Obesity remains one of the most serious health public issues. Obesity greatly affects all aspects of individual and public health. Adolescents are particularly susceptible to the risks of obesity. Negative implications of childhood and adolescent obesity continue to persist during adulthood. Unfortunately, the incidence and prevalence of childhood obesity do not decrease. As of today, almost 20% of children 6-11 in the United States are diagnosed with obesity (CDC, 2011). Two thirds of obese adolescents face at least one risk factor for developing cardiovascular complications (CDC, 2010). In Delaware alone, 33% of children are either obese or overweight (National Conference of State Legislatures, 2010). One of the Healthy People 2020 objectives is to promote healthy diets and maintain healthy body weights. In this situation, the need for implementing a public health plan is obvious. This plan must address the social and cultural concerns of the target population (fifth-tenth grade students), as well as induce and sustain the desired change in individual and community behaviors.
The proposed plan relies on and incorporates the elements of the Planet Health school-based community intervention against childhood and adolescent obesity, proposed by Gortmaker et al (1999). In the Planet Health intervention, each school received training workshops and classroom lessons, wellness sessions and funds. The proposed plan is limited to muscle strengthening activities; as part of the plan, each school receives the fullest information about the program, the program plan, teacher training workshops, public health recommendations, and funds. The goal of the program is to ensure that fifth-tenth grade students engage in at least three hours of physical activity every week. The program combines the features of a school-based policy, with a variety of extracurricular activities to strengthen muscles. The plan is implemented through changes in school curriculums and the development of extracurricular activities. The plan necessitates curriculum changes, to ensure that all students in grades through fifth to tenth have access to a minimum of three hours of muscle strengthening activities every week.
The program relies on collaboration among businesses, schools, and public health institutions. Sport and exercise activities to foster muscle strengthening among students necessitate active participation of businesses. Price discounts on pedometers are provided to encourage walking and running among children (Pratt et al, 2004). Local authorities and businessmen are encouraged to make investments in the development of new and improvement of the existing school-based sports equipment and facilities (Pratt et al, 2004). The program covers low-income school students and minority schools: the program involves the use of sport stamps, which are similar to food stamps and provide low-income students with free access to sports facilities (Pratt et al, 2004). Schools and recreational facilities are recommended and encouraged to enter in agreements, to avail their facilities for students outside of school hours (Pratt et al, 2004). Teachers and community nurses involve students in public leisure activities, to reduce the amount of time they spend in front of TV sets.
Assessing Health and Wellness
Universal Assessment and Chronic Care Models of Assessment are used to evaluate health and wellness of program participants and the entire community. The Universal Assessment model comprises the elements of identification, assessment, and prevention (Barlow, 2007). Body Mass Index (BMI) serves the basic measure of assessing and preventing overweight and obesity in students in grades five to ten. Children are divided into different health categories, based on their BMI (Barlow, 2007). Healthy children are those with 5-84th BMI percentiles. Children in the 85-95th percentiles are considered at risk of obesity, whereas children with the BMI above the 96th percentile are considered obese (Barlow, 2007). These children are encouraged to participate in the muscle strengthening activity program. Family history of obesity, physical activity and diet patterns are used to create a complete picture of health state.
The Chronic Care Model is integrally linked to and supports the implementation process. “The chronic care model envisions a new structure that integrates community resources, health care, and patient self-management to provide more comprehensive and more useful care” (Barlow, 2007, p. S170). Schools, sports facilities, and public health institutions are integrated into a single model of physical activity provision, which evaluates health improvements against the background of the program implementation. These resources also allow to repeat the cycle of interventions, until the desired goal is met (Barlow, 2007).
Assessing health and wellness of the program participants is impossible without considering the cultural and social factors affecting their health. This is because cultural beliefs about weight and physical activity greatly affect individual behaviors (Barlow, 2007). How individuals participate in physical activity differs across cultural, racial, and ethnic groups (Barlow, 2007). Many low-income mothers recognize obesity as a serious health problem, but not before their children become obese (Barlow, 2007). In this situation, obesity can become a limiting factor and children’s participation in the muscle strengthening activity extremely problematic. Therefore, health and wellness assessment among students in grades five to ten necessitates detailed assessment of their cultural values and beliefs.
