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Running head: CHILDHOOD OBESITY PREVENTION 1

CHILDHOOD OBESITY PREVENTION CAMPAIGN

NURS-6050, Section 02, Policy and Advocacy for Improving Population Health

February 06, 2016

CHILDHOOD OBESITY PREVENTION CAMPAIGN

Many health challenges affect the population. Besides, the government, and in particular the health sector, finds it hard to identify the root of the problem (Mahlin, 2010). Sometimes the way some campaigns are carried out are not in agreement with the population’s interest. They may not address the fundamental and real needs of the majority of the population. Therefore, a health advocacy campaign plan is necessary to realize effective result.

Childhood obesity levels remain escalated, and its prevalence among the teenagers and children in the United States had not changed in the past decade. Children today consume a lot of food that has less nutritional balance thus the excess energy encouraging overweight and obesity. Less physical activity has also prompted storage of these excess calories thus resulting in weight gain. The purpose of this paper is to provide policy changes that will encourage the eradication of all factors that promote obesity while simultaneously strengthening the factors that enhance healthy living.

Population Health Issue and Population Affected

Currently, about 17 percent of the American youth have obesity. Such figures have caused a stir, and massive campaigns have been developed to contain this. The rates in the US have almost tripled in the last three decades (American Medical Association, 2013). Overweight children usually proceed to be obese. Obese and overweight children account for 31.7 percent of the American children and adolescents population. If such is broken down into real numbers, greater than 12 million are obese. The addition of the overweight population puts the numbers at 23 million (American Medical Association, 2013). In February 2014 however, a decline was noted in obesity prevalence rates of children aged 2 to 5. It had dropped from 14 percent in 2004 to 8 percent.

Obesity in childhood has been linked to cardiovascular diseases in adulthood. Hyperlipidemia, diabetes mellitus, and hypertension are some of the diseases that use to manifest in adulthood but now is seen in our youth and have a direct relationship to obesity (American Diabetes Association, 2010)

Advocacy Programs Researched in this Area

Advocacy campaigns on Childhood obesity have been conducted in the past but to a lesser degree. Obesity rates have been on the rise lately and as such this issue needs to be addressed as soon as possible. The World Health Organization (2012), did similar studies and advocated for Diet, Physical Activity, and Health. The Global Strategy on Diet, Physical Activity, and Health (DPAS) was developed in 2004 to address this issue specifically.

The Centre for Disease Control and Prevention ([CDC], 2010) also did some studies suggesting the role of the community and especially local governments in addressing this menace. The argument is that for a given community to be healthy, it needs the full participation of the local government through legislation (CDC, 2010). Policies that are formulated are such that all less unhealthy foods and inactivity amongst adolescents and children are discouraged while simultaneously encouraging the consumption of safe, natural and healthy foods (CDC, 2010). Similar studies reiterate this concept, but none outlines the ingredients of healthy food, the exercise plan and general health measures involved. The three points form the basis of this advocacy. The campaign seeks to detail the exact components of the above strategies in a bid to eradicate and contain childhood obesity.

Effective Attributes of the Programs

CDC's DNPAO (Division of Nutrition, Physical Activity, and Obesity) is a state support program. It advocated for the role of local governments in managing the childhood obesity issues in communities. Realization of this is mainly through the formulation of effective policies. Such policies include policies meant to increase physical activity e.g. by ensuring that structures exist to maintain and repair gymnasiums, providing more space for recreational activities, creating walking lanes and encouraging bicycling (CDC, 2010). Another aspect was discouraging the unhealthy foods market and advocating for natural foods. The primary approach of this was by discouraging the advertisements of less healthy foods, banning such foods in public areas such as recreational parks and avoiding the use of sugar in beverages (CDC, 2010).

WHO’s The Global Strategy on Diet, Physical Activity, and Health (DPAS) emphasizes on the same concepts. The primary attributes are however physical activity and the diet. WHO (2012), used the ANGELO (Analysis Grid for Elements Linked to Obesity) process to break down the major ingredients of obesity. The approach is by policies formulation addressing the microenvironment e.g. schools, homes and workplaces and policies that address the macro environment which include the industries, government and health systems like hospitals (WHO, 2012)

Health Advocacy Plan

The plan seeks to highlight the key components of the strategies used to prevent childhood obesity. Particular interests include the diet and what it entails, exercise, health impacts and the policies that can facilitate the adoption of these strategies.

