Essay On School-Based BMI Programs' Effectiveness In Identifying Children/Adolescents At Risk Of Obesity And Eating Disorders.

Assume that the screenings will take place once a year. Evaluate the suggested intervention discussing the following key issues associated with the intervention:

1.a)  The perspective of the study: Consider cost of obesity/eating disorder to the individual with illness or to the society as a whole
2.b)  The intervention time frame: The period should be sufficiently long to cover program start-up phase and full program implementation (with ongoing costs and school schedule).
3.c)  The analysis time frame: You need to decide how long we should wait to see change in outcome of interest if the intervention is successful. For prevention strategies, the time frame should capture all potential costs and benefits of the program. However, you must consider how realistic and feasible data collection will be (i.e., very few outcomes might be detectable within a short period after screening, but very long- term follow up is not feasible).
4.d)  Data on all types of costs to be collected: including costs relating to actual implementation of the treatments.
5.e)  Data on relevant health outcomes within each of the following time frames: short term (e.g., one month), intermediate (e.g., one year), and long term (e.g., 10 years or lifetime). Rank the outcomes identified in (e) on the level of appropriateness for CEA. How feasible is it to obtain data on outcomes you have identified? If too difficult, what are the alternative outcomes that will still reflect the outcome of interest? What assumptions are you making regarding the alternatives as proxies for outcome of interest?
Outline the recommendations you would make? Support your analysis, evaluation, and recommendations through reference to the existing cost effectiveness literature.

Increment in Obesity in Children and Adolescents

How effective is the implementation of BMI programs in schools to aid parents and teachers in the identification of children/adolescents who are at high risk of developing obesity and eating disorders?

The prevalence of obesity and several eating disorders amongst children and adolescents has increased significantly over the past decade. The increment is mainly attributed to a culture of unhealthy lifestyle across the world. As such, the prevention of childhood obesity has become an international public health concern especially due to the positive correlation between eating disorders and chronic illness. Obesity causes serious development, well-being, and general health issues in children and adolescents. There are several international evidence based strategies that can be implemented by families, communities, and government to aid in the mitigation of childhood and adolescent obesity. The effectiveness of school-based BMI assessment programs that provide statistical data to parents and teachers for development of preventive measures should be evaluated across the world (A. J., 2008).  

Part A: The perspective of the study

Eating disorders like anorexia and bulimia are recognized as the third most common childhood and adolescent chronic illness; where asthma and obesity at up the first and second slots respectively. American medical reviews revealed that within the 2000s the cases of adolescent obesity increased by 20.5%. That figure has quadrupled in the past half-decade.  In most situations, eating disorders start during a person’s late childhood and early teen years. These conditions are most notable in girls and have been observed in children as young as 6 and 7 years of age.  Research has shown that adolescents who are obese or overweight have admitted to using laxatives and voluntary vomiting to manage their weight compare to normal teens (Yang, et al., 2016).  Eating disorders like anorexia nervosa and bulimia nervosa have also become a common diagnosis for American teens especially in urban and rich suburban neighborhoods. Anorexia is defined as a critical self-induced desire to maintain a given weight range that is motivated by fear of becoming “obese” or “overweight”;  even when the people is underweight or normal weight.  Anorexia is characterized by fasting, avoidance of previously love food items, over-exercising, and a significant reduction the portions of fluid and food consumed.  While, bulimia nervosa is associated with considerable binge eating and purging that is results in substantial abuse of laxatives and diuretic.  Majority of children and adolescents with Bulimia tend to eat a lot food in hiding and within a short period of time. Parent often notice significant quantities of food missing and empty food containers on the kitchen counter. In additions, these individuals are prone to taking long baths (time when purging occurs) and frequent bathroom trips especially after meals (Yang, et al., 2016).

