Powerpoint

Please see attached. Voice recording will be done at a later time.

Using the health problem or issue you selected in Unit 2, develop a presentation using the information you gathered for the previous assignments in this course. The presentation should contain 15–20 PowerPoint slides. Include the following elements:

Cover slide: One slide that includes the name and number of the course, name of project, submission date, name of learner, and contact information.

Introduction slide: One slide that provides a brief introduction to the public health problem or issue, describes the targeted population and community, and explains why this population was selected for this project. This is the elevator speech of the project and captures an overview in one small paragraph.

Scenario slide: One slide that explains details of the problem to be studied, describes the purpose of the proposed intervention program, and explains who might benefit from the findings of the program intervention and why. This includes the key questions to be asked.

Analysis of the Situation: A section of two to three slides that describes what you have discovered about the selected public health problem or issue to inform the program design. What key concepts and studies are relevant to the study?

Complete a review of at least three related peer-reviewed research articles on the topic to be studied.

Identify what has been studied on the topic you plan to study, and what has not been studied or studied very little. In addition, identify areas where findings are not in agreement on the topic you are going to study. Identify the leading theory you have found.

Diversity: One slide that directly addresses embedded diversity issues within the study topic and how this intervention program could be used to enhance public health outcomes of all cultural backgrounds and health needs.

Implementation and Design: A section of three to four slides that describes how the intervention will be designed and implemented.

Describe the population and sample from whom the intervention will be implemented.

Describe what resources and tools will be used to implement the intervention. For example, will faith-based organizations, public health departments, or social media platforms be used to reach the audience and introduce the intervention?

Identify program goals based on the SMART principles.

Timeline: One slide that shows the projected time estimated for the intervention and evaluation.

Health Equity: Discuss the means by which structural bias, social inequities, and racism undermine health and create challenges to achieving health equity at organizational, community, and societal levels. Discuss how that will be factored into the project time.

Data Analysis: A section of one to two slides that describes how data will be analyzed and processed to generate findings in order to inform decision making and practice.

Program Evaluation: A section of two to four slides that explains how the data analysis will be used to evaluate the program.

Analyze a policy recommendation based on the program evaluation results that can be used to address the selected public health problem or issue.

Identify how program evaluation results will be disseminated and to whom.

Identify how this proposed public health intervention program can inform future studies.

Summary: One slide that sums up the proposed program intervention and addresses the questions: “How can this proposal translate into real practice?” and “Could this really be implemented at a practicum site?”

References: This section should list, in APA format, the scholarly references used in creating the plan, especially with regard to the review of the literature.

To complete your assignment, use Kaltura to create an audio recording that accompanies the PowerPoint presentation. Do not read directly from the slides; instead, contribute additional information or elaboration on the content provided. You may find it useful to write a detailed outline or script as a reference to use as you create your audio recording.

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

Note: If you require the use of assistive technology or alternative communication methods to participate in these activities, please contact DisabilityServices@Capella.edu to request accommodations.

Additional Requirements

Length: A minimum of 15–20 slides, not including title and reference slides.

Font: Arial, at least 18 point. Use the Guidelines for Effective PowerPoint Presentations, linked in the Resources, for best practices when creating PowerPoint presentations.

References: Cite at least 15 references from peer-reviewed journals and primary Web sites, in addition to your text.

Format: Use current APA style and formatting.

1

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.

1

Program Evaluation: Changing Behavior for Children at Risk of Obesity

Jessica Tidd

Capella University

MPH 5900: Public Health Capstone

August 2022

Program Evaluation: Changing Behavior for Children at Risk of Obesity

Program Specifics

Diabetes is primarily caused by obesity, which in turn is a product of poor nutrition and sedentary lifestyles. The solution to solving the problem of childhood obesity is a change in behavior, which involves the adoption of healthy foods (diet) and an active lifestyle. Dieting is the main cause of childhood obesity in more than 70% of children in the US. Research that has been conducted in the past indicates that the main cause of childhood obesity is the consumption of foods rich in processed carbs and processed sugars. According to De Migule-Etayo (2013), there are various interventions that can be used to treat and reverse the increasing trend of childhood obesity, and these methods include dietary behavior change, surgical intervention, pharmacology and the adoption of an active lifestyle involving physical exercise.

