Preventing Obesity in the Adult Population of Tottenham, London, United Kingdom

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Obesity is a large complex multifunctional and preventable disease which is affecting one-third of the world’s population. It is best defined as excess body weight for the height of an individual which is also known as the Body Mass Index(BMI) (Kennet G Mac Donal et al,.). It occurs when there is an energy imbalance between calories consumed and calories surplus. Studies have shown that the increased in the consumption of food high in sugar and saturated fats and reduction with physical activity contributes to the likelihood of obesity.(Ref)

In Europe, adult obesity has increased from 13%-17% from 1992-2005. ( Adela Hruby et al. 2016) In the UK the prevalence of obesity is 62% with 53.5% of adults were eating the recommended five portions of fruit and vegetable a day, with 87% of the adult population exceeds the recommended daily amount of free sugar. (REF) ( Include risk factors such as women, environment, as well as diet)

Based on the latest data the prevalence of obesity in the adult population in Nottinghamshire is an estimate of 63.8% which is above the average percentage in the UK. Currently 1 in 4 adults in UK are obese and it has become a complication for health and social care as 6170000 hospital admission are in connection to obsesity. (REF)

Effective management and prevention of obesity will display a significant effect on the improvement of health and psychosocial wellbeing. By Implementing preventive strategies for obesity, it produces a most suitable solution in the reduction of incidences of obesity and prevalence of obesity. ( Campbell I. The obesity epidemic: can we turn the tide? Heart 2003; 89 Suppl 2: ii22–24.)

In 2008, NHS Brasslaw created a locally enhanced service(LES) for adult weight management programmed known and to be delivered via primary care. ( Refer)

Prevelance

The target population is the community Tottenham which is in the Borough of Haringey in the north of London, with a population 282,904 (2019) and BME or Other White ethnic groups account for 63% of the resident population. Population of Tottenham is 129,237.

According to Haringey.gov.uk, the London Borough of Haringey is a London borough in North London, classified by some definitions as part of Inner London, and by others as part of Outer London.

Haringey 6th slowest growing boroughs in London in terms of employment growth and highest self-employment. It is a strong labour market with low levels of unemployment. There are high levels of deprivation and low levels of social mobility, particularly to the East of the borough. While Haringey’s proportion of students attaining grade 5 or above in English and Mathematics GCSEs is higher than the national average, it performs worse than London. Income levels in Haringey are relatively low. Those who work in Haringey have relatively low incomes, with 29% of employee jobs in the borough being paid less than the London Living Wage.

Intervention Method

The intervention will be a locally enhance service for weight management. The Haringey Obesity Alliance which is the public health committee will develop a PCT specification which is deverived from the guidline of NICE CG43 which will be created and agree upon. A multi-dispernary team consisting of dietitian, GP practises, line reception, and team leaders will ensure the programme is inline with what Haringey Obesity Alliance propose its guidelines should be and NICE CG43 guideline. A partnership with the leisure centre and local gyms will proposed to provide physical activity opportunity for the participants. Community participatory approach will be adopted. The staff will be selected from the community and trained by course leaders who lead healthy and active lifestyles, providing a credible role models for the staff.

Participants will be recruited through referrals made by local GP practises and hospitals. A pilot group of 10 patient reviewed each session, progress and materials. Communication promotion material will be developed by clinicians (GP, Nurses, dieticians) and information leaflets were created for patients. The program materials and components are developed by the planning group and the Haringey Obesity Alliance Committee, taking into account regulatory, demographic and cultural differences to ensure the degree of the implementation of the intervention.

Patient educational packs personal plan which provided information and support for each of the 12-week programme to be created.

The following will be documented and measure;
demographics,
weight, height,
blood,
blood pressure,
medical history
enquiries
baseline data.
Attendance during programme
Attendance after post programme follow up.

These data will be collected before the intervention starts and after the intervention start for evaluation.

Eligible participants who are motivated for change will first be given pre-appointments by staff to help ensure that they have understood the programme. This is to minimise confusion and reduce drop-out rates. Information leaflets will be given during the pre-appointment session.

The weight management programme will be for 12 weeks with a 3, 6, 12 months follow up after 12 weeks.

The intervention will develop collaborative partnership with communities and community members which will be trained to be health champions in all aspect of project implementation.

Discussion

As Haringey is a multi-ethical borough, it is expectant to have participants from different ethical background. It is them important for the intervention is to develop partnership with community and culturally component strategies to sustain participants. Cultural tailored intervention should respect cultural practises, encourage retention of a healthy lifestyles, affordable food choices and practises and modified healthy versions of traditional food dishes.

Studies have shown that weight prevention interventions which portray their participants as lazy, unattractive and ignoring the influences of obesogenic environment are ineffective. (Craig.L.Fry et al,. 2012).

Culturally appropriate and health promotion programmes should aim to improve health behaviours and promote participant recruitment engagement. This will help to reduce health disparities in an ethnically diverse population To place the focus mainly on obesity will have an opposite effect to the success of the programme as in some culture, being ‘plump’ is accepted. (Melianda D Beinder et al., 2014). This intervention is to eliminate stigmation, blaming the victim and reinforcement of health inequalities. The intervention will focus on ways to improve lifestyles which taking account of the different culture belifs into consideration rather than promote weight loss.

Effective engagement with the community is essential as it will maximise the relevancy and acceptance of the development programme. (Andre MN Renzaho et al,.2015).

