Planet health policy advocacy for adolescent obesity
The planet health is a policy for advocacy focused on reducing the prevalence of the obesity among the university students, it is a joint initiative of the Kenya Defeat Obesity Community and the University of Nairobi. The Advocacy policy was formulated as a result of a collaborative effort of the two organization with the main aim of reducing the spread of obesity among the student’s community through promotion of intervention program aimed at improving physical activity among the university students, and encouraging healthy dietary practices. The overarching goals of Kenya Defeat Obesity Community members with a focus on the university students is to provide guidance and formulate policies advocating for the reduction of obesity with a clear focus:
- To promote intervention programs that prevent adolescents from developing obesity: This is done through advocating for individual students participation in the physical activities and encouraging the healthy dietary behavior.
- To provide guidance on the management of pre-existing obesity in adolescents through health education: this is achieved through offering nutritional education and encouraging provision of dietary regimes to the obese students. At the same time, advocating for policies that discourage discrimination against obese students.
The objective of this three-level health promotion intervention policy advocacy is to endorse and assess the impact of student’s participation in physical activities, advocating for healthy dietary practices among the student’s community, and encourage behavior change through health education. The expected outcome of this policy advocacy is a reduction in the prevalence of adolescent obesity among the students. Planet health policy advocacy, therefore, intends to:
- Improve the rate of student’s participation in physical activities: this is achieved by ensuring that physical activity training facilities are available for students
- Improve healthy dietary practices among the university students: the policy advocating for reduction in consumption of food with saturated fat and drinking of beverages with sweetened sugar
- Promote healthy lifestyle through health education integration in already existing curriculum
Obesity among the University students aged between 10-19 years
This policy is designed to advocate for health promotion interventions that help in reduction of the prevalence of obesity among the university of Nairobi students in Kenya. This policy describes the rationale for engaging youth in obesity prevention advocacy efforts targeting environment and policy changes to improve good nutritional behavior and active participation in physical activities. Advocacy involves health education, skill development, and behavior and attitude changes, with the goal of persuading more students to be actively involved health intervention promotion programs. Policy advocacy targeting the adolescents at the university level has been successfully used in substance use prevention, but it is a relatively new concept in obesity prevention (Millstein, 2014).
The excessive accumulation of fat deposits around the body tissues and organs have been cited as cause for Obesity according to (Uzogara, 2017). The Body Mass Index has been used as the standard marker for identification of obesity. According to the (World Health Organization [WHO], 2015), an individual is defined as obese having Body Mass Index (BMI) of ≥30 kg/m2. The transition of lifestyle and the trends in dietary behavioral changes has been associated with high prevalence in of obesity among the adolescents according to (Abu et al., 2010). For example, in the United States, there have been registered a steady rise in the prevalence of Children and Adolescent obesity, from the year 1971-2003 the rates have risen from 6% to 17%, and 12 million adolescent and children are considered to be obese (Friedman et al., 2008). The risk related to adolescent obesity include conditions such as diabetes mellitus and cardiovascular diseases among others. At the same time obesity and overweight are risk factors to poor mental status and well-being including depression, and low self-esteem (Martin et al., 2014). According to (World Health Organization [WHO], 2015), the global estimation of children and adolescent suffering from obesity is 170 million. The prevalence of adolescent obesity has been on the rise worldwide, but with high rates recorded in the low-middle income countries. For example, in Africa research findings have revealed that 8.5% of the children between the ages of 10-19 were obese in 2010, and the rate is expected to rise to 12.7 % by the year 2020 according to the report by the commission for ending child obesity commissioned by (WHO, 2015)
There is an increase in a number of reported cases of child and adolescent obesity among the first world countries. For example, research has revealed that almost a third of children and adolescent in the Unites States and a fifth in Europe are suffering from obesity (Langford et al., 2015). At the same time, in a wide range of countries including middle income and developing countries, there has been an increase in reported cases of child and adolescent obesity over the last 20 to 30 years (Ogden et al., 2014). Coming up with most effective intervention programs requires inquiry into the causes and outcome of the adolescent obesity in the population. The intervention policy for advocacy developed by WHO have centered on a population based approach that promotes prevention measures rather than intervention policy advocacy focuses majorly on a population-based approach that propagates prevention measures rather than single clinical intervention. For example, Health education-promotion frame work is such intervention programs developed by the WHO. The hallmark of this policy for advocacy by the WHO is due to the fact that it identifies the responsibilities that can be played by the health education in attempt to reduce rising cases of adolescent obesity among the students. Therefore, the intervention programs that focuses on the managing adolescent obesity prevention have been integrated into school curriculums, with an aim of promoting behavioral change among the students by encouraging active participation in physical activities, encourage good dietary practices among others (Blaine et al., 2017; Rouse and Biddle, 2011;Sassi et al., 2009).
According to (Plotnikoff et al., 2015; Swinburn et al., 2011), the most effective and efficient policy for advocacy should focus on the upstream or downstream based on the intervention program point of execution and the targeted population, that include both social and environment. The objective of such approach is to outline the circumstances and situations which constitute the underlying determinants of health and social equality in the society. The target of such intervention strategy is the food environment, physical activity environment and socioeconomic environment such as taxation and education, thus indirectly influencing the behavior of the population. Considering school environment as the target of the intervention strategy, schools plays a key role in providing daily meals and physical activity facilities to children bearing in mind that poor nutrition and obesity can negatively impact children. Therefore, schools form the optimum settings for the implementation obesity prevention policy advocacy (Pearce et al., 2013; Agron et al., 2010).
