Roles of Nature and Nurture in Childhood Obesity

Introduction

 Every year in the United States there is a rise in the prevalence of obese people as well as obese children. There is much controversy though of what the underlying cause is of obesity in adults and children. In this paper I will focus on the roles of nature and nurture in childhood obesity. Many people say that biology, genetics, and environmental factors have a huge role in this overwhelming number of obese children in the United States, but is there one with a greater influence than all of the others? For example statistics state that children have an 80% chance of becoming obese if their parents are both obese and a 50% chance of becoming obese if only one of their parents is obese (Benioff Children’s Hospital, 2018). Right now there are two sides to the argument of why there is an epidemic of obesity in children throughout the United States. The one side is nature in which we can look towards children’s specific genetic makeup, predetermined physiological range, genetic alterations, and advantageous gene selection to help explain childhood obesity. The other side is nurture in which we can look towards children’s physical inactivity, sociodemographic features, and their diet to help explain childhood obesity rates. There are many factors that contribute to childhood obesity, but is there a single factor that is more influential than all of the others? This is where the debate of nature versus nurture and their influence on childhood obesity begins.

Nature- Genetics and one’s Predetermined Physiological Range, Genetic alterations, and Advantageous Gene Selection

On the side of nature leading to childhood obesity, there are various biological factors that have been discovered to cause obesity. In detail, the understanding that childhood obesity is caused by nature implies that one’s own genetic inheritance influences a child’s risk for developing obesity. Specifically, the genetic material provides the framework to develop an individual and is therefore important to examine when trying to gain a better understanding on the contributing factors to the obesity epidemic. In depth, obesity has been linked back to biological factors, such as one’s genetic makeup by examining the body’s natural physiological ranges, genetic alterations, and advantageous allelic selection.

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Our body’s natural tendency to maintain a certain weight and stature, based on the amount of energy our bodies require, can lead to childhood obesity. According to an interview with Dr. Randy Seeley, director of Nutrition Obesity Research Center at MIT, our bodies have the ability to regulate fat via the hormone leptin. Leptin is produced by our body’s adipose cells to regulate the satiety and hunger centers in our brain, in which leptin travels to the hypothalamus to increase the satiety center (feeling of fullness) and decrease the hunger center (Cortell, 2014). This feedback mechanism tells us that our bodies have predetermined ranges for the amount of energy it requires to perform its daily bodily functions and activities. This mechanism is regulated by our fat cells, and can therefore stimulate the amount of food a child needs to consume, thereby leading to obesity in cases of positive energy intake.

In addition to a predetermined physiological range for our bodies, alterations in monogenic genes may also lead to childhood obesity. As discovered by Wabitsch et al. 2015, alterations in monogenic genes, such as the leptin gene, have been found to lead to severe early onset of obesity in a two year old child. In this study, a congenital leptin deficiency was found to alter the regulation of the satiety and feeding centers in the brain, leading to increased eating habits, as well as alterations in metabolic processes. In detail, the LEP gene has been mutated, thereby altering the correct formation of the leptin protein, thus altering the pathway in the central nervous system by decreasing the satiety center and increasing the hunger center. As a result, this tells your body that you are hungry and encourages the intake of food. Furthermore, immediate normalization of eating habits was rapidly achieved, in this study, when the child was treated with leptin, and thereby resulting in weight loss. Although this case points towards severe obesity resulting from a congenital mutation, it is important to recognize that congenital defects in the Leptin gene are rare (2%) and that this is also a case report on a single child, not a large population.

Not only can mutations occur in one’s genetic material to cause childhood obesity, advantageous selection of monogenic genes in humans distant past may also lead to childhood obesity. In the past, it was found that monogenic genes were advantageous, especially during time of famine, therefore the thrifty genotype theory may explain why some children become obese. The thrifty genotype theory focuses on the advantageous selection of specific genetic alleles that allowed our ancestors to survive when scarce food was available. Due to the selection of these variations and the availability of food in today’s society, individuals with these types of previously beneficial genetic variations are actually experiencing the harmful outcomes of obesity and subsequent comorbidities. Although few of these advantageous genetic variations have been discovered, some have been found and may therefore account for a subset of individuals who are obese (Southam et. al, 2009).

Although there are various biological factors that have been discovered to cause childhood obesity and contribute to the obesity epidemic, only a subset of the population may actually be affected by these factors. As a result, the environmental factors may possibly contribute to the majority of cases of children with obesity, which will be examined next.

Nurture- Physical Inactivity, Sociodemographic Features, and Diet

On the other hand, nurture seems to play a much larger role in childhood obesity. As previously mentioned, a child whose parents are obese have an astronomical increased risk of becoming obese (80%), which may reflect environmental influences their parents play on their child (Benioff Children’s Hospital, 2018). In this case, nurture is referring to all the environmental factors that may have an impact on a child and may lead to obesity, such as physical inactivity, sociodemographic features, and/or diet.

In the past decade, there has been a decrease in physical activity and a rise in obesity, correlating the two and most likely contributing to the obesity epidemic, especially amongst children. According to the Center for Disease Control and Prevention (CDC), it is recommended that children engage in 60 minutes of exercise every day to encourage a healthy lifestyle and reduce the risk for obesity as well as subsequent comorbidities (Healthy Schools: Physical Activity Facts, 2018). Unfortunately, most children are not meeting their recommended daily goal due to the increase in sedentary lifestyles, such as the shift from farmers and laborers to sitting in a classroom most of the day and focusing on studies, increased screen time on the computer or television, as well as influential behavior from family and friends (Pradinuk et. al, 2011). As a result, these environmental factors are decreasing children’s physical activity levels and are contributing to obesity.

In addition to the increase in physical inactivity among school-aged children, a low socioeconomic status (SES), as well as racial or ethnic backgrounds, have been linked to a higher prevalence of obesity. Specifically, young children in these groups were found to eat a larger amount of food in a single meal, as well as eat less frequently than their school-aged counterparts. It is believed that these eating habits (eating less frequently, but consuming more food) early in a child’s second year of life may influence their eating habits later in life in such a way that it may lead to over-eating, and ultimately obesity (Mcconahy et. al, 2002). Therefore, a child’s sociodemographic has a large impact early in life.

Along with the impact that sociodemographic features play on obesity, diet throughout a child’s life, especially during infancy, has been found to cause obesity in children. For instance, a child’s upbringing post-partum has been known to alter their microbiota. In turn, it was found that these alterations in their microbiota are connected to obesity. Although it is unclear whether variations in the microbiota are the cause or result of obesity, a connection between the two was found in a study by Kalliomaki et. al, 2008. This study compared children who were classified as obese to children of normal weight in the same age groups and were age-matched by the following features: birth method, BMI at birth, gestational age, duration of breastfeeding, use of antibiotics, probiotic supplementation, and atopic sensitization. It was found that children with higher levels of Bifidobacterium species in their microbiota were of normal weight, whereas higher levels of Staphylococcus aureus numbers were found in children with obesity. Therefore, environmental influences play an important role in influencing a child’s health as well as health outcome, such as obesity.

Overall, a shift in the Western society poses various environmental challenges that have been found to contribute to childhood obesity, such as an increase in physical inactivity, sociodemographic features, and diet. Thus far, it seems as if nurture plays a much larger role in the obesity epidemic.

Conclusion- Nature and Nurture in Harmonious Interplay

Although most cases of children with obesity may result from influences on their nurture, who is it to say that they single-handedly cause childhood obesity. There may be a synergistic type of effect, in which an individual’s genetic makeup may put a child at risk for obesity and on top of that environmental influences may drastically increase this risk. For instance, every individual’s body makeup is predetermined by their genetics, in which one’s genetics may interact environmental factors, such as stress, drugs, etc., that may alter their genetics, specifically a gene’s expression. It is impossible to eliminate one’s genetics, so although it seems as if nurture plays a larger role in leading to childhood obesity, it may have a synergistic interaction with nature. For this reason, I believe that nature and nurture are in a harmonistic interplay when it comes to childhood obesity. That being said, since environmental influences play a huge impact on childhood obesity, whether it be adjoined with nature or alone, as a society, we can easily help prevent childhood obesity and stop the obesity epidemic. In addition, our families play a huge and important role in our development, making this is a great starting point to prevent childhood obesity. For instance, it was found that tackling obesity as a family greatly improves physical activity and encourages healthy weight loss (Healthy active living for children and youth, 2002). At large, both nature and nurture factors need to be addressed, in regard to childhood obesity, to help diminish their influence on the obesity epidemic, as well as subsequent health problems.

References

Cortell, Reeder, FNP-C. 034 Set-Point, Biology, Environment, & Obesity: An Interview with Dr Randy Seeley. Weightloss surgery podcast. (2014). Retrieved from http://www.weightlosssurgerypodcast.com/034-set-point-biology-environment-obesityan-interview-with-dr-randy-seeley/

Healthy active living for children and youth. (2002). Pediatrics and Child Health. Retrieved from https://academic.oup.com/pch/article/7/5/347/2658428

Healthy Schools: Physical Activity Facts. (2018). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/healthyschools/physicalactivity/facts.htm

Kalliomäki, M., Collado, M. C., Salminen, S., & Isolauri, E. (2008). Early differences in fecal microbiota composition in children may predict overweight. The American Journal of Clinical Nutrition,87(3), 534-538. Retrieved from https://academic.oup.com/ajcn/article/87/3/534/4633266

Martin Wabitsch, M.D., Ph.D., Jan-Bernd Funcke, M.Sc., Belinda Lennerz, M.D., Ursula Kuhnle-Krahl, .D., Georgia Lahr, Ph.D., Klaus-Michael Debatin, M.D., Petra Vatter, Ph.D., Peter Gierschik, M.D., Barbara Moepps, Ph.D., and Pamela Fischer-Posovszky, Ph.D. (2015). Biologically Inactive Leptin and Early-Onset Extreme Obesity. New England Journal of Medicine,372(13), 1266-1267. Retrieved from https://www.nejm.org/doi/10.1056/NEJMoa1406653

Mcconahy, K. L., Smiciklas-Wright, H., Birch, L. L., Mitchell, D. C., & Picciano, M. F. (2002). Food portions are positively related to energy intake and body weight in early childhood. The Journal of Pediatrics,140(3), 340-347. doi:10.1067/mpd.2002.122467

Pradinuk, M., Chanoine, J.-P., & Goldman, R. D. (2011). Obesity and physical activity in children. Canadian Family Physician, 57(7), 779–782. Retrieved from Obesity and physical activity in children

Southam, L., Soranzo, N., Montgomery, S. B., Frayling, T. M., Mccarthy, M. I., Barroso, I., & Zeggini, E. (2009). Is the thrifty genotype hypothesis supported by evidence based on confirmed type 2 diabetes- and obesity-susceptibility variants? Diabetologia, 52(9), 1846-1851. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723682

 

What Are The Causes Of Childhood Obesity Health Essay

Throughout the years, obesity has been a very important topic in our society and has risen exponentially among children and many researchers have wondered what are the causes of childhood obesity. There are many components which contribute to the causes of child obesity. Also people need to understand what exactly is body-mass-index and how it will be used to decide whether the child is categorized as being obese or not. Here are the some of the primary causes that affect children leading into obsession. The children consume so much food, are exposed to too many advertisements, lack physical activity, parents influence their actions, and the children’s living environments and socioeconomic factors influence them. Many blame that children eat beyond their control and this happens to be the number one cause. The second cause is children are exposed too many food commercials of less healthy foods and eventually are convinced into consuming the product. The third reason is children tend to lack physical activity by rather spending countless hours playing video games and browsing the internet. The fourth cause is that the children parents influences them, and the genetics of the parents is a great influence on children’s overweight and obesity. The last cause is the child’s living environment and their socioeconomic status influences their decisions and actions. These are the main components that lead into causing obesity among the children.