Eating Disorders in Children and Adolescents

According to a report published by American Society of Clinical Oncology (ASCO) has shown that the American health system contributes more than $100 million towards the treatment of obesity and eating disorders annually; since 2009. Adjusting for inflation in healthcare costs, new illness cases, and deterioration in healthy living, it is estimated that treatment expenditure for obesity and eating disorders will be in excess of $200 million in the next three years. The productivity impacts with regards to lost revenue and income for eating disorders was estimated to be around $16.2 billion in 2017 (Waters, et al., 2011). According to Access Economics, this amount was almost the same as the $17.9 billon registered for depression and anxiety in 2010. 1.25% of this loss is attributed to unearned income from young people who lost their lives to obesity and weight related ailments.  The impacts of eating disorders normally extend for long durations (between 10-15 years) which results in extended productivity issues like low employment opportunities (costing $7.8 billion), higher absenteeism (costing $2.3 billion), and presenteeism (costing $5.4 billion).  This productivity costs are most borne by the individual   but also by the government I terms of less tax revenue and employees with regard to more sick days and low suboptimal production (Waters, et al., 2011).

Government provisions throughout the United States of America are geared towards the prevention or treatment of eating disorders.  Some of these provisions include the allocation of a higher budget to healthcare systems, increased research and development in healthy living techniques, and awareness campaigns on the dangers of eating disorders and obesity (Smith, et al., 2014).  This government lead incentives are estimated to cost more than the annual budget for most third world countries. Combined with out-of-pocket expenses for individuals with eating disorders and obesity the overall amount is registered at over $596 million. This amount is also inclusive of the amount of money spent by close family members and caregivers on the ill individual.  The “burden of disease” associated with eating disorder is estimated to cost around 52.6 billion. This figure is arrived at by multiplying all lost healthy life years (adjusted for any time associated with disability or incapability) by VSLY (Value of a Statistical Life Year) with regard to recommended provided by the US Department of the Treasury. This amount is larger than the figure observed for anxiety and depression which is recorded at $48 billion (Smith, et al., 2014).

Cost of Obesity and Eating Disorders

Part b: The intervention time frame

The assessment period should be considerably long to allow for conclusive data to be collect. Therefore, the intervention time frame should be 1 and ½ years to ensure that normally weight gain associated with development is not erroneously linked to obesity. It is therefore, important to understand different development and social issues that may influence weight gain during this intervention period. There is a need to understand the link between the development of female adolescents, complicated pregnancy issues, weight gain, and maternal obesity is critical in the pursuit of better healthcare for future generations. Excessive weight gain registered during an individual’s adolescent days tends to persist into adulthood resulting in complications during childbearing for women.  According to physicians, adolescence is a critical development period during which one stands the greatest risk of considerable weight gain (Shin, et al., 2016).  This period is characterized by a considerable change in eating habits, behavior, insulin sensitivity, psychology adjustment, and body composition. The excess weight gained during adolescence is normally had to shed one a person enters adulthood.  This means that women maintain unhealthy quantities of body fat during her childbearing years.  Development plasticity takes place during adolescence; this implies that lifelong habits can be initiated during this critical growth period that with either affect a person’s health positively or negatively.  In order to limit the risk of obesity and eating disorders, adolescents can be motivated to eat sensibly and engage in more physical activities. Obesity is considered a serious health issue with more than 60% percent of Americans being considered obese or overweight (Shin, et al., 2016).  

Physiological Changes during Adolescence: During this transition from childhood into adulthood the body undergoes physical growth and reproductive maturity. The rate at which these changes occur in an adolescent’s body is sufficient to cause confusion: insulin resistance, glucose metabolism, and release of hormones (Franklin, Kim, & Montgomery, 2012).  And becoming comfortable with these changes for most adolescents is challenging which leads to them  feel awkward and out-of-place; especially for girls, when they are transformed from immature children to young women almost overnight.  The accumulation of excess body fat can result in several health issues that can be observed in childhood, adulthood, and during old age. Old people and pregnant women are considerably crippled by excess fat with cause them to have numerous health issues such as joint pains, swollen legs, and extreme shortness of breath. The risk of contracting serious chronic illness later on in one’s life is greatly increased if that individual happens to be obese or overweight.  Moreover, eating disorders can affect the sociability of individuals causing them to have problems relating to spouses, children, and employers (Franklin, Kim, & Montgomery, 2012).

