Teen Obesity Prevention: Strategies, Models & Interventions

Introduction to Obesity and Its Scope

Obesity refers to the accumulation of harmful body fat, characterized by excessive adipose tissue relative to lean body mass (Donatelle, 2002). One primary cause is high caloric consumption combined with an individual's inability to expend those consumed calories. Obesity is generally understood as the outcome of an imbalance between food consumed and energy expended (Venes, 2005). However, a considerable body of research also demonstrates genetic and metabolic deficiencies in cases of obesity — including an inactive mechanism by which the body signals satiety, as well as deficiencies in proteins that suppress hunger.

Obesity is currently the second leading cause of preventable deaths in the United States, after tobacco consumption (Flegal, Carroll, Orden, & Johnson, 2000). On a global scale, it is considered the leading cause of preventable deaths. According to the World Health Organization (WHO), obesity has reached epidemic proportions worldwide, with over one billion adults classified as overweight and no fewer than 300 million classified as obese (WHO, 2003). Beyond its cosmetic and social implications, obesity poses critical health risks including, but not limited to, hypertension, type 2 diabetes mellitus, periodontal disease, high cholesterol, stroke, heart disease, and certain cancers (Goldie & Risbeck, 2006).

Evidence from the United States indicates that childhood obesity has increased fourfold within a span of 20 years (Williams et al., 2002, as cited in Lazarou & Kouta, 2010). In the United Kingdom, the prevalence of obesity in children rose from 1.5% in 1984 to 6.3% in 2003 (Stamatakis et al., 2005). By 2008 estimates, 15.2% of girls and 16.8% of boys in the 2–15 age group were classified as obese (NHS, 2010). These figures are deeply concerning, given that the risk of obesity in adulthood is approximately 1.5 to 2 times greater for individuals who were overweight in childhood (Guillaume, 1999; Nicklas et al., 2001, as cited in Lazarou & Kouta, 2010). Roughly 50% of obese children are estimated to remain obese in adulthood (Krauss et al., 1998, as cited in Lazarou & Kouta, 2010). Several risk factors are associated with childhood obesity; notably, children from families with hereditary cardiovascular diseases tend to weigh more than those without such family medical history (Krauss et al., 1998).

Managing obesity can be broadly divided into two approaches: medical intervention and behavioral modification (Wilborn et al., 2005). Behavioral modification applies learning theories to the treatment of obesity and has been a standard therapy for both children and adults for over 25 years (Bray, 2003). Medical intervention focuses on reducing energy intake (caloric consumption) while simultaneously increasing energy output (Wilborn et al., 2005). It may also include pharmacological treatment when necessary and, in extreme cases, surgical weight-loss procedures.

The phrase "evidence-based medicine" was coined in the 1980s to describe an approach that employs scientific evidence to determine best practices. The term was later refined to "evidence-based practice" (EBP) when non-physician clinicians recognized the importance of scientific evidence in clinical decision-making (Beyea & Slattery, 2006). While multiple definitions of EBP exist, the most widely cited 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 proposed in this paper combines three separate but analogous frameworks, each offering a distinct approach to the problem of obesity.

The first model, the Environmental Nutrition and Activity Community Tool (ENACT), was designed by the Community Obesity Task Force (COTB) of Albemarle-Charlottesville and surrounding areas in North Carolina. It provides a structure for planning and implementing community programs. Comprising seven categories that reflect a broad vision of community health — child care, healthcare, after-school programs, schools, workplace, government, and community — each category is subdivided into strategies, which in turn include various sub-strategies (Strickler, 2010).

The second model is Marin County's ecological framework for the prevention of childhood obesity. This framework recognizes that children's development does not occur in isolation; rather, it unfolds within an interconnected system of social environments. The framework addresses multiple levels of behavioral, environmental, and political influences, offering a comprehensive approach to childhood obesity prevention. Its primary objective is to increase collaboration and communication across systems while integrating policy and environmental changes that will reduce the rate of obesity in early childhood (Zarate, 2012).

Within the ENACT framework, healthcare strategies — specifically those focused on the healthcare activity and food strategies sub-group — are addressed. Before finalizing interventions, ENACT's planning process is worked through to identify the categories on which to focus. Each strategy is evaluated as a group, and individual priorities relative to community obesity are determined. Priorities are designated as low, medium, or high. Each strategy is then scored based on its current implementation status on a scale of 1 to 5: a score of 1 indicates that no elements are in place; 2 means a few elements are in place; 3 means some elements exist but are underdeveloped; 4 means several elements are in place; and 5 means the full series of developmental requirements is completely met (Strickler, 2010).

The third model, the Spectrum of Prevention, clearly articulates the flow of impact. It recognizes that a wide spectrum of factors contributes to health outcomes. Legislation, organizational practices, and policies all powerfully shape behaviors and attitudes toward health — and toward obesity in particular. Strengthening individual knowledge and skills must occur in conjunction with broader community-level efforts to inspire lasting change. The Spectrum of Prevention, developed by Prevention Institute's Larry Cohen, promotes a comprehensive selection of effective prevention activities (Zarate, 2012). The model includes the following levels: strengthening individual knowledge and skills, sponsoring community education, fostering networks and coalitions, training providers, altering organizational practices, mobilizing communities and neighborhoods, and influencing legislation and policies (Cohen, n.d., as cited in Zarate, 2012).

The combined model in this paper adopts intervention at multiple levels — individual, community, organization, and government (Strickler, 2010) — and spans healthcare, school, business, and other settings (Zarate, 2012).

Need for Change

The proportion of obese and overweight individuals in global society is rising at an alarming rate, with obesity rapidly becoming the most prevalent source of preventable deaths in the United States. As many as 32.2% of American adults were classified as obese in 2004. Co-morbidities and health problems attributable to obesity are increasing correspondingly. Clearly, effective action is needed to counteract the rise of obesity and its associated health consequences (Strickler, 2010).

The ongoing increase in obesity rates indicates that existing models for prevention and treatment are insufficiently effective. Furthermore, the medical understanding of obesity and its origins continues to evolve. This reality underscores the necessity for a new approach to managing adolescent obesity — one that incorporates updated evidence and multi-level strategies (Bray, 2003).