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What factors make children to be considered obese from a normal weight. What is obesity and BMI? Typically, obesity and overweight children are characterized as having a body-mass-index (BMI) greater than a particular threshold set point. BMI or body-mass-index undistinguished as a measurement in “kilograms divided by height in meters squared (kg/m2)” (Anderson 20). Reported by the guidelines in National Institutes of Health, a child is well categorized as obese if their “body-mass-index is less than 18.5”, the kids are considered overweight if their “BMI is 25 or more, and obese if his BMI is 31 or more” (20). Most people have no significant idea of what exactly is obesity. According to the Center for Disease Control and prevention, obesity is defined as “a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced 6 life expectancy and/or increased health problems” (CDC, 2013). In the article Childhood Obesity: An Overview, it mentions that it can happen only when the number of calories being consumed surpasses the quantity of calories burned, and usually an increase of this action has to last for long periods of time for obesity to be developed (Reily 2007) In order for a child to not be obese, it will take them days of lifestyle changes which produce a small every day calorie deficiency in their food diet. In the long run it is necessity that lifestyle changes is a huge contributor to the failure of efforts to resolve obesity once it has become established. When the children consume much more calories than they burn off, they increase that as obese weight. (WebMD 1) How children eat, how physically active they are, and many numerous components play a part on how it impacts their body and uses the energy units and when weight is increased. These are the basics of obesity and how the body-mass index is use to classified children as obese.
The number one cause is children intake way too much unhealthy food products such as soft drinks, fast food, convenient snack food, chips, and junk food, etc. When the children eat this certain type of food, the calories sum up creating body fat or also known as BMI. Most children tend to miss a great diet and are easily exposed to unhealthy food; therefore, they will consume as they are pleased (Anderson and Butcher 14). The three major food categories are convenience foods, soft drinks, and obviously fast food. All these are calorie dense and there is some evidence that consuming these items are correlated with obesity in children (35). Also the much more children consume this type of food, the easier it is for them to get addicted. The world’s leading global fast food service retailer with more than 34,000 and counting restaurants worldwide goes to the McDonald’s Corporation franchise and they happened to sell the two unhealthiest leading food products that causes obesity, which are french fries and chicken nuggets (McDonalds 1). Nevertheless, children tend to always eat them at any fast food place. They cannot enjoy their meal without a side of french fries or chicken tenders. Another thing children face are the easy access to junk food in schools. Much more schools across America have carried out school vending machines that contain highly calorie snacks such as candy bars and chips. Fast food companies use tactics against children such as advertising to brain wash them to consume their food products.
The second cause leading to child obesity is that many of the children that end getting overweight are exposed to hundreds of advertising of unhealthy foods. The television advertisements are very influential and persuasive to the children’s mind. On average, the child watches an estimate of more than 23,000 food commercials every year and works out to at least 60 commercials per day (Anderson and Butcher 32). Also many children get influenced by prizes or characters of the advertisement. For example, when children see an advertisement on the television for a kid’s meal; they will get convinced into buying the meal because their neurons urges the kid to wan the super, marvelous action figure found inside. This is why the McDonald’s Happy meals are the number one selling food product to children. The children in today’s society tend to not do physical activities because their days consist of computer and television interaction.
Another cause to child obesity is that many obese children do not control their overall health and lack physical activity to burn off the excess of calories. Children may be substituting different sorts of media for television watching, including video games and the internet (Anderson and Butcher 26). The kids already are not burning up the calories by not choosing to exercise and add many more calories to their bodies. The body systems of the child will not be able to burn off the calories when they do this actions. Thus, this cause raises the energy consumption or decreases energy outgo by even a little measure that will cause obesity in the long-run. Prospectively, physical activity was inversely related to with “BMI alteration in girls, and media time periods (watching television or videos, playing video or computer games) was directly connected with BMI alterations in both sexes” (Hans-Reiner Figulla 209). A factor that many really don’t notice that affect the child health choices are the parents themselves.
A cause that usually is not taken in consideration to child obesity are the parents themselves. While parental behavior is important, perhaps the largest influence on the children weight, and obesity is through genetics. For example, it is known that parents influence the children’s food choices. Also the laboring of the parents, makes it difficult to plan and cook healthier meals. For most Americans, it is effortless to get precooked products, eat out in the restaurants, or go to the store to buy products. But these types of foods are higher in fat and high in calories. The quantity of fast food products have gotten a lot bigger in size and this contributes to bad food consumption. Occupation agendas, lengthy travels from the workplace, and other commitments also cuts into the time period the parents have their kids doing physical exercise. Recent reports have concluded that about 26 to 41 percent of BMI is hereditary (Anderson and Butcher 10). Alternately it seems that parents may pass on to their children a condition to overweight in the existence of energy imbalance. (10) The environment in which the children live can also influence and effect children to getting obese.
The fifth cause is that is taken in consideration to child obesity is the environment and socioeconomic conditions of the children. Obesity is higher among minority children and low-income children such as African-American and Hispanics decent (Anderson 15). It all the depends where the children live. If the environment is under poverty conditions, the parents will most likely expose their children to consume cheap food for the penny. Now much more fast food corporations have increased their portion sizes of their products and cost a lot cheaper. Whose family members that are overweight may be at jeopardy of becoming overweight themselves, but this can be connected to common family actions such as consumption and human activity habits. For example, my mother was a considerably overweight at the time of pregnancy when she had me; therefore I was born obesity and I was two pounds overweight.
In conclusion, these are some of the major components that cause child obesity. Most of the time it isn’t just the child itself but there are much more to what causes obesity among them. Also most don’t realize that by using the body mass index or BMI is used to categorized the child as being obese. The obvious one is when the child over eats too much and doesn’t burn off the calories they intake and that add fat weight on their bodies. Many people also didn’t realize that the environment the child lives in can not only influence the children but also their parents. It is mainly the child’s environment that influences the children to either make positive or negative choices. The causes are child obesity are clearly that they consume so much food, are exposed to too many advertisements, lack physical activity performance, parents influence their actions, and the children’s living environments and socioeconomic factors influence them as well.
 

Obesity in Childhood

PREVENTION OF OBESITY IN CHILDHOOD
Introduction
In this assignment I will endeavour to tackle the prevention of obesity in childhood as an aspect of health promotion. The rationale of choosing this topic is that obesity and overweight increase the risk of contracting world killer diseases such as heart disease, cancer and diabetes .The prevalence of obesity in United Kingdom and other countries and the cost to National Health Service and economy will be looked into. An analysis of the behavioural change model and how it relates to health promotion initiatives will be discussed. The role of a nurse and other professionals with regards to heath education and health promotion will be highlighted.

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What is health The World Health Organisation (WHO 1986)defines health as a state of complete physical ,mental and social well being and not just the absence of disease and infirmity. Forster (2002) confirms that health is generally seen in terms of people being ill or well but indicates that this is a simplistic view, as being well or ill are not entirely separate notions but in fact overlap to some degree. Forster(2002) while concurring with the definition of health as provided by the WHO (1986) adds that this definition provides a positive view of health and suggest that health fluctuates over time along a continuum, good and poor health appearing at opposite poles of the continuum.
Ewles and Simnett(2003) also suggest that health is determined by many factors such as Physical health, body function, Societal health living accomodation ,employment status , Spiritual health, religious beliefs and moral values or behaviours, Social health being able to sustain relationships and make friends, Emotional health the ability to cope with depression, stress and anxiety. Therefore an individuals health position along this continuum is variable but no distinct demarcation line between health and ill health exists. With regards to the definition given it is argued that health professionals interventions should focus on helping the clients ,individuals, families and communities to gain health related knowledge, attitudes and practice associated towards achieving certain behaviours.
Obesity and associated problems.Obesity is a condition of excess body fat associated with increased risks such as diabetes, cardiovascular and other common diseases (Beebe 2008) and (Campbell and Haslam 2005). Like smoking eating is a complex combination of behaviour driven by social and psychological factors as well as biological compulsion (Croghan and Johnson 2005).They went on to say that people eat fast food because it is socially accepted. For example some fast foods have high fat and high sugar content and people tend to overeat them because they are the most palatable and provide pleasure. The prevention and management of obesity has been a national governmental policy for a number of years according to the Chief Medical Officer,s Annual Report 2002,(DoH 2003).Obesity has been highlighted as a health time bomb and seen as a challenge for the government as a whole (DoH 2003).The World Health Organisation,(WHO 1998) has described obesity as a global epidemic as evidenced by the growing trends in most developed countries.
Obesity in childhood carries health risks in both short and long term. Marshall et al (2003) agreed with Bond et al (2004) that obesity has been recognized as a major health problem as it is linked to number of diseases such as hypertension, cardiovascular diseases and diabetes .Obesity is known as a major risk factor in the development of many diseases such as arthritis of weight –bearing joints, gastro esophageal reflux, sleep apnea and certain types of cancer,(Bond et al 2004).Therefore obesity can influence physical, intellectual ,emotional and social development influencing childhood .It is for the above reason that long term eating and exercise habits need to be promoted in health and stop obesity in childhood years. Primary care should play a leading role in obesity management and prevention. The above statement is supported by the document Choosing Health ;Making Healthier Choices Easier (DoH 2004) which identified primary care as crucial to the provision of services for overweight and obese clients.
Obesity is associated with many illnesses and is directly related to increased mortality and lower life expectancy. Tackling obesity is a government wide priority .Obesity was one the key areas highlighted in the governments white paper that needed reform and the plan to meet this target was that each primary trust should have a specialist obesity service with the clients have able to access to a dietician and able to receive advice and support on changing behaviour (DoH 2004)
Possible causes of Obesity .A study by Mulvihill and Quigley (2003) has revealed that age, education, social class and prosperity have an important influence on the risk of becoming obese. Muller et al (1999) suggest that unhealthy eating habits are associated with overweight in children, they went on to say that overweight is linked with coming from a low socio-economic background, suggesting that these families should be a primary target for awareness and prevention campaigns. The figures released by the National Child Measurement programme are deeply disturbing.  The fact that 22.9% of children in year one in primary school are overweight or obese surely indicates that measuring the BMI of children should begin much earlier (National Obesity Forum 2008).
How childhood obesity in England compares with other countries and the implications to the NHS and ecomony
The 2002 review of the white paper (Health of the nation) target for obesity was just 6 per cent for 1992. A continuing rising trend in obesity to 2010 is predicted, when one-fifth of boys and more than one-fifth of girls will be obese,(King Fund 2007) . More recently the Munich Declaration(WHO 2000) recognized that actions need to be increased to enhance the roles of nurses and midwives in public health, health promotion and community participation. Irvine (2005) reported that in United Kingdom there has been corresponding growth in emphasis on health promotion in primary care. For example the liberating the talents policy document for England (DoH 2002) identifies the involvement of nurses in public health, health protection and health promotion as one of three core functions for nurses. In the United States the problem of obesity and overweight is a growing concern and the prevalence has nearly tripled during the past decade.
The economic cost is approximately 117billion dollars annually taking into account hospitalization and the lost workdays,(Sitzman 2003)In Australlia the child obesity has increased dramatically and the contributing factors include the availability of affordable energy –dense food supply and sweetened beverages that are marketed aggressively. The studies by (Kaplan and Wadden 1986) cited (Joanna Briggs Institute 2008) has shown that obesity also causes adverse psychosocial problem such as bullying, discrimination and in older children and adolescent and low self esteem. The reduction of physical activities such as walking or cycling to school and an increase in computer and electronic games has compounded the problem (Joanna Briggs Institute 2008).Simillarly a study by Jebb(2005)has revealed that obesity and overweight continues to be a serious public health problem as it is rooted in three main areas such as excess food ,absences of controlling food behaviour and lack of physical activity.
However the studies by ( Dietz and Robinson 2005,Kirk et al 2005 and Reilly 2006) cited by (Joanna Briggs Institute 2008) has evidence that indicates that a combination of dietary intervention, behavioural therapy and exercise will have significant impact on weight reduction in overweight and obesity children. In England the rates of obesity have increased dramatically over the last decade and if no action is not taken one in five children aged will be obese by 2010 (DoH 2003)The prevalence of obesity and overweight has a substantial human cost and serious financial consequences for the National Health Service (NHS) and the economy .In 1998 over 18 million days of sickness were attributed to obesity and the total cost of obesity was 2.6 billon (National Audit Office 2001). In order to tackle the growing problem of obesity, the then Public Minister of Health Tessa Jowell set in motion a wide ranging plan of action (DoH 1999) cited by White and Pettifer (2007) which included the following; Healthy school programme, living centres to be established , safe and sound challenge, to increase activity levels in children and to increase information for public ,so that they can make informed choices. The Choosing Health White Paper (DoH 2004) demonstrated this shift towards this awareness with two of the overarching principles of the policy being reducing obesity and improving diet, nutrition and increasing exercise.
Role of a nurse in health promotion
Health promotion is at the forefront of healthcare and the teaching role of the nurse is more important than ever (Rush et al 2005). Whitehead(2004) agreed that nurses impart healthcare related information that influences values, beliefs attitudes and motivations. It is for this reason that nurses in primary care play a pivotal role in the management of obesity. Encouraging people to change their attitude towards a health issue is an important part of any health education programme (Clark 1999). Health promotion is a process by which the ecologically-driven socio-political- economic determinants of health are addressed as they impact on individuals and the communities within which they interact (Whitehead 2004).In agreement with Whitehead (2004) , Tones and Tilford (2001) viewed health promotion as political advocacy which is aimed at representing the underprivileged sections of society by helping them to redress the imbalances in power. The WHO( 1986) also viewed health promotion as a mechanism to enhance health and to prevent ill health in order to maintain and impose better lifestyles.
Health education is an activity that seeks to inform the individual on the nature and causes of health/illness and that individuals personal level of risk associated with their lifestyle related behaviour (Whitehead 2004).He further states that health education seeks to motivate an individual to accept a process of behavioural-change through directly influencing their value, belief and attitude systems . However, Quinn (2001) argues that although health education is vital for health promotion ,the nurse must acknowledge that having the knowledge does not guarantee that people will implement healthy choices and a change in behaviour. To reduce obesity nurses can engage with young people for instance routinely measuring children s height and weight in order to obtain their body mass index (BMI),to establish the level of obesity. BMI is an accepted measure of obesity and is calculated as ratio of weight to weight, using the formula :BMI =weight in kilograms/height in square meters (Humphrey Beebe 2008).The National Institute for Health and Excellence (NICE 2006) and The Centers for Disease Control and Prevention’s ( CDC 2006) guidelines define those with a BMI between 25 and 29.9 as overweight and those with 30 and over to be obese. There are several approaches that health care professional can implement to tackle obesity in childhood.
For example the interventions and strategies can be targeted at the whole population ,individuals who are at risk , children and people with mental health problems. The House of Commons Health Committee’s recommendation (2004) that all children should have their BMI measured annually at school and that the results should be sent home to their parents or carers with appropriate advice. If fully implemented it would amount to full scale population level health screening programme that is cost effective. Health promotion is a vast subject with a variety of theories, models and approaches. Piper (2005) identified, the three models in health promotion frameworks that a nurse or midwife as behaviour change agent, the midwife or a nurse as empowerment facilitator ,nurse as strategic practitioner. Nurses as facilitators of self –help and promoters of positive health , are key to initiating change in this area (Croghan 2005).The nurses are ideally placed to adopt a public health role and can identify health needs as they are in regular and close contact with individual, families , communities and other health and social bodies (Jack and Holt 2008). The above models involve the midwives or nurses working with individual and the focus is on intervention.
According to Ewles and Simnett (2003) there are fives approaches to health promotion namely the medical , behaviour change , educational , client centred and societal change. The model by Ewles and Simnett (2003) identify the needs and priorities by setting the aims objectives and decide on the best way of achieving the aims by identify the resources ,plan and evaluate the methods ,set an action plan. In tackling obesity in children the medical approach would include the monitoring of the BMI. The medical approach is a reactive and opportunistic process and is adopted where the client has an existing condition or illness (Whitehead 2004) and (Ewles and Simnett 2003).The medical approach promotes medical interventions from professionals to prevent or reduce ill health and this requires the individuals to comply with preventative medical procedures. The educational approach provides individuals with knowledge and information thereby enabling them to make informed decisions and choices about their lifestyles. For example the educational approach would include teaching the children about the importance of nutrition and exercise. The behavioural change approach is targeted at the individuals ability to change their attitude and behaviour in order to adopt a healthier lifestyle.
However the behaviour change theory suggests that change will not occur until the individual is ready (Kopelman and Dietz 2005).The client-centred approach takes on the idea that people should act on their own problems. It helps client to identify what they want to know and act on them. The approach aims to empower the client. The societal approach aims to effect changes on the physical ,social , and economic environment to make it more conducive to good health (Ewles and Simnett 2003).Whitehead (2004) states that health education is an activity that seeks to inform the individual on the nature and causes of health or illness and that the individuals personal level of risk associated with their lifestyle related behaviour. The approach and aim of health promotion is to focus on changing the behaviour towards a healthier lifestyle. The stages of changes in health promotion developed by Prochaska and Di Clemente (1983)cited by Croghan (2005) are Precontemplation, contemplation, preparation, action , maintenance and relapse.
This model shows the process through which people travel to change addictive behaviour.. During the precontemplation stage the individuals are not thinking about making any change in their lifestyle. Not all clients are a stage in their life where they want to make a lifestyle behaviour change (Croghan 2005).The clients may not be aware that there is a problem and could be resistant to making changes. Contemplation is a point where the individual may be aware that there is a problem and at this stage they are weighing up the costs and benefits of change. Simillarly the Cognitive dissonance theory Festinger (1957) cited by Clark (1999) is a state of tension that occurs when an individuals beliefs are at odds with their behaviours .The cognitive dissonance is viewed as a motivational state as it enables the individual to bring the behaviour in line with beliefs such as binge eating and may change attitude towards it (Clark 1999).Croghan and Johnson (2005) agreed with the above that the support package should begin with an assessment of client s readiness and motivation to change.
Preparation is where the client becomes aware that the perceived benefits of change outweigh the costs, change is possible and small behavioural changes may occur. The Knowledge Attitude-Behaviour Model (KAB) proposes that as people acquire knowledge in nutrition and health areas, their attitudes change. Changes in attitude will then lead to changes in behaviours (Contento 2007). The next stage is where the individual takes action to change their behaviour and will lead to the maintenance stage where the new habits become established and the individual sustains the change in behaviour and moves on to a healthier lifestyle.
The NICE guidlines (2006) came up with a Obesity Intervention Pyramid aimed at tackling obesity for all children. It starts by adopting a whole school approach by addressing the levels of overweight and obesity in school children. If children are encouraged to become healthier eaters the interventions are more likely to succeed if it is applied as a whole and monitored daily.
This done by ensuring that the schools promote a culture where staff, pupils and parents or carers are encouraged to help each other to adopt a healthier lifestyle. The schools are advised to emphasise the importance of a balanced diet .A pictorial form of the balanced diet identifies those foods and drinks that should be consumed regularly and those that are high in sugar, fat and salt that should be limited. Physical activity in schools should be encouraged such as participate in sport and physical education(PE). Walking ,cycling, scooting and walk initiatives should be encouraged. This will reduce traffic outside the school thereby promoting healthy lifestyles. Avoid the blame culture that stigmatises those who are obese and overweight. Always stress the positive such as be healthy, get active, feel better and enjoy being active.
The Health Schools Programme approach involves parents and carers since they are the main influence on their children lifestyle .Parents and carers are important role models for children and can help them to stay healthy (NICE 2006).The school based activity should involve General Practioners (GP),Paediatricians ,School nurses, Dietacian and other health professionals. The behavioural programme uses the behaviour change techniques such as self-monitoring ,goal setting, positive enforcement, stimulus control and relapse prevention. BENEFITS AND BARRIERS AND WHAT HAS CHANGED .The benefits of engaging the children are improved health, concentration and behaviour. Nurses must identify potential barriers to participation in health promotion and intervene to reduce those barriers such as (Padula et al 2006)
Conclusion
Obesity is a problem that plagues millions of people, and can be considered an epidemic. Social changes and the increase in fast food corporations are leading to an escalation in obesity. Diet companies are profiting from the unhealthy habits of individuals and creating a false sense of relief. The rise in obesity is a social inclination, and needs to be seen as more of a health issue, and not as a counter-culture way of life. With a decrease in obesity, our country will become more active, and current obese people will have a new found sense of heightened self-esteem  

