Obesity and Eating Disorder of Australian Children in Childcare - Essay Example

Project and Evaluation Plan Obesity and Eating Disorder of Australian Children in Childcare Table of Contents Contents Contents 2 List of Terms & Abbreviations AHMC – Australian Health Ministers Council BMI - Body Mass Index LDC – Long Day Care NCOT – National Children’s Obesity Taskforce 1. Introduction 1.1 Agency The National Children’s Obesity Taskforce1 or NCOT is an agency developing and implementing innovative programs to address the increasing rate of obesity in children particularly those that are in childcare. 1.2 Target Group The project intends to promote healthy eating and implement dietary guidelines to children in childcare setting particularly those with high-rate or prevalence of obesity. However, since children are under the care of LDCs or long day care centres, the secondary target are individual and groups involved in providing care as they can directly influence a child’s eating habit and physical activity. 1.3 Project Outline Since 2005, NCOT has been nationally coordinating with State and Territory, and Australian Governments. It has been given $116 million by the Australian Government with assistance from the Australian Health Ministers Council or AHMC to support its various projects for six years that include health promotion through posters and brochures intended to provide carers, parents, and teachers some important information in improving healthy eating and physical activity levels of children. NCOT established a network of community health weight promotion centres and sharing knowledge and expertise in Victoria and the Hunter-New England region. The role of childcare in shaping children’s dietary intake, physical activity, and combating childhood obesity is very important as children’s healthy behaviours are formed during these early developmental years. As more mothers find jobs outside the home, the percentage of children in childcare centres increase thus the quality of food and physical activity levels in these centres should be monitored and guided. Recent study shows that a combination of unhealthy meal, decreased physical activity, and hours of watching television contribute to around 49% of obese children. Similarly, recent review of interventions in day care centres aimed to prevent obesity among children suggests significant reduction in weight status or body fat (Waters et al. 2011, p.6). NCOT, with its considerably long experienced in promoting health for children now embarks to a new project aimed to promote healthy eating and physical activity ti prevent and reduce obesity problems in childcare setting. NCOT will be deploying two groups of community development workers. The first group will going to concentrate on childcare centres operating in Victoria while the other will be responsible for centres located within the Hunter-New England region. These groups will be working in coordination with existing NCOT network of community health promotion centres and selected childcare establishments in the area. The primary concentration is on delivering important nutritional and health information on childcare practitioners and monitor the progress through survey and statistics. The promotional materials as well as staff expenses will be funded from the grant awarded by the Australian Government through the Australian Health Ministers Council. The fund will support the following community development workers category: 1. Health promotion workers – 35 (including group leaders) 2. Development and training for new recruits and skills upgrading of existing staff 3. Planning, design, printing, packaging, and distribution of health promotion materials to different childcare centres. 4. Monitoring and evaluation – 6 months 1.4 Project Team The project will be under the supervision and control of existing NCOT Board of Directors while NCOT board appointed, well-experienced group managers will head the actual implementation. These managers will be responsible for coordination and distribution of health eating promotional materials in their respective jurisdiction. They will be also responsible for monitoring the progress and updating the board on the status of the project. 2. Background 2.1 Target Group Researchers and policy makers according to Paxon (2006), often neglect the role of childcare establishments in preventing or reducing childhood obesity. This is despite of the fact that childcare setting is a major driving force in shaping children’s dietary intake, physical activity, and energy balance. Childcare providers are responsible for large and growing numbers of children during developmental years thus, the best place to address the problem of obesity in children (p.144). Diet and exercise is very important in children’s development but there are evidence that children today are not eating a balanced diet. As shown by increasing number of overweight and obese children, it is evident that they are taking more energy that their body requires. For instance, children who are obese usually eat high levels of fat and carbohydrates rather than eating vitamin rich fruit and vegetables (Tassoni 2007, p.260). Obesity in childhood particularly in Western countries is a serious issue not only because they are making children grow into obese adults but the emotional and physical health related risks associated with obesity. For instance, overweight children are often unhappy because their size and shape are common targets for bullies. Moreover, obesity coupled with lack of exercise often result to respiratory problems and acquisition of type 2 diabetes that can severely affect these children’s health during their adult life. Since obesity is commonly viewed as 20% percent more weight than the recommended body weight, the problem is usually found in two closely related causes. First, children are allowed to develop poor eating habits such as unrestricted intake of high sugar drinks and sweets, crisps, and other convenient foods. The second cause is the combination of poor diet and lacks of exercise due to unrestricted hours of passive activity such video games, television, and others (Lindon p.90). According to Mathews (2004) children obesity and eating disorder is a very serious issue in any community. In Australia, there is an increasing concern that diets of many children are poor, too high in fat, salty, low in fibre, and too high in energy. The number of overweight children is increasing rapidly as children are consuming more energy than they could expend. Study shows that food preference and attitudes towards food starts early in life thus childcare centres should encourage children to eat a well-balanced diet and develop positive attitudes towards nutritious food. Moreover, children with working mothers spent around 8 hours of their time in childcare thus most of their daily food requirements are prepared within this setting. Therefore, childcare centres are in better position to provide nutrition program for children (p.166). 