Planning, Implementation and Evaluation of overweight and obesity prevention

Planning, Implementation and Evaluation of overweight and obesity prevention at primary school

 

AT
Present days various technologies and facilities has modify old traditional
ways into modern lifestyles and living standard however these availabilities
are demoting healthy life resulting  in
low level of physical activity and unhealthy food habits.  Australian people are also suffering from
various health conditions including overweight and obesity and the most
important thing is children are also in risk of obesity and overweight which in
future cause heart diseases. Abnormal and over excess lipid accumulation inside
the body parts that results in the risk of various health conditions are called
overweight and obesity (WHO,
2017Obesity,Retrieved from http://www.who.int/topics/obesity/en/). The fat
level in the body is calculated by Body Mass Index (BMI) formula.

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BMI = a person’s weight (in kilograms)/ square of his or her height (in
meters)

A person BMI below 25 is consider as normal weight person,  a person with a BMI equal to or more than 25
is considered overweight  and a person
with a BMI of 30 or more is generally considered obese.

Environment
of Glenroy Central Primary School

Glenroy Central Primary
School is established in 2010 with flexible learning environment and is
situated at the northern part of Melbourne 13 km far from the main city. It
has approximately 230 students and is a very multicultural community.
School has strong connection with the community traits and values. School
teachers and staffs are well talented and highly professional. School buses are
available for students and staffs for transportation. Students have opportunity
to work on beautiful learning spaces through school Junior Learning Community
and a Senior Learning Community. The Junior Learning Community has a Prep Area
and a Year 1/2 Area.  The Senior Learning Community has a Year 3/4 Area
and a 5/6 Area. These areas have sufficient needs, flexible working spaces for
all students, library, creative spaces, and technologies. The school has 3
special areas in Visual Arts, Performing Arts and Physical Education.

Also for public transport, there is Craigieburn metro
line services (Glenroy Central Primary School guide 2010). (Glenroy Central
Primary School guide, 2010. Retrieved from http://www.glenroycentralps.vic.edu.au/)

Etiology
and epidemiology

In these recent years, childhood obesity is
increasing worldwide which is the risk factor several chronic diseases. The prevalence of obesity in children rose worldwide
by 47.1% between 1980 and 2013 (Pienaar, A. E. (2015The rate of obesity in 5-12
years boys increase from 4% to 8% whereas boys aged 13-17 was increased from 6%
to 13% in the year 1995. The rate of obesity in young boys of aged 5-17 was 5%
in 1995 which had increased to double (10%) till 2008.

The rate of obesity for girls (aged 5-17) was 6%
which was an unchanged rate as compare to boys. While the rate of obesity in
remains unchanged from 1995 to 2008. On the other hand the proportion of
overweight in girls of aged 13-17 years was increased from 12% in 1995 to 20%
in 2008. Whereas in younger girls of aged 5-12 years, the rate of overweight
remain constant at 17% in both time periods.

Socio-economic factors

The
number of family members and relatives also influence the rate of obesity and
overweight in children. Children staying with greater number of family and
relative members had more than double rate of obesity such as 28% than the
children living in less number of family members that is 13%. Other than
socio-economic variations between areas in phrases of schooling, earnings and employment,
some areas might also provide extra possibilities for physical activity and
higher access to healthy food options.

Physical activity

Australia’s Physical Activity Recommendations for children in
2004 recommends that children of aged 5-18 years need at least 1 hour physical
exercise every day. The survey of Australian Bureau of Statics shows all the
results after physical activities in children. In 2006, an organised and
informal sport was conducted for 1 year before interview in children of aged
5-14 Years. They were participated in culture and leisure activities. Overall
the collective information provides insight into some of the physical
activities in which children aged 5-14 are participating.

Children aged 5-14 years

In
2006, 63% of children had performed game which were organised via a school,
membership or affiliation outside of school hours, an increase from 59% in
2000. Over the six 6 duration, ladies’ participation in organised recreation
rose by 6% points from 52% to 58%, as compared with three percentage factors
for boys from 66% to 69%. even as the participation charges of approximately 45
% had been similar for children aged five years, through 13 years of age the
participation price for boys become seventy three% and for women changed into
fifty five%. The highest rate of participation for boys become at 10 years (77%),
while for women it became nine years (67%)

Children who spend at least 6 hours per fortnight on organised sport have less
possibility of obesity. Swimming and out of doors soccer games have been the
maximum popular sports activities. The survey also accrued facts on casual
sports, together with bike driving, rollerblading and skateboarding, to get
some indication of children’s involvement in informal physical activities. The
survey found that around 2/3 of kids have been driving motorcycle and a quarter
of them were skateboarding or rollerblading inside the previous two weeks. The
amount of time spent on these informal activities was similar to organised
recreation participation, with a mean of 6 hours per fortnight.