Communication Strategy In Obesity Awareness Health And Social Care Essay

Communication is a procedure that is basically concerned with the transmission and acceptance of messages which may either change people’s perception or not (Tones and Green, 2005). This delivery of information and counsel is fundamental to strategies in a well being programme development (Naidoo and Wills, 2009, p.185). This procedure and the result of its accessibility, presents impulsive responses that affect the attitudes and opinions of many people.

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Therefore, communication strategy means the use of conventional media support to pass across important information to the populace so as to enhance a change in people’s way of life (Naidoo and Wills, 2009, p.185). The communication strategy for this assignment will focus on the issue of obesity among college students in Newtownabbey area of Northern Ireland, how to raise awareness about its risk, and how to combat it through informed knowledge by reducing the havoc it can cause later in life to young adults if proper strategies are not put in place.
Rationale
In the western world most especially in the UK and the USA an outbreak of diet associated ailment is affecting the general public, which had led to an exceptional increase in the occurrence of obesity and its related ailment, that have led to imperative intervention for its eradication (Department of Health, Chief Medical Officer, 2003). It was also estimated by the (World Health Organisation [WHO], 2002) that roughly 58% of type 2 diabetes, 21% of CVD and 42% of some kind of cancers are ascribed to surplus adiposity in the body. This data was supported by a report written by the National Audit Office (2001) stating that over 9000 premature mortality is recorded each year in England due to obesity related disease, which causes a reduction in life anticipation by about 9 years.
The consequences of obesity can have a serious impact on people’s health and wellbeing especially teenagers by affecting them socially, psychologically and physically. This impact of obesity was summarised by (DHSSPS, 2002; Fit-future, 2006) as
Socially causing a reduction of life expectancy by roughly nine years.
Physically causing a major increase in the risk of Northern Ireland leading destructive ailment like cardiovascular diseases, diabetes and cancer.
Psychologically causing a major impact on teenagers’ self-esteem and emotional well being.
Physically predisposing overweight children to becoming obese adults in future.
In Northern Ireland it was reported that obesity was said to be causing 450 deaths every year which is equal to more than 4000 years of misplaced life (DHSSPS, 2002). Also it was gathered that this pandemic always lead to a 260 000 wasted productive years, which is equivalent to around £500 million economic lost (Fit-future, 2006).
Background
Obesity in children has drastically increased in England from 11% in 1995 to 19% in 2004 among boys of ages between 2-15 years old while the same trend also affected girls of the same age range by a radical increase from 12% in 1995 to 18% in 2004 (Department of health [DH], 2005). Fit-future (2006) also reported that the level of obesity in children in Northern Ireland is increasing every year resulting in about 20% of boys and 25% of girls being overweight or obese in primary one. This has resulted into more than a quarter increment in overweight and obesity in the last 10 years among 12 and 15 years old teenagers residing in Northern Ireland (Watkins and Murray, 2005).
This is why this communication strategy intervention needs to be promulgated to ensure that young citizens are fully aware of the consequences of obesity and its predisposing factor.
Management and Theoretical Opinions
People’s way of life in relation to their health has been regarded as the origin of several current diseases, which can be controlled by exploring many models in health that recognizes the reasons for behavioural transformation (Naidoo and Wills, 2009). Kobetz et al. (2005) claimed that a well constructed and strategic propagation of a theory based health communication and identifying the relevance of the theory is a major input to achieving a successful communication.
In order to have a valuable communication strategy that is well managed to combat the pandemic of obesity in childhood, the health promoter has sourced the help of a model called the Health Belief Model (HBM) (Becker, 1974). Janz and Becker (1984) declared that this model was previously developed to envisage precautionary health behaviours. The model looks at how beliefs impact on behaviour (Abraham and Sheeran, 2005), .i.e. what a person put into practice depends on how defenceless they recognize themselves to be to the ailment, their idea about susceptibility to the ailment (obesity) and its predisposing factor, the anticipated severity of that incidence, the advantage of implementing self-protection, and the barrier to its implementation. Where such health beliefs are understood from health education or perceived symptoms, it can help in stimulating healthy behavioural change (Naidoo and Wills, 2009). This is why a college is chosen to propagate and increase the awareness of obesity pandemic among children and to suggest a solution that could be of help to teenagers.
Prochaska et al. (1992) also brought the idea of another model that suggests that individuals change their actions at some specific stages in life rather than making a single revolution. This model identifies that an individual move through several ladder to attain a healthy living only if they are aware of the necessity to make corrections.
Empowerment as related by (Tones and Tilford, 2001) was pointed out to be the major goal of health message propagation, because it help to develop individual autonomy and ensure they gain more power over their daily lives. It focuses on a “bottom-up” programme development technique (Laverack, 2005), because it tends to appraise peoples necessities before a strategy that will suit their condition is planned. An empowered and independent individual who recognizes that being obese can results into a lot of life threatening diseases later in life, which could make life miserable would tend to be cautious about the kind of lifestyle they adopt. This empowerment approach is viewed from the micro and macro perspectives, which are the self-empowerment and the community development approach (Naidoo and Wills, 2009). The former shows the extent at which individuals have authorities over their relationship with the society (Berry, 2007), while the latter encourage groups in the community to collectively discover their needs. Therefore, an approach that empowers, inform and enhance change in conduct is required for an effective health campaign.
In planning a health communication programme whose overall goal is to increase the awareness of obesity, it is very crucial that the establishment work collectively together and coordinate themselves in the same direction. This combined work is evaluated by using the idea of the SWOT analysis which considers the interior and the exterior component of an environment as a very important part of the premeditated planning process (Jackson et al., 2003). This assesses the “strengths, weaknesses, opportunities and threats” involved in planning the strategy. This assessment includes:
Strength: The help of some of the staff of the institution will be requested for volunteering role to reduce the finances of the plan, and to make student have a sense of belonging, since some of their tutors will be involved in impacting the messages.
Weaknesses: Problems might arise from encouraging food vendors to change the kind of food they prepare , because they might be reluctant in making changes due to an anticipated reduction in their sales and profit.
A conflict problem might also arise when trying to create partnership among the department that would be involved.
Funding of the strategy might also create a hindrance.
Opportunities: This strategy might help to reduce students thought of choosing to eat food that are life threatening.
Threats: This can lead to reduction of student’s purchasing power on foods that are high in cholesterol, which could affect the shops that need to make profit.
All effective organisation routine relies on the triumphant management of the prospects, challenges and the risks presented by the outside atmosphere. A well recognized technique for analysing the general environment is the PEST analysis .i.e. the Political, Economic, Socio-cultural and Technological influences (Harvard Business School Press, 2006). The key issues pertaining to the current strategy are explained below:
Political: The existing nation policies will be sourced to ensure the effectiveness of the new strategy by checking whether there are surviving political issues on obesity, and to exercise how this new intervention will add more to the knowledge of the public.
Economic: An approximate idea of the student finances will be identified, to assess if they will be able to afford the healthy food, so as to ensure compliance.
Socio-cultural: Student belief about the kind of food they eat their environmental and peer group influence on the choice of food they purchase will be examined.
Technological: Effort to provide weighing machines for Body Mass Index (BMI) check on campus and in the hall of residence and also provision of healthy food transaction machines.
In an organizational system it is of utmost significance that the manager and the leaders in charge of the success of an organization are well equipped with the traditions and personality of the people they work with. An effective leader and manager must ensure that they play a dynamic role, designate people and resources to the right avenue, and promote success all the time (Young and Dulewicz, 2009). A manager duty was summarized by (Stewart, 1999) as someone that makes a decision on how an establishment should be run by laying good examples in practice, cultivating the act of motivating the staff, encouraging good interpersonal interaction and communication, as well as ensuring improvement of staff skills and knowledge through different improvement programmes. It was also stated by Hargie and Dickson (2004, p.8) that managers at all levels must engage in four major activities to ensure the success of an organisation, this includes: planning, organising, leading and evaluating.
There are different management theories that can be used in planning this strategy, but the contingency theory is the best (Donaldson, 2001). It was claimed by (Vecchio, 2000) that the technique and systems of running an organization bulge down to the incentive given to the staff and the dedication of the staff to the company.
Leadership was also described by (Mullins, 2002) as the value that can be introduced into a profession which is not designated to a particular person but comes as an impulsive reaction.
In achieving an effective management technique, maintaining a conflict free team work must be the ultimate duty of a leader as well as a good manager. A management skill that will ensure acknowledging the ideas of all team members must be established to avoid conflict, because a victorious team must have an apparent goal, good interpersonal relationship, excellent communication skills and must be up to the task. This idea was supported by Hargie and Dickson (2004) when they highlighted the four major skills that must be exercised to shun conflict.
Martins and Rogers (2004) stated that to properly deal with a team conflict, a manager must adopt the ability to negotiate and bargain, which is very important in tackling a team problem. This help to create a rapport among the team members which will ensure reaching a compromise by finding solution to the conflict. Martin and Rogers (2004) also suggested that for a manager to be in full control, he must be calm, logical in his thoughts and be able to control his emotions.
To meet the overall aims of this strategy, Martin and Rodgers (2004) pointed out that it will be important to adopt a coordinated partnership approach. This will involve statutory sectors, particularly health and education, local, voluntary and community sectors such as Health and Social Trust, as well as Healthy Living Centre. Such organisations could be involved in supporting and providing information to increase awareness.
Communication Strategy
The chosen venue for the proposed communication strategy is the Northern Regional College (NRC) in Newtownabbey area of Northern Ireland, since early years of children and teenagers has been described as a period when they tend to acquire long term behaviours and attitudes (Naidoo and Wills ,2009, p.206).The NRC is an educational and learning institution where skills can be impacted in a secure and compassionate environment ,which made it a perfect place for propagating a health message ( Xiangyang et al., 2003). In view of the fact that teenage years are characterized by peer group influence, the school surroundings provides a chance to communicate with adolescent and provides learning opportunities and a secure environment to perform latest skills (Naidoo and Wills, 2009, P.207).
This strategy will focus on young children of both sexes in a college setting of age range 14-16 years old through the adoption of a classroom-based method of delivering lecture that will enlighten the students on the proper dietary habit and the kind of healthy food they can lay their hands on. This educational intervention will comprise of about five lectures, which will be accomplished in a week. Different materials like visual aids, slides and transparency that have been pre-tested in the pilot study will be used by the volunteers and the health promoter involved in propagating the messages. The visual aid will contain important information on diet and health, many food deficiency disorders, and importance of physical activity and the various kinds that will suit the student daily life. Interpersonal interactions, small group discourse and group work, as well as workshops that will comprise of the use of the slides to convey healthy eating messages to increase the awareness of obesity, that is tips that will assist them to eat well will also be show cased to augment the stuff of the message being delivered (Parrot, 2004). A follow up pamphlet containing all the messages delivered will be provided for the college students to upgrade the information they have heard during the intervention. Posters displayed at every corner of the school will also be involved to ensure students are well informed.
Overall Goal
The overall aim of this communication strategy is to inform and raise the intensity of consciousness among college students about the risk of obesity.
Objective
The purpose of this proposed strategy will centre on enlightening student by creating alertness, which will result in healthy way of life from the scrash by catching them in their juvenile years. The objective is adapting the term (SMART), which means the aim must be “Specific for the programme, Measurable, Achievable in its totality, and Realistic to the target group as well as Time conscious” (Mullins, 2002). The learning objectives are
To create awareness about the kind of healthy food that can promotes healthy living among teenagers.
To guarantee teenagers disseminate the message received from school to other members of the families for optimum health.
To enlighten students about the kind of lifestyle they need to instill to avoid the risk of having the ailment.
To establish whether student have a prior knowledge of the ailment and its consequences.
To prevent obesity and overweight by promoting attitudes, knowledge and communication skills that makes healthy eating practices realisable.
Time Frame
The anticipated time for the programme would be within a three months period. Which means the strategic planning should start roughly in May 2010 and execution of the plan should begin in June and end in July 2010.
During this period the pilot study that is incorporated into the plan will be undertaken, to provide an opportunity to appraise and monitor the effectiveness of the strategy, so as to make amendment where necessary.
Implementation of the Strategy
To achieve a success in carrying out this strategy an ethical issue must be considered, since the target group are among the vulnerable groups of the society. This view was declared by (Beauchamp and Childress, 2001) where they highlighted the four famous ethical principles that need to be put in place when organising any health promotion campaign. This include respecting peoples autonomy and confidentiality, being beneficence, causing no destruction to people, and making good justice as at when necessary. Considering all this ethics the message to be delivered must be free of ambiguities, threat free, and must also be from an authentic source to avoid misinformation.
Evaluation The appraisal for this strategy must be in line with measuring the goal set down during the planning of the strategy. Since evaluation is done mainly to assess the development and the usefulness of a programme, it is fundamental to gather information during the commencement and closing of an intervention program (Naidoo and Wills 2009, p.296). The type of data considered necessary for this anticipated strategy will involve the use of the two means of gathering information .i.e. the qualitative and the quantitative method of data collection (Parry-Langdon et al., 2003). An impact assessment method of evaluation will be incorporated into the sessions by distributing questionnaires to the college students to fill in furtively before each session and instantly after the session to assess their knowledge about obesity ailment and its risk before and to measure the impact of the strategy on the college students after the intervention. A focus group dialogue will also be held among students and their tutors to establish if the modus operandi used for the programme execution was a good idea. This is needed to prove the quality of the future programme that will be executed (Nutbeam, 1998).
Conclusion
Obesity is regarded as one of the key health predicament facing both the developed and developing society today, and it is fundamental that society are provided with all the essential information and support required to improve and sustain high-quality health. The role of communication in enabling and empowering the populace to make intelligent decisions about life is vital to changing behaviour, and the approach in which knowledge is assimilated goes a long way in effecting change.
The effectiveness of communication depends on the authenticity of people’s daily lives and their present practices, as well as their perception towards existence.
To attain prolong success in health promotion; it is very crucial that work is motivated by using the bottom up approach (Naidoo and Wills, 2009), and to ensure all management issues are taken into consideration.
 