Government Provisions

Such rifts in communication cause people with eating disorders to become withdrawn, lonely, depressed, and low-income earners. Behavioral Changes during Adolescence: the creation of captivating video gaming technology and the prevalence of smartphone usage has greatly diminished the desire of children to engage in physical activities around the household and outdoor games like soccer and athletics (Park, et al., 2017). Medical professionals have in recent years termed the adolescent years as critical periods during which eating habits can either make or break a child’s future. This transitional period is normally viewed to be just as important as the periods when child transition from high school to higher learning institutions and from higher learning facilities to the entrepreneurial or employment world.  It is therefore necessary that individuals take part in the development of enforceable weight control programs and awareness incentives that will reduce the number of obese children and adolescent found across America. It is suspect that out of the more than 60% of American who are obese/overweight/eating disorder, 45% of this proportion is comprised of children and teenagers (Park, et al., 2017).

Part c: The analysis time frame

A school-based BMI measurement solution has been developed that seeks to address the issue of obesity and eating disorders. This idea was created due to the extensive consumption of food amongst American children and teenagers. It is estimated that 78% of all American teenagers develop eating disorders during school periods (Lee & Park, 2016). The remaining 22% is witness at home. The one and a half year time frame will be appropriate as it will allow for proper examination of BMI over an extended duration.   A school-based BMI measurement program has been introduced in the State of Virginia that is expected to aid in the proper management of adolescent and childhood obesity. This study is designed to evaluate the effectiveness of school-based BMI programs in the prevention of obesity in individuals aged 10-16 years. The study has employed one thousand participants, all of which are all between the fifth and tenth grade of schooling. The participants were then randomly assigned to either the intervention group or control group to limit any biasness during the process.   The cohort of intervention members was required to undertake BMI testing and the results submitted to parents; while, the BMI of the control group was not assessed throughout the 1 ½ years (Lee & Park, 2016).

Part d: Data on all types of costs to be collected

Intervention Time Frame

The expected costs will range in the millions with regard to the provision of health care professionals to schools to aid on the assessment of the BMI of student throughout the period. Moreover, a data transfer and feedback platform has to establish that will allow the school to transmit student BMI results to their parents/guardians. The result will be then used by caretakers of the children and adolescent to implement a feasible dietary schedule that will ensure their children do not become obese or overweight. For instance, a family can limit the number of sugary items offered to the children throughout the days. Moreover, the family can introduce more greens and a workout schedule. The treatment of Obesity in America can be costly and complicated, and normally involves numerous weight management techniques such as surgical, pharmacologic, and behavioral interventions. The adolescence period in an individual’s life presents a very opportune time for lifestyle incentives to be instituted that can aid in the long-term management and prevention of body fat accumulation.

The participation of most young people in sports and physical activity generally decreases during adolescence especially for girls (Amini, Djazayery, Taghdisi, & Nourmohammadi, 2016). A person’s diet also undergoes significant change as one gains more autonomy over his/her life.  Most pubescent changes normally result in creased physical demands that can greatly influence unhealthy eating habits, poor weight control, and eventually trigger body dissatisfaction. This discontent with one’s physical appearance results in drug abuse (for instance; laxative), skipping of given meals, and restricted intake of protein, dairy foods, and carbohydrates. The discovery of effective weight management techniques will assist in the breaking of a continuous cycle of intergenerational weight gain. Children born to mothers with normal weight are at a lower like of becoming obese compared to those born to overweight women (Amini, Djazayery, Taghdisi, & Nourmohammadi, 2016).   

Part e: Data on relevant health outcomes within each of the following time frames

The study as performed with regard to a 12-week efficacy assessment and a six-month follow-up examination to clearly affirm the long-term preventive benefits of this BMI measurement program in the management of obesity. The program seeks to create a communication avenue that will involve all stakeholders: children, adolescents, parents, and teachers. This achieved through the introduction of a school website with discussion platforms, child-parent mobile interphase, as well as a child-teacher web question and answer segment (Todd, Street, Ziviani, Byrne, & Hills, 2015). The primary statistics assessed during the study are the participants eating habits, level of physical activity, body mass index (BMI), psychological perceptions, and body mass index z-scores. The analysis segment will employ a quantitative approach that will evaluate correlation, prediction, and significant.

