Health Promotion For Childhood Obesity - Term Paper Example

Managing Childhood Obesity Name: Institution: Course Title: Tutor: Date: Table of Contents Table of Contents i 1.0 Introduction 1 2.0 Key Parameters and Definition of Terms 2 2.1 Childhood Obesity 2 2.2 Health Promotion Management Program 3 2.3 Parameters for Evaluating Health Promotion Management Program 4 3.0 Health Promotion Management Program 5 3.1 Weight Centred Approach 5 3.2 Health Centred/ Biopsychosocial Model 7 3.3 Model of Routine Opportunistic Clinician Delivery 9 3.4 Settings-Based Health Promotion 10 3.5 Leadership 11 4.0 Discussions 11 5.0 Conclusion 12 References 14 1.0 Introduction World Health Organisation (2013) conceptualises obesity as a health condition that is demarcated with excessive fat accumulation thereby posing risk to an individual’s health. Further, WHO (2013) statistics indicates that obesity poses a threat to public health/ wellness not only to the high income countries and individuals as earlier believed, but also to middle and low income countries. For instance, they note that obesity rates has doubled since 1980; over 40 million children are overweight yet this is a precursor of obesity and lastly, it is real that obesity is preventable. Ailments have a negative impact not only one's health, but also on income & productivity. Moreover, those suffering from obesity are highly predisposed to contract other diseases such as type 2 diabetes & cardiovascular ailments (Plourde, 2006). It is these alarming realities that call for multidisciplinary health promotion management program so as to address the health issue of obesity in children. Obesity health promotion management program among children should address issues such as physical fitness, nutrition & nutrition education, lifestyle behaviours & risk factors so as to curtail health risks & maintain healthy lifestyles (Story, 1999). Nevertheless, the challenging question is which is the most appropriate intervention program in curtailing obesity in children should be implemented since the adoption of appropriate method is critical in curtailing the negative effects associated with the disease? This lead to adoption of analysis parameters fronted by Naidoo & Wills (2000) which include effectiveness, appropriateness, acceptability, efficiency and equity. Hence, the above parameters constitute the principal framework for evaluating health promotion management programs for obesity in children for this paper. Having realised that the ultimate aim of health promotion program is to reduce the vulnerability of individuals or to curtail further development of that disease, the aim of this paper is to establish the most appropriate health promotion program management for childhood obesity. To answer this concern, the paper analyses four intervention/ promotion programs. The first two are based on the proposition by Berg, Buechner & Parham (2002) on obesity prevention. These are weight centred approach to the health / management of obesity and health centred Model/ Biopsychosocial. The third program for managing childhood obesity is based on the proposition by M McElwaine et al. (2013) which is referred to as a model of routine opportunistic clinician delivery. The fourth is anchored on a proposition by de Silva-Sanigorski et al. (2010) which is a settings-based health promotion intervention. The paper argues that all the four programs are effective in addressing the issue of childhood obesity. In additionan to the four the paper proposes that effective leadership is requisite in managing obesity. Nevertheless, the paper appreciates that these programs should not be implemented in isolation since they support each other in the achievement of the desired outcomes. 2.0 Key Parameters and Definition of Terms 2.1 Childhood Obesity Obesity or for specific reason childhood obesity refers to excessive fat accumulation by an individual which is likely to impair one's health. This is measured by what is known as Body Mass Index. In this context, the weight of an individual in kilogram is divided by the square of her or his height in meter. As such, when one has a BMI greater than or equal to 25 he or she qualifies to be termed as overweight while if an individual has a BMI that is greater than or equal to 30, he or she is considered to be obese (World Health Organisation, 2013). Bellows & Roach (2009) defines Body Mass Index (BMI) as ‘a measure of weighted adjusted for height, used to determine weight categories for adults and children’. Nammi et al. (2004) notes that the disease is heterogeneous and multifaceted in nature since it is caused and aggravated by numerous factors such as lifestyle, nutrition, social and genetic factors. Additionally, it is indicated that 80% of overweight adolescents have a higher chance of becoming overweight adults and this is likely not only to have a health impact, but also economic and social connotations (Ahmed et al., 2010). WHO (2013) indicates that childhood obesity is on the rise. Currently they estimate that across the globe there are over 40 million children considered overweight or overweight. For instance, Bellows & Roach (2009) observes that 32% of children aged from 2-19 in United States of America can be classified as overweight while 17% are considered to be obese. On the other hand, in Australia, National Health Survey indicates that 24.9% of those aged 5-17 are overweight or obese (Australian Department of Health and Ageing, 2010). 2.2 Health Promotion Management Program Musich, Adams & Edington (2000) observes that’ the goal of health promotion programs is a risk reduction’. Dursi (2008) conceptualises health promotion program as entailing placement of various interrelated intervention mechanisms for group of individuals who are at risk of certain health conditions. These interventions can be premised on behavioural or clinical approaches. In relation to behavioural approaches, the focus is on curtailing unhealthy lifestyles that contributes towards enhancing the risk of an individual. These might include behaviour such as smoking, excessive alcohol consumption, physical inactivity combined with junk food intake and unbalanced diets. In a nutshell, this is geared towards preventive aspects. On the other hand clinical approach is more towards treatment of the ailment. Whichever, promotional program is chosen, both of them can be divided into five distinctive themes such as wellness/ prevention, population health improvement, population-based disease management, high risk management and case management. 