Health Promotion Strategies for Obesity

Introduction
Australian Health Ministers have identified obesity as an area of National Health Priority Area as evidenced and supported by Durand 2007 “reversing the obesity epidemic is an urgent priority”. Through this essay we will discuss the determinants of health, what is obesity and possible strategies for primary, secondary, and tertiary health promotion for obesity. Most of the primary strategies used are targeted towards children as most of the programs used to promote healthy eating and exercise, according to the literature, reside predominantly in schools while secondary and tertiary promotion are targeted at adults and families.

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The key feature of the primary strategies of health promotion to deter behaviors and lifestyle choices that leads to obesity is education, which is why the school aged population is targeted. The discussion of the primary strategies in health promotion will generally focus on school run programs and activities. From here we will explore the options of screening and testing under the secondary health promotion for obesity which will be aimed at children, adults and families before delving into management of obesity, patient education and other tertiary health promotions available although in this instance most will mostly be targeted towards the adult population. Through the discussion of this health promotion, will we analysis and determine possible limitations and implications for nursing practice. We will commence with the definition of the determinants of health which in this case refers to the causes of obesity in our community and briefly explore possible causes and reasons for obesity.
Determinants of health
Buttriss (2008) theories that the current obesity trend threatens public health and the research (Galani, Al, Schneider, & Rutten, 2007)supports that not only does obesity become a precursor to morbidity and mortality but an economic drain on government funds the healthcare system in turn cause implication for nurses to accommodate a bariatric patient who will become physically difficult to manually handle and becomes a drain on the nurses resources for a condition that could have been prevented or minimized through deterrence’s and patient education. The Body Mass Index (BMI) is the accepted measurement to determine at what state the body is currently in. Chapman, (2004) explains that a BMI of between 18.5 and 24.9 is a normal weight range and is therefore the desired state however, the trends in this research confirms a steady increase of BMI’s over the last 20 years. As a western style nation we have unlimited access to promotion of fast foods and sedientry like activities (internet, video games etc) and in turn have allowed unhealthy food of convience that are econmically and geographically avaliable destroy our health. Television advertisements target young children during children programming hours inluence there decisions and according to Galani (2007) most of the underprivileged suburbs contain the most amount of fast food outlets. So from the research gathered can we establish the obesity impinges on the under privilaged, uneducated and the easily influenced minds of children who in turn influence the main purchasers of groceries. Obesity and other related chronic health condition order to maintain a healthy body weight you must be able to “balance intake with expenditure” (Frable, Dart, & Bradley, 2002) which is were the health promotion strategies take effect by educating about how to conduct this balancing act and why it is important to be within a normal weight range.
Primary Health Promotion strategies for obesity
Primary health promotion is encouraging behviours that will improve health and over all well being, when relating primary health promotion to obesity we are identifying programs and strategies avaliable to the public in paticular, school aged children. Durand, Logan, & Carruth (2007) have labeled childhood obesity “as a critical public health threat for the 21st century” and so we will examine how some of the programs being run at school will benfit not only the general health of children but also reduce future implications on the nursing practice as these children become adults.
The Stephanie Alexander Kitchen Garden National Programs (Better Health, 2009) is a government funded program for primary school children that teaches them to grow and harvest their own fruit in vegetables in a school garden, how to cook and appreciate fresh and seasonal foods and has the benefits of teaching them lifelong skills, keeps them moving and activate in the garden and linking good food choices to optimal health. School ride-a-thons, and walk to school day are also school promoted activities to encourage movement and exercise while portraying exercise to be fun and social activity. Physical education has become an integral part of primary school life where children are encouraged and given an incentive to participate in team sports and activities with a little healthy competition to help motivate and in some children serve a purpose to an exercise. Programs that are inclusive to all children and are made fun provide the incentive they need to get moving and exercise.
By promoting positive healthy eating and exercise will help them the healthy choice the easy choice. Schools are enforcing healthy lunch policy where children are encouraged to bring along healthy foods for lunch and monitored by the teachers. Teachers are encouraging experimenting with foods by awarding points or awards for the healthiest food or most interesting food brought during the week and also undertaking a session on the food pyramid and the 2 and 5, 2 fruit and 5 veg a day theory and to enforce these positive attitudes you only have to look to the likes of Sesame Street where the characters explain what a “sometimes type of food is” meaning food and treats in moderation and on occasion. Popular fruit commercials with catchy jingles such “Bananas, make those bodies sing” all equate healthy food choices to being healthy. Commercial campaigns like “Life be in it” displaying fun activities that children can partake in and new adventures to have all while being active and involved in some sort of physical activity.
Opposed to secondary and tertiary health promotion of behaviour modification (Galani, Al, Schneider, & Rutten, 2007), these programs influence children and their food and exercises choices to have a positive relationship with food and link good food and physical exercises choices with optimal health.
Although these programs are designed for children, the influences of their learning’s may well sway their parents and family to also adapt a healthier lifestyle pattern and in turn succeed in promoting health and the healthy choice to their families, friends and well into their communities. These programs run at school are addressing the childhood obesity epidemic by providing education in a fun way about healthy choices and in turn will decrease the amount of children becoming obese adults. Although Kelly & Melnyk (2008) research shows that the combination of nutrition, physical activity and education decreases BMI, this theory, however, is partial to the limited research on the affects of these programs and a study should be conducted on how these principals may change or influenced once leaving primary school and progress through the life span as according to Buttriss (2008) “as yet, no indication of a decline in the rates of obesity in children and adults” although Barlow et al (2002) argues that these health promotion preventions may lead to favourable long term outcomes. Regardless of the limitations discussed these positive approaches to healthy eating and embracing an active lifestyle will set them ultimately as an adult with good lifestyle choices and therefore reduce the risk of obesity in adulthood.
Secondary Health Promotion Strategies for Obesity
Interventions and screening for obesity are necessary in order to battle this increasing epidemic plaguing the general population. As with the education and programs being run at school with the primary strategies of health promotion, schools are now undertaking responsibility of some possible interventions and screening. As Physical Education has become an integral part of the school’s curriculum, the subject measures the BMI students in conjunction with fitness tests and provides information, strategies and resources to those most vulnerable to obesity and how as a family they can combat the prevalence of obesity. As its teachers who are involved with students for most part of the day, they are able to accurately assess using observation of a pupils motivation and participation in activities and according to Larson, Mandleco, Williams, & Tiedman (2006) “a happy child if often a healthy one.”
Australian Goverment Department of Health and Ageing (2009) has introduced a health check program called “Get set 4 life”. It is avaliabe to all Australian residents aged 4 years and serves the purpose to detetrmine if these children are fit, healthy and ready to learn as the enter their first year of primary school. Carried out by a GP or a nurse registered with the program and involves a history collection and assessment and in return provided with interventions and health advice. Using age appropriate tools and resources, this program teachers parents how to teach there children from an early age about better health while making it fun. The benefits of the program is that it is covered by medicare and so can they be bulk-billed and that they can recieve this check with their 4 year old vaccination. These health checks are used as an early detection device to examine those most at risk of childhood obesity and the research conducted by Durand et al (2007) illustartes that only 1 in 5 mothers were able to correctly identify that they child was in fact overweight which was prevalent in low education knowledge and a high risk of obseity themselves on the mother behalf and “may be the barrier to prevention of childhood obesity.” This is imperative as Larson et al(2006) research identifeys a link between paternal obesity and the risk of children developing obesity .These health checks provide a professional health care point of view and dilvierd with the best possible intentions and most up-to date resources. Some of the limitations of this program is that it is only avaliable for 3 to 5 year olds and only one health check can be made. With no review or follow up of how effective these interventions and strategies actually are, we are implementing a program that the research in unable to justify.
Moving away from just child secondary health promotions we can also explore the Australian Better Health Intiative Campigan, (2009) called “Measure up” targeting 25-60 particularly families and older Australians most likely to already be suffering from one chronic health condition possibly exacibated by high BMI. This campigan however does not differ from other screening and prevention tools as the goals are still to make healthy lifestyle choices and associate good life style choices with optimal health. This campaign sends measureing tapes out to the population to measure their waist and given an indication of what sort of risk they may be in developing chronic health conditions related to expanding waist lines. This campigan offers the population the chance to investigate for themselves options in reducing their risk of chronic health conditions and to seek further advice from health care professionals with any concerns or further testing while encouraging an invested intrest in their own health as well as that of their families.
Tertiary Health Promotion for Obesity
Tertiary health promotion in obesity is often when obesity has been identified and management of the condtion which includes “a wide variety of treatments for obesity are avaliable including diet, physical exercise, behavioural modifications, pharmacological treatmet and surgery” (Galani, Al, Schneider, & Rutten, 2007). In order to undertake these treament , assessing and “identifying at risk families as early as possible” (Buttriss, 2008) is benficial to ensure exstreme measures of treatment are not offered when aquate patient education will suffice. Of course the best way to intervene is to modify behaviours and lifestyle choices to encourage opitmal health.
If these means are in no way effective, then surgical options “should be offered to patients who are morbidly obese, well informed, motivated and willing to accept the operative risks” (May & Buckman, 2009)
 

Impact of obesity on womens health during pregnancy

Obesity is a clinical term used to describe excess body fat. The most common method of measuring obesity is the Body Mass Index (BMI). BMI is used because, for most people, it correlates with their amount of body fat. It is calculated by dividing a person’s weight measurement (in kilograms) by the square of their height (in metres). a BMI of 30 or above means that person is considered to be obese (DoH, 2010).
Rising rates –
Obesity is an increasing phenomenon worldwide. In 2008, the Health Survey for England (HSE) data showed that 61.4% of adults (aged 16 or above) in England were overweight and of these 24.5% were obese. They found this was an increase since 1993.
In pregnancy-
In pregnancy the incidence is around 18-19% in the United Kingdom (Kanagalingam et al, 2005).
Between 2004 and 2007, 15% of all UK maternal deaths occurred in women with a BMI of more than 35, half of which had a BMI of over 40. Fifty-two per cent of deaths occurred in women with a BMI of over 25, which is classed as over-weight (Lewis, 2007)
Dangers and complications-
Obesity is a common risk factor in many conditions, especially metabolic (e.g. type 2 diabetes), circulatory (e.g. cardiovascular disease) and degenerative (e.g. osteoarthritis). For women, the risk of gynaecological complications, like endometrial cancer, infertility, menstrual disturbances and ovulation disorders, increase if the woman is obese.
There are many significant risk factors during pregnancy that are affected by obesity. These include early miscarriage, gestational diabetes and pregnancy hypertension/pre-eclampsia (Andreasen et al, 2004/Duckitt et all, 2005/Erez-Weiss et al, 2005/Shaw et al, 2000), venous thromo-embolism and anaesthetic problems, e.g. tracheal intubation or epidural/spinal insertion (Irvine et al, 2006).
If maternal complications develop the fetus/neonate is also at risk of neural tube defects (Shaw et al, 2000), late still birth (Irvine et al, 2006) and neonatal death (Kristensen et al, 2005), fetal macrosomia (Yogev et al, 2005), fetal trauma and neonatal unit admissions (Irvine et al, 2006).
Obesity also causes issues pertaining to the value and reliability of certain aspects of care during the antenatal period. These include difficulties in performing amniocentesis (Irvine et al, 2006), difficulties in achieving venous access, difficulties in performing abdominal palpation (Farrell et al, 2002) and difficulties obtaining ultrasound data for fetal anomalies and growth (Martinez-Frais et al, 2005).
There are significant risk factors due to obesity during the intrapartum period. These comprise increased rates of prolonged labour (Vahratian et al, 2004), risks associated with macrosomia e.g. shoulder dystocia (Irvine et al, 2006/Andreasen et al, 2004), increased rates of operative birth (Irvine et al, 2006/Fraser, 2006), especially for primigravida (Dempsey et al, 2005), difficulties in undertaking instrumental and operative procedures (Irvine et al, 2006/Andreasen et al, 2004) and difficulty siting an epidural or spinal for labour or caesarean section (Irvine et al, 2006).

