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CHANGING BEHAVIOR

Changing Behavior in Dieting and Physical Activity for Children at Risk of Obesity

Jessica Tidd

Capella University

MPH 5900: Public Health Capstone

August 2022

Changing Behavior in Dieting and Physical Activity for Children at Risk of Obesity

Background of the problem

The problem of child obesity is fast becoming a pandemic in the United States, putting both children and adolescents at risk of diabetes and generally poor health. The prevalence rates of obesity among children in the developed world remain high (Karik & Kanekar, 2012). According to statistics posted by the Center for Disease Prevention and Control, for children between the ages of 2 and 19, in the period between 2017 and 2021, the obesity rate was 19.7% and affected over 14.7 million adolescents and children. In children between 2 and 5 years, the obesity rate was 12.7%, while the same was 20.7% in the children aged between 6 and 11. In children between 12 and 19 years, the obesity prevalence was 22.2%. The CDC study was also broken down into ethnic groups where obesity rates among children were found to vary between races. For instance, the prevalence rate among white children was 16.6%, 26.2% among Hispanic children, 24.8% among Black non-Hispanic children, and 9% among Asian children who are not Hispanic (CDC, n.d).

The conditions related to obesity include high blood pressure, high cholesterol levels, type 2 diabetes, asthma, sleep apnea, and other problems such as joint problems. This is why the problem of childhood obesity needs to be tackled (Ogden et al., 2014). The above-highlighted statistics further demonstrate that there is a need to lower the childhood obesity rates both in the short and long run.

Dieting changes behavior as an intervention

Obesity is caused by poor nutrition; therefore, the solution to tackling child obesity is a change in nutrition (Han et al., 2019). The rates of childhood obesity are high in the United States because foods consumed in US households are high in calories and carbs. Consumption of foods rich in processed sugars such as cakes, candy, fast food, and soft drinks is the number one cause of high obesity rates in the developed world. According to De Miguel-Etayo (2013), various strategies that can be used to treat childhood obesity typically range from lifestyle changes, surgical interventions, and pharmacotherapy. Among these three methods, the most effective method is dietary changes because it is the cheapest and the easiest to implement. De Miguel-Etayo et al. (2013) state that the aim of dietary treatment of childhood obesity should be to enhance the proper growth of children and development by reducing the accumulation of excessive fat and avoiding the loss of lean body mass, improving self-self-esteem and well-being and preventing the regain of excessive weight in future.

Dietary change is a change behavior intervention because an unhealthy diet is a habit. To effectively modify this behavior, management protocols need to be put in place. These management protocols include elements such as family support, modifications of behavior, and change of lifestyle, which may require multi-disciplinary team involvement. Additionally, other studies support the use of dietary interventions in conjunction with other strategies such as increasing physical activity and using psychological interventions to support behavior change.

Brown et al. (2019) conducted a study to determine the effectiveness of a broad range of interventions, including dietary and physical activities. The researchers conducted an RCT of 153 studies that were mostly derived from either the US or Europe. 13 studies were based on upper to middle-income countries such as Brazil, Mexico, Thailand, Turkey, and the US-Mexico border. The majority of the results, that is, 16 RCTs, showed that dietary change combined with physical activity reduced the BMI. The results also showed that when dietary or physical activities were used alone, there was no significant reduction in BMI among children with obesity. The above two studies prove that diary change is an effective intervention in reducing childhood obesity.

Community resources to be used in the intervention

Dietary behavior change as an intervention requires the involvement of community resources to be implemented effectively. Community resources range from facilities, community networks, schools, community centers, hospitals, and other healthcare facilities. According to Warren et al. (2020), schools play an important role in changing dietary behavior. Schools teach students the importance of proper dieting and healthy nutrition. Other community resources that can help in dietary behavior change include community centers and community healthcare organizations which play an important role in educating parents on the dangers of childhood obesity, diagnosis of childhood obesity, and treatment of childhood obesity (Verduci et al., 2022). Education plays the most important role in reducing childhood obesity, and the bulk of education occurs in schools. Another essential community resource for tackling childhood obesity is community gardens and farms in rural and urban areas. According to Mohamed et al. (2018), community gardens and farms have effectively reduced cardiovascular diseases and obesity among adults in areas where these farms have been implemented. Community farms and gardens are most effective in food deserts which are majorly found in low-income neighborhoods. This phenomenon partially explains the high prevalence of childhood obesity among Black and Hispanic demographics.