2.2 Needs and Issues In a study conducted in Australia from 1985 to 1995, the level of combined obesity in children doubled. In 1995, 21% of children as young as 2 years of age are obese while the proportion of obese girls aged 7-15 years increased from 1.2% (1985) to 5.5% a decade after. Similarly, obesity in boys of the same age rose from 1.4% to 4.7%. Obesity in children suggest 25 to 50% chance of being obese in their adult life and development of endocrine, gastrointestinal and other orthopaedic problems as well as long-term cardiovascular diseases. Moreover, study shows that childhood obesity not only results to health problems but social discrimination, poor self-esteem, and depression (Funnel et al 2008, p.197). According to Barnes & Rowe (2008), child health issues is not just a matter of health and community service but appropriate governmental, state, and local policies and programs. A review of Australian health policy in 2004 suggests that initiatives for child health issues are commonly leaning towards nutrition and does not include childhood obesity. It was only in 2008 that Australia’s “Healthy weight” national agenda for young people and their families consider inclusion of childhood obesity in health policies and programs (p.28). The increasing obesity problems and its latter implications strengthen the need for (Hills & King 2007, p.98): Strategies for increase physical activity Reduction of sedentary behaviour Judicious control over food choice Selection of low to medium energy dense diets at home and in childcare centres Childhood obesity is a medical condition that is affecting children particularly in industrialized nations. Similar to other health conditions, childhood obesity is influenced by several or combination of two or more factors (Mobile Reference 2007, p. 6). Bagchi (2010) enumerated and explained some of the issues concerning obesity in children that has strong cultural components (p.132): Increase time pressure as a consequence of social changes This specifically includes the emergence of global economies demanding flexible labour workforce and non-routine work schedules resulting to busyness and time pressures. Individuals and families are now faced with too many activities that could fit within a day, technological innovations offering extreme convenience, and energy dense fast foods well suited for busy lifestyle, advertising and availability of unhealthy foods in schools, and all those goods that have been adapted to child’s eye view of convenience. Convenience around food and activity Vending machines makes access to food convenient, automobile, and other mode of transportation makes travel quicker with less bodily energy consumed. Use of energy-demanding forms are transport such as walking, cycling, and taking mass transport decreased considerably while most children are chauffeured to schools by their parents. Changing family dynamics Families in Australia have change structure, function, and culture since the 1960s as population undergo demographic, epidemiological, technological, and nutritional transitions. Changes in technology and nutrition was triggered by economic growth the eventually turned the environment obesogenic as family food and physical activity change to energy-dense fast food and convenient way of living. Moreover, since more and more mothers are entering the paid workforce, children’s diet and activities are being managed by childcare centres, which are also influenced by busy lifestyle. 2.3 Assets and strengths The significance of early childhood is widely recognized in Australia thus it is not difficult for children in childcare to eliminate obesity, eating disorder, and subsequent complications. For instance, states and federal government recognizes that reality of early childhood experiences’ impact on individual’s competence and success. The lack of good nutrition, health and safe environment, poverty, and obesity as predictors of later child development difficulties (Edgar 2005, p.75). Moreover, both states and the Australian federal government developed programmes for community development and in 2006, the latter initiated “Stronger Families and Communities”, a strategy with sharper focus on early childhood. The intention was to help families and communities build strength and capacity so they can solve local problems. This well funded initiative has four elements namely ‘Communities for children’, ‘Early childhood- invest to grow’, ‘Local answers’, and “Choice and flexibility in child care’. The last elements include prevention of child abuse in foster, care and childhood obesity and type 2 diabetes (Barnes 2006, p.118). Childcare centres is one of key settings for promoting health weight as they deal with virtually all children during the critical years of child development. This includes children at the highest risk of obesity such as those belonging to low-income families. According to Kopelman et al. (2009), the common approach for childcare obesity prevention is health promotion that includes policies on physical activity and nutrition, development of structures that support sport and active life, and increased availability of health choices in food services (p.478). This project therefore will find it easy to coordinate and further strengthen these existing health promotion initiatives as opposition may be totally absence from the target population. 