Teenagers and the Obesity Crisis

Obesity, Prevention and Control in Teens

Obesity refers to accumulation of harmful body fat levels, with excessive loose connective adipose tissues relative to lean body mass (Donatelle, 2002). One of the causes of obesity is high calorie consumption and the individual's inability to burn up the consumed calories. Obesity is said to be the outcome of imbalance of food consumed with energy expended (Venes, 2005). However, there are also considerable studies demonstrating genetic and metabolic deficiencies and disorders in cases of obesity; these include an inactive mechanism by which the body signals 'satiety', as well as deficiency of important proteins that turn off 'hunger'.

Obesity is presently the second reason for preventable deaths in the U.S., after tobacco consumption (Flegal, Carroll, Orden, & Johnson, 2000). Moreover, obesity is considered to be the leading cause for preventable deaths on a worldwide scale. In accordance with a study conducted by the World Health Organization (WHO), obesity has attained epidemic proportions worldwide, with over 1 billion adults in the 'overweight' individuals' category, and no less than 300 million among them in the 'obese' category of individuals (WHO, 2003). Apart from its cosmetic and societal implications, obesity is stated to pose a critical health risk including, but not restricted to, hypertension, type 2 diabetes mellitus, periodontal disease, high cholesterol, stroke, heart disease and certain types of cancer (Goldie & Risbeck, 2006).

Evidence from the United States (U.S.) indicates that childhood obesity cases have increased four-fold within 20 years (Williams et al., 2002 as cited in Lazarou and Kouta, 2010). The occurrence of obesity in children in the United Kingdom (UK) has reportedly risen from 1.5% (1984) to 6.3% in 2003 (Stamatakis et al., 2005). These data include 15.2% girls and 16.8% boys in the age-group of 2-15 years being categorized as obese, according to 2008 estimates (NHS, 2010). The statistics quoted above are disturbing, as the risk of obesity in adulthood is on the order of 1.5-2 times greater in individuals who are overweight in their childhood (Guillaume, 1999; Nicklas et al., 2001 as cited in Lazarou and Kouta, 2010). Roughly 50% of obese children are estimated to remain obese in adulthood (Krauss et al., 1998 as cited in Lazarou and Kouta, 2010). Several risk factors are associated with obesity in children; as well, children hailing from families with hereditary cardiovascular diseases tend to weigh more than those individuals from families without such medical history (Krauss et al., 1998).

Managing obesity can be divided into two parts: medical intervention, and behavioral modification (Wilborn, et al., 2005). The latter refers to applying learning theories to treatment of obesity and is a standard therapy for treating obesity in both children and adults that has been used for the past 25 years (Bray, 2003). The former is concerned with reduction of energy intake (food calories), with simultaneous increase in energy output (Wilborn, et al., 2005). Medical intervention may also include prescription of pharmaceuticals if deemed necessary, and, in extreme cases, one of several 'weight-loss surgeries'.

The phrase "evidence-based medicine" was coined in the 1980s, to depict an approach that employed scientific evidence for determining the most excellent practice. The term was later modified to "evidence-based practice" when clinicians who were not physicians acknowledged the significance of utilizing scientific evidence in making clinical decisions (Beyea & Slattery, 2006). Several ways to define evidence-based practice (EBP) can be found, however, the most common definition is "the explicit, judicious and conscientious utilization of the best current evidence to make decisions regarding the care of each individual patient" (Sackett, Rosenberg, Gray, Hayes, & Richardson, 1996 as cited in Beyea & Slattery, 2006).

Change Model Overview

The model will combine three separate models that are analogous, but with different approaches.

The 1st model, labeled Environmental Nutrition and Activity Community Tool (ENACT), and designed by COTB (Community Obesity Task Force) of Albemarle- Charlottesville and neighboring areas in North Carolina, offers a structure for planning and implementing community programs. Comprising seven categories that encompass a broad vision of community health, the program includes child care, healthcare, after-school, schools, workplace, government and community. Every category is divided into strategies, each having various sub-strategies (Strickler, 2010).