Components of the intervention

The intervention that will be implemented is a change in dietary behavior and physical activity. Since childhood obesity affects children between 2 and 19, the behavior change intervention must target all the children along this continuum. There will be three components to the intervention, which include, the education of children and parents, change of school feeding programs on an experimental basis, and implementation of a physical activity program for older kids. Other sub-components will include communication change, psychological interventions such as interpersonal counseling, and mass media campaigns to promote healthy diets for children in public eateries.

· Education and effective communication – this component marries with the schools as community resources for effecting behavior change in school-going children. In the US, a significant part of the children’s diet is taken through school lunches and other snacks, making schools the perfect point to start reversing harmful dietary behaviors. Children as young as two years old can be taught about healthy diets in class. Schools can also cultivate healthy eating behaviors in children by modifying school diets to include more servings of healthy foods compared to unhealthy foods. Dudley et al. (2015) conducted a systematic review of randomized controlled, quasi-experimental and cluster-controlled trials to examine how school-based teaching interventions can be used to implement dietary change behavior in children. The researchers limited the systematic review to only four healthy eating outcomes, which include increasing the proportion of fruits and vegetables in the diet, reducing the consumption of sugars except for whole fruits, increasing nutrition knowledge, and reducing the size of portions that children took. The results showed that experiential learning strategies effectively effect dietary change in school-going children. Sugar consumption and preferences for sugary foods were most influenced by cross-curricular approaches baked into the interventions. The researchers concluded that educational interventions used for behavior change produce positive changes in primary school children’s healthy behaviors. This intervention will be used because it has the biggest impact on behavior change.

· Education of parents- eating behaviors at home are also responsible for high childhood obesity rates in the US because children spend a significant amount of time at home. Dudley et al. (2015), for instance, found that the early introduction of toddlers to solid foods rich in sugars instead of breast milk in the first six months is one of the primary factors for high obesity rates in children. This component is important because parents are an essential stakeholder in effecting diet change in children since they are responsible for nutrition for children.

· Targeted change in school feeding programs – school feeding programs have been identified as the weakest link in the fight against childhood obesity. Modifying school diets to contain larger servings of fruits and vegetables and eliminating high-calorie foods, fast foods, and high sugars is one of the methods established to reduce childhood obesity levels. Schools can implement healthy foods on their menus and teach students about healthy eating habits. This component is crucial because school lunch programs are an important part of children’s diets.

· Physical activity for children- The Brown et al. (2019) study found that physical activity is an effective component of a dietary behavior change for reducing childhood obesity. Along with a change in diet, physical activity is effective for reducing weight, reducing the likelihood of cardiovascular diseases and improving the general well-being of children.

Assessment of population needs, assets and capacity that affect community health

The target population for the intervention is children under risk for childhood obesity, aged between 2 and 19 years. The needs of this population in regards to this intervention are minimal. The population needs include education materials and equipment for physical exercise. This population does not have any assets to facilitate the behavior change, and the population lacks the capacity to effect this change on their own. This is why there is a need for community support and other support structures to implement this behavior change fully.

How SMART objectives will be used to achieve the goals of the program

For the program to be successful and effective, SMART goals will be used. Having SMART goals is important in implementing a behavior change because it helps clarify the achievement of the proposed interventions. Smart objectives are specific, measurable, attainable, realistic, and timely. Smart objectives help steer the intervention to the targeted area, helps to create a space for measuring and evaluating the progress of the intervention, and set realistic objectives that can be fulfilled using the available resources. The following objectives will ensure the success of the program

1. Specific and time-bound

· Target to reduce childhood obesity rates throughout the United States by implementing a diet behavior change program which is combined with physical activity

· Effect dietary behavior change in childhood through effective media communication

· Conduct healthy diets education in elementary and high schools

2. Measurable and Realistic

· Reduce childhood obesity rates from the current 18.7% to under 5% in the next five years

· Reduce the rate of sugar consumption in children by half

· Increase the number of fruits and vegetables in children’s diets in school and at home by 50%

3. Attainable

· Launch a childhood obesity awareness campaign in neighborhoods, churches, and schools and conduct sensitization sessions for parents on ways to combat childhood obesity

Desired outcomes

The desired outcomes in this program are generally the reduction of childhood obesity rates and the promotion of healthy eating habits. In their study, Brown et al. (2019) used BMI as the main variable of interest in their research. BMI can also be used to measure the effectiveness of the proposed interventions since it is the most robust measure for weight loss or gain. The desired outcome should therefore be the reduction of BMI in the children who are obese or at risk of being obese, a complete change of dietary behavior from consumption of unhealthy meals to consumption of healthy meals, an increase in physical activity, and a decrease in sedentary lifestyles. Additionally, the educational intervention seeks to make children identify unhealthy foods such as fast foods and to know healthy foods.

