PREVENTION OF OBESITY IN CHILDHOOD
In this assignment I will endeavour to tackle the prevention of obesity in childhood as an aspect of health promotion. The rationale of choosing this topic is that obesity and overweight increase the risk of contracting world killer diseases such as heart disease, cancer and diabetes .The prevalence of obesity in United Kingdom and other countries and the cost to National Health Service and economy will be looked into. An analysis of the behavioural change model and how it relates to health promotion initiatives will be discussed. The role of a nurse and other professionals with regards to heath education and health promotion will be highlighted.
What is health The World Health Organisation (WHO 1986)defines health as a state of complete physical ,mental and social well being and not just the absence of disease and infirmity. Forster (2002) confirms that health is generally seen in terms of people being ill or well but indicates that this is a simplistic view, as being well or ill are not entirely separate notions but in fact overlap to some degree. Forster(2002) while concurring with the definition of health as provided by the WHO (1986) adds that this definition provides a positive view of health and suggest that health fluctuates over time along a continuum, good and poor health appearing at opposite poles of the continuum.
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Ewles and Simnett(2003) also suggest that health is determined by many factors such as Physical health, body function, Societal health living accomodation ,employment status , Spiritual health, religious beliefs and moral values or behaviours, Social health being able to sustain relationships and make friends, Emotional health the ability to cope with depression, stress and anxiety. Therefore an individuals health position along this continuum is variable but no distinct demarcation line between health and ill health exists. With regards to the definition given it is argued that health professionals interventions should focus on helping the clients ,individuals, families and communities to gain health related knowledge, attitudes and practice associated towards achieving certain behaviours.
Obesity and associated problems.Obesity is a condition of excess body fat associated with increased risks such as diabetes, cardiovascular and other common diseases (Beebe 2008) and (Campbell and Haslam 2005). Like smoking eating is a complex combination of behaviour driven by social and psychological factors as well as biological compulsion (Croghan and Johnson 2005).They went on to say that people eat fast food because it is socially accepted. For example some fast foods have high fat and high sugar content and people tend to overeat them because they are the most palatable and provide pleasure. The prevention and management of obesity has been a national governmental policy for a number of years according to the Chief Medical Officer,s Annual Report 2002,(DoH 2003).Obesity has been highlighted as a health time bomb and seen as a challenge for the government as a whole (DoH 2003).The World Health Organisation,(WHO 1998) has described obesity as a global epidemic as evidenced by the growing trends in most developed countries.
Obesity in childhood carries health risks in both short and long term. Marshall et al (2003) agreed with Bond et al (2004) that obesity has been recognized as a major health problem as it is linked to number of diseases such as hypertension, cardiovascular diseases and diabetes .Obesity is known as a major risk factor in the development of many diseases such as arthritis of weight –bearing joints, gastro esophageal reflux, sleep apnea and certain types of cancer,(Bond et al 2004).Therefore obesity can influence physical, intellectual ,emotional and social development influencing childhood .It is for the above reason that long term eating and exercise habits need to be promoted in health and stop obesity in childhood years. Primary care should play a leading role in obesity management and prevention. The above statement is supported by the document Choosing Health ;Making Healthier Choices Easier (DoH 2004) which identified primary care as crucial to the provision of services for overweight and obese clients.
Obesity is associated with many illnesses and is directly related to increased mortality and lower life expectancy. Tackling obesity is a government wide priority .Obesity was one the key areas highlighted in the governments white paper that needed reform and the plan to meet this target was that each primary trust should have a specialist obesity service with the clients have able to access to a dietician and able to receive advice and support on changing behaviour (DoH 2004)
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Possible causes of Obesity .A study by Mulvihill and Quigley (2003) has revealed that age, education, social class and prosperity have an important influence on the risk of becoming obese. Muller et al (1999) suggest that unhealthy eating habits are associated with overweight in children, they went on to say that overweight is linked with coming from a low socio-economic background, suggesting that these families should be a primary target for awareness and prevention campaigns. The figures released by the National Child Measurement programme are deeply disturbing. The fact that 22.9% of children in year one in primary school are overweight or obese surely indicates that measuring the BMI of children should begin much earlier (National Obesity Forum 2008).
How childhood obesity in England compares with other countries and the implications to the NHS and ecomony
The 2002 review of the white paper (Health of the nation) target for obesity was just 6 per cent for 1992. A continuing rising trend in obesity to 2010 is predicted, when one-fifth of boys and more than one-fifth of girls will be obese,(King Fund 2007) . More recently the Munich Declaration(WHO 2000) recognized that actions need to be increased to enhance the roles of nurses and midwives in public health, health promotion and community participation. Irvine (2005) reported that in United Kingdom there has been corresponding growth in emphasis on health promotion in primary care. For example the liberating the talents policy document for England (DoH 2002) identifies the involvement of nurses in public health, health protection and health promotion as one of three core functions for nurses. In the United States the problem of obesity and overweight is a growing concern and the prevalence has nearly tripled during the past decade.
