Overweight and Obesity Among Primary School Children

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Introduction

Overweight among children is an alarming health related problem which is seen throughout the world. About “20 million children worldwide under the age of 5 years were overweight in 2005.” (1) This has lots of repercussions in different aspects of life with regard to health, pecuniary and social realms. “Overweight “and “obesity” are terms which are being used in the same sense to indicate an unhealthy state which is associated with the occurrence of weight that is excess than the normal. (2)

Excess weight will ultimately influence the wellbeing and the life expectancy of children. The after-effects of excess fat in the body will take several years to become visible and has the ability to cause serious diseases. In children, this will cause many problems in future “such as Type-2 diabetes, cardiovascular diseases, hypertension and certain forms of Cancers (WHO, 2008).” (3)

Energy drinks and Obesity

There are various reasons for obesity in children. But, the disparity between consumption and utilisation of energy is the fundamental reason behind obesity. The main factors responsible for this serious health issue are “genetic, endocrinal or idiopathic.” (4) The intake of “carbonated drinks” with excess calorie is a complementary factor. These drinks are having glucose content and are rich with energy. A child who regularly consumes a carbonated drink daily will get 10% excess energy than a child who does not consume. (5) This excess energy, if not expended properly, will result in obesity.

Snacks and obesity

“Snacks” are very rich in energy content. (6)

Children take more foodstuffs outside home and this includes snacks too. The frequent consuming of these types of food and the absence of physical activities will ultimately result in obesity. In addition to this, taking snacks is the easiest way to control appetite.

Energy dense snacks and primary school children

Primary school children have been consuming “fat and added sugars” more than the optimum amount. Use of “fizzy drinks” has increased in the last few years. (7) There is a higher content of fat in the refreshment drinks taken from outside. “School children in UK are spending more than £1.3bn a year on food.” (7) They spend around 75% of their money for refreshment foods and drinks. With regard to the custom that the primary children follow, they are permitted to bring refreshment foods “as part of the government fruits scheme.” (8) The problem of obesity among children has to be addressed since it leads to health related issues.

Around fifteen percentages of children are suffering from overweight in America. Childhood overweight is becoming more problematic because there is a chance of “developing Type II Diabetes, hypertension, heart disease and other obesity-related diseases at a very young age.” (9) Besides these health issues, they may suffer from a psychological disturbances if they are mistreated by friends or other people.

Decrease in energy dense snack consumption is one of the ways in getting rid of obesity. Childhood obesity and increase in high energy dense food intake are related.

Intervention

A study was conducted to design a replica to explain the low nutrient density food. They proposed children to take less nutrient density food items. The low nutrient density foods are “baked and diary desserts, sweeteners, salty snacks, visible or discretionary fat ad miscellaneous.” (10)

Recommendations

The food industry has suggested minimising fat food intake by manufacturing low level fat foods. Commercialisation of snack food mixture of CHOs will help to reduce the fat. Including a large amount of fruits and vegetables instead of high energy density food and increasing starchy food will help to reduce obesity.

Strategy to decrease energy dense snack consumption

Revealing and making aware of the outcome of the research and programs conducted in relation to high energy dense food and overweight.
Understanding the recommendations and suggestions of health department of government.
Making aware the relation between high energy dense snack and overweight.
Designing a plan for the communication on this health problem among the children.
Designing guidelines, brochures for the public to make aware about the health problem of the children.
Including health related subjects in the curriculum.
Selecting the food which is less energy dense.
A continuous observation on the decrease of childhood obesity and less energy dense food intake.

One of the interventions used for tackling this problem is to bring changes in the social and environmental aspects of life that might be affecting overweight among the children. UK has taken a special interest to bring down the rates of overweight of children. This intervention supports decrease in energy dense snack consumption, taking nutritious food and body exercises like jogging a long distance, pedalling bicycle etc. Social intervention tries to inculcate the influence of “social meanings and values attached to weight, food or physical activity.” (11)

An interventional programme conducted for the reduction of overweight among children shows good results within one year. It is the outcome of the hard work of elementary school children and each and everyone who is related to those children like “parents, teachers, school food service providers, health care providers and policy makers, as well as before-and-after school programmes, restaurants, and local media outlets in Somerville, Massachusetts.” (12)

School based programme to decrease overweight of the children is effective in its objective. Allowing the students to play more time is more successful than compulsory physical exercise. The students from a school which runs overweight reduction programme are found healthier than the students from the schools where there is no nutrition programme. (13)

Changing behaviours

To make the required and the desirable changes in the behaviours is the best possible way to prevent occurrence of childhood obesity. As remedial measures, there are two important methods that can be adopted by the children to obtain a better health condition and reduce the harmful effects of this disease. They are changes in “physical activity and nutritional behaviours.” (14)

The strategy included in the targeted physical activity is to inspire the usage of staircases, “brisk walking”, “aerobic exercises”, “jogging”, “running”, and “rowing.” (15)

Activities like cycling; playing games like football, cricket, basketball etc. should be carried out with optimum intensity under strict supervision. The changes in nutritional behaviours include changes in food habits, such as, taking fruits with water in place of fruit juices, increasing the amount of vegetables in routine food, inspiring the child to eat at the dining table instead of at the time of watching television etc., to schedule the time of taking food. (16)

All the objectives mentioned above are very much helpful in reducing the ill effects of obesity in primary school children and all these are based on “SMART” criteria i.e., they are “specific, measurable, achievable, relevant and timely.” (17)