The second adopted model is Marin County's ecological framework for prevention of childhood obesity. This ecological frame understands that development of children does not take place in isolation; rather, it occurs within an arrangement of interconnected social systems. The frame concentrates on various levels of behavioral, environmental and political influences, providing a thorough approach to prevention of childhood obesity. The objective of the framework is increasing collaboration and communication among systems, in addition to integrating policy and environmental changes, which will decrease the rate of obesity in early childhood (Zarate, 2012).

In the ENACT framework, the strategies for healthcare which focus specifically on the healthcare activity and food strategies sub-group will be addressed. Before developing final interventions, ENACT's plan should be worked through to deduce the categories on which to focus in this sub-group. Each strategy is discussed, as a group, and individual priorities given to the strategies, in relation to obesity within the community, are determined. Priorities are designated as 'low', 'medium' or 'high'. Next, each strategy is scored based on its present status, on a numerical scale ranging from 1 to 5. Strategies scored 1 imply that the elements aren't in place, while a score of 2 depicts a few of the elements in place; 3 refers to some in place, however, not developed well, 4 denotes several of the elements in place; finally, 5 depicts that the series of developmental requirements is completely met (Strickler, 2010).

The third and final model, termed "Spectrum of prevention" explains impact flow clearly. It recognizes that a wide spectrum of factors contributes to health. Legislation, organizational practices and policies all powerfully influence the shaping of behaviors and attitudes regarding health, at large, and, in particular, obesity. Strengthening the knowledge and skills of an individual should be in tandem with wider community elements to inspire lasting change. A systematic instrument, "Spectrum of Prevention," devised by Prevention Institute's Larry Cohen, promotes a comprehensive selection of effective prevention activities (Zarate, 2012). The following levels are included in the model - strengthening individual skills and knowledge, sponsoring community education, fostering networks and coalitions, training providers, altering organizational practices, marshaling communities and neighborhoods, and influencing legislations and policies (Cohen, n.d., as cited in Zarate, 2012).

The model in this paper adopts intervention at different levels such as individual, community, organization and government (Strickler, 2010), in addition to healthcare, school, business and others (Zarate, 2012)

Need for change

The fraction of obese and overweight individuals in global society is rising at a distressing rate, with obesity rapidly turning into the most widespread source of preventable deaths in the U.S. (1). As many as 32.2% adults in America were categorized as obese in 2004 (2). Co-morbidities and health problems arising from obesity can also be seen to increase (3). Obviously, something ought to be done to counteract rising obesity and the health problems associated with it (Strickler, 2010).

The rise of the obesity rate indicates that present models for preventing and curing the disease are not efficient enough. As well, the medical understanding of obesity and its origins is still growing. This offers an explanation for the necessity for change, with a novel approach to manage adolescent obesity (Bray, 2003).

Intervention and design

After dealing with theories for program planning, and the models stated above, as related to the problem of obesity, more specialized interventions can be formulated, which convert the theoretical changes into practice. Further, the significance of educating individuals and sparking awareness is reiterated, to make the most of the modifications enacted (Strickler, 2010). The three models- Ecological, ENACT and Spectrum of prevention - will be employed, as mentioned above, to develop specific interventions; intervention categories are from the ecological framework (Zarate, 2012) and ENACT model (Strickler, 2010).

Clinical intervention

• Promotion and advocating of breastfeeding as well as breastfeeding resources.

• Endorsing "infant-friendly" hospital certification.

• Formulation of systems for providers of healthcare, for implementing culturally appropriate pediatric and obstetric obesity and overweight prevention systems [inclusive of BMI measurement in annual physicals].

• Providing training to all healthcare personnel [nurses, healthcare providers, front-line workforce, health educators, medical assistants] on culturally- apt prevention and treatment practices and messages, for childhood obesity, including referrals and counseling.

• Training of healthcare staff and providers with regards to specific challenges faced by diverse population segments, and cultural norms influencing their choice of lifestyle.

• Distribution of active living and healthy eating information, in addition to local resources [such as farmers markets, pantries / food banks, WIC, food stamps, etc.] for accessing food, comprising of fresh vegetables and fruits.

• Incorporation of important resources and messages for healthy lifestyle into patient appointments, website, newsletters and events.