The economic cost is approximately 117billion dollars annually taking into account hospitalization and the lost workdays,(Sitzman 2003)In Australlia the child obesity has increased dramatically and the contributing factors include the availability of affordable energy –dense food supply and sweetened beverages that are marketed aggressively. The studies by (Kaplan and Wadden 1986) cited (Joanna Briggs Institute 2008) has shown that obesity also causes adverse psychosocial problem such as bullying, discrimination and in older children and adolescent and low self esteem. The reduction of physical activities such as walking or cycling to school and an increase in computer and electronic games has compounded the problem (Joanna Briggs Institute 2008).Simillarly a study by Jebb(2005)has revealed that obesity and overweight continues to be a serious public health problem as it is rooted in three main areas such as excess food ,absences of controlling food behaviour and lack of physical activity.
However the studies by ( Dietz and Robinson 2005,Kirk et al 2005 and Reilly 2006) cited by (Joanna Briggs Institute 2008) has evidence that indicates that a combination of dietary intervention, behavioural therapy and exercise will have significant impact on weight reduction in overweight and obesity children. In England the rates of obesity have increased dramatically over the last decade and if no action is not taken one in five children aged will be obese by 2010 (DoH 2003)The prevalence of obesity and overweight has a substantial human cost and serious financial consequences for the National Health Service (NHS) and the economy .In 1998 over 18 million days of sickness were attributed to obesity and the total cost of obesity was 2.6 billon (National Audit Office 2001). In order to tackle the growing problem of obesity, the then Public Minister of Health Tessa Jowell set in motion a wide ranging plan of action (DoH 1999) cited by White and Pettifer (2007) which included the following; Healthy school programme, living centres to be established , safe and sound challenge, to increase activity levels in children and to increase information for public ,so that they can make informed choices. The Choosing Health White Paper (DoH 2004) demonstrated this shift towards this awareness with two of the overarching principles of the policy being reducing obesity and improving diet, nutrition and increasing exercise.
Role of a nurse in health promotion
Health promotion is at the forefront of healthcare and the teaching role of the nurse is more important than ever (Rush et al 2005). Whitehead(2004) agreed that nurses impart healthcare related information that influences values, beliefs attitudes and motivations. It is for this reason that nurses in primary care play a pivotal role in the management of obesity. Encouraging people to change their attitude towards a health issue is an important part of any health education programme (Clark 1999). Health promotion is a process by which the ecologically-driven socio-political- economic determinants of health are addressed as they impact on individuals and the communities within which they interact (Whitehead 2004).In agreement with Whitehead (2004) , Tones and Tilford (2001) viewed health promotion as political advocacy which is aimed at representing the underprivileged sections of society by helping them to redress the imbalances in power. The WHO( 1986) also viewed health promotion as a mechanism to enhance health and to prevent ill health in order to maintain and impose better lifestyles.
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Health education is an activity that seeks to inform the individual on the nature and causes of health/illness and that individuals personal level of risk associated with their lifestyle related behaviour (Whitehead 2004).He further states that health education seeks to motivate an individual to accept a process of behavioural-change through directly influencing their value, belief and attitude systems . However, Quinn (2001) argues that although health education is vital for health promotion ,the nurse must acknowledge that having the knowledge does not guarantee that people will implement healthy choices and a change in behaviour. To reduce obesity nurses can engage with young people for instance routinely measuring children s height and weight in order to obtain their body mass index (BMI),to establish the level of obesity. BMI is an accepted measure of obesity and is calculated as ratio of weight to weight, using the formula :BMI =weight in kilograms/height in square meters (Humphrey Beebe 2008).The National Institute for Health and Excellence (NICE 2006) and The Centers for Disease Control and Prevention’s ( CDC 2006) guidelines define those with a BMI between 25 and 29.9 as overweight and those with 30 and over to be obese. There are several approaches that health care professional can implement to tackle obesity in childhood.
For example the interventions and strategies can be targeted at the whole population ,individuals who are at risk , children and people with mental health problems. The House of Commons Health Committee’s recommendation (2004) that all children should have their BMI measured annually at school and that the results should be sent home to their parents or carers with appropriate advice. If fully implemented it would amount to full scale population level health screening programme that is cost effective. Health promotion is a vast subject with a variety of theories, models and approaches. Piper (2005) identified, the three models in health promotion frameworks that a nurse or midwife as behaviour change agent, the midwife or a nurse as empowerment facilitator ,nurse as strategic practitioner. Nurses as facilitators of self –help and promoters of positive health , are key to initiating change in this area (Croghan 2005).The nurses are ideally placed to adopt a public health role and can identify health needs as they are in regular and close contact with individual, families , communities and other health and social bodies (Jack and Holt 2008). The above models involve the midwives or nurses working with individual and the focus is on intervention.