This proposal proposes a 6-month program involving a dietary behavior change and adoption of physical exercise for a group of 12 children at the risk of childhood obesity or who are already suffering from childhood obesity.

Assessment of population needs

The population that is going to be targeted with this program are children between the ages of 2 and 17. The role of dietary behavior modification as an intervention for childhood obesity has been documented widely in literature. In a study by Golan et al. (1998), a family-based treatment for childhood obesity was evaluated. Golan et al. (1998) exclusively used the parents as the agents of change, as opposed to using children. The researchers hypothesized that if the parents are used as the main agents of change to manipulate the environment of the children, then the children would easily overcome the unhealthy dietary habits. Focusing on the parents as the agents of change and having the intervention target parents would also take the focus off of the children and preserve their identity as well as their self-esteem as they participated in the program. The researchers postulated that focusing the intervention on the parents would induce a greater behavior modification as well as a bigger decrease in food consumption, leading to better outcomes compared to conventional methods which have always focused on the children.

The assumptions in Golan et al. (1998) were based off of their previous studies where they found that greater weight reduction in children with obesity was achieved when the parents were actively involved in the interventions as the main agents. The assumption was also based on the fact that an approach that is focused on the parents would also eliminate the predisposition to eating disorders in the long-term, a factor which has been cited as a third variable in studies on dietary change as intervention for childhood obesity. Kamath et al. (2008) also conducted an RCT study to investigate the efficacy of various interventions for preventing childhood obesity. The study was primarily focused on studying the effectiveness of various change of lifestyle strategies which included physical activity, decrease of sedentary lifestyle, the decrease in unhealthy dietary habits and an increase in the intake of healthier foods options. The main parameter of measurement was the decrease in BMI of the study participants.

Unlike in the study conducted by Golan et al. (1998), Kamath et al. (2008) used interventions which were mainly focused on the children. Both studies used children between the ages of 2 and 18. Kamath et al. (2008) defined lifestyle behaviors to include dietary changes (increase in healthy diet and decrease in unhealthy diet) and two, changes in physical activity (decrease in sedentary lifestyle and increase in physical activity). The Kamath et al. (2008) study used parents and family members as secondary subjects and assets to the study where the parents and family members reported on the progress of the children in terms of adherence to the study. The children that participated in the study that was conducted by Kamath et al., (2008) received interventions either at school, home, in the clinic, or in the community setting. Stakeholders that participated in delivering the interventions included community members, healthcare professionals, parents, health authorities and school leaders. Multimodal and simple interventions were administered.

Assets

Assets refer to the people, resources and equipment that will be utilized to realize the program objectives. Assets are different from stakeholders in that they are resources, either material or human that are necessary for the success of the program, whereas stakeholders are the people that are going to be affected, either positively or negatively by the program. The following assets will be important in carrying out this program.

· Healthcare authorities

· School administration

· Books, films and learning materials

· Exercise equipment

Activities in change behaviors

The change behaviors in this program are dietary behavior modification and physical activity. Consistent with both Kamath et al. (2008) and Golan et al. (1998), this program will include the following activities.

· A 180-day dietary modification, where parents of the children enrolled in the program will implement a diet that has been recommended by a pediatric nutritionist as effective for reducing childhood obesity

· Children will participate in a physical exercise that is age appropriate both in school and at home. Parents will for instance take the children out for 30-minute walks every day for a period of six months

· Parents will regulate the amount of time that children watch television or play video games and set this to a minimum.

· Parents will report progress to the program leader after every 30-days

Projected program goals

The parameter of interest in the study conducted by Kamath et al. was the measurement of BMI. BMI is the most reliable proxy measure for the risk of obesity in all demographics. The CDC benchmark for instances categorizes children with BMI above the 95th percentile of the CDC sex-specific BMI as obese. Other measurements for childhood obesity are the reduction on symptoms such as joint pains, shortness of breath and sleep apnea.

