Developing Community Coalitions to Combat Childhood Obesity: Key Stakeholders Identified

As a professional chef, trainer, and Health Coach, combating the epidemic of childhood obesity is very near and dear to my heart.  The statistics regarding trends in childhood obesity speak volumes.  According to data from the National Health and Examination Survey (NHANES), “approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese” (CDC, 2011).  Shockingly, the prevalence of obesity among children and adolescents has nearly tripled since 1980 (CDC, 2011).  The American Heart Association (AHA) warns that although atherosclerotic disease does not clinically manifest until adulthood, epidemiological studies and autopsy data have indicated that “ the atherosclerotic process, as evidenced by functional and morphological changes in the heart and blood vessels, begins early in childhood” (AHA, 2011).  Since obese children are more susceptible to a myriad of diseases, including cardiovascular disease and Type 2 diabetes, this will undoubtedly increase the burden on public health in America.  This necessitates immediate interventions in communities all throughout America in both home and school environments.

A solution to the problem is certainly not easy.  As noted in the study provided, socioeconomic play a definitive role.  Nutritious foods, fitness and sports programs, exercise clothing, and equipment all require sufficient finances.  A lack of supermarkets in the community can significantly reduce adequate intakes of fresh fruits and vegetables.  Families surviving on low incomes, especially those in low, socio-economic communities may have little funding to support the continued purchase of a wide variety of healthy and organic foods.  Similarly, participation in active forms of recreational activities can intensify financial hardship amongst struggling families.  The absence of ample sidewalks as well as the presence of city pollution can deter or even prohibit exercise throughout the community.  Neighborhoods in which public parks and recreational facilities are unsafe and/or overcrowded may further limit opportunities for physical activity.  The rising prevalence of childhood obesity is also threatened by a troubled economy.  Recent budget cuts in school districts compromise funding for extracurricular activities.  Inadequacies in nutrition and physical education in provided at school place an even greater responsibility on the parent(s)/guardian(s) to imbue the foundations for healthy eating and regular physical activity in children.

Coalitions for resolving childhood obesity should implement an evidence-based approach that initiates with a review of pertinent literature on trends and statistics.  The U.S. Department of Health and Human Services and the United States Department of Agriculture are two organizations that have produced an ample amount of reliable information.  The Bogalusa Heart Study and a USDA Economic Research Service study have both attempted to link obesity to children’s diet.  Specifically, the Bogalusa Heart Study analyzed the eating patterns of children over twenty years from 1973-1994 using cross-sectional surveys given to ten year old children.  The USDA Economic Research Service Study focused on the link between fruit consumption and BMI using a cohort of children between five and eighteen years of age from 1994 to1996.  Although both failed to find a direct link between children’s diets and the premature onset of obesity, the sources provide a basis for intervention initiatives and the task at hand.

PARENTS

The identification of key stakeholders is a necessary preliminary step when developing an intervention.  Since children are the target of the intervention, it is imperative that parents be considered the most significant stakeholders.  The foundation for dietary and physical habits is framed at a young age and is developed through the learned behaviors and role modeling of parents and siblings.  Food availability and selection is almost entirely determined by the child’s parent(s)/guardian(s).  Unhealthy dietary patterns during childhood such as increased frequency and duration of meals, enormous portion sizing, and food associations with punishment and/or reward can germinate.  An emphasis on sugar-sweetened, processed, and/or high fatty foods in the home can resonate far into adulthood.  The Bogalusa Heart Study analyzed the eating patterns of children over twenty years from 1973-1994 using cross-sectional surveys given to ten year old children.  The study found that “offspring who had a parental history of diabetes were significantly more obese, irrespective of age” (Bao, Wattigney, and Berenson, 1995).

HEALTH PRACTITIONERS

Pediatricians, physician assistants, and nurses play a major role in the identification of high risk populations and the dissemination of pertinent health information to parent(s)/guardian(s).  Practitioners in the public and private sectors engaged in prevention and wellness programs and activities are also essential.  These individuals can perform the necessary screening for obesity at regular checkups in a clinical or school setting.  The school nurse is especially important as they can identify potential health risks in the school environment.  A school nurse is more accessible to a child who reports to school on a daily basis.  He or she comes in contact with school children more frequently than pediatricians at regular “check-ups.”  They can conduct invaluable medical surveillance to identify children at risk and to oversee school programs for improving physical activity and nutrition.  They can also serve as a liaison between a child’s pediatrician and his or her parents, alerting parents to risk factors including high BMIs and Waste-to-hip ratios.  As coalition members, health practitioners play critical roles in explaining, advising, and supporting parents in improving their child(ren)’s health and wellbeing.

GOVERNMENT OFFICIALS

Government officials serve as the leading agents for convening coalitions and securing the necessary funding, resources, and contacts to support the coalition.  As the Mayor of New York City, Michael Bloomberg can obtain pooled members and external resources in the form of government funding and grants.  Government officials play an integral role in obtaining State and Federal funding/assistance for making large-scale community interventions possible.  In a nation that is suffering economically, our leadership is tasked with prioritizing the needs of the community.  This is a daunting endeavor and the topic of much debate among constituents and needy populations.  Coalition members representing diverse interest groups and organizations committed to combating childhood obesity can come together to lobby important leaders of government to help resolve this pertinent issue.  They can also implement effective policies such as banning hydrogenated foods and including nutrition facts on menus.  These are powerful initiatives to promote positive change.

