access to high calorie foods and beverages (Lobstein, Baur, & Jackson – Leach, 2010, p. 7). Primary Age Group for Commencing Prevention In general, children are regarded as the priority population for any programme aimed at reducing obesity or overweight. Children admit of a larger number of prospective interventions, in comparison to adults. For instance, schools provide a natural environment for improving physical activity and encouraging better food habits (Pařízková & Hills, 2005, p. 350). Another reason for such preference is the fact that it is a very difficult task to reduce excess weight in adults, subsequent to its formation. Consequently, it is much more pragmatic to treat and prevent obesity during childhood. There are several strategies for preventing obesity, such as focusing upon the diet and physical activity of children (Dehghan, Akhtar – Danesh, & Merchant, 2005, p. 27). Prevention, at the primary or secondary level, has the potential to provide the much needed impetus for controlling the contemporary obesity epidemic in the Kingdom of Saudi Arabia. There is considerable scope to implement several effective strategies to address diet, physical activity and the built environment (Dehghan, Akhtar – Danesh, & Merchant, 2005, p. 29). Such approaches can be commenced at home and in the pre – school institutions, schools or after school care services. These strategies hold out the promise of affecting physical activity and diet. It is essential for these schemes to be culture oriented and ethnical (Dehghan, Akhtar – Danesh, & Merchant, 2005, p. 29). Objectives of this Programme The purpose of writing a plan is to present a clear picture of our present position, in the context of the problem, and how to obtain successful outcomes. Plans in general are concerned with change or endeavours to uphold the important features of the present situation. Objectives are the end results towards which the action is focused. These objectives represent not only the end result of the planning but also the goal towards which the activities involving organising, staffing, leading and controlling are aimed at (University of Zanjan, 2011). Thus, you have to plan the objectives of your programme in a manner that highlights your actions regarding the issues relating to the plan. For instance, you should consider whether the project is aimed at educating parents and society about the problem or whether it is aimed at effecting a change in the dietary habits of children. This has to be achieved by means of proper training and other techniques. However, you should have no doubts regarding what you intend to achieve at the end of the programme. This will enable you to fulfil the objectives effectively. A major danger is posed to the individual who is overweight. This is all the more true of persons who are obese. Such individuals are at a significantly increased risk of developing diabetes mellitus, hypertension and coronary heart diseases (Al-Riyami & Afifi , 2003, p. 641). This project was created with the intention of addressing the problem of childhood obesity. Planning a Health Promotion Programme to Reduce Obesity among Saudi Children Strategic planning is seized with realising the best correspondence between an organisation and its environment. Consequently, attention to the external environment and mandates can be viewed as planning that proceeds from the external to the internal. In general, it is essential to address imminent strategic issues effectively and expeditiously, if the organisation is to flourish and survive (Bryson, 2011, p. 56). Failure to respond to strategic issues can generate undesirable results for organisations, from a missed opportunity or threat. The strategic planning process is characterised by a recurring nature. This becomes apparent when participants discover that the information discussed or created during the preceding stages comes to the fore, anew, as a strategic issue feature (Bryson, 2011, p. 56). The number of published intervention studies have been few and far between, and the major portion of the evidence relating to obesity prevention has been derived from these studies. Moreover, these studies have failed to be comprehensive and have emphasised single strategies in single settings. In addition, few of these studies have depicted an impact on the target group (Simmons, et al., 2009, p. 312). Consequently, guidance in the literature regarding the tangible measures to be adopted to prevent obesity among children at the community level, tends to be trivial. This tends to be all the more relevant with regard to the culturally and socially diverse populations (Simmons, et al., 2009, p. 312). An enormous challenge is envisaged while attempting to have in place a desirable environment for efficient action, Vis – á – Vis control of the obesity epidemic among children. The cause for this challenging situation is the absence of evidence and the intricacy involved in implementing a holistic approach towards the prevention of childhood obesity (Simmons, et al., 2009, p. 312). It is essential to adopt a broad action plan for preventing obesity among children. This strategy is assisted to a major extent, when it is combined with a capacity building approach. The latter facilitates interventions traversing multiple settings, by utilising multifarious strategies, with respect to healthy eating and physical activity (Simmons, et al., 2009, p. 321). A few of the theoretical models and conceptual frameworks employed with research on obesity prevention among children are; the Transtheoretical Model, Health Belief Model, Social Cognitive Theory and the Socio – ecological Models. In the majority of the instances, these theories and models have furnished the bedrock for studies founded upon a specific number of variables that admit of change (National Institutes of Health, 2008). However, these theoretical models had failed to explain more than half of the variations consequent to behaviour modification interventions. It was discerned that behaviour change was subject to a marked degree of variation, susceptible to the incipient conditions, nonlinear, and entailed manifold interactions with the physical and social environments (National Institutes of Health, 2008). One of the proposals, in this context, was to scrutinise the principles of self – determination and chaos theories, as a framework for conceptualising change. This was based on the perception that behaviour change was often nonlinear in nature. One of the clinical strategies compatible with these theories