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Postpartum related obesity issues consist of longer post-operative recovery times and increased rates of post-operative complications, e.g. infections of wounds and urinary tract (Irvine et al, 2006). Women who are obese during pregnancy exhibit a tendency to retain fat centrally on their abdomens postnatally, which may results in increased morbidity and mortality later in life (Soltani et al, 2002). Contraception choices will also be influenced by the presence of complications.
Whilst out on my community placement, I was involved in the care of a woman who had a BMI of 52. We were caring for her postnatally after an elective caesarean section. Most likely due to her weight, the surgeon chose to use metal skin clips on her wound, rather than a suture (Irvine et al, 2006). On day five postnatally we were due to remove alternate staples. However, we could see the wound was still gapping and not fused closed so we left them for one more day. On day six we returned and removed the alternate clips with no problem. Irvine et al (2006) recommend an interrupted suture or skin clips on the basis that if a small haematoma or a localised area of infection develops, a few clips/sutures can be removed to aid resolution.
When we revisited the woman on day eight, we found the wound to be very red, oozing puss and giving off a very offensive smell. The woman simply could not get any air to the wound, due to the ‘over-hang’ of her stomach on to the wound. Even whilst lying down, the stomach still covered the area if it was not held up and supported.
I feel this was an important factor to her getting a wound infection. Due to the over hanging of the pannus, women are significantly at increased risk of wound infection even if given postoperative prophylactic antibiotics (Irvine et al, 2006).
Discuss differing health promotion strategies according to context of the case study
Obesity levels in England have currently reached epidemic levels and Suffolk is consistent with this. Suffolk is below the average obesity level, but this varies across the county (Transforming Suffolk, 2008).
A new project has been launched, called Healthy Ambition Suffolk to make Suffolk the healthiest county in the UK by 2028. Part of this includes tackling obesity.
Governments – 5 a day scheme
In January 2009, the Government began a campaign in response to the rising rates of obesity. Change4Life is England’s first ever national social marketing campaign to promote healthy weight and supports the overall Healthy Weight, Healthy Lives strategy. One of Change4Life’s recommendations is to eat 5 A DAY as part of a healthy balanced diet (DoH, 2010).
Eating at least five portions of fruit and vegetables everyday seems valuable, however it is hard to see exactly how this will help with the fight against obesity, unless it is thought that consuming more fruits and vegetables will transfer calories from other sources.
Healthy start vouchers
The Government has also introduced another health promotion strategy called Healthy Start. This consists of vouchers with a monetary value which can be used against fresh fruit and vegetables, fresh milk and also infant formula. Not every woman will be able to claim these, they are income assessed and women need to fit certain criteria (DoH, 2006).
Dietian/nutritionalist referrals
In accordance with the National Institute for Health and Clinical Excellence (NICE, 2010), pregnant women with a body mass index of more than 30 will be under consultant led care and receive any additional care they require.
Midwives should refer women to a dietician for assessment and advice on healthy eating and exercise. However, they should not recommend weight-loss during pregnancy (NICE, 2008).
In 2003, a report on obesity by the House of Commons demanded six other government departments joined forces. These departments were:
Department of health: Main responsibility as obesity is a public health issue.
Department of culture, media and sport: For promoting sports and physical activity.
Department for education and skills: To ensure that children get adequate physical education at schools and have access to food at schools.
Department for transport: For making ‘healthy’ transport policies to encourage cycling and walking.
Department of environment, food and rural affairs: For farming and produce of healthy food.
Department of trade and industry: For food manufacturing and retail industry
Analyse concepts of poverty, disadvantage and inequality and the impact on childbearing women, babies and their families.
There is evidence that maternal obesity is related to health inequalities, particularly socioeconomic deprivation, inequalities within ethnic groups and poor access to maternity services (Heslehurst et al 2007). Healthy food is often more expensive and gyms facilities and fitness classes are not readily available for low income families.
Analyse and reflect upon the role of the midwife and other professionals in their contribution to the public health agenda
The Faculty of Public Health define public health as “the science and art of preventing disease, prolonging life and promoting health through organised efforts of society”
(Acheson, 1988). Public health is about promoting physical, mental or emotional well-being by inspiring, educating and empowering the public to stay healthy (CSP, 2010). Midwives play a very important role in achieving this. When initially booking women for their pregnancy care, if there are any health concerns the midwife should advise and refer to other health professionals if necessary.
The role of the midwife has evolved in recent years with more emphasis on a
public health role (DoH, 1993).
It is reasonable to expect that midwives should have a working knowledge of the effects obesity, as well as other common public health issues, including teenage pregnancy, drug and alcohol abuse and smoking. They should have an understanding of the common risks associated with obesity and what they should be able to offer by way of support (English National Board, 2001).
The Saving Mothers’ Lives report (2003-2005) carried out by the Confidential Enquiry into Maternal and Child Health (CEMACH) recommends that obese women should receive help to lose weight prior to conception. However, this is not always possible.
I believe the Government are currently taking the correct steps to combat obesity. Whilst working on community and undertaking booking appointments, I have not actually seen women being referred for high BMI’s. This is due to my Trust not taking a woman’s height and weight at the booking appointment so their BMI is unknown. These details are recorded when the women go for their 12 week dating scan. Therefore, referrals for high BMI’s are carried out from the antenatal clinic.
As midwives, we are used to managing women with complex needs in partnership with other agencies. I believe it is working within the multi-disciplinary team which gives the best care to women.
The Royal College of Midwives (RCM) surveyed midwives and new mothers, which were published during Midwifery Week 2008. They showed that due to the shortage of midwives women are being short-changed on essential public health services and advice and are not getting the level and quality of service needed in areas such as obesity, smoking cessation, breast feeding and alcohol intake.
The level of help that obese pregnant women are receiving is a cause for concern. Only 8% of women were offered help and advice, while the amount of women who said they would have liked to have had the service was 30%. The midwives surveys supported these findings, with only a fifth (22.5%) stating that they are able to offer or run obesity clinics, and 71% saying their Trust do not run them (RCM, 2008).
 

Causes and effects of childhood obesity

Childhood obesity has become a worldwide epidemic, and the condition is now obvious much earlier in life. Thirty years ago, less than five percent of children were considered obese. Today’s figures put the number of obese American children somewhere between 12 percent and 15 percent! That translates into millions of children, preteens, and teens suffering from very adult conditions like diabetes and depression related to weight gain (Tessmer, Beecher, & Hagen, 2006). Overweight and obesity in childhood are recognized to have significant impact on physical and psychological health. There are several causes that lead children to become obese. Childhood obesity is now considered a disease and is diagnosed by doctors. Not all children that watch television several hours a day or are inactive or just eat mal-nutritious foods develop obesity, many children get obese because of genes inherited from their parents. Some children become obese because of their lifestyle. For example, late-day or night eating, snacking and other behavioral behaviors have influence on the progress of obesity. Moreover, social and economic conditions are shown to have a significant relationship to nutrition and dietary intake. In addition, there are certain effects resulted from childhood obesity such as physical, mental, emotional, and social effects. Obesity in childhood is responsible of early development in girls and delayed development in boys. It’s also found to be associated with numerous medical problems related to physiological, metabolic, and structural changes. What is more is that obese children are more likely to develop psychological problems. Physical, social, and mental well-being is considered health related quality of life. Low self-esteem and social discrimination can be noted in obese children due to physical limitations, feelings of isolation or loneliness, and teasing from class mates.

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Causes and Effects of Childhood Obesity
Childhood obesity has become a worldwide epidemic, and the condition is now obvious much earlier in life. Thirty years ago, less than five percent of children were considered obese. Today’s figures put the number of obese American children somewhere between 12 percent and 15 percent! That translates into millions of children, preteens, and teens suffering from very adult conditions like diabetes and depression related to weight gain (Tessmer, Beecher, & Hagen, 2006). Obesity is defined as a disproportionate buildup of stored fat tissue when compared to other tissues. Childhood obesity is now considered a disease and is diagnosed by doctors. Children become overweight for a variety of reasons. The most common causes are genetic factors, lack of physical activity, unhealthy eating patterns, or a combination of these factors. Moreover, socio-economic factors have influence on children, which may cause a child to become obese. In addition, there are certain effects resulted from childhood obesity such as physical, mental, emotional, and social effects.
Diagnosis of Childhood Obesity
Only a doctor can diagnose children for obesity by evaluating adiposity, or “how much fat a person has.” Adiposity can be assessed using different ways, for example, by using an underwater scale, or by an MRI, but these methods are considered excessive and expensive. Another way of evaluating children for obesity is by measuring the distribution of body fat. Also, a chart called the body mass index (BMI) is used to optimally measure the amount of fat person carries most frequently to differentiate between just an overweight child and the one who is really obese. In addition to BMI and charting weight on the growth charts, the doctor also evaluates the family’s history of obesity and weight-related health problems, such as diabetes, the child’s eating habits and calorie intake, the child’s activity level, and any other health conditions the child may have.
Causes of Childhood Obesity
After the child gets diagnosed as obese, the doctor will start investigating the causes that lead this child to become overweight. To begin with, there are several causes that lead children to become obese. First of all, many children get obese because of heredity. Because of some genes inherited from parents, those children have higher risk of becoming overweight. For example, not all children that watch television several hours a day or are inactive or just eat mal-nutritious foods develop obesity. Therefore, heredity has been found to have effect on fatness, distribution of fat on body, and response to overfeeding. It has also been suggested that heredity does not only concern the genes but also resulting dietary habits, food intake, and lifestyle, including physical activity level and spontaneous interest in exercise (Paˇrízková & Hills, 2004). Moreover, mothers whom are overweight are found to born neonates that are less active and gain more weight compared to neonates born of normal weight mothers, which suggest a preserving energy inborn drive. The information taken from genes can suggest that genetic factors can take role to determine the susceptibility of adding or losing fat in response to physical activity and diet. The life style of some children also plays a role in being obese. Some behaviors, present in certain children (late-day or night eating, snacking, etc.) ease the progress or persistence of obesity. Children spend several hours each day watching television, and eating lot of snacks that is high in calorie. Food is nothing more than easy to cook energy. The potential energy is measured by the calories that are contained in specific amount and type of food. A body needs a minimum amount of calories in order to perform its basic functions, and the recommended caloric intake for this purpose varies according to age, body frame, and activity level (Tessmer, Beecher, & Hagen, 2006). Obese children do not show excessive appetite for sweet foods. Children and adults simply enjoy foods high in fat. Ice cream, cakes, and biscuits are all examples of high fat foods which are very popular among obese and non-obese people alike. Physical activity is important for achieving proper energy balance, which is needed to prevent or reverse obesity (Flamenbaum, 2006). Moreover, distribution of body fat is affected independently by physical activity which affects body weight. Last but not least, social and economic conditions have a significant relationship to nutrition and dietary intake. For example, as income increases, the type of the diet is going more likely to change in a persistent manner. In particular, the sugar, protein and animal fat intake increases, while the intake of vegetable fat, complex carbohydrates and protein decreases. Also, if the family has a higher income, there might be an increase in take away readymade foods intake which is high in fat content or an increase in intake of meat. The lower social support in low social class is associated with a high food intake and higher weight of children. Another study showed that children from low-income families who were exposed to less cognitive stimulation and who had an obese mother showed an increased risk of obesity independent of other demographic factors (Paˇrízková & Hills, 2004). However, the general effect of these changes in consumption behavior with the high intake of total fat is the increase in the occurrence of obesity.
Effects of Childhood Obesity
As a result of the above, there are certain effects that might result in children from being obese. To start with, the physical effects in childhood obesity include, for example, the increase adult morbidity in men for gout, and in women for arthritis. Obese children are usually above average height for age (Dietz, 1993). Obesity in childhood is responsible of early development in girls and delayed development in boys. For women, menstrual problems in middle age are found to be associated with childhood. Men whom are overweight during adolescence have three times more possibility to develop gout when compared with men whom where normal weight. Furthermore, Obesity in childhood is associated with numerous medical problems related to physiological, metabolic, and structural changes. It’s suggested that adult obesity developed from childhood may be more problematic than adult-onset obesity due to an increased risk of the metabolic syndrome (Vanhala, 1998). Obese children have a higher risk for developing hypertension, high cholesterol levels, diabetes, and metabolic syndrome. Research shows that obesity in children, particularly during adolescence, persists into adulthood and is associated with an increased risk of many diseases including atherosclerosis, cardiovascular disease, cancers, respiratory disorders, gall bladder disease, infertility and several non-fatal but debilitating conditions (Flamenbaum, 2006). Obese children have approximately a threefold increased risk for hypertension compared to their normal-weight peers. The prevalence of obesity in children affected by diabetes was on average twofold from the age of 2 years onward compared to control children (Paˇrízková & Hills, 2004). What is more is that obese children are more likely to develop psychological problems. Severely obese children recorded their quality of life with scores as low as children undergoing chemotherapy for cancer (Walker, 2005). Physical, social, and mental well-being is considered health related quality of life. Low self-esteem and social discrimination can be noted in obese children due to physical limitations, feelings of isolation or loneliness, and teasing from class mates, in example, which is frequent in young people who are obese. The age of onset of obesity, presence of emotional instability, and negative evaluation of obesity by others may predispose an obese person to a disturbed body image. These include during the formative years. Disturbances in adulthood are often commonplace in those who became obese during childhood or adolescence Depressed obese children are more likely to stay depressed all over adulthood.
Prevention of Childhood Obesity
The technique used to prevent childhood obesity is by keeping the weight from coming back. Such technique requires great effort as overweight is not just a hit-and-run problem, where the child can simply drop the weight and be free from obesity the rest of his life. It’s always easy to get overweight than to lose weight. A child who lived a sedentary lifestyle with bad eating habits is at higher risk of getting back to such habits because such habits are just easy to follow. It’s so a lot easier for children to sit at home and watch TV rather than going outside with others or alone to play. This is why parents, physicians, and nutritionists should sit together and set a plan for the child. The plan should include the restriction of fast food and soft drinks, limitation of time allocated for watching television or computer, and promotion of physical activity. However, this plan must be monitored and supervised by parents and a physician to ensure the elimination of any side effects that might occur from the prevention plan.
Conclusion
To summarize, childhood obesity is now considered a global epidemic. There are multiple causes that lead certain children to become obese. Genetic factors and environmental conditions play a great role in the early development of childhood obesity, but the condition varies in different countries. In addition, it appears that there are dangerous effects that result from being obese which can continue till adulthood. Therefore, parents should be aware of their children life style and the food they consume to avoid such health problems in their later adulthood. Moreover, the picture of the obese child as unhealthy, unfriendly and fat is best to prevent as early as possible. As for prevention of childhood obesity, it is also recommended that parents, physicians and nutritionists set together to set the proper plan. Nevertheless, there must be raising in alertness, consideration, and public understanding for the matter of childhood obesity
 

The Social Determinants Of Childhood Obesity Health Essay

Childhood obesity is an international problem in the 21st century. In Hong Kong, it is easy for us to find the increasing trend of child obesity rate from the media. Why does the problem happen in Hong Kong? Are there any solutions to reduce the childhood obesity? In this paper, I will firstly to talk about the seriousness of childhood obesity in Hong Kong. Then, I will explore the childhood obesity from the social determinants. Then, I will talk about the solutions of this health problem by using health promotion strategies.
The current situation of childhood obesity in Hong Kong
Childhood obesity as an international health problem
Childhood obesity is now becoming a worldwide problem nowadays. Obesity means a people who accumulates too much body fat and he or she will face on health problems in the future (Haslam & James, 2005). According to World Health Organization (2012a), obesity is one of the serious health problems in the 21st century and now there are 170 million overweight children who are under 18 years old. Also, more than 40 million children in the world under the age of five were overweight in 2010 (World Health Organization, 2012b).In every year, there are at least 2.6 million people die because of overweight or obese (World health organization, 2012c).
The negative effects from childhood obesity
Childhood obesity causes different problems in children’s development and health. LeBow (1986) had come out three potential dangers of not treating the fat child, including persistent obesity, barriers in the life and potential health threats. He thinks that obese children are stigmatized from peers, parents and society in the children’s development. This will leads them to enter into vicious circle that they have low self-esteem and become fatter and fatter. Many obese children think that they will still obese and it continues after they grow (Peckham et al., 1985; Stunkard & Burt, 1967). Yung (2009) has illustrated what diseases may lead by childhood obesity (See Figure 1). He also mentioned that if government fails to curb childhood obesity, there will be a lot of youngsters suffering from the diseases in the future.
Figure 1: Classification of medical and psychosocial consequences of childhood obesity (Yung, 2009).
The numbers and phenomenon of childhood obesity in Hong Kong
In Hong Kong, there is an increasing trend on the overall childhood obesity rate. Appendix 1 shows the latest data on childhood obesity in Hong Kong. According to the “EatSmart@school.hk” Campaign (2012a), the overall obesity rate increases from 16.4% to 20.9% in the past 15 years. The numbers also show out that boys are easily to become obese than girls with around 5-10% of disparity on the obesity in different gender.