Measurement of the progress of the program

To measure the progress of the program, there will be milestones set that have to be achieved after a period of time. The duration of the intervention program is 18 months, which is enough time to not only effect complete behavior change, but also enough to measure desired variables in isolation of exogenous variables. More specifically, the program’s progress will be measured after every 3 months, and the BMI of the children under the program will be measured. The desired outcome is that the BMI will reduce by small margins after every three months. Additionally, the progress of the children for every physical activity they will be doing will also be monitored and measured. Success in the program duration will be the following indicators;

· Reduction of the BMIs of the children after the close of the program

· Elimination or reduction in unhealthy portions in the school lunch menus

· Increase in the capacity of the children for more physical activity

· More time spent outdoors than indoors

Mode of delivery of the intervention

For this intervention to succeed, the patient’s full participation is required. Because the target population of patients is children, the participation of parents, guardians, community resources, and schools will be necessary. The children must be fully involved in the program through active participation by following the healthy diets prescribed in the program, participating in exercises and activities and giving feedback on the program’s progress. The intervention, therefore, requires the patients’ presence, participation, and feedback throughout the program duration.

The intervention will be delivered through school and home meal plans. First, the children at risk of childhood obesity will be sampled from schools in the school district where the program will be implemented. A survey will then be conducted among the children’s parents to identify those willing to participate in the program. A seminar will then be held with the parents of these children to educate them on how to implement a diet change at home as one of the measures of helping their children to reduce weight. The school management will also be sensitized on the ways to combat childhood obesity through the modification of school meal plans to include healthier options

A broader media campaign will also be used as another channel to reach the audience. The children will be reached through the distribution of picture books depicting healthy and unhealthy foods, while the parents will be reached through other media channels such as mass media, social media, and brochures.

Importance of cultural competence when communicating public health content

Cultural competence is the ability to interact with people from other cultures, either professionally or in social settings. Cultural competence is very important in communicating public health content because communication of public health messages is targeted to a wider audience which comprises people from various cultural backgrounds. Cultural competence has been identified as one of the ways of addressing healthcare disparities that exist in the United States. Presently, healthcare professionals must be culturally competent due to the diversity of the patients they are expected to serve.

In this particular intervention, cultural competence is important because different cultures interpret diet differently, and food is regarded in different cultures differently. In some cultures, for instance, excess weight is interpreted as a sign of health and well-being. In the media culture, excess weight is a source of shame, especially for women, which may lead to low-self esteem and even stress.

For this program intervention to succeed, cultural awareness must be incorporated into it. The program will recognize that there are children who come from cultural backgrounds where particular foods are a staple. For instance, obesity rates are high in the Native American population because of high consumption of foods with high calories. Additionally, Black and Hispanic children are primarily from low-income communities with limited access to healthy options. In this case, the program will mostly rely on the school lunch program to implement the healthy diet plan since the children will not have access to a healthy diet at home.

The intervention has to be tailored for each family and each school. Some schools, for instance, lack funding for extracurricular classes, while some schools have no funding for meal plan modifications. All these factors have to be taken into consideration when implementing the program. Therefore, the intervention must be tailored to fit the cultural context of the children. In areas where it is implemented, there has to be a clause that specifies that the document can be adapted to the cultural and ethnic needs of the population to which it is being applied.

For this particular intervention, culture will be a consideration in the application of the intervention, from how it will be communicated to how it is applied. For instance, culture is not only about ethnic and traditional practices but also about how people relate to one another. In the US for example, it is unlawful to implement programs like this on children without parents’ permission. Therefore, the permission of parents will be sought first. Secondly, in cases where some foods are eaten as part of a culture, this will be taken into consideration and allowances made.

References

Center for Disease Control and Prevention (n.d). Childhood Obesity Facts: Prevalence of Childhood Obesity in the United States..

