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Evidence review

Discuss about the case study Public Health for Many Chronic Diseases.

Overweight and obesity are now dramatically on the rise in the leading urban countries of the world. It is the major risk factor for many chronic diseases like diabetes, high blood pressure, cancer and cardiovascular disease. According to Australian Bureau of Statistics report, over 63.4% of Australian adults were found to be obese in Australia. In Australia, everyone in five children is either overweight or obese ("4338.0 - Profiles of Health, Australia, 2011-13", 2016). Several health promotional activities have been undertaken to address the prevalence of obesity in children and youths. In the school, setting strategies have been taken to address physical activity and nutrition through a coordinated school health program. It included maintaining an active school health council and strengthening school’s nutrition and physical activity policies. It also focussed on implementing high quality health promotion program for school staff. It encouraged school members to participate in health assessment, nutrition classes to improve physical and mental health problems (Centers for Disease Control., 2013).

Another article reported a rapid rise in obesity among children even in low and middle-income countries. It suggested countries should implement nutritional policies that promote healthy growth, household nutrition security and protect children from inducements to inactive life and over consuming foods of poor nutritional quality. The existence of poor nutrient products has lead to rapid weight gain in childhood and exposed children to risk for chronic diseases. It suggested maximum public health effort is required to restrict adverse marketing of breast milk substitutes and protecting older children from sedentary activities and nutrient poor foods (Lobstein et al., 2015).

The study on lesson learnt from obesity prevention efforts in Australia revealed that government action regarding obesity prevention started in the 1980s and the increased media reports in 2000s further created the pressure to take action. The food industry worked to ensure front food labeling and restricting marketing of unhealthy food to children. Healthy school food guideline was implemented, and the Government of Australia established an organization to reduce childhood obesity. However, despite strong advocacy, many regulatory policies remained unimplemented because of the domination of private sectors over public policy development (Swinburn & Wood, 2013).

Based on the evidence-based discussion on health promotion activities to reduce obesity, I observed that making lifestyle changes from childhood is essential to prevent obesity. People who are obese from childhood continue to be obese even in adulthood. Therefore, as a health promotion worker in an urban government funded health service in Australia, I plan to take actions to improve dietary intake and active living in children below 0-5 years so that they grow up to be healthy and confident citizens.

Aim and objective

My aim and objective to promote healthy eating and active living in early childcare sector (daycare centers and pre-schools for children up to 5 years) are as follows:

  • Teach parents about healthy eating and activity habits and providing the healthy environment for children to play, eat and grow.
  • Provide children opportunities for active play and fun in short sessions throughout the day.
  • Providing a varied and balanced diet and emphasis on minimally processed foods.
  • Provide nutritional guidelines to parenting to develop healthy eating habits in their children.
  • Regulating infant feeding and mealtime habits (Bleich et al., 2013).

The additional evaluation that I would like to do in my project is to monitor the problem and level of intervention in childhood day care center. Estimate of the number of children who are obese in these units will give an idea of the amount of efforts required to prevent obesity. It will also be necessary to enquire parents about their nutritional knowledge. Other forms of evaluation that I will do are assessing child's lifestyle, the status of linear growth, calorie intake and genetic syndrome (Natale et al., 2013). This is essential because some child may have poor linear growth due to endocrine dysfunction. It will help in understanding the nature of the problem and the context of intervention. The information through surveillance and monitoring will also help to evaluate progress in this step and enable advocacy. Many unhealthy dietary and physical habits that account for the development of obesity are established by the age of five. Therefore children enrolled in early childcare facilities are an ideal setting to implement and evaluate childhood obesity prevention program (Dietz et al., 2015).

While planning my evaluation the issue that I would like to consider the issues related to obesity such as-

  • Food choices- I will evaluate whether children are choosing high fat and sugary foods instead of healthier food options. It will be done by evaluating their snack and meal patterns, the kind of foods they bring from home (Bray & Bouchard, 2014).
  • .
  • Lack of physical activity- In this area, I will judge what factors had lead to increased physical inactivity among children. It will involve analyzing how much time children spend on watching television per day or the time they spend in watching computer and electronic games. Modern life, electronic gadgets, mobile phones and many others might be a factor in sedentary life in children (Karnik & Kanekar, 2015).
  • Overweight parents- A family's eating pattern can have a remarkable influence on children eating habit and maintaining a healthy weight. Therefore, I want to evaluate these factors because overweight patterns may be less concerned about their child being overweight and they will only feed them more unhealthy and oily foods. If the parents are health conscious, they will develop this habit in their children too (Bray & Bouchard, 2014).
  • Genetic factors- I also want to explore genetic factors in children because some rare gene disorder may cause severe childhood obesity. It is also possible that genes acting together make children more susceptible to obesity. If there is a tendency in certain families to become overweight, I would like to parents to be more aware of taking healthy food choices for the sake of whole family (Karnik & Kanekar, 2015).