Physiological Changes during Adolescence

The approach focuses on the employment of regression model, correlation tests, and assessment of BMI significance for both the control and intervention groups.  The study results indicated that the use of the informative health platform Happy Me results in improved physical activity in children that resulted in diminished cases of obesity amongst the intervention group (no significant change was observed in the control group over the nine months of assessment) (Todd, Street, Ziviani, Byrne, & Hills, 2015). The program seeks to identify weight loss within year and the maintenance of a much healthier body weight six months later. The alternative to the desired outcome will be increment of student’s body throughout the initial 12 months and the follow-up six months. The assumption to be made with regard to the alternative results is that parents or teacher were encumbered in the implementation the BMI program with regard to resources and clinical machinery.

Conclusion

Proper communication highways that promote healthy living discussion, exercise habits, and requisition of psychiatric help should be enforced throughout American schools to ensure children are able to deal with issues of obesity and eating disorders. BMI measurement programs should be made mandatory in all schools because they allow students to share health issues in a friendly environment via a familiar medium. The data retrieved via this school-based BMI assessment programs will allow children to gain insight on how to deal with issues like Bulimia and Anorexia without receiving unnecessary scrutiny and judgment from other members of society (Shin, et al., 2016).

References

J., H. (2008). Obesity and eating disorders. Academic Unit of Psychiatry and Behavioural : University of Leeds, 1-5.

Amini, M., Djazayery, A., Taghdisi, M., & Nourmohammadi, M. (2016). A school-based intervention to reduce excess weight in overweight and obese primary school students. Biol. Res. Nurs, 531-540.

Franklin, C., Kim, J., & Montgomery, K. (2012). Teacher involvement in school mental health interventions:A systematic review. Child Youth Serv. Rev., 973-982.

Lee, H., & Park, H. (2016). The mediation effect of individual eating behaviors on the relationship between socioeconomic status and dietary quality in children: The Korean National Health and Nutrition Examination Survey . Eur. J. Nutr., 12-24.

Park, B., Nahm, E., Rogers, V., Choi, M., Friedmann, E., Wilson, M., et al. (2017). A Facebook-Based Obesity Prevention Program for Korean American Adolescents: Usability Evaluation. Pediatr. Health Care, 57-66.

Shin, D., Joh, H., Yun, J., Kwon, H., Lee, H., Min, H., et al. (2016). Design and baseline characteristics of participants in the Enhancing Physical Activity and Reducing Obesity through Smartcare and Financial Incentives (EPAROSFI): A pilot randomized controlled trial. Contemp. Clin. Trials, 115-122.

Smith, J., Morgan, P., Plotnikoff, R., Dally, K., Salmon, J., Okely, A., et al. (2014). Rationale and study protocol for the “active teen leaders avoiding screen-time” (ATLAS) group randomized controlled trial: An obesity prevention intervention for adolescent boys from schools in low-income communities. Contemp. Clin. Trials, 106-119.

Todd, A. S., Street, S. J., Ziviani, J., Byrne, N. M., & Hills, A. P. (2015). Overweight and Obese Adolescent Girls: The Importance of Promoting Sensible Eating and Activity Behaviors from the Start of the Adolescent Period. International Journal of Environmental Research and Public Health, 1-24.

Waters, E., de Silva-Sanigorski, A., BJ, H., Brown, T., Campbell, K., Gao, Y. A., et al. (2011). Interventions for preventing obesity in children (Review). The Cochrane Library, 1-214.

Yang, H. J., Kang, J.-H., Kim, O. H., Choi, M., Oh, M., Nam, J., et al. (2016). Interventions for Preventing Childhood Obesity with Smartphones and Wearable Device: A Protocol for a Non-Randomized Controlled Trial. International Journal of Environmental and Public Health, 1-10.