Childhood Obesity Summary of Public Health Program Capstone Project

Childhood Obesity

Summary of Public Health Program Plan and Purposes of Evaluation

Obesity is a growing problem in the United States for both children and adults. Over the past 30 years, obesity has more than doubled among U.S. children ages 2 to 5 and nearly tripled among young people over the age of 6 (Obesity, 2011, NIH). Low-income and minority children are statistically more likely to suffer this condition: although the reasons for this are complex and difficult to determine, a lack of access to healthy, affordable food and places to exercise as well as cultural factors such as chronic food insecurity are implicated as factors. On a personal level, obesity can have devastating psychological and physical consequences for the individual; on a social level, an increase in obesity means that healthcare costs for the chronic conditions associated with obesity, including diabetes and heart disease. Obese children are more likely to become obese adults and the earlier children have weight problems, the longer their health problems will be a burden to themselves and to others.

The title of my program will be: "Healthy communities: Building health from the ground up." Until recently, most intervention programs have focused on changing students' lunches and exercise habits in school as a way of lowering BMI. However, this ignores the important influence the home can have on children's eating habits. Children who are not supported by their family in their healthy eating habits may still bring unhealthy foods to school, snack on unhealthy foods after school, and be served high-fat, high-sugar foods at home. The program will attempt to create a proactive strategy of change that reeducates the entire family and works with the family to create an eating strategy that is affordable and feasible.

Given the importance of early intervention, middle school children at two local inner-city public schools with a high percentage of obese children will be the focus of the program. Both children and their parents will participate in the program. The mission will be to create a 'healthy household' for both children and parents. Stakeholders include the participants (children and adults); the community as a whole and also the entire United States, given the need to reduce obesity in high-risk populations. Problems may arise given that lifestyle changes are inevitably difficult to orchestrate and economic problems as well as typical dieter's cravings must be dealt with -- even families that want to eat healthy may struggle because they are unable to afford certain foods. Working with families' budgets as well as nutritional education is essential.

Reference

Obesity. (20111). National Institutes of Health. Retrieved from:

http://www.nih.gov/about/discovery/allages/obesity.htm

Week 2: Program Evaluation Plan -- Goals and Objectives, Evaluation Design, and Types of Evaluation

Because weight loss is usually a slow process, and for children obesity reduction may involve waiting until the child 'grows into' his or her weight rather than actually loses weight, tracking the success of this obesity program solely by weight loss is inherently problematic. Instead, a more useful strategy for short-term goal-setting is to track the changes made by different families involved in the program. Program leaders will set goals regarding agreed-upon changes in the family's eating habits and grocery buying, and the ability of families to meet these goals (such as including a green vegetable at every meal time, switching to lower-fat dairy products, using fruit instead of desserts as treats) will be counted as part of the success rate of the program. Each goal will be given a point value. In the long-term, it is reasonable to track reduction in BMI for children and adults as a sign of program success. The ideal impact in the long-term is a meaningful reduction in BMI.

To evaluate the program requires comparing the student-participants to a control group of demographically similar students whose families did not undergo the intervention. The control group would be comparable in terms of age and socioeconomic status. On a longitudinal basis, the control group and the experimental group would be regularly compared at annual intervals in terms of their BMI and family eating habits (Evaluation design, 2013, The World Bank). This would be called a quasi-experimental design, given that to obtain permission and to ensure logistical feasibility, the experimental group would be selected by design rather than randomized as would the control group, but there would be sufficient similarity between the two groups to ensure a meaningful comparison. Studying people in such a fashion can be difficult, however, given that families are functioning 'in the field' of life, not under controlled circumstances in a laboratory.Additionally, there is always the question that while 'an intervention' may work, because there was no intervention at all in the control group, the intervention may merely be 'better than nothing' and not necessarily the most optimal expenditure of finite resources.

Another evaluation method which could be deployed is a non-experimental, qualitative design in which the program participants could offer their input about the efficacy of the program in the form of interviews. They could discuss they perceived the intervention changed lifestyle, perceptions of food, and overall health.

References

Evaluation design. (2013). The World Bank. Retrieved:

http://web.worldbank.org/WBSITE/EXTERNAL/TOPICS/EXTPOVERTY/EXTISPMA/0,,contentMDK:20188242~menuPK:412148~pagePK:148956~piPK:216618~theSitePK:384329~isCURL:Y,00.html

Week 3: Program Evaluation Plan -- Data Collection

The program evaluation will consist of both a questionnaire and post-intervention interviews. Over the course of the program, families will receive support from nutritionists and counselors regarding how to change their eating habits and grocery-shopping. The pre -- and post-study questionnaire will evaluate the items purchased at the grocery store; times eating fast food and other unhealthy trigger foods; foods served; foods consumed and discarded. The participants' BMI will also be monitored. At annual intervals, both participants in the experimental and control groups will be subjected to these questionnaires and BMI measurements for comparison.

Outtake interviews regarding the subjective perceptions of the effectiveness of the program will also be undertaken via semi-structured interviews of program participants. The sample population of low-income children and their families at high risk for developing long-term complications for obesity will be able to talk about their feelings as to how the program changed their eating habits and perceptions of themselves. The extent to which healthy eating remains a logistical and psychological challenge will also be discussed, to ensure that the solutions offered are tailored to the needs of the targeted community.

The questionnaire will be deemed suitable for the population in terms of reading level, language and cultural appropriateness because it will be relatively straightforward and specific for both children and families, asking about specific types of foods consumed using phrases such as 'how many times did you serve green vegetables' versus more difficult to remember and measure concepts such as 'did you include 4-5 serving sizes of vegetables into your diet?' Because of the reading level of middle school children, children and their parents will be asked to fill in the evaluation measure together.

Week 4: Standards of Program Evaluation

Engage stakeholders

To engage in proactive health changes regarding weight requires the willingness of the target population to make a change. Altering food-related behaviors can be difficult even with highly motivated subjects, and low-income families may be so focused on survival, health is not a top priority. Additionally, there are different cultural expectations regarding what constitutes a healthy weight amongst some families, and some families may genuinely not believe that their child has a weight problem despite a child's high BMI. Before the program is instituted, within the school's health class and through materials disseminated to parents at home, there will be an effort to educate the population about the importance of weight management.

Describe the program

The program will attempt to change the eating habits and attitudes of middle school children's families, rather than solely focus on the children alone. Middle school children at schools with high rates of obesity in urban communities will be the focus of the program. The children will receive education about making healthy choices in health class but the parents will also be involved via intensive educational seminars in which nutritionists experienced in dealing with low-income communities will discuss meal planning and grocery shopping on a budget. Families will set goals about making healthy improvements in their lifestyles.

Focus the evaluation design

Students' BMI will be tracked via an initial assessment, a post-intervention assessment, and then annually in the longitudinal follow-up from the experiment. Eating behaviors of families as a whole will be assessed pre and post-intervention, and different goals will be established for program participants regarding introducing healthy foods and reducing the consumption of unhealthy foods. Adherence to these goals will also be assessed.

Gather credible evidence

Data as to the efficacy of the program will be established through the comparison of respondents with a demographically similar control group who did not experience the intervention. Qualitative outtake interviews will allow participants to discuss subjective perceptions of improvement.

Justify conclusions

To ensure that the program made a meaningful change in the lives of participants, the BMI of students and eating behaviors of parents will….....