Children aged 15-17 years

In
2007-08 over 3-quarters of 15-17 years children, they all took part in
recreation or recreational exercise within the two weeks previous to the
national health Survey. But, just below one quarter stated that they either did
no exercise, or very low amounts at some point of the 2 week length.

Sedentary lifestyles

According to the Department of Health
and Ageing Australia’s Physical Activity recommendations for children
suggests that children who don’t get enough physical exercise and spend maximum
period of time in secondary schools have maximum chance bad health and fitness,
can develop obesity, high rate of cholesterol in blood and being lifetime obese
in maturity. Associated research has also proven that the occurrence of obesity
is highest among children who watch television for long intervals every day,
compared with children who watch television for a smaller quantity of time
every day. Australian child health guidelines suggests that children should not
spend greater than two hours in a day watching television, gambling computer
games or using different digital media for entertainment.

In
2006, almost all children of aged 5-14 had watched television, videos or DVDs
at some point of the two-week length of the survey and almost two-thirds had
played electronic or computer video games. Among them around 45% of children who
watched television, films or DVDs, and 10% of kids who played electronic or
laptop games, did so for 20 hours or more over the fortnight duration. An
average, amount of time spent on these sports by using maximum kids averaged
throughout a two-week length, become 2 hours per day.

Some of
the etiological factors for obesity and overweight problems are

Genetic Factors

On the basis of genetic etiology:
Obesity can be monogenic, Syndromic and polygenic obesity where syndromic and
polygenic obesity are applied to both childhood and adult forms of human
obesity. Monogenic and syndromic forms of obesity occur often in very early stage
of life. On the other hand, a high birth weight is normally related to elevate
BMI in maturity. The birth weight is directly correlated to BMI in maturity
whereas inversely associated with imperative weight problems, insulin
resistance, type 2 diabetes, cardiovascular conditions, and other metabolic
syndrome.

 

Neuroendocrine system irregular
functioning

 

Neuroendocrine control system
controls appetite and metabolism and regulates numerous factors and body
hormones. If there irregularly function of neuroendocrine system there may
induce various redundancies including more than one hormone with very similar
functions which controls body system. Neuroendocrine hypothalamus helps in fat
regulation in body systems.  Therefore
some abnormal conditions in its system leads to 
irregular accumulation of fat and fatty acids in body which in long term
can cause rapid rise in obesity.

 

Food eating Patterns and habits

 

Eating patterns and habits is
also associated with socio-cultural and economic characteristics of the
population. It also influence by the factors affecting personal and family
environments. These

Factors are directly related to establishment
of obesity.

 

Other factors of overweight in children are unhealthy
food advertisements and its high amount of consumption, lack of physical
activities like watching television, video games, computers and mobile ,
Cultural factors and sometimes due to low socioeconomic status .

·       
High Consumption of high calories energy
dense foods and beverages

·       
Lack of physical activities

·       
Hereditary and Genetic factors like
Bardet- Biedl syndrome, Prader- willi syndrome

·       
Low economic  and socioeconomic status

 

Obesity rate among infants and young children from age 0 to 5
has been increase from 32 million to 41 million globally from 1990 till 2016.

Overweight and obesity is one of
the growing problems worldwide. In Australia, the problem is also hitting on
the health system. Among five children and adolescents one of them is either
overweight or obese (WHO, 2017).
At this trend the rate of obesity and overweight is predicted to be increased
by 65% by 2020 (Better health channel, 2013). Childhood obesity has various
physiological and psychological consequences.

Physiological
consequences

o  
Obesity in adulthood

o  
Fatty liver

o   Dyspepsia

o  
Polycystic ovarian syndrome

o  
Cardiovascular diseases

o  
Type2 Diabetes Mellitus

o  
nocturnal breathing
cessation

o  
Orthopaedic disorder

o  
Esophagitis

 

Psychological
consequences

o  
Social isolation

o  
Low self esteem

o  
Depression

o  
Poor body image and negative
self-perception

o  
High risk of mental illness

 

Factors that may cause children to become overweight and obese at
Glenroy Central
Primary School are

·        
Selection of  food  –
 The food which contains high calorie sugar
and salt contain

·        
Lack of physical activity –
Australian children now a days are take less participation on physically active
games than in past.

·        
Spending a lot of time on sedentary
pursuits – Making an investment for an occasional measures and events to once
inactive pursuits for example Australian kids watch around 2½ hours of
television an afternoon, and in addition making an investment time on utilizing
computer systems and tabs, also exclusive electronic gadgets.