Implementation

Step 1. Pilot study

A needs assessment will be conducted as identification of barriers and facilitators of implementation. Adopters for the intervention are required to be identified as adopters’ or implementers’ attitudes toward innovations or new programs can influence decisions to adopt or implement the program. Maria E. Fernandez et al,. 2019)

Adopters for this intervention will be clinicans i.e GPs, GP nurses and community dietitians.

The researchers will then approach the local council for the borough of Haringey and discussed which health facilities in Haringey borough will refer their patient for the programme. The GP Practices will be selected by the provincial government then helped create partnerships with the community and GP practises.

A focus group interview which consists of local clinicians and Haringey Obesity Alliance committee will help identify barriers and facilitators to lifestyle changes. The focus-group session will be conducted by a trained research assistant using a semi-structured classroom-guide. The focus group will be recorded and transcribed verbatim and analysed using systematic text condensation.

In this focus group recruitment for team leader will be proposed to train the staff based on the ability to display coaching and leadership style which will be used as it influences employee’s motivation and job satisfaction. They will manage change in handling the complicity of the process and making sure the change is worthwhile by being informative as well as supportive. (Kari et al ,.2015)

Step 2

These performance objectives state what the participants had to do or how the environment had to be modified to accomplish the health-related behaviours described in the program objectives. By conducting the literature review, focus group sessions with key stakeholders, and the classroom session, it helped to identify essential and actable behavioural and environmental determinants of physical activity, dietary habits and regulation of family life ( Tonje Holte Stea et al. 2016).

Crossing determinants created the change of objectives with performative purposes. The change objectives were formed as action statements which described what participants and environmental agents had to do to accomplish the health-related behaviours, which were described in the objective of the program.

Cognitive behaviour modification education will be applied as it will be setting realistic goals, groups and frequency of activities, social reinforcements and restricting maladaptive thoughts, self-reinforcements and problem-solving. Structure type parental will be used as it recognises the use of clear and consistent limits that predicts the child’s determinants. Behavioural action that the target groups have performed in order to change behaviour as part of performance objectives successfully. This is because changes in lifestyle habit through physical activity requires long term self-management skills which require regulations as well as adaption to changing circumstances. Self-regulatory models were used to guide the creation of performance objectives.

Step 3

A discussion and research will be conducted on what theory-based methods most likely to influence changes in the selected determinants and under what conditions the methods are most likely to be effective and most likely to achieve the goals that were presented. After that, the theory-based plans were formed into practical strategies that matched the change objectives from the project’s performative objectives.

An ecological approach will be implemented when developing the intervention, which supports the use of multiple theories, as opposed to one single view. The sustainability of health behaviours increases when a patient experience a certain level of self-determination. This is done by maximising the participants’ understanding of the basic psychological needs of autonomy, competence, and relatedness in health care settings. The Basic Need Theory, which is a mini-theory within the Self-Determination Framework, states that these are the three initial needs that must be satisfied for individuals to obtain positive development and optimal motivation function. It is noted that the more autonomously regulated an individual is towards a given behaviour, the tremendous effort, engagement, persistence, and stability the individual is likely to produce.

The behavioural models and educational strategies that will be use will provide general information, tailored information and practical learning sessions. Participants will at the same time be encouraged to attend workshops intending to increase knowledge and awareness of regulation challenges, healthy eating habits and helpful suggestions for implementing healthy behaviours into everyday life. Paricipants will be educated on how to use these strategies at home, to further support their children in improving their actions.

Step 4

The program components, tools and materials are developed based on the results of the first three steps of the IM protocol and designed to increase healthy lifestyle habits, in particular by encouraging enjoying physical activity and healthy dietary habits, enhancing self-efficacy, and engagement The behavioural models and educational strategies include individual follow-up (meetings) providing general knowledge and improving practical skills of nutrition and weekly physical activity sessions aimed at increasing moderate-to-vigorous intensity physical activity to improve motor control.

The intervention material is developed in cooperation with the participating local government committee comply with the national guidelines and being sustainable in everyday life.

Step 5. Plan Program Implementation

The focus of this step in the implantation is the adaptation and the implementation of the intervention. To make sure it reached its target audience and with the combination of a high probability of sustainability, there require agreements about the local strategies during the pilot and focus group sessions. In months before the intervention, the planning group and the stakeholders are to discuss the recruitment of the participants and the application of the different program components. The study design is cluster randomised, controlled trial

For successful implementation of the present intervention, research groups focused on safeguarding behavioural capability, necessary skills and self-efficacy and realistic outcome expectations of those responsible for the implementation and sustainability of the program. ( (Tonje Holte Stea et al. 2016)

Evaluation

Implementation was to be evaluated by identifying the critical enhancers and barriers related to the adoption and implementation, which were identified by the representatives. Important stakeholders highlighted the necessity and value of having determined and highly committed project leaders, community leaders and initiators. This is paramount in the process of establishing agreements with locally-based partners and council. Specific barriers may arise that are important to the adoption and implementation of the study, such as resistance from the participants and a lack of program funding.

The intervention will have two evaluation process which will be process evaluation and outcome evaluation using a quantitative categorial data. Process evaluation seeks to explore, what is happening within a project. It brings explanation of how or why intended outcomes of the project came to be.

Outcome process evaluation will focus on the various impacts of the project over the period of time. It will examine the progress of the project against its original objectives and determines with it has achieved it intended results. The stakeholders will evaluate the intervention using these two methods.

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