Health promotion framework
According to (Millstein and Sallis, 2011), the policies for advocacy on the intervention programs focusing on nutrition and physical activities and behavioral changes the environment and policy changes is a promising, though the approach is under-studied and under-evaluated, as an intervention strategy for handling child and adolescent obesity. The health promotion framework of the planet health policy advocacy for the reduction of obesity among the students has three main domains that include interventions to increase energy expenditure through increased physical activities, promotion of healthy dietary practices among the students and advocacy for behavior change through health education. According to (Plotnikoff et al., 2013; Haynes et al., 2017), the policy advocating for the prevention of adolescent obesity is more effective when the interventions skewed towards enhancing individual autonomy to the greater extent than those policies that discourage autonomy. Therefore, planet health policies are advocating for the reduction of obesity by recognizing the individual’s contribution by promoting the interventions that focus on reducing the time spent by the students on sedentary lifestyle activities and promoting the time students spend on physical activities. For example, this policies advocates for reducing the 8 hours students spend in playing computer games in a day to an average of 2 hours, this can be achieved by encouraging university to provide an alternative leisure-time exercise such as sports to improve active participation of students in physical activities, at the same time, it discourages students from consuming commercially processed sugar, sweetened beverages, and intake of food products with high saturated fat contents such as food rich in very-low-density lipoproteins nevertheless the policy advocate for healthy dietary practices such as daily consumption of fruits and vegetables and advocacy for healthy lifestyle that leads to reduced risk of adolescent obesity. The success of any intervention advocacy is based on person’s attributes of advocates that include observed incentive value, perceived policy control, leadership competencies and outcome expectancies as suggested by (Millstein and Sallis, 2011). The conceptual model structure of the can be implementation at different stages that include:
The individual factors are discussed in the context of both changes in the psychological processes, dietary practices, and physical activities through the process of advocacy. On the prevention of adolescent obesity, it is expected that some of the targeted population’s attributes will change. The policy for advocacy focuses on the three different levels of promotion including physical activity, good dietary practices, and healthy lifestyle.
Figure. 1 A three level conceptual model of inputs, interventions, and outcomes of student advocacy for obesity prevention.
The conceptual model represents the supposed influence or the result, ranging from the level of student to the policy. The orange colored boxes are efforts by the representatives of the policy advocacy action and elements of training. While the advocacy programs are placed at the center. The blue coded boxes are desired outcome of the advocacy input.
The intervention advocacy at the Social level has the capacity to influence students participation in groups taking part in different school sporting activities, the advocacy training group in the social context is designed to improve the ability of the individual student to participate in the group activities and change group interactions. In this policy, the group norms and expectation are considered to have a major role in advocacy that influences healthy behavior change. For example, community-wide informal training and social support have been linked to increased participation in physical activities leading to increased energy expenditure (Haynes et al., 2017; Millstein, 2014). Therefore social level factors have been considered as important mediators for policy for advocacy outcome.
The environmental level comprises of the surrounding characteristics in the broader context of the university population as a community. According to (Millstein, 2014), there have been a lot of interest from researchers to establish the influence that built environment has on the prevention of adolescent obesity. It has been established that several built environmental feature have been recognized for promoting individuals students participation in physical activities and improved dietary behavior (Millstein, 2014). For example, planet health policies advocates for safe walking infrastructures and the availability of the recreational facilities within the university to enhance students participations in physical activities such as walking and riding bicycles within the campus . At the same time, the nutrition environment, with the availability of local food has been established to greatly impact on the dietary behavior of students, for example, availability of fast food restaurants within the university environment has been associated with poor dietary quality among the students. The planet health policy, therefore, targets the university feeding programs, restaurants around the university and vending machines to improve the dietary behavior of the students through sensitization and nutritional education.
Recommendations/calls to action
- The government should provide guidelines and formulate standard national school-based policies on nutrition education to sensitize the restaurants within and without the university environment on the benefits of healthy diet to the students. At the same time, the government through the university administration should put a ban on selling soft drinks that are sweetened with commercial sugar and the same should apply to food with saturated fat and trans-fat food products within the school environment. However, the school administration should be encouraged to provide fruits and vegetables to the students the government should formulate policies that encourage Universities to have wellness policies that focus on the promotion of nutritional education, and active participation of students in physical activities. The universities should be encouraged by the government to regularly carry out screen test for obesity among the students that include taking the measurement of the students BMI. The government should employ physical education teachers and nutritionists to help in the implementation of the programs. At the same time, the students should be encouraged to walk to school by the provision of safe walking pavement along the school environment.
- The government should enact legislation that put a ban on the advertisement on junk foods and sugar-sweetened beverages in schools on scoreboards, vending machines, in textbooks. At the same time, the government should put in place laws that increase the taxes on sweetened drinks and low-nutrient foods. The government should fund intervention programs that lead to the reduction in adolescent obesity among the students.
- The government should facilitate accessibility to cheaper healthy food, the government should provide subsidies on fruits and vegetables to the universities to improve the student’s consumption.
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