The following are the goals of the program

· Assist the children to change their dietary behavior from unhealthy eating habits to healthy eating habits

· Assist the children to increase their levels of physical exercise and effect behavior change from a sedentary lifestyle to a physical-activity lifestyle

The SMART objectives for the program are also reiterated below:

· 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

1.
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%

2.
Attainable

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

Expected outcomes of the program

There are various expected outcomes of the program. The outcomes can be categorized into short and long-term outcomes. The long-term outcomes are the expected adoption of new habits while the short-term outcomes are the improvement in the measures of childhood obesity. In the Golan et al., study, 60 obese children (20% over the ideal age-specific BMI) were randomly selected. The children were aged between 6 and 17. The experimental group was treated with interventions for a period of 12 months. The control group were children would were responsible for their own weight.

Interventions included hour-long support-educational sessions conducted by a clinical dietitian. The sessions include 14 sessions for parents in the experimental group and 30 for parents in the control group. The results showed that the mean weight reduction in the children who were enrolled in the experimental group were higher than that of the control group. The study concluded when parents are engaged as the main agents of behavior modification in their children, the changes tend to be greater than when the children are taken as the main agents. On the other hand, the outcomes of the interventions that were implemented in the Kamath et al., study only caused a small change in target behavior and no significant effect on the BMI. This disparity in outcome can be explained using two reasons, one is that the focus on parents as agents of change is more effective than using the children, and two, that in the Kamath et al., study treated the experimental group over a shorter period of time.

Both of these studies influence the choice of desired outcome in this program. Because the treatment given in the program is the same as in both of the cited studies, we expected similar results over the 180 days period that the program is going to last. The following are the short and long-term expected outcomes of the program:

· Reduce the BMI of the subjects to within the CDC range of “normal” BMI

· Eliminate symptoms of obesity in the participants

Long-term expected outcomes

· Prevent progression of childhood obesity to diabetes type 2

· Help the participants to pick up positive dietary behaviors and discard negative dietary behaviors

Expected effects of the Program

The program is expected to have several effects. First, just like in the Golan et al., (1998) study where parents were the main focus, in this study, it is expected that the parents and teachers will the best foods to give their children to avert negative health issues. Second, it is expected that the children participating in the study will succeed in reducing weight and picking up new habits which will help them to adopt positive eating habits in future.

Stakeholders to the program

The main stakeholders are going to be parents and children. Just like in the Golan et al study, the focus of the program will be targeted behavior change in the children that is facilitated by the parents. This method has been proven to be more effective at achieving better outcomes compared to conventional methods which focus on children. The primary stakeholders to this program include children aged 2-17 years, their parents, school teachers, healthcare professionals and community resources. The children are the main stakeholders in this program. They are expected to adhere to the requirements of the program for the entire period of 180 days. The children are the primary intended users of the program and also the ones who are affected by the program.

The parents are the second most important stakeholders of the program. They are expected to help in the implementation of the behavior change by implementing the diet plan and the exercise routine. The school teachers and the school administration are the third category of stakeholders. Their role will involve piloting a new menu in the schools and assessing the impact of the healthier meal option on the eating habits of the students. Community health authorities will be contacted to advice on the structuring of the program and its implementation in schools and homes. The community healthcare authorities will also help with resources for program monitoring and evaluation.

The need for the program

The World Health Organization (WHO) has described childhood obesity as one of the most serious health challenges in the 21st century. In a 2016 survey, the World Health Organization also found that globally, about 41 million children under five years were overweight while those between the ages of 5 and 19 who were overweight were slightly more than 340 million. The Center for Disease Control and Prevention in the US estimates that approximately 19% of children between age 2 and 19 years-old are obese in the US, which translates to about 1 in five children. The CDC has also indicated that for the past 30 years, the rate of childhood obesity has increased by three.

This program is needed because childhood obesity is an immediate healthcare problem that can be solved though well-structured programs. Several studies have found that change modification is the easiest and most effective ways to lose weight across all gender and age demographics. Obesity is mainly caused by unhealthy eating habits and a sedentary lifestyle. Adopting healthy diets and frequent and routine physical activity has been found to be a remedy for obesity across all age groups. This program is also important because studies suggest that if left untreated, childhood obesity persists up to adulthood leading to a myriad other physical and mental health problems such as type II diabetes, physical joint pains, hypertensions and low-self esteem among others.