·        
 Overweight history – Every family has their
own food eating patterns and habits which also have major impact on children’s
food eating consumption.  

·        
Genetics – sometimes gene disorders
also cause severe childhood obesity and overweight.  Parents and grandparents heredity characters
are likely to be transferred to their children, many people with particular
genes (gene activated for food metabolism) are more susceptible to transfer
their gene o their children resulting in severe childhood obesity and
overweight. Therefore, family members who have history of obesity must be aware
of food choices and physical activities to avoid tendency of becoming their
child overweight in future.

Control
measures of obesity

WHO (2017) recommends:

·        
Within
one hour of birth mother should initiate breastfeeding.

·        
Exclusive
breastfeeding continues for the first 6 months of life and introduction of
nutritionally-good enough and safe complementary (stable) ingredients at 6
months collectively with persevered breastfeeding up to 2 years of age or
beyond.

·        
Complementary
foods must be wealthy in nutrients and given in enough quantities. At six
months, caretaker needs to introduce small amount of ingredients and steadily
increase the quantity when kids getting older. Young children have to get hold
of a spread of meals together with meat, chicken, fish or eggs as regularly as
viable. Meals for kids may be specially organized or changed from circle of
nutrient food. A complementary meal has high in fat, sugar and salt should be
prevented.

·        
School-aged
children and adolescents should limit high calorie, high sugar containing food.
Children should be encourage for consumption of fruit and vegetables, as well
as legumes, whole grains and nuts and participate in regular physical activity
(60 minutes a day).

·        
Reduce
intake of processed foods and ensuring healthy and nutritious choices at affordable
cost to all consumers.

·        
Individual
performs principal function to limit obesity but society can form the general
population. Accessibility of wholesome meals alternatives, availability of
centres for physical games with minimal or free of cost can inspire people in
society to appropriate meals and fitness. Parks and play grounds for kids can
assist bodily sports in youngsters and regulations for increasing tax on
unhealthy food and ingredients and sugary beverages can restrict its uses to
some extent.

Food industry can show some
responsibility by;

§  Adding
less sugar and salt in processed products.

§  Healthy
food choices and physical activity area availability in workplace.

§  Marketing
of processed food not targeting the children and teenagers (Australian Bureau
of statics 2010)

Stakeholder
group selection

Stakeholders like teachers, health staffs, family or
care taker, community organisations and other members like Family and friends
have major role for fulfilling the interventions in control and treatment of
obesity and overweight in school children. Categorizing food menu and changing
food habits of children which can be guided by parents, and teachers. Interventions
should have focused on environment and policy changes rather than relying only
on individual behaviours too. (Leeman, Sommers, 2012).

Evaluation
of childhood obesity and overweight

1. School-based interventions

·       
Proper nutrition
knowledge, diet, and healthy habits

·       
Physical exercise  and regular sports education and practice

·       
Merchandising
machines and availability of snacks; cafeteria foods and ingredients.
Governmental Policy (e.g., federal, country, and neighborhood) as well as
colleges have their own regulations which can have an effect on students’ eating
behavior and physical activities in schools and colleges. For example providing
nutritional foods and drinks within school and college cafeteria

2. Home-based
interventions 

·       
Daily intake of nutritional diet and continuing
healthy eating habits

·       
Proper parenting styles/education for
physical exercise and

·       
Proper policy

3. primary care-based interventions

·       
patient counselling

·       
Referrals to nutritionists

·       
Policy (e.g. federal, state, and local
government and policies related to the practice in the primary care setting )

 

4.Child-care setting-based interventions

·       
Changing food menu

·       
physical exercise procedures

·       
policy implementation  

·       

5.
Community-based or environment-level interventions 

·       
physical exercise

·       
farmer’s marketing processes and
building community and home gardens

·       
cooking lessons for children, increasing
green space, parks and sidewalks

·       
Access to healthy food choices to every
individual.

·       
Formulation of  Policy (e.g. federal, state, and local
government or other organizations (e.g. chain food stores)

6.
Consumer health informatics applications

·       
web-based interventions

·       
Cell phone-based interventions

·       
policy(e.g. federal, state, and local
government policies related to food and physical activity related products or
services provided via internet and cell phone)

7. Multi-setting interventions 

·       
Any combination of the above
interventions

Outcomes

Primary
outcomes

Decline
in prevalence of obesity
change
in BMI or BMI distribution in the population
Decrease
lipid deposit in body surfaces and major organs

Intermediate
outcomes

Increase
knowledge on nutrition , attitudes, beliefs, and diet
food
access and consumption behaviors
physical
activity , exercise and regular sports
sedentary
behavior

Adverse
effects

Psychosocial
outcomes- irregular eating habits
Irregular
growth and development negative impact in proper growth
Injury
and increase cost in health

Obesity-related
health outcomes

Cardiovascular
outcomes
Metabolic
outcomes
Psychosocial
outcomes

Evaluation
Process

There are 4 components that should be considered for
Evaluation Preview

1.    
Evaluation
Design

Both
the qualitative and quantitative data are used for analysis. Outcome assessment is for 1-year
from the baseline assessment for preventing obesity in children, home-based interventions should carried out. After 6
months assessing the outcomes comparing from the baseline assessments for comparative effectiveness of school-based interventions.