I would like to address and minimize the factors lead to increased rate of childhood obesity. The factors that have altered lifestyle and physical activity are changes in the marketing of food, physical and social elements in the community, home and childcare environment and role of parents. Now people prefer readymade packaged food like fast food, frozen food, burgers, pizza and unhealthy oily foods. Increased consumption of convenience foods has occurred because of rising cost of healthy food items. Marketing and advertising practices for healthy foods are also a major contributor to childhood obesity. I would prefer giving information to children and parents regarding how this food will be harmful to them. I will also like to evaluate the environment inside and outside schools and child care facilities. Many child care centers and school canteen serves unhealthy and unhygienic foods (Pearce & Langley-Evans, 2013). Therefore, evaluation in this area will help me to judge how much school and day care centers are concerned about their health. I will implement practices of serving healthy foods to children in schools and parents must also be encouraged to give them healthy nutritious food in their lunch box. I will also like to address issues like culture and lifestyle pattern in families that influences their choice of food, leisure time and time spent in child care. Educating parents will be one important strategy for me to enable healthy living in children (Kjeldsen et al., 2014).

Additional formative evaluation

Based on this evaluation, I will plan my steps to reduce childhood obesity. I work in the following areas:


Physical activity: My action steps to improve physical activity are

  • Making children above 12 months attend 60 minutes of outdoor or indoor physical activity per day. It would involve free play, teaching-oriented activities, music, and movement.
  • Children will be limited to the minimum time of television viewing such as not more than 60 minutes per educational programs.
  • Ensuring physical activity is a positive experience for children, and it is not used negatively to control behavior. Children will not be forced to engage in physical activities if they are not willing to participate in such activities (Deitz, 2015).

Nutrition: The action steps to improve nutrition in infants are:

  • Encourage child care providers to provide the variety of nutritious food and limiting junk foods and sugary drinks.
  • Parents will be encouraged to incorporate healthy eating habits in children and feed them nutritious food.
  • Provide written guidelines and posted menus to parents regarding the kind of food they should feed their infants (Foltz et al., 2012).

Evaluation question

Describe  specific indicators that will answer this

Describe the method you would use

Comment on things you need to be aware of and plan for

Outcome evaluation

How will the environment to support healthy eating and active living be implemented in an early child care setting?

Indicators related to child’s lifestyle, eating pattern, physical activity, food choices, nutritional food marketing will answer this question.

The methods for promoting physical activity in children are:

1. Facilitate and encourage physical activity in children in day care center by involving children in recreational activities like fun games, cycling. 2. Arranging for two to three outdoor activities for daily active play and removing barriers to outdoor play.

3. Limit the time that children spend in restricted seating.

4. Keep screen media off around children below two years and minimize screen time in children above two years (Heath et al., 2012).

The methods to improve early child care nutrition are:

1. Provide balanced diet food in day care facilities like green vegetables, whole grain food ed items, healthy lean protein, food containing healthy monounsaturated or polyunsaturated fats like olive oil or safflower oil.

2. Introduce complementary foods at an appropriate age (Ludwig et al., 2012).

I would plan for implementing this active session in dare care center and encouraging day carer to plan lessons based on outdoor and active tasks. I would ensure that this is documented in the daily schedule so that children get exposure to outdoor activities in the school setting. I will delegate the task to caregivers and food service personnel regarding implementing the nutrition plan.

Impact evaluation

How far has parents and childcare facility taken the responsibility to reduce obesity in children? What will the impact of the above intervention plan?

The indicators to predict impact evaluation are-level of consciousness among parents to introduce healthy food habits and avoidance of junk food, the level of physical activity that children are now getting involved in and measurement of sitting time in children.

Surveillance and monitoring of child care center to evaluate the child obesity prevention strategies for parents and child care. Review the effects of the plan by statistics on the reduction of obesity and overweight pattern in children. Regularly maintain a healthy weight checklist for children (Castro et al., 2013).

I need to be aware of how far children are exposed to screen time such as gadgets, mobile phones, televisions and computer games. I will evaluate how much time do day care center spend in teaching children through video. I will also plan to check the interest of children in daily life activities

Process evaluation

What efforts have child carer/ teacher taken to encourage healthy food and active living in children?

Indicators are data and records to measure progress in obesity prevention efforts both at community and state level

Process evaluation will be done by assessing who are involved in the process and what cost it will have on the overall project. It will judge the percentage target achieved for obesity prevention in the community (Ma et al., 2013).

I need to be aware quality and consumption of food in children after the implementation of the plan. I plan to instruct day schools to collect BMI data of children to assess progress in obesity prevention. Vendor sales data will be made public to for analysis of types of food items purchased by parents.