2.4 Rationale of the Project Although the increasing numbers of mothers entering the workforce is a good sign of prosperity, its negative consequence is much greater than its benefits. For instance, according to OECD (2005), mothers devote less time to childcare due to pressures on family life and work. Consequently, it affects the amount of care children receive and increases their vulnerability to several forms of distress such as the disturbing trend towards overweight and obese children resulting to loss of self-esteem, depression, type 2 diabetes, and higher rates of heart disease (p.71). For this reason, there is a strong need to develop a project that can effectively look after and prevent obesity in children in childcare. Project Rationale: Obesity is one of the two most preventable causes of type 2 diabetes (Pearce & Witten 2010, p.24). Sensible diet may help alter the course of children’s cardiovascular destiny (Mogadam 2001, p.271). Physical activity can be enhanced by policies, regulations, and guidelines that support and promote active recreation and transportation (Kopelman et al. 2009, p.478). Food supply intervention can greatly influence the availability, accessibility of certain types of food thus programs promoting fruit, and vegetables are likely to increase consumption on the target population (Kopelman et al. 2009, p.480). Healthy diet and active life promotion: Develop and distribute informational materials about the serious consequences of obesity Develop and promote healthy foods and beneficial physical activities for children at childcare centres Encourage parents to monitor their children’s eating habit Support existing childcare anti-obesity programs Empower children by educating them about obesity and the benefits of healthy foods and proper eating habit. 3. Project Plan 3.1 Project Aim This project’s main aim is to reduce and prevent obesity and eating disorder among children in childcare centre through healthy diet promotional materials and support for existing childcare anti-obesity initiative. 3.2 Objectives and Strategies/Activities Each strategy of this project is selected in terms of their relevance and effectiveness to realize the objectives of the project and ability to be use in other similar activities in childcare setting. Objective # 1 Connect to existing NCOT promotional structure, coordinate with childcare institutions, and parent groups. Strategies for this objective: Present a project proposal to NCOT Project Assessment Committee and get approval for funding release and implementation. Hire well-experienced health promotion workers with knowledge of childcare setting. Select and assign each group to Victoria and Hunter-New England region. Create a monitoring and assessment team that would monitor and report progress to the NCOT Assessment Committee Rationale: These strategies are developed with the needs of the target group in mind. The purpose of submitting the project proposal is to ensure compliance with all legal and ethical requirements particularly when it involves children and their well-being. Although NCOT already have an existing infrastructure for health promotion, hiring health workers that are well experienced in childcare setting can be more effective since they already familiar with children’s behaviour and preference. The monitoring and assessment team can help ensure timely identification of project flaws and adjustments required. Objective # 2 Training and development for new recruits and upgrading of knowledge and skills for existing NCOT staff Strategies for this objective: Explain the goals and objectives of the project and the outcome that must be achieved. Train new staff in handling health promotion involving children Re-assess and upgrade existing NCOT staff on current requirements particularly those involve legal and ethical concerns. Rationale: The rationale of this strategy is derived from common practices in community development, which is development of knowledge and skills suitable for a particular project. This is to ensure that all staff are well-informed and capable of managing the target population effectively. Objective # 3 Develop suitable health promotion materials with special emphasis on children’s obesity and eating disorder in childcare environment. Strategies for this objective: Research about children and obesity in children, childcare policies and procedures, childcare food preparation practices, and government requirements Research on serious consequences of obesity Establish connection with existing NCOT health promotion network including target childcare institutions for additional information Study and evaluation project requirements Design and printing of health promotion materials Rationale: The objective requires complete and current information on obesity in children and childcare environment thus it is logical to research on various aspects of children eating behaviour, causes and implications of obesity, the childcare environment, and others. Objective # 4 Monitor and evaluate project progress to ensure relevance, effectiveness, and sustainability Strategies for this objective: Create an independent monitoring and evaluation group Report progress level to NCOT Assessment Committee Review and analysed requirements Take necessary action Rationale: It is common knowledge that monitoring and progress evaluation are important aspects of projects and in health promotion concerning children in childcare, it is paramount that NCOT management is well informed and updated on the status of the project. The purpose is to quickly identify strategies that are working as well as those that need modifications and require immediate action. 