SCHOOL OFFICIALS

Efficacious interventions that support healthy behavior change need to focus on educating children.   Without an acceptable knowledge base, unhealthy behaviors go uncorrected and the child remains ignorant to the negative health consequences throughout development and life.   Local school and public officials and directors of community-based organizations are integral to providing an age-appropriate knowledge base and opportunities for sufficient physical activity.  School principals, teachers, and physical education instructors can collaborate to provide programs that support the identification of healthy foods, portion sizing, and obesity-related diseases.

DIRECTORS  OF COMMUNITY-BASED ORGANIZATIONS

After school programs that allow for ample amounts of exercise and recreational activities provide opportunities for fitness and social interaction as opposed to sedentary behaviors practiced in the home environment.  Fitness and youth directors at the local YMCA support various programs that motivate and inspire children to engage in healthy physical activities.  These facilities offer programs that are more accessible to children when compared to private health clubs and corporate gyms.  In a nation of “latch-key” children and busy parents, after school programs can fill the void in physical activity that is sickening our children.

VOLUNTEERS

In lower socioeconomic areas, volunteers may be necessary to bridge the gap between these programs and a lack of funding.  Volunteer leaders and paid staff can facilitate the collaborative process and coalition functioning (Glanz, et. al, 2008).  Tax incentives to these individuals can elicit further involvement.

HEALTH EDUCATORS

Health educators can provide an additional means for educating parents and guardians on the dangers of obesity in children.  They can build on the information and support provided by health practitioners and school educators to parents.  They can also advise school officials on the proper planning and implementation of appropriate educational programs by identifying the issues that are most important to guide interventions.  Health educators are equipped at identifying ways to implement behavior change with minimal resources.  They can help remove barriers attributed to a lack of finances and adequate food markets by helping parents identify healthy, affordable options.  They can also advise parents on fitness activities to involve children in the home.  Whether advising school officials or parents on the preparation of healthy foods and cooking techniques or identifying kid-friendly forms of exercise, health educators are key contributors of valuable information and resources.

Proper planning would be centered on the evaluation of needs assessment data concerning children in a particular community.   A historical understanding of the community is imperative as a successful intervention strategies build on community strengths.  This can identify community context, the characteristics that catalyze or inhibit coalition function and influence how the coalition develops such as geography, demographics, politics, social capital, and community readiness (Glanz, et.al, 2008).  The procurement of data pertaining to social indicators such as home and built environments as well as epidemiologic indicators including nutrition-related disease prevalence would facilitate assessment and planning strategies.  Behavioral risk factors involving overnourishment and lack of physical activity should be investigated along with the knowledge, attitudes, and skills necessary for improving dietary and fitness habits should also be considered.  Additionally, community needs and access to health care are important for a thorough analysis. This would improve community capacity to improve its ability to identify, mobilize, and address childhood obesity.

Structures such as formalized organizational agreements and coalition rules, roles, objectives are essential.  Objectives and goals should be clear and measurable so as to determine short and long-term health outcomes which are vital for determining program success.  Objectives should be prepared by experts with substantial experience in the area of childhood obesity.  Objectives should be specific, measurable, attainable, realistic and timely.  Each should have a reliable data source, baseline measure, and targets for improvements to be achieved over a predetermined time period.  They should focus on the reduction in prevalence of overweight/obese children, especially those younger than five years of age.  Objectives should also address the social determinants of health to eliminate health disparities. Coalition operations and processes should facilitate communication between coalition members and staff for decision making, conflict management, organization, and member engagement (Glanz, et, al 2008).  This maximizes member engagement, the extent of participation, commitment, and satisfaction of the members of the coalition to ultimately strengthen the coalition (Glanz, et. al, 2008).

An evaluation of the intervention should also be planned.  The evaluation should determine the number of children served, the time period of service, and the consistency of the intervention’s implementation.  It should also include an assessment of performance of various members of the staff.  Interventions at the community level can potentially require an evaluation of multiple individuals in various sites.  Ideally, all outcomes should be measured at all level of the causal continuum to determine the overall efficiency and effectiveness of the intervention.  Community participation including work conducted by existing community organizations as well as volunteer contributions should not be excluded.  This will provide valuable information for initiating future interventions.

References

Bao, W., Srinivasan, S.R.,Wattigney, W.A., & Berenson, G.S. (1995). The Relation of ParentalCardiovascular Disease to Risk Factors in Children and Young Adults: The Bogalusa Heart Study.  Journal of the American Heart Association, 91, 365-371. doi: 10.1161/01.CIR.91.2.365 Retrieved from http://circ.ahajournals.org/content/91/2/365.full

The Centers for Disease Control and Prevention. (2011). US obesity trends. Retrieved from http://www.cdc.gov/obesity/data/trends.html

Glanz, K., Rimer, B., & Viswanath, K. (Eds.).  (2008). Mobilizing organizations for health promotion. In, Health behavior and health education, pp. 335-361. San Francisco: Jossey-Bass.

Prabhakaran, B., de Ferranti, S.D., Cook, S., Daniels, S.R., Gidding, S.S., Hayman, L.L.,McCrindle, B.W., Mietus-Snyder, M.L., & Steinberger, J. (2011). Nontraditional risk factors and biomarkers for cardiovascular disease: Mechanistic, research, and clinical considerations for youth : A scientific statement from the American Heart Association. Journal of the American Heart Association. Retrieved from http://circ.ahajournals.org/content/123/23/2749.full.pdf+html

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