Objectives of the Policy Implemented

The main aims of this policy include (1) To decrease the consumption of unhealthy foods and drinks. (2) To increase the access to affordable, safe and healthy foods. (3) To engage the society through the education of the various stakeholders regarding childhood obesity. (4) To recommend strategies that firmly support physical activity and above all to enhance formulation and adoption of policies aimed at preventing childhood obesity

Communication to Various Stakeholders

Childhood obesity prevention involves fundamental changes that need to be adopted in education, parenting, nutrition, industry, Transport, Agriculture, Trade and Commerce and also engagement of the Non-governmental organizations (Milstead, 2013). Contacting of the stakeholders should occur at least 30 days before the date scheduled for the given workshop. These workshops should, at least, be held three times during a three-month period. Senior members of the advocacy team are the ones mandated to contact the stakeholders. The remaining tasks involving organizing the workshop and consequent running can then be completed by students, the project workers or even the research assistants.

Data and Evidence to Substantiate Proposed Need

Obesity is a condition where one has excess body fat. It is a prevalent nutritional disorder among the children and, in fact, occurs in 16-18% of children in the United States. A further 21-24% are overweight. This condition causes children to be susceptible to diabetes mellitus, Hypertension, Dyslipidemias, Liver diseases, renal diseases and reproductive disorders. Cardiovascular disease occurs more frequently in the presence of obesity (Knickman & Kovner, 2015). A Body Mass Index (BMI) of 30 and above is defined as obese. The management of this nutritional conditions is primarily by modification of lifestyle habits.It usually entails healthy eating and enhanced physical activity. Socially the impact may be devastating to the child as colleagues will brand names and lead to the isolation of the child. This further causes mental illnesses like depression, loneliness, and an eating disorder is eminent thus exacerbating the condition (CDC, 2012).

Health care expenditures on obesity burden the nation significantly, annual projection in costs related to obesity is about $150 billion. The state meets about $60 billion through taxes obtained mainly by Medicare and Medicaid (Deyton, Hess & Jackonis, 2008). In other fields concerning national security like the military, 25 percent of the youth have been disqualified due to obesity (Deyton et al., 2008). Thus, obesity is an issue that should be addressed soon before children become adults. Further data indicates that childhood obesity if unresolved will lead to cardiovascular problems like stroke and even cancers in adulthood (Crippen & Barnato, 2011). The government and health sectors need to create awareness among the population on embracing healthy lifestyles. Supporting health campaigns to sensitize the community, is a great step in ensuring the change. Some members are not aware how unhealthy lifestyles contribute to the obesity leading to chronic diseases. Therefore, there is a need to carry out the campaign in order to improve awareness(International Council of Nurses,2008).

Application of Attributes of Effective Advocacy Programs to Proposed Campaign

According to Vancouver Coastal Health. (n.d.), the advocacy programs should be legal, effective and of true impact. The majority should accept it and be readily available for most if not the entire population. There are various suggestions for managing childhood obesity that forms the basis of this campaign. The key strategies that have been suggested by WHO and CDC are nutritional changes. Various revolutions seen in this century has brought other ways of food processing. Natural, healthy foods that are affordable have been a primary goal for WHO. However, the difference in policies between countries is a major drawback in the implementation of this strategy. Natural foods are expensive regarding taxes by the government which prompts consumers to settle for the alternatives available (Knickman & Kovner, 2015). These alternatives, however, are non-healthy and promote the pathogenesis of obesity. Policies that discourage advertisement of less healthy foods and drinks, restriction of unhealthy foods and beverages in public places, increased support for breastfeeding is also important (CDC, 2010).

Encouraging of physical activity amongst children and adolescents should also be accompanied by limitation of sedentary activity (Knickman & Kovner, 2015). This places emphasis on reduction of screen time in homes and public venues like cinemas. The communities have also been encouraged to participate in the promotion of physical activity. They can realize this by improvement of the outdoor recreational resources, laying down infrastructure to support bicycling and walking, improvement of security in a given region such that people can work out safely, enhancement of traffic safety in the areas where people are physically active (CDC, 2010).