was that of motivational interviewing, since it could facilitate the inducement of moments of sudden revelation for individual behaviour change (National Institutes of Health, 2008). In their manual on developing quality in health promotion services, the Society of Health Promotion Specialists in the UK isolated the indispensable issues at the service level. The issues so identified were; first, guidelines relating to the practice and provision of service. Second, employing education and training to engender professional development. Third, the principles pertaining to professional practice. Fourth, selection and recruitment. Fifth, monitoring and measuring the standards of practice (Green & Tones, 2010, p. 188). With regard to the quality of the service provided, audits have been deemed to be appropriate. The term audit, in this context, has been described as the methodical and decisive analysis of the worth of a health promotion programme. This term has been regarded as being the same as quality assurance (Green & Tones, 2010, p. 188). Evans and fellow researchers have proposed a quality assurance cycle involving the following stages. First, identification and review of the crucial areas for quality assurance. Second, establishing standards. Third, identifying the benchmarks to be used for measuring these standards. Fourth, making a comparison between practice and these standards. Fifth, taking action. Sixth, conducting an appraisal of the previous stages. The result of the sixth or final review stage should form the basis for the first stage of a new cycle (Green & Tones, 2010, p. 188). Health promotion tends to be substantially varied and the related services are structured in several different ways. Spencer and fellow researchers have contended that the important functions of health promotion should be subjected to quality assurance. In this context, these researchers identified the following functions, strategic planning, programme management, monitoring and evaluation, education and training, information and resources, and consultancy and advice (Green & Tones, 2010, p. 188). As such, strategic planning was recognised as a cardinal function of health promotion. Evaluation Planning Programme evaluation provides a device for illustrating accountability to a wide range of stakeholders; such as community leaders, local and state agencies implementing the programme, policymakers, and funding sources. On account of evaluation, there is improved scrutiny of a programme’s operation, such as the activities that are conducted, the entities that conduct these activities, and the individuals affected by these activities (Centers for Disease Control and Prevention, 2012). Moreover, evaluation depicts the extent to which a programme complies with the implementation conventions. Furthermore, programme evaluation enables one to determine whether the implementation of activities complies with the plan, to identify the strengths and weaknesses of the programme and to identify the areas that are to be improved (Centers for Disease Control and Prevention, 2012). Thus, a treatment programme could be marked with a high degree of efficiency, with respect to those who complete it. However, the participants in such a programme could be insignificant. One of the benefits provided by programme evaluation is that it can determine whether the venue of the programme or the absence of transportation are impediments to attendance (Centers for Disease Control and Prevention, 2012). Thus, it is indispensable to evaluate the project plan, in order to obtain the latest position regarding its implementation. In addition, evaluation makes it possible to assess the impediments that affect implementation and provide an alternative to such difficulties. Theories Regarding Obesity Lay Theories In order to assess the belief of individuals, with respect to the problem of obesity and to provide a suitable approach to deal with the problem, the following theories need to be examined. It is the general tendency among individuals to entertain naïve beliefs regarding the underlying reasons and outcome of several phenomena. Despite the fact that such opinions are frequently rejected by science, they do tend to have a deep and lasting effect on conduct and judgement (McFerran & Mukhopadhyay, 2013, p. 1428). Thus, in a study by Robins and Pals, it was observed that some of the college students during their academic sojourn resorted to lay theories to justify academic failure. This, in a few cases, resulted in reactions of despondency and decreased self – esteem, which served to have a harmful effect upon their academic performance (McFerran & Mukhopadhyay, 2013, p. 1428). Such ingenuous convictions, regarding the reasons behind obesity, have also been discerned. These beliefs tend to exert a strong and systematic effect upon the dietary habits and body mass of the individual. In one study in 2010, Nimrod and Heine provided the participants with research works that attributed obesity to genetics or social networks. These researchers found that the participants who had perused articles claiming genetics to be the cause of obesity consumed a much larger amount of comestibles (McFerran & Mukhopadhyay, 2013, p. 1428). All the same, the lay theories regarding obesity that hold greater sway than the theories involving social networks or genes, have been seen to prevail to a much greater extent. In general, it is believed that individuals are principally responsible for their obesity. As such, it is significantly simpler to make rapid changes to exercise and diet patterns, as opposed to genes or social networks (McFerran & Mukhopadhyay, 2013, p. 1429). This provides a possible reason for people to regard absence of exercise and the excessive consumption of food to be the more usual reasons for obesity. It is quite evident that the lay theories influence eating behaviour. Those who promote the exercise theory believe that the influence of diet upon weight is trivial (McFerran & Mukhopadhyay, 2013, p. 1429). Individuals, in general, tend to believe in lay theories regarding the cause of obesity. Moreover, these convictions influence the possibility of their being overweight. Some studies have disclosed that the lay theories believed in by individuals, in the context of obesity, have a substantial effect upon their food choices (McFerran & Mukhopadhyay, 2013, p. 1433). It has been demonstrated that belief in a lay theory regarding obesity, is sufficient to influence the actual likelihood of its occurrence. A considerable