2.3 Parameters for Evaluating Health Promotion Management Program According to Tang (2000), there are five types and levels of evaluation in health promotion program so as to establish its appropriateness. These include formative evaluation, process evaluation, impact evaluation, outcome evaluation and economic evaluation. The focus of the paper is on impact and outcome evaluation. Outcome evaluation concentrates on long term effects. The outcome to be evaluated relates to a reduction in risk factors such as excessive intake of junk food; reduced morbidity as hospital admission and cardiovascular diseases and reduced mortality (Thorogood & Coombes, 2000). On the other hand, impact evaluation is premised on how the promotional program influences behavioural outcomes such as change in behaviour, attitudes and creation of awareness (Goodman, et al., 1998; Dixon, 1995). Within these two selected types of evaluating health promotion program (impact & outcome), the main framework that informs the paper on how to analyse the most suitable health promotion management program appropriate for childhood diabetes is anchored on the parameters fronted by Naidoo & Wills (2000) such as effectiveness, appropriateness, acceptability, efficiency, participatory levels and equity. For the purpose of this discourse, the paper narrows on two parameters which are effectiveness and appropriateness. The paper treats effectiveness as the rate at which the program is successful or useful in addressing childhood obesity. These include how it reduces health risks and improves health promoting behaviours; increasing of awareness; increasing of detection of the diseases and referral of patients to medical professionals (CDC Community Guide Task Force, 2007 cited in Goetzel, 2008). On the other hand, the paper treats appropriateness as how the promotional programme fits within the macro and micro objective of addressing obesity. For instance, does the program has multiple interventions for single health issue/ obesity since it has been proven that combined strategies are more effective that one intervention. In a nutshell, is it multifaceted and integrative/ holistic or stand alone that addresses specific issues such as lifestyles, a given population group or a given setting say schools alone? Are the intervention/ program able to address other health issues at the same time? This is critical since it can be used to address two health issues at the same time. Additionally, is the health promotion program focused towards population wide issues or individual/ clinical based? Lastly, which level of prevention does the program fall? Is it primary, secondary or tertiary? The rationale for this is rooted on the fact that primary prevention is critical since it is proactive as the other stages tend to be reactionary in approach. 3.0 Health Promotion Management Program Anchored on the parameters identified on sub-section 2.3, the discourse below interrogates the appropriateness of the four health promotion identified earlier in managing childhood obesity so to reduce the risk of those who are vulnerable and those who are already infected. Additionally, the paper incorporates the central role leadership can play in managing obesity. 3.1 Weight Centred Approach Weight centred approach to health promotion is highly informed by the fact that excess weight/ obesity is as result of imbalance between energy consumed and energy expended (Ahmad et al., 2010). Therefore, it is premised on healthy eating behaviours/ nutritional campaigns and need for regular physical activities. The question is how effective and how appropriate is the approach? In terms of effectiveness, weight centred promotion campaign comes out as effective program. The rationale is anchored on the fact that it falls within the domain of primary prevention and thus critical in addressing population health at a larger platform. Angela (2013) observes that primary intervention or prevention constitutes of placement of mechanism prior to illness for those who are vulnerable. Indeed vulnerability of children is affirmed by Kiess, Marcus & Wabitsch (2004, p.98) who indicates that there is strong positive association between consumption of junk foods and obesity especially where there is minimal physical activity that could help in expending calories gained from these junks. According to Blom-Hoffman (2004), poor eating habit reliant on the junk food stuff is a predisposing factor in obesity. Indeed, this is what weight centered approach to managing obesity is anchored. It cajoles public to watch their weight by minding what they eat and to engage in intentional weight loss. Weight centred promotional campaigns urge public to watch what they are eating so as to reduces chances of becoming overweigh and or obese by having optimum BMI and weight. It aims at what is known ‘population weight goal for obesity prevention’ (Koplan, Liverman, & Kraak, 2005). This can be attained by ‘sating in terms of changes in the mean BMI and in the shape of the entire BMI distribution’ (Koplan, Liverman, & Kraak, 2005). For instance, Federal Government of Australia launched a weight centred promotional campaign dubbed ‘Swap It, Don’t Stop It’. This was a four year print, television and radio campaign which consumed $ 41 million cajoling people to adopt healthier eating options instead of junk foods. The campaign helped in creating awareness and attitude towards a healthy life style (Whyte, 2012). Additionally, knowledge on obesity has been advanced to the public on how to create a balance between calorie consumed and energy expended. For