Strategies suggested

Since the target group is a group of children in the primary classes, one has to adopt specific strategies to ensure proper implementation. Regarding the policy measures for the prevention of childhood obesity in primary school children the World Health Organization (W.H.O.) put forward a “global strategy” to deal with. (18)

The main objectives are to build up knowledge and alertness among the stake holders, to build up, reinforce and execute “global, regional, national policies and action plans” and to supervise and support the explorations in the field of child health. (19) “Social marketing uses the principles and processes of commercial marketing, but not with the aim of selling products and services. Rather, the goal is to design and implement programmes to promote socially beneficial behaviour change.” (20)

Social marketing of good and healthy eating habits and the need for proper exercises is a necessary factor in the promotion of obesity prevention programme. This includes informative, educative, and communicative actions to make the target group aware about the specific programmes. In this context, the children and their parents and other stakeholders are provided with the information on good eating habits and the importance of physical activities in the promotion of health. But this strategy alone will not produce much desirable results. In order to bring the preferred behavioural changes in the children, the role of education cannot be overlooked.

It has a crucial role to play in the promotion of awareness among the stake holders regarding good and healthy food habits, and significance of physical activities in health promotion etc. In school curriculum, the children should be given education on the topics which will inspire them to take up healthy food habits. This may include adjusting the pattern of food intake, getting rid of specific foods which are found to be harmful and the reduction in the consumption of fat etc. Building Partnerships: “Many constituencies and interest groups are already active on obesity or can be tapped to encourage public sector support to fight obesity.” (21)

So, there should be a clear understanding and co-operation among them to make all their attempts successful. Training programmes given to teachers, school staff, coaches and other related individuals will be an added advantage and by virtue of that, they will know how to control food habit of the children so as to make them healthy. “Be Active, Eat Well is a community-based initiative designed to provide the opportunity, resources and support” to better the health and wellness of the individuals. (22) This initiative tries to bring healthy and desirable changes in the daily life activities of the individuals.

Evaluation plan

Process evaluation: It deals with the documentation of the programme which includes what is the programme, why it is implemented, where and when it is implemented, description of the target groups and the expenses for the programme etc. As an example, an overweight reduction programme in a school is evaluated here. It was conducted in an “elementary school in Somerville, Massachusetts.” (11) This programme was implemented in association with various stake holders. The main objectives of this programme were enhancing most suitable eating patterns and regular physical exercises. Major works done in this programme are listed below.

Tie up with the school mess-in-charge to make available better food, prescribe healthy diet and inspire the children to take latest food through instructions.
Homely training in cookery, visit to areas in which food crops are grown.
Appraisal and developing guidelines which influence wellbeing of the students.

Since the epidemiology of overweight and risks of developing other health related problems are increasing remarkably, childhood obesity prevention should be carried out as a remedial measure. That is why the programme was executed in 2007. As a result of this programme, the students came to know about good as well as healthy food habits, after-effects of unhealthy food habits, latest food items, and they acquired knowledge in cookery. These positive outcomes enabled the students to make preferred changes in their current food habits and to reduce overweight and other associated health problems.

Impact Evaluation

Here, impact means the influence and effect of this programme. While evaluating the impact of this programme, the changes occurred in the nearest target group i.e., primary school children and in the surroundings should be considered. Health literacy of the children has improved in the following areas.

Healthy and unhealthy food habits
Reasons of overweight and associated health problems
Various food items and their effect on health
Awareness on how food items are grown
Cooking healthy foods
Came to know about new food items.
Started to perform various physical exercises like jogging, walking a long distance, pedalling bicycle, playing games etc.
Insights on what is health, what are the health issues etc.

Social implications

There was an integrated participation from the part of students, teachers, parents, health professionals, restaurant workers, farmers, and media people. Teachers participated by giving proper guidance and inspiration to the children and parents supported them. Health professionals made them aware about various topics related to overweight and illness. Restaurant workers facilitated the interactive session held in the restaurant under the supervision of school mess-in-charge. Farmers allowed the students to visit their fields. Media supported them by telecasting outlets regarding the issues on overweight and other health related problems and unhealthy food.

Ultimately, this was a community empowerment process which reinforced the existing social norms and values. The term health has many aspects like social, environmental, economic, hereditary and behavioural. Basically, overweight is a lifestyle disease which is related to behaviour of the individual to a large extent. Here, social groups, such as teachers, parents and other stake holders tried to put some restrictions on the behavioural aspects of the students.

Organizational policy

The ultimate goal of the school where an individual is moulded is the growth and development of the students in all aspects like imparting education, behaviour modification, cognitive restructuring, health and well being. Each and every school is guided by its own policies, values, ethics and principles. Therefore, this obesity prevention programme was strictly on the basis of the stipulated health and development policy of that particular school. The resources required for this programme were allocated by the officials of the school. Both internal and external resources were used. The internal resources were human resources, canteen and the travelling facilities. The major external resources were human resources and natural resources.

Conclusion

This paper highlights major health issues faced by primary school children due to their defective lifestyle. Overweight is an emerging lifestyle disease with numerous other related health issues with serious implications. The evaluation of overweight prevention programme among primary school children shows the social impact of this programme and the effect on the primary school children. Children show a significant improvement in reducing their overweight within one year of practising the childhood overweight prevention programme.

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