Dudley, D. A., Cotton, W. G., & Peralta, L. R. (2015). Teaching approaches and strategies that promote healthy eating in primary school children: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 1-26.

Mohamed, W., Azlan, A., & Abd Talib, R. (2018). Benefits of community gardening activity in obesity intervention: Findings from FEAT programme. Current Research in Nutrition and Food Science Journal, 6(3), 700-710.

Warren, A. M., Frongillo, E. A., Nguyen, P. H., & Menon, P. (2020). Nutrition Intervention Using Behavioral Change Communication without Additional Material Inputs Increased Expenditures on Key Food Groups in Bangladesh. The Journal of nutrition, 150(5), 1284–1290. https://doi.org/10.1093/jn/nxz339

De Miguel-Etayo, P., Bueno, G., Garagorri, J. M., & Moreno, L. A. (2013). Interventions for treating obesity in children. World review of nutrition and dietetics, 108, 98–106. https://doi.org/10.1159/000351493

Brown, T., Moore, T. H., Hooper, L., Gao, Y., Zayegh, A., Ijaz, S., Elwenspoek, M., Foxen, S. C., Magee, L., O’Malley, C., Waters, E., & Summerbell, C. D. (2019). Interventions for preventing obesity in children. The Cochrane database of systematic reviews, 7(7), CD001871. https://doi.org/10.1002/14651858.CD001871.pub4

Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2019). Childhood obesity. The lancet, 375(9727), 1737-1748.

Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA, 311(8), 806–814. https://doi.org/10.1001/jama.2014.732

Verduci, E., Di Profio, E., Fiore, G., & Zuccotti, G. (2022). Integrated approaches to combatting childhood obesity. Annals of Nutrition and Metabolism, 1-12.

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

After a program has been created, it must be evaluated in order to determine its success. For this assignment, complete the following:

1. Incorporate the changes to address the feedback received.

a. Use the feedback from your instructor to address pertinent sections for errors or insufficiencies. Implementing this feedback will help you draft this assignment and your course project.

2. Discuss the program to be introduced to the selected population to address the specific public health problem or issue.

a. Assess population needs, assets, and capacities that affect communities’ health through epidemiological records and literature reviews. Explain activities and resources to be introduced and used for this program to change behaviors and health outcomes and why they are selected.

b. Describe the projected goals for the program.

c. Based on past studies and available data, analyze the projected expected effects of the program.

3. Identify the engaged stakeholders.

a. Describe those involved, those affected, and the primary intended users.

4. Gather credible evidence to substantiate the need for the program.

a. Identify past programs similar to the proposed program and the outcomes for those past programs.

b. Explain past study results and epidemiological data for similar programs implemented.

c. Justify conclusions on the past programs and provide lessons learned for implementing this program.

5. Analyze how data will be collected from program participants and other relevant stakeholders to determine program effectiveness.

a. Identify what instruments will be used to collect data, such as surveys, focus group interviews, or key informant interviews.

b. Determine who will analyze the data and how the data will be analyzed.

6. Propose policy recommendations.

a. Evaluate policies for their impact on public health and health equity. Discuss multiple dimensions of the policy-making process, including the roles of ethics and evidence.

b. Discuss dissemination and communication suggestions for the evaluation results both in writing and through oral presentation.

c. Explain how the results will be shared with key stakeholders and the community.

d. Identify how the results will inform future programs and how they can improve health outcomes.

View the scoring guide to ensure you fulfill all grading criteria.

Additional Requirements

· Length: A minimum of 10–12 double-spaced pages, not including title and reference pages.

· Font: Arial, 12 point.

· References: Cite at least eight references from peer-reviewed journals.

· Format: Use current APA style and formatting.

FEEDBACK FROM PREVIOUS ASSIGNMENT:

Great program intervention paper with SMART objectives! When reading through your work, I could see a clear plan for your program intervention with SMART objectives. You have identified the intervention to be implemented, analyzing how it will be used and included SMART objectives. You designed a population-based policy, program, project or intervention based on best practices for your issues. SMART objectives are an essential public health tool for programming, policy, research and evaluation. I am very proud of the work you put into this assignment.

Content: Points made are great. Appropriate amount of detail to document the need to examine your public health issue. Well written/formatted, and your references all substantiate your supporting points.

Mechanics: Well written and nicely organized

Format: Thank you for including all the required information

Overall Comment: Great program intervention paper with SMART objectives!

Dr. E