3.3 Performance indicators The goal of the project is to reduce and prevent further obesity and eating disorder in children at childcare centres. It is therefore necessary to measure success using the following performance indicators (see details in Appendix 1): Children are increasingly shifting towards fruit and vegetable diet while avoiding vending machines and high-energy foods. Children are more active and getting involve in beneficial physical activity such as sports and exercises. Decreased number of obese children in childcare 3.4 Timeline and Implementation Plan Four important objectives must be realized in this project thus corresponding activities for each objective must be taken into account and schedules. See table below and Appendix 2 for details. Objectives Work Requirements Work Duration Connect to existing NCOT promotional structure, coordinate with childcare institutions, and parent groups. Submit proposal to NCOT Project Assessment Committee Approval and funding release Selection and hiring of workers Orient and assign workers to Victoria and Hunter-New England region. 11/ 21/2011- 12/ 21/2011 Training and development for new recruits and upgrading of knowledge and skills for existing NCOT staff Present project’s goals, objectives, and expected outcomes Train new and upgrade existing staff 12/26/2011- 01/ 26/ 2012 Develop suitable health promotion materials with special emphasis on children’s obesity and eating disorder in childcare environment. Research and analysis of all aspects of children, obesity, and childcare setting Implementation 02/03/2012-10/03/ 2012 Monitor and evaluate project progress to ensure relevance, effectiveness, and sustainability Monitoring and evaluation/reporting/review and analysis/action 03/03/2012- 10/03/ 2012 3.5 Ethical Issues There are a number of ethical issues involve when someone try to intervene with the well-being of overweight children. For instance, compulsory membership to a soccer club, banning of soft drinks vending machine, and interfering with parental care being provided by parents of obese children entails sensitive ethical issues such as stigmatization, justice and interference (Waters et al. 2009, Introduction). It is therefore necessary to consult parents as well as the childcare practitioners on ways and means health promotion will be ethically acceptable to them. One way is to get parents informed consent as children are legally cannot decide on their own. Informed consent is very important since reduction of obesity often involve behavioural modification, diet alteration, increased physical activity, and intrusion into someone’s private life (Jelalian & Steele 2008, p.242). Although most parent support BMI reporting, they are often concern with their child’s privacy and threatened by the thought that their children will be stigmatized (Waters et al. 2009, p.8). It is therefore necessary to respect children’s privacy regardless of serious obesity problem. Moreover, it is also important to take into account ethical issues involving food companies that may be affected by the anti-obesity promotional materials. Respect to stakeholders’ right must be taken seriously to avoid legal and ethical implications (Burniat 2002, p.252). 3.6 Monitoring and Evaluation Plan The Australian Federal Government as well as the Australian Health Ministers Council deserved to know the progress of projects they funded. Similarly, the entire NCOT management and staff, the NCOT project assessment committee are expecting feedback from the field. Therefore, NCOT project for obesity and eating disorder should conduct its own impact evaluation and report to these stakeholders the level of accomplishments and outcome. Data will gathered through both qualitative and quantitative method since individual perception and statistical data are both required. These can be either results of interviews, data from surveys, evaluator observation, and statistics. Evaluation of this project may require the following critical questions: Is the project on track and being implemented based on specified plan and procedures? Is there any problem in accessing the target population? What are the issues? Is the present outcome sufficient to justify the cost? Is alteration of original plan required? What are the benefits? Knowledge of the actual progress including the cost of operation is very important since it would determine the success of the project. Therefore, monitoring should start the moment the project started and continue until all expected outcomes are achieved. Report should flow from the field to the NCOT obesity and eating disorder project management, the NCOT Assessment Committee, Health Ministers Council, and to the federal government. 4. Appendices 4.1 Appendix 1 NCOT Obesity and Eating Disorder Project Service Delivery Plan Aim: To reduce and prevent children obesity and eating disorder in childcare Objective Strategies Performance Indicators Connect to existing NCOT promotional structure, coordinate with childcare institutions, and parent groups. Submit proposal to NCOT Project Assessment Committee Approval and funding release Selection and hiring of workers Orient and assign workers to Victoria and Hunter-New England region. Approved Fund released/ Project fully supported Completed workforce requirements Number of members complete and mobilized to respective area Training and development for new recruits and upgrading of knowledge and skills for existing NCOT staff Present project’s goals, objectives, and expected outcomes Train new and upgrade existing staff Competent staff and smooth implementation Develop suitable health promotion materials with special emphasis on children’s obesity and eating disorder in childcare environment. Research and analysis of all aspects of children, obesity, and childcare setting Implementation Complete and accurate information Promotional materials relevant and correct Monitor and evaluate project progress to ensure relevance, effectiveness, and sustainability Monitoring and evaluation/reporting/review and analysis/action Progress known/Actions are taken in timely manner 4.2 Appendix 2 Objectives/Activities Month/Year 2011-2012 Nov/11 Dec/11 Jan/12 Feb/12 Mar/12 Apr/12 May/12 Jun/12 Jul/12 Aug/12 Sept/12 Oct/12 Connect to existing NCOT promotional structure, coordinate with childcare institutions, and parent groups. Training and development for new recruits and upgrading of knowledge and skills for existing NCOT staff Develop suitable health promotion materials with special emphasis on children’s obesity and eating disorder in childcare environment. -Implementation- Monitor and evaluate project progress to ensure relevance, effectiveness, and sustainability 5. 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