According to Ewles and Simnett (2003) there are fives approaches to health promotion namely the medical , behaviour change , educational , client centred and societal change. The model by Ewles and Simnett (2003) identify the needs and priorities by setting the aims objectives and decide on the best way of achieving the aims by identify the resources ,plan and evaluate the methods ,set an action plan. In tackling obesity in children the medical approach would include the monitoring of the BMI. The medical approach is a reactive and opportunistic process and is adopted where the client has an existing condition or illness (Whitehead 2004) and (Ewles and Simnett 2003).The medical approach promotes medical interventions from professionals to prevent or reduce ill health and this requires the individuals to comply with preventative medical procedures. The educational approach provides individuals with knowledge and information thereby enabling them to make informed decisions and choices about their lifestyles. For example the educational approach would include teaching the children about the importance of nutrition and exercise. The behavioural change approach is targeted at the individuals ability to change their attitude and behaviour in order to adopt a healthier lifestyle.
However the behaviour change theory suggests that change will not occur until the individual is ready (Kopelman and Dietz 2005).The client-centred approach takes on the idea that people should act on their own problems. It helps client to identify what they want to know and act on them. The approach aims to empower the client. The societal approach aims to effect changes on the physical ,social , and economic environment to make it more conducive to good health (Ewles and Simnett 2003).Whitehead (2004) states that health education is an activity that seeks to inform the individual on the nature and causes of health or illness and that the individuals personal level of risk associated with their lifestyle related behaviour. The approach and aim of health promotion is to focus on changing the behaviour towards a healthier lifestyle. The stages of changes in health promotion developed by Prochaska and Di Clemente (1983)cited by Croghan (2005) are Precontemplation, contemplation, preparation, action , maintenance and relapse.
This model shows the process through which people travel to change addictive behaviour.. During the precontemplation stage the individuals are not thinking about making any change in their lifestyle. Not all clients are a stage in their life where they want to make a lifestyle behaviour change (Croghan 2005).The clients may not be aware that there is a problem and could be resistant to making changes. Contemplation is a point where the individual may be aware that there is a problem and at this stage they are weighing up the costs and benefits of change. Simillarly the Cognitive dissonance theory Festinger (1957) cited by Clark (1999) is a state of tension that occurs when an individuals beliefs are at odds with their behaviours .The cognitive dissonance is viewed as a motivational state as it enables the individual to bring the behaviour in line with beliefs such as binge eating and may change attitude towards it (Clark 1999).Croghan and Johnson (2005) agreed with the above that the support package should begin with an assessment of client s readiness and motivation to change.
Preparation is where the client becomes aware that the perceived benefits of change outweigh the costs, change is possible and small behavioural changes may occur. The Knowledge Attitude-Behaviour Model (KAB) proposes that as people acquire knowledge in nutrition and health areas, their attitudes change. Changes in attitude will then lead to changes in behaviours (Contento 2007). The next stage is where the individual takes action to change their behaviour and will lead to the maintenance stage where the new habits become established and the individual sustains the change in behaviour and moves on to a healthier lifestyle.
The NICE guidlines (2006) came up with a Obesity Intervention Pyramid aimed at tackling obesity for all children. It starts by adopting a whole school approach by addressing the levels of overweight and obesity in school children. If children are encouraged to become healthier eaters the interventions are more likely to succeed if it is applied as a whole and monitored daily.
This done by ensuring that the schools promote a culture where staff, pupils and parents or carers are encouraged to help each other to adopt a healthier lifestyle. The schools are advised to emphasise the importance of a balanced diet .A pictorial form of the balanced diet identifies those foods and drinks that should be consumed regularly and those that are high in sugar, fat and salt that should be limited. Physical activity in schools should be encouraged such as participate in sport and physical education(PE). Walking ,cycling, scooting and walk initiatives should be encouraged. This will reduce traffic outside the school thereby promoting healthy lifestyles. Avoid the blame culture that stigmatises those who are obese and overweight. Always stress the positive such as be healthy, get active, feel better and enjoy being active.
The Health Schools Programme approach involves parents and carers since they are the main influence on their children lifestyle .Parents and carers are important role models for children and can help them to stay healthy (NICE 2006).The school based activity should involve General Practioners (GP),Paediatricians ,School nurses, Dietacian and other health professionals. The behavioural programme uses the behaviour change techniques such as self-monitoring ,goal setting, positive enforcement, stimulus control and relapse prevention. BENEFITS AND BARRIERS AND WHAT HAS CHANGED .The benefits of engaging the children are improved health, concentration and behaviour. Nurses must identify potential barriers to participation in health promotion and intervene to reduce those barriers such as (Padula et al 2006)
Obesity is a problem that plagues millions of people, and can be considered an epidemic. Social changes and the increase in fast food corporations are leading to an escalation in obesity. Diet companies are profiting from the unhealthy habits of individuals and creating a false sense of relief. The rise in obesity is a social inclination, and needs to be seen as more of a health issue, and not as a counter-culture way of life. With a decrease in obesity, our country will become more active, and current obese people will have a new found sense of heightened self-esteem