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Besides the data from the government, more information reflects that the potential crisis on suffering from other diseases related to childhood obesity. A cross-sectional study from CUHK shows out that about 13% of boys and 11% of girls were obese in examining around 2 600 children aged 6-13 (Sung, 2007). It also mentioned that about 10% and 3% of the children were detected on having three or more and four or more of the six cardiovascular risk factors respectively, including high systolic blood pressure or diastolic blood pressure, high blood triglyceride, low blood high-density lipoprotein, high blood low-density lipoprotein, high blood glucose and high blood insulin (Sung, 2007). Also, patients are getting younger and younger to suffer from diabetes or cardiovascular diseases because of childhood obesity (Wan jiu xue tong, 2007).
Therefore, childhood obesity has become a major health care issue in Hong Kong from the facts in both statistics and news reports. In the next part, I will talk about the social determinants of childhood obesity.
The social determinants of the childhood obesity
The framework of social determinants in analyzing the childhood obesity
According to World Health Organization (2012d), social determinants of health include life, development and health system afforded by the distribution of power and resource. It also shows out the phenomenon as health inequity which affects people’s health status. World Health Organization – Western Pacific & South-East Asia (2008) had set up some index to evaluate the public health in Asia Pacific. In this time, I will borrow the framework to analysis childhood obesity in Hong Kong with adjusting the index and adding related factors (See Figure 2). The reason of adopting this framework is to show out how our social settings make childhood obesity instead of attributing to self-responsibility from individual. I also add the item “main stakeholders” because they are the main media to lead the things happening in society.
Factors
Main stakeholders
Original meanings
Adjusted meanings
Income and poverty
Family
Overall economic situation
Overall economic situation
Economic status of the grassroots
Lifestyle
Family
Eating habits
Physical activities
Eating habits
Physical activities
Personal growth
Education
School
Literacy rate
School setting
Culture and knowledge
Society
Not including
Traditions,
views and knowledge of food
Figure 2: The framework to analysis the childhood obesity in Hong Kong
Family
Family is one important sector in enforcing the childhood obesity because they have the most responsibility to take care their children. From our born to independence, it is not only fulfill children’s basic life but also learning the foundation of knowledge and skills. Therefore, they have an important responsibility in forming the childhood obesity.
Income and poverty
Economic status affects people’s health in their life. World Health Organization – Western Pacific & South-East Asia (2008) mentioned that poor people are hard to maintain their health because they lack of resource to access health service and take actions to prevent diseases. It also mentioned that Hong Kong is regarded as a high-income country from the World Bank in 2008. It also has a better medical system comparing to other developed countries. At the same time, there is a big disparity between the rich and the poor with high gini index around 53.3% (Central Intelligence Agency, 2007). So, the overall economic situation and economic status of the grassroots should be attended on analyzing the health problem in different class.
Meals with more meat and less vegetables are common after the improvement of economy. Every Hong Kong people consume 150KG meats in 2011 which is more than the US (Gang ren shi rou, 2012). Many parents regard children should eat more meat in their meals because of their physical development. Some parents even do not limit the amount of meat to their children because they think they should provide the best to their children if they can. In hence, children may bring up an unbalance diet. Parents will become more difficult to improve children into correct diet. When the children eat too much meat unconsciously, it will cause child obesity if the children lacks of enough exercise at the same time.
To the grassroots, fast-food is easily to lead childhood obesity. It is because poor children in Hong Kong usually follow their mothers, who are usually the new immigrants, to the fast food shops. According to Chan, Deave and Greenhalgh (2010), fast-food shops are good places for them to meet other parents and friends. They also think it is a more safety places than playgrounds. Additionally, Hong Kong style fast food is unhealthy. For example, 2 pieces of Western Toast (西多士) have 356 kcal, 19g fat, 116mg cholesterol, 513mg sodium and 8g saturated fat (Xiao xue sheng san, 2004). It is easy for children to overtake nutrition and harmful substances as Trans fats.
Except the grassroots, having too much fast food is also common for normal families. According to Chan, Deave and Greenhalgh (2010), long-hours culture is always happened on adults. To save time, some parents may buy fast-food or pre-prepared food as dinner to their children. Some children may provide “holding meal” in the evening and it always leads them not to eat dinner very late at night. Children eat too much fast food chronically and it will easily to become child obesity.
Lifestyle
Lifestyle is the way a person lives. From the World Health Organization – Western Pacific & South-East Asia (2008), diet and physical activity are the ways to promote and maintain good health in a country. Obesity means the unbalance state in high diet and low physical activities. Family should make sure their children to have enough nutrition but not overdose.
Unhealthy meals are one of the main factors to cause childhood obesity. Except having fast food or meals with more meat and less vegetables, another source of unhealthy meal is from bad cooking habits both from Chinese and Western. One of the examples is that Chinese prefer to use more oil and animal fat to cook the meal so the children have higher Cholesterol levels than foreign children (Fu mu tai qian, 1999). Another example is that Western meals may have high calories but low fiber as Baked Pork Chop with Rice containing over 1,200 calories (Yuan li zhu pai fan, 2003). If parents do not count nutrition intake, children will eat too much and it will become obese very easily.
Another factor for childhood obesity is lacking exercise. Doing exercise is a way to consume extra nutrition and maintain personal health. According to the Community Sports Committee of the Sports Commission (2012), about 80% tested children thinks that they have enough exercise but only 9% fulfill the US standard of physical fitness. Lacking exercise of Hong Kong children has lasted over 10 years.
There are few reasons to explain the phenomenon. The first reason is the school setting and I will explain later. The two one is the sense from parents. If parents are active in doing exercise, their children will also have more sense to do the exercise. Unfortunately, there are around 35% of parents with no participation in sports and more than 60% of families cannot arrange family sports time during each weekend (Community Sports Committee of the Sports Commission, 2012). The third one is the children spend too much time on different electronic screen. According to the Community Sports Committee of the Sports Commission (2012), about 40% of Hong Kong children aged 7-12 spend more than 5 hours on sedentary activities like studying and recreation. If children spend more time on the screen, they will have less time to do the exercise.
School
Schools are another important stakeholder in solving the childhood obesity. It is because children spend 1/3 of the whole day in schools for learning. If a school can convey enough health information through lessons and activities to the students, they can sustain their health on their lifetime and produce less health problems when they grow up.
Education
Public concerns on education are largely on formal education issues in a school setting. World Health Organization – Western Pacific & South-East Asia. (2008) evaluates the public health in different countries by assessing the literacy rate and enrollment rate. In Hong Kong, compulsory education is provided to the children for leading high literacy rate and enrollment rate, which are 94% and 74% respectively (World Health Organization – Western Pacific & South-East Asia, 2008). So, it seems the childhood obesity may not relate to insufficient knowledge. According to the Community Sports Committee of the Sports Commission (2012), the tested children reflect that too much school work is the barriers for doing exercise. Therefore, school setting may be a good way to observe childhood obesity.
Unhealthy food provided by the tuck shops and lunch supplies lead childhood obesity. Although Education Bureau and Department of Health create different guidelines to encourage schools for providing healthy food, there are still a lot of schools providing unhealthy food through tuck shops and meals. According to Chen (2008), 90% of primary schools still sell unhealthy snacks in their tuck shops. Maintaining revenue and student tastes are the reasons for the tuck shops continuing to provide unhealthy food. Also, guidelines cannot limit the schools to provide unhealthy food. Over 40% of primary schools still provide unqualified meals without enough vegetables and fruits (Si cheng xiao xue, 2009). 80% of kindergartens provide unqualified meals with over intake of fat, salt and health food products (Du & Cai, 2011). If children eat too much unhealthy food without enough exercise, it is not difficult for them to become obese.
Indifference on Physical Education and play areas is another reason to lead childhood obesity. Normally, students in primary schools have 2-3 Physical Education lessons with 35 minutes per lesson in each week. Only 22 minutes are doing exercise and even 4 minutes for moderate to vigorous exercise can be done in each Physical Education lesson (Chen, 2006). For kindergarten students, there are only 20 minutes for physical activities (Chan, Deave and Greenhalgh, 2010). Many schools also do not allow students to run during the recess because of not enough space and safety to everyone. It is a backward concept criticized by Dr. Patrick Lau who is a professor of the Department of Physical Education at Hong Kong Baptist University (Jia Xiao jin pao, 2005). Students can only conduct static activities which leads them have no chances to do the exercises. This will let students cannot release the extra nutrition which will cause obesity.
Over-emphasizing on academic subjects is also the problem for childhood obesity. Starting from Primary 4, students are forced to put more efforts on academic subjects because of a good path for a better secondary school and university. Sometimes, Physical Education lessons are sacrificed for academic subject lessons or classroom guidance. Also, tutorial classes after school is very common in Hong Kong.. Whether primary school or secondary school students, they will always spend some time after school to attend those lessons. This will reduce the student’s chance to do enough exercise to prevent child obesity in their leisure time.
Society
Society is the third stakeholder in solving the childhood obesity. It is because society has a force to integrate and coordinate different people and organizations for solving the problem. Also, it has the most influence on promoting healthy lifestyle.
Culture and knowledge
Culture is the values, beliefs, behavior and material objects that together form a people’s way of life (Macionis, 2006). Knowledge is someone who familiarizes somebody or something on facts, information, descriptions, or skills from experience or education. Culture and knowledge are directly affecting people’s mind and behavior.
Some Chinese tradition proverbs do not encourage children to do the exercise in their daily life. One is called “Fat equals to blessing” (肥是福氣). It means if a person is fatter, it also equals to a stable life. This is more popular to old generation because they have lower education level comparing to the young couples. Another one is called “diligent makes contribution and games are no use” (勤有功¼Œæˆ²ç„¡ç›Š). These concepts are widely in our society so that exercise is not preferred. For example, some grandparents may think that English is important than games because of low walkability and limited opportunities (Chan, Deave and Greenhalgh, 2010).
Fast food culture is also common in Hong Kong. It is not difficult for us to find a fast food shop in urban areas. They always promote their food or promotion on different media as TV or websites. The culture is very fit in Hong Kong because fast food strengths on efficiency which matches long working hours. On the other side, children loves to eat fast food too because it fits their taste.
The information of nutrition is not very clear to Hong Kong people. Although Hong Kong has nutrition labels since 2010, there are still around 40% people not or seldom attending the labels (Janice, Mingo & Sharon, 2011). Public are always late to know some of the products which is not as health as they imagine. According to Huang and Xin (2006), the content of sugar, salt and fat are over the normal standard in many corn chips.
Because of the social determinants in childhood obesity, the obesity rate for overall primary school students raises from around 16 % to around 21% in the past 10 decade. In the next part, I will introduce the health promotion strategies to reduce the problems of child obesity.
The health promotion strategies to tackle the childhood obesity
Health promotion means a process to lead people for improving their health with increasing the sense and applying the behavior. The responsibility of health promotion is not only at the health sector, but also to reach healthy lifestyles (World Health Organization, 1986). To solve the childhood obesity, I regard five approaches to health promotion by Naidoo and Wills (2000) and social marketing should be used to solve childhood obesity in Hong Kong. It is because it can easily to assess what strategies Hong Kong has done and anything should be improved during the promotion. In the next part, I will talk about what stakeholders would be needed to conduct the health promotion. Then I will focus on the five approaches with related measures to solve the problem, introducing current measures and new measures.
Stakeholders for health promotion
In the social promotion, there will be two stakeholders to conduct the health promotion. One is the government and another one is the Non-Government Organizations.
Government
Government is very important in the health promotion. It will have different cooperation between hospitals, clinics, District Council, sport facilities, schools and families.
Non-Government Organizations.
Non-Government Organizations are always the forerunner to sense the problems in society. They are also strength on the flexibility when they promote in small organizations.
It is because there are so many plans conducting to reduce childhood obesity, I can only use some famous examples to talk about how the strategies apply in our daily life. First, figure 3 shows the effects of the six approaches to health promotion in child obese.
The medical approach
Prevention and treatment
Behavior change
Encouraging somebody to adopt health behaviors
The educational approach
Providing knowledge and skills for personal choice in applying health behavior
Empowerment
Powering up somebody to concern and help in the issue
Social change
Creating choices with suitable cost, availability or accessibility
Social marketing and media
Increasing public awareness on particular concepts or behavior and stimulate public’s mind for the response
Figure 3: The effects of the six approaches to health promotion in child obese
Source: Naidoo and Wills (2000)
Promotions from government
Medical system in stopping childhood obesity
This system will focus on the prevention and treatment of childhood obesity in the media way. This is using the medical approach because of prevention and treatment in childhood obesity. Nowadays, Hong Kong had created the family health service and student health service for the children to check their health status from their born to 18 years old. It also connects with Specialist for the referral to treat the obese children. Maternal and Child Health Centres and Student Health Service Centre are distributed in different areas for children to do body check. Different Student Health Service Centre has the connection with hospitals in the same network. For example, the centre in South Kwai Chung can refer the children to Pediatrics and Adolescent Medicine at Princess Margaret Hospital.
The government can use the centres for scanning out the obese children from the checking on BMI, blood pressure and urine. Overweight or obese children will refer to assessment centres or Pediatrics and Adolescent Medicine in hospitals. They will do more body checking as exsanguinate to confirm their body status and give suitable treatment to them as Nutritionist for health meal suggestions. This approach is to find out the obese children and reduce the deterioration of them.
Social marketing
Social marketing and media is common used by local government. The promotion is using a simple and clear way to focus on single concept or behavior, The usage is to raise public awareness on particular concepts or behavior and stimulate public’s mind for the response. For example, the government had promoted the concept of “Two Plus three Every Day” through the TV advertisements. The aim of this advertisement is to explain the importance of enough amounts of vegetables and fruits in daily life. It also presents the examples on how do we count on eating enough vegetables and fruits.
Campaign cooperating with schools
EatSmart@school.hk is one of the campaigns to promote healthy lifestyle in eating. It uses educational approaches to do the promotion because the plan provides teaching materials for school to spread the knowledge to parents and students for choosing health meals in daily life. Except teaching, the scheme wants schools to provide more healthy food to the students by giving them some guidelines. For example, there are over 20 documents to help schools for choosing suitable food supplies for tuck shop and lunch (“EatSmart@school.hk” Campaign, 2012b). Through this approach, government prefers schools and students can choose the more healthy meals by themselves.
Promotions from Non-government Organizations
Smart Kids Fitness project
This project was created by Centre for Health Education and Health Promotion from the Chinese University of Hong Kong. There is cooperation between the professionals, schools and parents. This plan includes teacher training and support, needs assessment and progress monitoring, parent training and supports, tailor-made weight-management plan for individual students, 12-week weight management intervention programme and school-based health promotion programme (Centre for Health Education and Health Promotion, 2008). Figure 4 shows the concepts of the project.
Figure 4: A Health Promoting Schools’ Approach in Addressing the Problem of Childhood Obesity (Source: Centre for Health Education and Health Promotion, 2008)
It contains different approaches for its promotion. Firstly, Education approach is used to teachers, parents and students with related knowledge. The project strengths at using behavioral approach and empowerment approach. Through the tailor-made weight-management plan and 12-week weight management intervention programme, students had created the sense to supervise their own health and try to improve their health with changing their habits with their parents. This can also power up their confidence to manage their health. Last but not least, the organization thinks that it is success because they can create sustainability on the participators (Centre for Health Education and Health Promotion, 2008).
Recommendations for reducing childhood obesity
To me, different strategies applied by the government and non-government organizations are needed in reducing childhood obesity. From my observation, I regard many strategies focus on creating health lifestyle but little on food choices and easy exercise which can do it everything. So I will suggest two directions for increasing the approach of behavior change and social change.
Firstly, the government can cooperate to Green Monday, which is a non-government organization for promoting vegetarian food on each Monday for health and environment. For example, Cafe De Coral is one of the restaurants to join Green Monday. It will provide 2 dishes of vegetarian food on the Green Monday. The government can encourage food suppliers to join by adding the conditions in the tenders of tuck shop and lunch suppliers. Specific details need to be discussed but I may suggest some conditions to explain the idea. For example, tuck shops and lunch suppliers need to provide at least 50% of healthy food and drinks on Green Monday. If the bidders can meet the conditions, he or she will have the advantages in bidding the contracts or having subsides in operating the business. The reasons of promoting the day are to respond some of the tuck shops or lunch suppliers still providing too much unhealthy food to the students for many years and create a sense to students that they can choose for eating healthier meals.
Secondly, the government can promote easy exercises for urban people. One of the social determinants is parents and children have no sense to do the exercise. Climbing stairs activities and fitness walking are two examples for the promotion. Both exercise are easy to learn and do it in the surrounding areas as park or blocks. They are also suitable to whole family members. These exercises may increase the incentives to people for doing exercise.
Conclusion
To conclude, Hong Kong is an international city who also has childhood obesity as other countries in the 21st century. Everyone knows that obesity is harmful to adults and child but it is different to change personal lifestyle because society contains different elements which are not benefit to our health. Although our government and non-government organizations try their best to change the situation, there are still a lot of children who are living in unhealthy life. But I think we should have confidence to face on the childhood obesity because social atmosphere of healthy lifestyle will be informed gradually if we insist for healthy lifestyle.
 