Past studies using the intervention

Two past studies (Golan et al. (1998); Kamath et al. (2008) have been cited in previous sections on the effectiveness of dietary behavior modification and physical activity as two core interventions against childhood obesity. In a subsequent study conducted in 2006, Golan et al. conducted a study to compare two interventions, one which involves parents working with the child and the other intervention only involving the children. Golan et al., evaluated the relative efficacy of treating childhood obesity through family-based health centered intervention, which involve only parents, and another intervention involving parents and children. In this study, 32 families with children who were between 6 and 11 years were selected randomly to participate in the study. Both groups were exposed to a 6 months comprehensive educational and behavioral program targeting behavior modification. Additionally, in both of the groups, the parents were encouraged to adopt authoritarian parenting style (parents are firm but supportive, they lead change but grant the children some freedom). The study found that only in the group where the intervention was led by and targeted at parents. For instance, the percentage of the children that were obese at the end of the program was lower in the parents-only group compared to the parents-and-children group.

Johnston & Taylor (2008) also cite several studies (Summerbell et al., 2003; Israel, 1999; Chambless and Hollon (1998) which have found that a multimodal approach such as the one adopted by Kamath et al. (2006) is also more effective in tackling childhood obesity.

Data collection

Data is going to be collected throughout this program. In the study by Kamath et al. (2006), data was collected using questionnaires, and interviews of the parents. In this study, data is going to be collected from the participants of the study using various ways. First, the main measure which is BMI will be collected from the participants after every 30 days. This will be measured using weight scales at home, by a healthcare professional or parents trained in the proper way of measuring BMI. This data will be self-reported, where parents will be required to collect and remit the data to the program manager.

Instruments of data collection

· Surveys and questionnaires to identify participants

· Self-reported measurement data for all categories required

· School reports on the progress of dietary behavior change programs

· Interviews conducted by the program officer and administered on school teachers and parents

The data collected will be analyzed using qualitative methods. This data will be analyzed by the program officers with the help of clinical healthcare authorities. The outcome of the program will be used to draft policies for implementing a wide-reaching behavior modification program across the state as a means of treating childhood obesity.

Policy Recommendations

The outcome of this program will inform policy making on the best ways to combat childhood obesity. The following two policies are recommended to combat childhood obesity at society-levels.

i) Regulate the TV ads of unhealthy foods that are targeted at children

Studies have established that TV advertising of unhealthy foods is one of the major drivers of unhealthy eating habits among children in the target demographic for this program. When children see the advertisement of meals such as burgers, fried chicken and chips, foods cooked with processed sugars and cornstarch etc., they tend to associate such foods with healthy eating habits. Children places a premium on what they see on television, a habit which brands have taken advantage of to influence purchasing decisions of parents. Using the results from this program, legislators will be lobbied to regulate the advertisement of foods targeted at children.

ii) Implement healthier diets in schools

Children spend most of their time in school. Schools across the US serve millions of plates of unhealthy meal options every single day which has been a significant contributor to childhood obesity. Public schools have a higher proportion of unhealthy meal plans because of lack of funding. The outcome of this program will hopefully convince school district heads to change school diets in favor of healthier meals after presentation of evidence from the program.

Dissemination of results

The dissemination of the results of this study is important. The stakeholders involved in this program need timely and accurate feedback and information from the data collected through this program. The information is going to be disseminated through a formal report of the program to the key stakeholders. The data analysis showing the outcome of the experiment will be shared with the parents of the children, the school teachers and the health authorities. Oral presentation of the program results will be presented to peers in the industry in a PowerPoint format.

How the results of this program will affect future research

There is still ongoing research in the field of childhood obesity. Many more interventions, including pharmacological interventions are being proposed, while researchers are exploring various ways of tackling the issue of childhood obesity. Various policies exist, enacted by state and federal governments about how to arrest the problem of unhealthy diets in schools, but childhood obesity rates keep going up. This program and research is adding to the body of knowledge about what is known about childhood obesity and possible interventions. This research also highlights two key policy recommendations which are open for more debate and discussion within the field of medicine and in education. This study is limited by the intervention that it proposes. In future, other kinds of interventions can be scrutinized in relation to how they help solve the problem of childhood obesity.

References

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