instance, it is recommended that ‘One small chocolate chip cookie (50 calories) is equivalent to walking briskly for 10 minutes’ (Koplan, Liverman, & Kraak, 2005). However, O’ Reilly (2011) notes that weight-centric approaches are not all rosy as it may be thought of. He observes that while weight centred management of obesity has taken centre stage. In certain circumstances it has proved to have harmful negative side effects such as emergence of eating disorder; mental health issues; harm from weight cycling and social stigmatisation. From the above, the method is effective in reducing health risks, improving health promoting behaviours, increasing of awareness and increasing of detection of the diseases since it offers information on the percentiles of BMI which a child of given age should fall in. However, it scores poorly in referral of patients to medical professionals. In terms of appropriateness, the program adopts two simple approach of creating balance between energy consumed and that expended. Moreover, this campaign fits well at population level albeit it can be also applied at clinical situation where health professionals cajole individuals at risk to watch their weight in terms of nutrition and physical activity. However, in certain circumstances it proved to have negative impacts such as adoption of poor eating habits in hope of attaining required weight. 3.2 Health Centred/ Biopsychosocial Model These are non-diet centred interventions that aim to manage childhood obesity (O’ Reilly, 2011). This is an integrative and holistic approach in the assessment, prevention and treatment of a obesity. This approach appreciates the fact that obesity is a multifaceted disease that is not only a function of nutrition, but also a function of other factors such as genetics and physical environment and socio-demographic factors (Havelka, Lucanin & Lucanin, 2009). This approach targets a population and not an individual by proposing raft of measures that can aid in behaviour change in terms of policy such as developments in built environment, creation of awareness and institutional linkages such as collaboration with food manufactures on the requisite ingredients that should accompany junk food or the requisite ration that schools should adopt (Walls et al., 2011). For instance, Department of Health and Ageing (2013) launched a program known as ‘a healthy and active Australia’. These include get set 4 life: habits for healthy kids, healthy spaces & places, learning from successful community obesity initiative and healthy weight information & resources. This approach is highly plausible option since it conceptualises obesity management from a larger picture rather than through selective mode. WHO (2012) in formulating Global Strategy on Diet, Physical Activity and Health (DPAS) indicates that prevention and control of childhood obesity should be an interlinked affair that take cognisance of other principal NCD risk factors. Therefore this calls for concerted effort from all levels and quarter. Hence, in terms of effectiveness it is an effective approach in reducing health risks, improving health promoting behaviours and increasing of awareness. Nevertheless, it plays no major role in increasing of detection of the diseases and referral of patients to medical professionals. Moreover, it is appropriate in application as a population wide strategy. 3.3 Model of Routine Opportunistic Clinician Delivery Kikano et al (2000) observes that opportunistic routine clinic delivery entails a form of preventive care that is geared towards the belief that a health care professional should wait until the patient visit the facility next time while complaining of given ailment, but to exploit the contact he or she has had with the patient to diagnose different ailments even t5hose that the patient have not complained of. According to Butler et al (2013), holistic approach to prevention is significant as result of the fact that most patients are likely to have multiple, inter-related lifestyle patterns that calls for treatment that is anchored on systems view rather than small bits that might not yield the desired results. In this context, all children visiting health facilities/ professionals should be encouraged to undergo comprehensive check up for the risk of overweigh/ obesity. Cohen et al (2004), indicates that “although infrequently used, quantitative data suggest that the use of opportunistic approaches to deliver preventive services during illness visits can enhance preventive care rates. Interventions aimed at helping clinicians develop effective strategies for offering preventive care during illness visits may be an important complement to existing mechanical interventions that might, by themselves, be insufficient to improve preventive care”. As such, opportunistic preventive care strategy should be advocated for by decision makers so that there are guidelines for conducting holistic assessment, brief advice and referral/ follow up in regard to various behavioural risks (M McElwaine et al, 2013). From the above, it occupies a significant position in driving behaviour change since a diagnosed individual can be advised appropriately. Additionally, it has a positive strength in increasing of detection of the diseases and referral of patients to medical professionals. In terms of appropriateness, the program is only suitable at clinical and not population wise level. 