One study highlighted the methods taken for evaluation of childhood obesity prevention program in the childcare center setting. A randomized controlled obesity prevention trial was conducted for three years in ethnically diverse child care centers with about 1000 children. It tested the efficacy of parent and teacher role intervention on children's nutrition and food activity patterns. The program consisted of implementing daily curricula for parents, teacher and children regarding nutritional intake and technical assistance with more fresh food instead of canned foods. It also implemented a policy for physical activity, screen time and dietary requirement of children. The outcome measure was defined change in BMI and score for fruit and vegetable intake.  The result indicated that implementing prevention strategies in the first few years of life is the best way to prevent obesity in children (Natale et al., 2013). 

Based on analysis of evidence-based intervention, I plan on efforts to change diet and behavior in the school setting by providing healthy early environments to children in a childcare setting. 

Aim of the projects is to

  • Involve day carers and food personnel in the drive for obesity prevention in the school setting.
  • Implement high quality intensive intervention in the early years to boost health in adulthood.
  • Implement curriculum changes and written nutrition in a school setting so that balance of both work and active play is given to children (Sobol‐Goldberg et al., 2013).

The primary strategies that will be taken for obesity prevention in child care setting are as follows:

  • Monitor and evaluate standards of physical activity and quality food served in day care centers
  • Training and technical assistance to teachers to inculcate healthy food habits and active play in children.
  • Changing child care environment to provide outdoor playing opportunities to children.
  • Provide nutritional information to parents regarding foods that they should feed children during infancy.
  • Reducing screen timing for children and keeping them away from junk foods (Bleich et al., 2013).

The persons who will be involved in this initiative are food personnel, dietitian, day care staff, parents and funding partner. Funding partners will aid in the cost involved in the project and look after all investment required in day care centers to promote active living and healthy eating habits in children. A nutritionist will be consulted regarding setting the menu for types of food that will be provided to children to child care centers (Wang et al., 2015). Their task will to make a written healthy food plan for children and give detail on the nutritional requirement for effective child growth. This food plan will be distributed to parents, and a session will be taken that will educate parents about the risk associated with obesity and the things that they should do to reduce overweight in their children. The food personnel will be contacted to provide the supply of healthy and nutritious food in child care centers. The teachers at daycare center will be given technical assistance and training to plan the daily curriculum that is a balance of study and active learning activities. Teaching through television assistance will be minimum, such only 30 minutes per day. They will be asked to plan such outdoor activities that limit children sitting time as well as make them enjoy in the process. Teachers will be asked to assess BMI of each child regularly and accordingly give feedback to their parents (Ward et al., 2013).

Evaluation planning

The success of my project is dependent on factors like availability of resources, human efforts, timeliness, cost and finance factor and consciousness of parents regarding the issue of obesity. The child care education program is targeted to improve nutrition, provide breastfeeding support, enhance physical activity and reduce screen time. The spectrum of opportunities for obesity prevention are administrating regulations for food safety at child care centers, implement the quality rating and improvement system, availability of funding and finance and professional development of day care staff. Facility level intervention will help to provide technical assistance and access to the healthy environment for children. The primary strategy is family involvement on this drive as they are the person who spends the most time with children and plays a role in the development of eating habits of children. There will be rating systems that will communicate publicly how well child care facilities are meeting the criteria for obesity prevention. Regarding funding assistance for the project, help will be taken from government and investors. The program will ensure that educator at child care units is trained on physical activity and nutritional needs of an infant (Natale et al., 2013).

Parents might be a potential threat to this project. This is because many families have this culture of eating rich foods with oil and they like their children to be overweight. They may not understand the seriousness of the problem associated with obesity and to manage this risk; major focus will be on educating parents on obesity and healthy living. There will be strict ruling regarding providing healthy lunch boxes to children from the home. I will also identify any gap in the process and if teachers do not meet the criteria for obesity prevention. They may face penalties like the closure of their facilities (Kelly et al., 2013).

Planned task

Jan-March 2016

April-June

2016

July-Sept 2016

Oct-Dec

2016

Jan-March 2017

April-June

2016

July-Sept 2017

Oct-Dec

2017

Select day care centers

Find funders for the project

 

Involve day care staff for intervention

 

Implement written guidelines for serving healthy food

 

Include curricula for physical activity

 

Educate parents on healthy food guideline

   

Evaluate child’s BMI post intervention

Reference

Bleich, S. N., Segal, J., Wu, Y., Wilson, R., & Wang, Y. (2013). Systematic review of community-based childhood obesity prevention studies. Pediatrics, peds-2013.