Public Health Obesity And Nhs Health And Social Care Essay

When the NHS was established in 1948, one of its founding principles was that it should improve health and prevent disease as well as providing treatment for those who are ill. In November 2004, the government produces a white paper choosing health, and one of its main purposes was to improve health of the national by setting goals, putting strategies and guidelines that would have the effect of increasing the general standard of the Public health (Choosing Health 2004). Although this white paper has many strands but the one which will be looked on this assignment is obesity as a Public health issue.

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This essay will start by looking the concept of health and it will look Public health and how it relates with overall care of obesity. A scenario will be used to describe the physiology of obesity’s patient and how it is affecting psycho social perspective of their life. The essay will also explain the roles of nurse in supporting individuals with health problems within the community setting as a part of inter-professional team. Government policies and frameworks in relation to patient needs will be provided. Different sources of information such as internet, books and journals to demonstrate the points will be used. Any name mentioned in this scenario has been changed in order to respect individuals’ confidentiality and comply with the code of NMC (2008).
Health has been seen as a complex concept. It means that health has different things to different people and is affected by a wide range of factors such as lifestyles, social, economic and environment such as whether people live in as a free society, what social support network are available, and how they live in terms of employment, income and housing (Simnett et al 2003). Health has two common meanings, one is negative which is the absence of disease or illness and is the meaning of health within the western scientific medical model. The other meaning of health is a state of complete physical, mental and social wellbeing, not merely the absence of disease or illness (Naidoo et al 2000). Other writer such as Seedhouse suggests that health is about improving people’s quality of life by enabling them to fulfill their own potential and empowering them so that they are capable of becoming (Simnett et al 2003). According to Ottawa Charter of November 1986, a conference primarily was response for growing expectation for new Public health movement around the world has seen health as a resource of everyday life not the objective of living (W.H.O 2000).
There are huge ranges of factors that affect health. Health can be affected by genetic, gender, lifestyle and behavior, housing, environment, food policy and many more. In Acheson report into inequalities in health on socio economic model of health, it shows the main determinants of health as layers of influence one over another. At the centre are individuals with their inbuilt genetic, age and gender related factors. Surrounding the individuals are layers of influences that in theory could be modified to allow the best possible of health. The inner layer is their personal behavior or lifestyle, with factors such as smoking and drinking habits, and physical activities with the potential to promote or damage health. Individuals are seldom alone; they interact with friends, relatives and community and come under social and community influence. This model emphasizes interaction between these layers. The model has been used to guide research for example it shows that the social environmental people live is related to their health behavior, patterns of eating, drinking, smoking and physical activities. The model also demonstrates the various interventions on attempting to change individuals’ risks by encouraging people give up smoking and change diet (Acheson 1998).
Obesity is a condition which weight gain has reached a point where it causes a significant risk of health (NICE 2006). World Health Organization defined obesity as abnormal or excessive fat increase that may impair health; this means BMI (Body Mass Index) is equal to or more than 30. (BMI is defined as the weight in kilograms divided by the square of the height in meters) World Health Organization indicated that, globally approximately 400 adults and 20 million children under the age of 5 were obese on 2005 and by 2015 the number will reach more than 700 million. Obesity is one of the most Public Health challenges of the 21st century in the world and is already responsible for 2 to 8% of the health cost and 10 to 13% of deaths indifferent parts of the region. Obesity is also a major contributor to the global burden of chronic disease and disability (WHO 2010). Public health is a social and political concept aimed at the improving health, prolonging and improving quality of life of the population through promotion, prevention of disease and other forms of interventions (Acheson Report 1988).
According to the Department of Health guidance of March 2006, obesity is one of the biggest public health issues facing England. Estimates suggest that more than twelve millions adults and one million children will be obese by 2010 if no action is taken (NICE 2006). Obesity has grown up almost by 400% in the last twenty five years and it will entail levels of sickness that will put huge pressure on the health services (The House of Common 2004). According to the government study of 2007, half of the population could be obese within 25. Obesity has a substantial human cost by contributing to the start of the disease and premature mortality and it has serious financial consequences for the National Health Service (NAO 2001). It suggests the cost of epidemic, in terms of health care provision could reach 45 billion a year by 2050 (BBC 2007). There is also a cost to society and economic mostly on sickness absences which reduce productivity (DOH 2010).
The cause of Obesity is complex, and can be grouped into different areas. Individual’s genes may play an important part in influencing metabolism and the amount of fat tissues in the body. Genes could also affect individual’s behavior, inclining individual towards lifestyle choices that may increase the risks of obesity. The risks of excess weight also can be contributed by the pattern of growth during early life. The growth of the baby’s rate in the womb, following the birth is the part determined by parent’s factors especially with regards to mother’s diet and how she feed the baby (DOH 2008). The availability of more variety, cheaper and testes processed food with bigger size portion has also contributed obesity. More people are eating pre package food, fast food and soft drinks which are regularly high in calories, salt, fat and sugar. These foods are heavily advertised especially to children (Cancer Research UK 2009). The modern physical environment has contributed to increasingly inactive lifestyle over the past fifty years because of changing in work and shopping patterns from local to distant that has results people dependence on motorized transport. Other factor is UK has changed from an industrial to a service based-economic therefore fewer jobs are now requiring physical work. Obesity has also been contributed by poor urban planning where pedestrians and cyclists have lower priorities than for motor vehicle. Most people now spend less time on active games and more time in sitting at the computer, watching TV and playing video games. Our exercise, eating and drinking habits also are greatly influenced social and psychological factors (DOH 2008).
This example relate to an obese and a type two diabetes patient whom has been referred to District Nurse by a General Practitioner following her health condition. Her name is Maria, sixty two years old and she lives alone in a one bedroom flat. Maria is hardly walks because of her condition; she spends more time sitting in a chair and sleeping on her bed. She depends on Carer for her personal hygiene and preparing meals. A District Nurse visits her twice a day to administer insulin. Maria sometimes looks to be confused. She has been advised several times by Dietician and District nurse on her habits of eating unhealthy food, but she says she is not bothering and she does not feel sorry with her condition. Maria background shows that her father was obese and a diabetic, he dead from heart failure.
Obesity is a central player of pathophysiology of diabetes mellitus and insulin resistance. It is a major contributor to the metabolic dysfunction involving lipid and glucose. It influences organ dysfunction involving liver, endocrine, pulmonary and reproductive functions. It also increases the chances of myocardial infarction (Redinger 2007). Diabetes can cause heart disease, amputation, kidney failure and more death than cancer (Diabetes UK 2080). The case study shows that Maria father had died from heart disease.
People like Maria needs support to improve their health. The support could be treatment, a promotion activity, or a care services. According to the Ottawa Charter, health promotion is a strategy that aims to integrate skills and community development and to create supportive environments for health, make efforts to build healthy public policy and look at re orienting health services (WHO 1986). The Jakarta declaration on leading health promotion into the 21st century confirms that this strategy and action areas are relevant to all countries including cities, municipalities, local communities, schools, workplaces and healthcare services. The declaration identifies priorities on promoting health social responsibility, expand health promotion partnership, empower the individual and expand community capacity and secure health promotion infrastructure (WHO 1998). The WHO global strategy on diet, physical activities and health urged all the stake holders to take action to support healthy diets and physical activity global, regional, and local levels to reduce the prevalence of chronic disease and their common risk factors, primarily unhealthy diet and physical activities (WHO 2010).
In 1999, the UK government document Our Health Nation, has identified a three way partnership for a better health. The government, local communities and individual have to work together in partnership to improve our health. Partners include the government, health authorities, local authorities, business, voluntary bodies and individuals (DOH 1999).
Locally, Community care means to provide the right level of intervention and support to people and enable to achieve maximum independence and control over their own lives (Titterton 1994). The Acheson report on Public health, it defined public health as the science and art of preventing disease, prolonging life and promoting health the organized effort of society (Naidoo et al 2000). NHS original goals of providing a comprehensive health service, improving physical and mental health and to prevent, diagnose and treat illness is much in common with the health promotion. Use of the health services is universal so that everyone at some point in their lives comes into contact with the health service providers. Primary health care is the first level of contact of individuals and community with the national health system bringing health care as close as possible to where people live (MacDonald 1993). Primary health care provides a setting where health promotion at primary, secondary and tertiary levels takes place (Naidoo et al 2000). The primary prevention is to delay or prevent the beginning of disease. Joyce treatment of diabetes would have started at this point by screening and advising on changing diet and her lifestyle (SIGN 2007). The secondary and tertiary prevention is sought to reduce the occurrence of relapses and the establishment of chronic conditions through example, effective rehabilitation (WHO 1998). At secondary stage patients are vulnerable and require regular monitoring such as weight monitoring, signs of deterioration, etc.
One of the aims of the district nurses in the community is to improve health of the population by reducing obesity and increase the awareness of the positive healthy behaviors in community. Nurses delivering public health by influencing public policy and health promotion and are working to create the opportunity for people to live positive healthy lives (RCN 2007). The first visit of District nurse to Maria’s home was to assess the needs and prepare a care plan. The plan will include advice and educate on health eating and blood sugar management. District nurse visits will include administering of insulin depend on how serious the diabetes is. Because Maria spends more time sitting, the chance of developing pressure sore and leg ulcer is higher, a District nurse will advice Maria on how to avoid possible break of skin. The district nurse will refer Maria to dietician for advice on Maria’s diet, physiotherapist to help her on physical problems and occupational therapist who will work to improve her ability to perform daily tasks. A district nurse will do referral to social service if required. The general practitioner will be involve in the care of Maria on prescribing insulin and losing weight medicine such as orlistat which works by blocking the action of enzymes that is used to digest fat ( NHS choices 2010).
On the government side, Department of Health is responsible for policy on public health aspects of diet, nutrition and physical activities. It ensure that public and others have the information they need to improve health. It sets national priorities to improve health and reduce health inequalities. It also commissions research on the effectiveness of interventions. Department of Health works together with the Department for Education on promoting education and health school also encourage young people to be active by participating in sports within and beyond school. Schools provide a healthy diet and education and nutrition so that young people can eat a balanced nutrition diet. Department of health also works with other department such as the Department the culture, media and sports to promoting walking and cycling, facilitate active leisure and to improve quality of life for sporting activities so that more people to participate in sports( NAO 2001).
Many people like Maria do not even know that obesity as a problem because they have no access to health information services or support for individuals need’s for information is sometimes underestimated. It could be even health practitioners do not use their skills to promote health of individuals. Health professionals need to work face to face to with individuals so that to provide advising and persuading them to make them change their lifestyles. Accurate and appropriate information about people’s health should be provided and what social and behavior factors can affect their health. People should be made aware of important of health benefits associated with active lifestyle for examples, improve their self efficacy and confidence and enhanced their social opportunity. They should be aware that food high in fat, sugar and salt are not necessary and should be avoided or eaten in minimum (SIGN 2010).
To summing up, obesity is possibly dominating the public health issue in UK today and its effect can not be seen as an individual but is a society a whole. Communities, individuals and other groups need to work together in tackling obesity epidemic and work together in promoting health and well being.
 