3.4 Settings-Based Health Promotion de Silva-Sanigorski et al. (2010, p.2) observes that setting-based intervention in managing obesity has mainly been concentrated in school since this constitutes a huge percentage where children spend their life and thus, has a huge impact on their lifestyle. This approach under socio-ecological framework identifies the multi-level influences on individual behaviours and recognises that culture and ethos of the settings, organisational policies, practices and regulations and engagement with wider community are all important factors’. This promotional approach utilises award-based program to enhance the socio-cultural, policy and physical environment connected with healthy eating and physical activity. This indicates that setting-based health promotion is a localised weight-centric, health-centric and biospychosocial promotions. An example is the initiative dubbed Kids - 'Go for your life' (K-GFYL) implemented in Australia targeting school going children. US have equally implemented Healthier US School Challenge which aims at enhancing quality of nutrition given to children at school and enhance physical activity engagement in school. The other is known as School Breakfast Program which gives cash assistance to pupils so that they can afford breakfast (Sinnott, 2011). The above shows that this is a localised program that integrates weight based issues. Therefore it is a hand on approach that is effective not only on creating awareness and promoting desired behaviours, but also on implementing the desired outcomes. However, it has a shortfall in terms of increasing of detection. In terms of appropriateness, the approach is limited to given settings especially school environment. 3.5 Leadership Leadership is critical in health management and this implies that the same is applicable to management of childhood obesity. Leadership is a critical ingredient in driving change behaviour through transformative leadership that shows sense of possibility among the public and the health workers (Curtis, Vries & Sherein, 2011, p.306). This is really critical as one step towards managing childhood obesity is through behaviour change in relation to diet and physical activity. Leadership is equally integral in building followership (Frankel, 2008, p.24).is a leader in a health sector can attain leadership within the health department responsible for preventive public health care, they can create sense of direction where they engage communities at the lowest of various issues that contribute to obesity that are easily avaoidded through well designed built envuironment, reduction of sedentary lifestyles and healthy eating habits. Leadership is important in determining skill mix, resource allocation and organisational policies & procedures (Duffield et al., 2010. p.2244). Davis (2011, p.7) notes that skill mix is important in availing the right staff that can be used to manage childhood obesity. Secondly, resource allocation is important in managing obesity. Therefore leadership has an important role of lobbying so that adequate resources areallocated for chilodhood obesity management (Mittmann, 2008, p.54). the last one relates to organisational policies & procedures. this is highly reliant on organisational culture which leadership is important in defining. Hellriegel et al. (2004, p.366) notes that health sector culture in managing childhood obesity should be marked with personal commitment, team work and loyalty. 4.0 Discussions The emerging observation is that the five health promotion programs are unique in their own ways. This implies that not any of these can claim to have higher comparative advantage over the other. For instance, weight-centric approach is critical in creating awareness, but not in creation of detection. On the other hand, opportunistic treatment is critical in increasing detection while it is not significant in driving desired behaviours. Opportunistic promotional program on the other hand shows more strength in relation to detection and referral, but it is not appropriate for population level, instead it is appropriate at clinical level. However, Biospychosocial model shows more strength since it borrows from the other four programs. This shows that these promotional programs for preventing and controlling obesity should be implemented in an integrated manner. Moreover, the paper appreciates the fact that leadership is principal in the whole process as it is critical in galvanising support, comminment and showing sense of direction thus, aiding in managing obesity right from top to bottom. 5.0 Conclusion Childhood obesity is one of the non-communicable diseases that are currently posing challenge to humanity globally across different economic and social divides. Owing to such realisations, there is need to have health promotion programs so as to cushion those at risk and aid those already within this status to regain normalcy. Critically, within the scope of preventive health, this calls for health promotion program as a means of managing childhood obesity. However, the significant concern is that among the possible health promotion programs anchored on different principles which one is the most appropriate. Hence, the ultimate focus of the discourse was to establish the most appropriate health promotion program for managing childhood obesity. In order to attain this concern, the paper conducted impact and outcome evaluation based on two parameters. These parameters are effectiveness and appropriateness. On the other hand, the management programmes analysed included weight-based intervention, health based intervention/biopsychosocial program, setting based intervention and opportunistic based intervention. In terms of effectiveness, the paper established that any of the four are effective in their own right. In terms of appropriateness, the four programs/ models varied. For instance in addressing specific concern especially at school where most children spend their time setting based promotional intervention proved worthwhile. For addressing population and clinical issues, the health-centred strategy proved worthwhile. In terms of clinical intervention alone, opportunistic testing proved a plus as it is one of the entry steps in secondary treatment. Finally, the paper observed that within these processes leadership is significant as it is important in directing all synergies and inculcating sense of possibilities among health professionals and public in managing obesity. References Ahmad, Qazi Iqbal et al. (2010). Childhood Obesity: Indian Journal of Endocrinology and Metabolism, 14(1), 19-25. Angela, M. (16 August, 2013). Primary prevention of obesity. 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