• Promotion of better compensation for obesity treatment and prevention practices.

• Modeling active living and healthy eating.

• Sponsoring of forums for active living- healthy eating, for patients, staff and the general community (Zarate, 2012).

Healthy Eating

• Adoption of an all-inclusive healthy eating policy for kids, families as well as staff which follows nutritional standards.

• Using mealtimes for serving and introducing a range of diverse healthy-foods including fresh vegetables and fruits, fat-free and low-fat dairy, lean proteins and whole grains.

• Modeling active living and healthy eating.

• Implementation of a physical activity and nutrition self-assessment practice for determining priority areas of improvement, and creation of a strategy to tackle them.

• Sharing and modeling best practices, information and resources for active living and healthy eating, with peer-care providers.

• Implementation of policies which support the staff for modeling active living and healthy eating.

• Eating meals in a 'family style'.

• Serving water at all meals, and making it available all through the day.

• Elimination of the practice of using of foods as rewards for children.

• Training of childcare providers and personnel with regards to resources and prevention of childhood obesity (Zarate, 2012).

Active Living

• Implementing policies developed by NASPE [National Association for Sports and Physical Education] for physical activity for primary care settings.

• Providing a minimum physical activity of 2 hours a day; half of it for structured activities, the remaining half for unstructured free play.

• Providing developmentally appropriate equipment and toys for active play and physical activity.

• Modeling of healthy behavior by staff and teachers through participation in play time and physical activity with children.

• Collaborating with organizations offering opportunities for physical activity [LIFT, YMCA, etc.].

• Incorporation of physical activity in existing curriculum.

• Eliminating or limiting screen time to none under the age of 2 years, and up to 30 minutes for ages 2 years and above (Zarate, 2012).

Family Intervention

• Modeling active living and healthy eating.

• Serving vegetables and fruits at all meals.

• Eating meals in a 'family style'.

• Serving water, and not sugary beverages, at all meals, and making it available all day long.

• Serving milk that is low-fat.

• Providing breast milk for infants and introducing nutritious solids in the right age.

• Eliminating or limiting screen time to none under the age of 2 years, and up to 30 minutes for ages 2 years and above.

• Disallowing TVs and computers in kids' rooms.

• Switching off the computer and TV during mealtimes.

• Promoting activities that substitute screen time.

• Advocating active living and healthy eating policies at the pre-school and school level.

• Promoting and supporting the supply of healthy snacks at school and community events.

• Growing a home-garden or joining a garden for the community. Also, cooking and eating products from these gardens.

• Shopping at farmers markets or local farms.

• Organizing or participating in projects which make it easier as well as safer to bike, play and walk in the neighborhood [viz. safe routes for going to schools].

• Requesting grocers to set up aisles that are candy-free, or offer 'child- healthy' options at check stands.

• Endorse the development and maintenance of trails and parks (Stickler, 2010).

Synthesize the best Evidence

Most of the schemes for evidence-rating acknowledge that the strongest evidence can be accumulated from scientific research. In the broad sphere of research, several different kinds of studies are presented; these differ with regards to the depth of the evidence provided by them. The present research evidence discussion focuses on the following kinds of studies: experimental (controlled randomized trials), meta-analysis, meta-synthesis, quasi-experimental, qualitative, and non-experimental (correlational and descriptive research), (Newhouse, Dearholt, Poe, Pugh, & White, 2007).

Non-empirical evidence and empirical research were necessary for supporting practice transformation. Empirical evidence comprises non-experimental stage researches, clinical trials and meta-analyses/systematic reviews, while non-empirical evidence comprises protocols/guidelines and published reviews (Beyea & Slattery, 2006).

Implement and Evaluate the Change in Practice

The CDC encourages states to consider the adoption of a collection of milestones for developing an accountable and comprehensive plan. The following are the milestones as recommended by the CDC (Mattessich, 2009).

Initial phases

• Development and implementation of a training strategy to increase the capability of local and state health department personnel and partners to carry out activities defined in the state's plan.

• Publishing and disseminating the state plan.

• Development of an implementation plan for the state plan.