Challenges Related to Improving Population Health
Any improvement in public health is impossible, if nurses and health departments fail to overcome individual barriers to program implementation. These barriers include but are not limited to the lack of parent involvement in the program, lack of motivation among children and their parents, and the absence of quality support services (Story et al, 2002). On the institutional side, pediatricians and nurses often lack time to develop, implement, and participate in such programs (Story et al, 2002). Nurses may lack skills and training required to manage behavioral interventions and guide parenting techniques (Story et al, 2002). Parental concern about how much children weight and participate in physical activity presents a serious barrier to improving population health (Kumanyika, 2008). Mothers may be simply unaware that the child is becoming overweight and needs more physical activity (Kumanyika, 2008). Chamberlin et al (2002) also list the factors impeding improvements in children’s health, including the use of food as a coping mechanism. In the meantime, mothers may lack knowledge about normal eating and physical activity behaviors in children (Chamberlin et al, 2002). Sometimes, multiple program players provide conflicting advice to mothers, whereas the latter fail to increase the amount of time spent by children in muscle strengthening activities (Chamberlin et al, 2002).
Socioeconomic, infrastructure, worldwide, ecological, and environmental barriers can reduce the efficiency of the proposed muscle strengthening activity program. Changes in built environments reflect and pursue a common shift toward sedentary lifestyles (Sallis & Glanz, 2002). These changes cause direct effects on the incidence and prevalence of obesity among children (Sallis & Glanz, 2002). The significance of the relationship between built environments and adolescent obesity cannot be overstated (Sallis & Glanz, 2002). Recent development patterns, including the lack of sidewalks and sports facilities in low-income schools, as well as long distances and busy traffic, discourage children from walking, biking, and participating in muscle strengthening activities (Sallis & Glanz, 2002).
Environmental and ecological implications contribute to public health problems in the target population. Changes in social and economic conditions include increased television advertising, increased portion sizes in restaurants, increased popularity of fast food, and even increased concerns about neighborhood safety; all these factors may prevent students in grades from five to ten from attending physical activity programs (Chamberlin et al, 2002). Socio-cultural environments and poverty challenge public health improvements (Kumanyika, 2008).
Epidemiology and Data Models
Numerous models can help to determine and assess the epidemiology of obesity and overweight among fifth-tenth grade students in Delaware. First, the Body Mass Index (BMI) exemplifies an important and useful approach to measuring changes in the epidemiology of child obesity (Stunkard, 2008). The model allows for determining the risks of overweight and obesity, by measuring body fat distribution through the waist-hip quotients. The Behavioral Risk Factor Surveillance System (BRFSS) is another epidemiological surveillance model for monitoring the prevalence of obesity in the target population (Wang & Beydoun, 2007). The system relies on recurrent surveys to determine the presence or absence of factors that facilitate the development of a disease. The National Health and Nutrition Examination Survey (NHANES), hospital registries, and obesity incidence data have the potential to create a complete and sophisticated picture of obesity epidemiology in the target population. The NHANES model entails the use of cross-sectional observation surveys to collect information regarding obesity (Wang & Beydoun, 2007). The use of multiple instruments of data collection will enhance the validity and reliability of primary data.
Obesity greatly affects all aspects of individual and public health. Therefore, it is essential that a muscle strengthening activity is implemented, to improve the epidemiological picture of overweight and obesity among Delawarean fifth-tenth grade students. The program incorporates the elements of school-based interventions and extracurricular activities. The main goal of the program is to ensure that fifth-tenth grade students spend at least three hours in muscle strengthening activities every week. Certainly, the program is just a minor element in a sophisticated network of public health activities to reduce and prevent obesity in school children. Additional efforts are needed to sustain the achievements and results of the program in the long run.
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