Kelly, A. S., Barlow, S. E., Rao, G., Inge, T. H., Hayman, L. L., Steinberger, J., ... & Daniels, S. R. (2013). Severe obesity in children and adolescents: identification, associated health risks, and treatment approaches a scientific statement from the American Heart Association. Circulation, 128(15), 1689-1712.

Natale, R., Scott, S. H., Messiah, S. E., Schrack, M. M., Uhlhorn, S. B., & Delamater, A. (2013). Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health, 13(1), 1.

Natale, R., Scott, S. H., Messiah, S. E., Schrack, M. M., Uhlhorn, S. B., & Delamater, A. (2013). Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health, 13(1), 1.

Sobol‐Goldberg, S., Rabinowitz, J., & Gross, R. (2013). School‐based obesity prevention programs: A meta‐analysis of randomized controlled trials. Obesity, 21(12), 2422-2428.

Wang, Y., Cai, L., Wu, Y., Wilson, R. F., Weston, C., Fawole, O., ... & Chiu, D. T. (2015). What childhood obesity prevention programmes work? A systematic review and meta‐analysis. Obesity Reviews, 16(7), 547-565.

Ward, D. S., Vaughn, A., & Story, M. (2013). Expert and stakeholder consensus on priorities for obesity prevention research in early care and education settings. Childhood Obesity, 9(2), 116-124.

4338.0 - Profiles of Health, Australia, 2011-13. (2016). Abs.gov.au. Retrieved 20 August 2016, from https://www.abs.gov.au/ausstats/[email protected]/Lookup/by%20Subject/4338.0~2011-13~Main%20Features~Overweight%20and%20obesity~10007

Bleich, S. N., Segal, J., Wu, Y., Wilson, R., & Wang, Y. (2013). Systematic review of community-based childhood obesity prevention studies. Pediatrics, peds-2013.

Bray, G. A., & Bouchard, C. (Eds.). (2014). Handbook of Obesity–Volume 2: Clinical Applications (Vol. 2). CRC Press.

Castro, D. C., Samuels, M., & Harman, A. E. (2013). Growing healthy kids: a community garden–based obesity prevention program. American journal of preventive medicine, 44(3), S193-S199.

Centers for Disease Control. (2013). Make a difference at your school.

Dietz, W. H., Baur, L. A., Hall, K., Puhl, R. M., Taveras, E. M., Uauy, R., & Kopelman, P. (2015). Management of obesity: improvement of health-care training and systems for prevention and care. The Lancet, 385(9986), 2521-2533.

Foltz, J. L., May, A. L., Belay, B., Nihiser, A. J., Dooyema, C. A., & Blanck, H. M. (2012). Population-Level Intervention Strategies and Examples for Obesity Prevention in Children*. Annual Review of Nutrition, 32, 391-415.

Heath, G. W., Parra, D. C., Sarmiento, O. L., Andersen, L. B., Owen, N., Goenka, S., ... & Lancet Physical Activity Series Working Group. (2012). Evidence-based intervention in physical activity: lessons from around the world. The lancet, 380(9838), 272-281.

Karnik, S., & Kanekar, A. (2015). Childhood obesity: a global public health crisis. Int J Prev Med, 2012. 3 (1), 1-7.

Kjeldsen, J. S., Hjorth, M. F., Andersen, R., Michaelsen, K. F., Tetens, I., Astrup, A., ... & Sjödin, A. (2014). Short sleep duration and large variability in sleep duration are independently associated with dietary risk factors for obesity in Danish school children. International journal of obesity, 38(1), 32-39.

Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., ... & McPherson, K. (2015). Child and adolescent obesity: part of a bigger picture. The Lancet, 385(9986), 2510-2520.

Ludwig, D. S., Blumenthal, S. J., & Willett, W. C. (2012). Opportunities to reduce childhood hunger and obesity: restructuring the Supplemental Nutrition Assistance Program (the Food Stamp Program). JAMA, 308(24), 2567-2568.

Ma, J., Yank, V., Xiao, L., Lavori, P. W., Wilson, S. R., Rosas, L. G., & Stafford, R. S. (2013). Translating the Diabetes Prevention Program lifestyle intervention for weight loss into primary care: a randomized trial. JAMA internal medicine, 173(2), 113-121.

Natale, R., Scott, S. H., Messiah, S. E., Schrack, M. M., Uhlhorn, S. B., & Delamater, A. (2013). Design and methods for evaluating an early childhood obesity prevention program in the childcare center setting. BMC Public Health, 13(1), 1.

Pearce, J., & Langley-Evans, S. C. (2013). The types of food introduced during complementary feeding and risk of childhood obesity: a systematic review. International journal of obesity, 37(4), 477-485.

Swinburn, B., & Wood, A. (2013). Progress on obesity prevention over 20 years in Australia and New Zealand. Obesity Reviews, 14(S2), 60-68.

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