Health Essays – Childhood Obesity Overweight

Childhood Obesity Overweight
Introduction
Childhood obesity in the United States is proving to be a topic of major concern. Throughout the past decades, this issue has been overlooked and simply unattended to. Other health issues such as second-hand smoke and cancer have indeed been the more popular topics addressed. However, people are starting to notice a change in the leaders of tomorrow. Quite frankly, these children are becoming extremely unhealthy and overweight. In the past, it was out of the ordinary to see a child that was obese.

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However, overweight children in the United States are actually starting to become a norm (Koplan, Liverman & Kraak, 2005). This is where the problem begins to unfold. Parents are becoming increasingly concerned about their children’s health due to the fact that obesity hinders a wide range of factors. Imagine a child that cannot participate in any extracurricular activities such as baseball, soccer, or basketball due to his or her weight.
Then, try to explain to that child that due to being overweight, he or she might have an increased chance of heart disease, strokes, and high blood pressure (Vessey & MacKenzie, 2000). Above all, imagine being a child and learning that one of their peers has just died due to the fact that he or she was obese. One must begin to realize that the lives of children in the United States are at stake.
Science in the past has told the public that each generation is living longer than its precedent. The tide has turned sadly enough as scientists are predicting that this verity is now untrue (Kimm & Obarzanek, 2002). With that being said, if lives are beginning to shorten, one might conclude that it is now time to take some action.
In an attempt to explore the idea of childhood obesity one must result to an interdisciplinary analysis. The topic involves a wide range of disciplines such as biology, sociology, psychology, and business, which should all be taken into consideration to avoid an oversimplification. There is not one single discipline that can fully address the entire scope of childhood obesity (Repko, 2005). By narrowing down the research, a large amount of data will be looked at using numerous perspectives to try to avoid a biased outcome.
The extent of obesity in children is an extremely multifaceted topic and desperately needs to be approached this way to fully grasp and comprehend the issue. Also, for a complete understanding and resolution to be formulated, every discipline needed to investigate the issue must be used. Childhood obesity contains a vast range of disciplines to help in its characterization. With that being said, these disciplines tend to all be interlocked with one another.
Looking at childhood obesity through the discipline of biology for instance would constantly be leading the researcher to a psychological standpoint every time a page is turned. Simply ignoring certain disciplines would be an extreme mistake in trying to come to a conclusive solution of the issue addressed and would most likely lead to a biased opinion.
Disciplines
The following is a compilation of all the disciplines used along with each of their contributions in the process of addressing the issue of childhood obesity. There is indeed a vast range of disciplines that are included. Chemistry, economics, law, and history all bring important insights to the table when addressing childhood obesity. Chemistry will look at various experimental data to try to assess the various structures of fats and sugars that are involved in a child’s diet.
Economics could be used to try to understand the possible effects that production and distribution of certain foods has when placed in front of children. Why are these extremely unhealthy foods being put on the shelf for kids to buy? Economics would try to investigate this issue and bring forth a decisive explanation. In addition, law would be utilized to help to understand what governmental efforts have been made towards the issue of childhood obesity.
Are the steps being taken by are government in the right direction or are they simply dancing around the heart of the issue? Finally, history is a very helpful discipline in referencing statistical data taken about obese children. Has this problem always been around or is it just now becoming an issue? History with the help of statistics will also illustrate past successes and failures of strategies that were put in action to help to aid the issue being discussed.
Throughout the course of the investigation of childhood obesity all the preceding disciplines listed will be taken into consideration. However, biology, sociology, and business will be most relevant and crucial to the process of defining the issue at hand.
Biology
Biology will be used to try to understand the needs of the human body to progress and function. Each person has a minimum amount of calories that must be consumed to properly run its processes. Likewise, each person has a unique rate of consuming these calories and converting them to energy. The researcher can use biology to place an actually measurement of health of an individual.
Attaining a proper measurement or gauge of health has proven to be a very difficult task. Height, sex, genetics, bone structure, and even ethnicity are all very important factors that determine a child’s proper weight. Biology will help to place a gauge on each of these factors and formulate a proper medium for each person. This discipline will be examined first in the following writing because one needs to understand what obesity is before he or she can begin to examine the problem. Biology will basically lay a foundation for the rest of the disciplines as to how they are to be used to assess obesity in children.
Sociology
Next, a viewpoint based on sociology must be addressed. Demographics of families, along with their ethnicities will be looked at to try to explain the effects of obesity on certain specific populations. Society will be investigated to try to expose the viewpoints of obese children and their parents. Does society really understand the issue? Do children place any concern with health and fitness? These are both very important questions that sociology will help to address through the aid of statistical data.
Also, every child does have the right to choose what he or she consumes on a day-to-day basis. Hence, each child must face all of the problems that arise if he or she becomes obese. Obesity is not purely a biological problem. If the previous statement was true, a child could then simply consume less calories and loose weight. However, a child has to make cognitive choices and observations about what is acceptable.
Sociology will step in and try to uncover any problems that may be resulting in a population of obese children that simply are misguided by the viewpoints of society. This discipline will be used after biology in hopes to build upon the new understanding of the problem. Once a person understands the physical aspects of childhood obesity using biology, then he or she can delve into the societal traits.
Business
Finally, obesity has become such a large issue that it has effectively created an entire new industry to take care of itself. Business is a discipline that will be used to help explain the way industries portray children and how they affect what populations recognize and understand. Business will try to assess ethical issues as to whether the food industry for example is making an effort to help.
There are obviously many businesses in the United States that are trying to educate children about obesity. However, for every positive product formed, there is another marketing scheme that is made to try to take advantage of a very helpless situation. As a result, the structure and function of the food industry needs to be addressed and scanned for possible pitfalls and shortcomings.
Lastly, the discipline of business will be used in the final part of this paper in hopes to illustrate how it relates back to the obese children. The reader will then furthermore understand the extremity of this issue and how it is rooted in almost every aspect of life.
In summation, childhood obesity is an extremely sophisticated problem involving the ethics and morals or our society. Children cannot be expected to solve their own problem and desperately need help from all ends of the spectrum. The purpose of this paper is to lay the foundation for a better understanding and new perspective of childhood obesity.

This perspective will hopefully stem new possible outcomes that are constructed by the synthesis of each of the discipline’s contributions. Furthermore, the following writing will attempt to educate society of the dangers of childhood obesity and show that this is not a problem caused by one situation. Hopefully the reader will realize that through an interdisciplinary understanding, bringing an end to obesity in children is not an unattainable goal.
Background
How is childhood obesity defined? Has this issue been around for a long time or is it merely just beginning to cause trouble for the United States? These are two very important questions that every individual needs to be aware of. One cannot expect to be able to successfully tackle an issue without knowing its history beforehand.
First, childhood obesity is basically defined as a person that has a body mass index that is above the 95th percentile. That is, the individual exceeds his or her natural weight by approximately 20%. Body mass index is the most widely accepted procedure for sampling obesity in large populations.
Basically, it is a numerical measurement composed of a person’s height and weight. Although this particular test does not take a persons bone structure into consideration, the average of an overall population remains very accurate (Vessey & MacKenzie, 2000).
The people involved in this issue are individuals between the ages of 6 and 17. Male and female children including every ethnicity that resides in the United States are included in this problem. Although obesity rates are increasing almost exponentially in all age groups, children seem to be of the most concern to health experts today. These children are in the most important stage of their growth. An overweight child is putting his or her entire lifespan in jeopardy (Green & Reese, 2006).
Adolescent obesity has not been around as long as other problems such as cancer, leukemia, or the flu. Yet, it is unique due to the fact that childhood obesity is growing at such an alarming rate. The first signs of childhood obesity began to appear in the 1960’s (Schwartz & Puhl, 2003). What caused this sudden weight gain in children during this time? There are several possible explanations however there does not seem to be one clearly defined culprit.
The fast food industry is just one of the possible causes that is often looked at. Critics believe that during the 1960’s fast food was starting to embed in American culture. McDonalds restaurants were popping up all around the United States offering a quick and effortless meal. Before fast food, most families were dependant upon time consuming home cooked meals. However, for the first time, people were starting to realize that a ready-to-eat meal was just a few dollars away. Consequently, people started putting the healthy meal aside and began to grab a quick sandwich from a fast food restaurant.
Hence, in the 1960’s children’s calorie intake began to rise as their eating habits were basically being altered by society. Statistics showed during this time that the percentage of obese children was approximately 4.5%. As calorie intake began to rise, physical activities began to decrease. Approximately 33% of students in high school do not expose themselves to any strenuous physical activity.
Present day schools are so involved in standardized testing that extracurricular activities have been in some ways taken out of the daily lesson plan. Even technology, which usually always aids in the advancement of society, has played a role in increasing rates of childhood obesity. Computer based games, and highly sophisticated cell phones are a few examples that have placed negative outcomes on beneficial cardiovascular events (Harper, 2006).
Heath experts began to see a problem by the 1970’s. The National Health and Nutrition Examination Survey was one of the first efforts in addressing the issue of childhood obesity. A study was done in three parts during a 25-year span starting in the late 1960’s. The test studied the body mass index of children and adjusted the results as age, sex, and ethnicity of the population of children changed through time.
The results were anything but subtle. There was a 40% increase of overweight children in the ten-year span of the first and second studies. No other illness at this time was even close to growing at such an astounding rate (Rosenbaum & Leibel, 1998). With that being said, the third study that was completed in 1994 delivered a divesting knockout punch. The National Health and Nutrition Survey revealed that the number of obese children in the United States had grown a monstrous 100% in the past 10 years (Dietz & Gortmaker, 2001).
Obesity in children was now considered an epidemic. In the past decade, the percentage of obese adolescents in the 95th percentile has once again doubled. Obese children between the ages of 6 and 11 seemed to have the highest grow rates of any other subgroup. Estimates were now showing that almost 15% of the children in the United States are obese or extremely overweight. Obesity does not seem to be biased towards any particular age, race, or gender. However, African American girls, Hispanics, and American Indians were shown to have the largest overweight populations (Koplan, Liverman & Kraak, 2005).
Why are obese children the population that is drawing the most attention? First, biologists studying this epidemic have noted that fact that the gene pool in the United States has basically remained the same over the past 15 years. This tends to rule out any possible explanations dealing with actual evolutionary changes or modifications in the human body. As a result, scientists tend to believe that the causes of the increase in children’s weight are a product of environmental effects on metabolism.
At any rate, it is shown that individuals who are obese as children are most likely beginning a lifelong fight (Dietz & Gortmaker, 2001). Present studies have shown that approximately 95% of obese individuals who succeed in loosing weight tend to gain almost all of it back over time (Koplan, Liverman & Kraak, 2005). This statement is supported by our ever-increasing percentage of obese adults. In 2001, statistics show that there were 29 states containing a percentage of obese adults of 20% or greater.
Hence, prevention at the earliest possible age is said to be the only hope for success in stopping this seemingly out of control problem. It is shown that the younger the child is, the less likely he or she will have developed bad eating habits. Also, younger children tend to be much easier to work with as oppose to stubborn teenagers who may not accept parental influence.
All in all, childhood obesity tends to result in numerous mental, physical and social health disorders for the growing individual. Without immediate intervention at a young age, obesity in children may continue to grow (Kimm & Obarzanek, 2002).
The following writing will continue to decipher the issue of adolescent obesity and will expose crucial concepts, theories and assumptions dealing with each discipline involved. Biology will first be discussed with the goal of further defining the physical and biological effects of childhood obesity. One must understand how the child physically becomes obese and what biological factors are involved.
Next, sociology will be addressed with the goal of educating the reader of the impacts that society has on obese children. Are there any direct causes of obesity that society may have initiated? Finally, business will be mined for possible ways that large companies and organizations have affected the issue. Are these interventions effective or are they merely ways to mask the problem?
In conclusion, each discipline involved offers its own understanding of childhood obesity. One must take each possible approach into consideration in hopes of forming a new more comprehensive explanation. An interdisciplinary approach is used in this situation to help organize the inputs of the disciplines and then synthesize them into a new holistic picture. This process helps to avoid a biased opinion, which is likely formed by increasing specialization of the disciplines. Furthermore it attacks the issue from every angle within the reach of the disciplines used (Repko, 2005).
References
Biology
Dietz, W., & Gortmaker, S. (2001). PREVENTING OBESITY IN CHILDREN AND
ADOLESCENTS. Annual Review of Public Health, 22(1), 337. Retrieved
February 29, 2008, from Academic Search Complete database.
Kimm, S., & Obarzanek, E. (2002, November). Childhood Obesity: A New Pandemic of
the New Millennium. Pediatrics, 110(5), 1003. Retrieved February 8, 2008, from
Academic Search Complete database.
Rosenbaum, M., & Leibel, R. (1998, March). The physiology of body weight regulation:
Relevance to the… Pediatrics, 101(3), 525. Retrieved February 29, 2008, from
Academic Search Complete database.
Vessey, J., & MacKenzie, N. (2000, September). Childhood Obesity: Strategies for
Prevention. Pediatric Nursing, 26(5), 527. Retrieved February 8, 2008, from
Academic Search Complete database.
Sociology
Green, G., & Reese, S. (2006, Fall). CHILDHOOD OBESITY: A GROWING
PHENOMENON FOR PHYSICAL EDUCATORS. Education, 127(1), 121-124.
Retrieved February 29, 2008, from Academic Search Complete database.
Koplan, J., Liverman, C., & Kraak, V. (2005, Spring). Preventing Childhood Obesity.
Issues in Science & Technology, 21(3), 57-64. Retrieved February 4, 2008, from
Academic Search Complete database.
Schwartz, M., & Puhl, R. (2003, February). Childhood obesity: a societal problem to
solve. Obesity Reviews, 4(1), 57-71. Retrieved February 29, 2008, from
Academic Search Complete database.
Business
Harper, M. (2006, October). Childhood Obesity. Family & Community Health, 29(4),
288-298. Retrieved February 29, 2008, from Academic Search Complete
database.
Other disciplines
Repko, A (2005). Interdisciplinary practice a student guide to research and writing.
Boston, MA: Pearson Custom Publishing.