amount of research has been conducted upon the demographic, medical and social features of obesity, which continues to be a major health concern (McFerran & Mukhopadhyay, 2013, p. 1434). There has been a conflict between two theories. The first of these theories advocates a change in the diet, in order to address obesity. On the other hand, the second theory promotes the idea of regular physical exercise to reduce weight. The medical profession has provided a conclusive opinion regarding the relative merits of these two theories (McFerran & Mukhopadhyay, 2013, p. 1434). One research study has provided empirical evidence that dietary change has the maximum effect upon obesity. Such results serve to reiterate medical opinion that obesity is best reduced by resorting to a change in the diet. However, it should be understood that exercise reduces weight. Nevertheless, exercise should not be accompanied by an increase in the number of calories consumed (McFerran & Mukhopadhyay, 2013, p. 1434). The reality is that weight management is fruitful, only when it is recognised that there are several factors that have to be addressed. One of the chief contributors to overweight has been identified as the accessibility to foods that are high in fat content, consumption of portions that are large, and limited scope for physical exercise. Several research works have shown that successful weigh loss is possible, only if there is a substantial amount of self – control and persistence despite being exposed to unceasing temptation (Burnette, 2010, p. 419). Implicit Theories The implicit theories relating to body weight provide certain predictions regarding the success of dieting in reducing weight and the subsequent strategies of self – regulation. Obesity persists to be a major societal concern; hence, the possibility exists that an implicit theoretical approach has to be adopted toward this problem. This could improve understanding regarding what promotes expectations concerning dieting success and subsequent motivation to prevent gain of excess body weight. Such improvement arises due to clarifying the psychological context, in which the dieting goal is realised (Burnette, 2010, p. 420). Researchers in the US have depicted a merger between the approaches of the implicit theory towards weight management with the approaches of the theory of value expectancy (Editors of Health & Medicine Week, 2010, p. 1914). The early years present the most opportune time to inculcate active lifestyles and encourage the consumption of nutritious food. These initiatives can prevent excessive weight gain. Clinical decisions, in the context of patient management, frequently tend to be intricate and challenging, due to the various factors involved (Lobstein, Baur, & Jackson – Leach, 2010, p. 7). Among the economically underdeveloped nations or the nations experiencing economic development, families with the highest levels of education or incomes depict the highest incidence of obesity and overweight. For example, as of the year 1997, 20% of the Brazilian children belonging to the higher income families were observed to be overweight or obese, whereas the corresponding proportion for children from the middle class families was 13%. With regard to children from the lower income families, this proportion was a mere 6% (Lobstein, Baur, & Jackson – Leach, 2010, p. 7). Schools provide the ideal background for implementing interventions related to childhood obesity. This is due to the fact that children develop habits relating to physical activity and eating, during their early years. Interventions that are school based have to concentrate upon the prevention of childhood obesity (AlMazooqi & Nagy, 2011, p. 59). In addition, these interventions have to promote increased physical activity and healthy nutrition, in order to reduce the body mass index. Physical activity behaviours can be altered substantially by increasing the duration and variety of school based activities (Al-Riyami & Afifi , 2003, p. 59). Conclusion It is my considered opinion that strategy planning constitutes the best option for contending with the problem of obesity among the children of the Kingdom of Saudi Arabia. Subsequent to identifying the principal target group as that of the school children, I recommend the formulation of a strategic plan to overcome this problem successfully and effectively. Quality assurance is important, while assessing the effectiveness of the programme. Moreover, the health professionals should be provided with sufficient training regarding this problem. The guidelines provided by the Society of Health Promotion Specialists could prove to be beneficial, in this context. In addition, the steps to be adopted in the strategic plan are as follows. Step One: Develop a vision and mission. Step Two: Establish the objectives and priorities. Step Three: Finalise the strategic plan. Furthermore, the strategic plan should necessarily incorporate a work plan with information relating to strategies to be adopted or what is to be done; the people responsible for implementing these strategies; the schedule for implementing the strategic plan; the resources required; and the collaborators and partners for this strategic plan. Step Four: Implement and assess the strategic plan. Any serious endeavour to reduce obesity or overweight among the children of the Kingdom of Saudi Arabia, has to necessarily concentrate upon the schools. The latter furnish the optimal environment for implementing measures aimed at addressing childhood obesity. It is during the early years that children develop habits pertaining to eating and physical activity. I am certain that this information will provide you with the wherewithal to plan and implement a successful programme aimed at reducing obesity among the schoolchildren of the Kingdom of Saudi Arabia. Yours sincerely, References AlMazooqi, M. A., & Nagy, C. M. (2011). Childhood Obesity Intervention Programs: A Systematic Review. Life Science Journal, 8(4), 45 – 60. Al-Riyami, A. A., & Afifi , M. M. (2003). Prevalence and correlates of obesity and central obesity among Omani adults. Saudi Medical Journal, 641 – 646. Amin, T. T., Al – Sultan, A., & Ali, A. (2008). Overweight and obesity and their relation to dietary habits and socio-demographic characteristics among male primary school children in Al-Hassa, Kingdom of Saudi Arabia. European Journal of Nutrition, 47(6), 310 – 318. Arroyo, K., & Herron, D. M. (2013). The Epidemiology of Obesity. In C. C. 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