 

Steps
of evaluation

i.       Study
design- Pre-assessment and post-assessment has to report for comparing the
changes before and after program implementation.

 ii. Data collection
tools

For data collection a
simple form should be used for reporting age, weight and height to calculate
BMI of each child. This information helps to measure the indicators.

               iii. Data collection

Interviewing with
school staffs, each child also with parents helps to collect information so the
sources of information are interviews at the mid-term and end-of -the project,
school staffs, steering board, focus group, programme staffs, local
authorities. Focus groups are mainly primary school children; parents. School polices
should not be harmed in any matter, workshops and training should be given
prior program implementation and also after the survey some workshops and
training should be given to control the measures.

 

2.    
Data
collection

 

Designing
appropriate seminars and training sessions to impart healthy food consuming
behaviors. Designing a form format for filling the answers of research
questionnaire and finally writing feedback of participants on the form. These
activities can be fulfill by the steering committee and parents who are more
familiar with activities of children. These data on BMI of participants
collected by working staffs on periodic basis. Information level assessment
from claiming members Furthermore guardians ahead seeing of physical exercises
Furthermore their importance ahead wellbeing guiding panel create workshop once
physical activity, Pre-and-post surveys once seeing of fact that physical
exercises Also its use on Every day basis, in general angle of the task may be
that the wellbeing advancement officer meetings with way stakeholders.

3.    
Data
analysis and interpretation

 

            In this section the collected data are
categorize and summarised for evaluation and interpretation of outcomes to fulfil
the aim of the survey. Analysis of data is done by using Microsoft programmes
like Microsoft words, Microsoft excel.

Quantitative
Data; Graphs, pie chart tables, bar graphs and some of the descriptive
statistics are measure and reported for analysis quantitative data whereas
Qualitative Data measures the quality of the data. It helps to answer the key
questions of the survey. Some of the key questions are

1.     Does
the implemented program was helpful for the prevention, evaluation and analysis
of the obesity and over weight in school going children? 

2.     Has
the programme meet the desired impact? Why? Why not?

3.     How comparative effectiveness of home-based
interventions performed?

4.     How comparative effectiveness of primary care-based
interventions performed?

5.     What
are the barriers for the study?

6.     What
modifications can be done in future to make it more successful?

7.     What
are the lessons learnt by this programme?

 

4.    
Disseminate
lessons Learned

            This step responses in regards to
collection of major finding or data that to be publish. Last report and
finding, arrangement of the report card and the lessons figured out how that
fruition of the programme makes scatter in the report? This majority of the
data may be flowed “around the stakeholders, administration organizations
also publish on sites. The confirmation for this exploration might be used to
pass on the progress to guidelines.

There must be period
Furthermore subsidizing allocated to those spread of the report card with the
goal as to guarantee most extreme impact of the wellbeing programme. People in
general wellbeing officer will be mindful on assess the discoveries and create
an assessment report card. Assessment majority of the data could specifically
profit regulate interest Assemblies Also stakeholders Also by implication of
the different assemblies who would not straightforwardly included in the
programme. Therefore the responses are important for final report, format of
the report as well as for completion of programme in the report.

 

Reference

World Health Organization,
2017. Commission on Ending Childhood Obesity, Facts and figures on childhood
obesity. Retrieved from http://www.who.int/end-childhood-obesity/facts/en/

Better
health channel, 2013,Obesity in
children – causes. Retrieved from https://www.betterhealth.vic.gov.au/health/healthyliving/obesity-in-children-causes#lp-h-1

Australian Bureau of
statics 2010, FEATURE ARTICLE 1: CHILDREN WHO
ARE OVERWEIGHT OR OBESE. Retrieved from http://www.abs.gov.au/AUSSTATS/[email protected]/Lookup/1301.0Chapter11062009%E2%80%9310

Leeman, J., Sommers, J., Vu, M., Jernigan, J.,
Payne, G., Thompson, D., … & Ammerman, A.

       
(2012). Peer Reviewed: An Evaluation Framework for Obesity Prevention
Policy

       
Interventions. Preventing chronic disease, 9.