Enactment of Policy through Modification of Existing Policy OR New Legislation

In carrying out the campaign, the money allocated to the health sectors will be the main focus. Its review and specifically actions and steps to increase it are the aims. Another aim will be to allow for the creation of the policies of the nursing body giving way to programs that fight childhood obesity privately and separately. The government will also be tasked with providing support to various organizations that work to sensitize the population on healthy lifestyles. Besides, the improvement of the health facilities must be realized (Karpf, Ferguson, & Swift, 2010).

Impact of Existing Laws or Regulations

The laws should fully support creating awareness and campaigns regarding health issues. Therefore, laws hindering freedom of expression should be reviewed (Davis, 2011). The legislations are a major way of influencing public health. This is because socioeconomic factors that relate to public health work within certain regulations. Alterations will usually entail the engagement of other vital sectors of the economy. Such areas will include education, transport, agriculture, environment, industry and health. It is important to ensure that all these sectors are in harmony.

Current legislation on food facilitates overweight nature that culminates to obese children. Some of the laws need to be changed and a few new ones formulated. Alteration of the food prices, modification of our exposure to certain kinds of food and advocating for the natural and healthy food while simultaneously campaigning against the unhealthy foods is essential. Certain beverages and foods with high sugar and fat should be discouraged since such foods have less overall nutritional value thus promoting weight gain and obesity (Knickman & Kovner, 2015).

Prices and taxes on the healthy foods should be reduced. Current legislation demands that such foods be highly taxed. Decreasing their costs e.g. fewer taxes for fruits and vegetables and increasing costs for the less healthy foods would mainly boost the consumption balance (Knickman & Kovner, 2015). Taxes on tobacco have ensured that the use of nicotine is placed in check. It provides a basis for application of the same in the food industry (Laureate Education, 2012f).

Farmers should have even more incentives to meet this demand for the healthy, natural foods. Another approach could be providing bonus vouchers for purchases made on fruits and vegetables (CDC, 2012). Such can be covered effectively under Supplemental Nutrition Assistance Program, which would ultimately increase the demand. The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could also assist. Companies and transact through vending machinery would be mandated to provide a healthier variety of food while getting rid of the unhealthy foods

Schools should also get rid of unhealthy foods. The same should also apply to the neighborhood such that students access healthier varieties of food and beverage outside the school meal programs. It’s significant to note that restrictions imposed on the erection of fast food premises would not be sufficient since such unhealthy food may be available somewhere else (CDC, 2012).

The Federal Trade Commission (FTC) in 2009 suggested that advertisement of foods that don’t meet guidelines be banned. The United States should emulate UK, Sweden and Norway in banning advertisements containing unhealthy foods that are directed to children (Federal Trade Commission, 2010).

Policies should also refocus from the emphasis on academic excellence to physical activity. The emphasis has proven to produce physically unfit student populations. In a bid to achieve certain credentials in academics, most individuals put more time in study (CDC, 2010).

Analysis of Methods used to Influence Policy Makers

Carrying out roadwalk is necessary to lobby members of the population to join in the campaign. The campaign conducted should be within the legal frames. The policy makers will then see the need of acting to ensure that they address the needs of the population (Vancouver Coastal Health, n.d.). Policy makers will be highly influenced if the proposed system has worked somewhere else. An excellent example is the banning of advertisements containing unhealthy foods that are directed at children. The policy has worked in the United Kingdom, Sweden and Norway (Federal Trade Commission, 2010).

Another method is through education, and this can be arranged such that legislators are taught by an expert concerning childhood obesity and the ill effects associated with it. It would enlighten them so that they look at the whole thing in a public health perspective (CDC, 2010).

Anticipated Obstacles and Strategies

The main obstacle in carrying out the campaign is resources. Conducting questionnaires through social media or physical have expenses attached to them (ICN, 2008). The notion that consumption of food is usually an individual decision or the family concerned and is not inclined to public health is a belief among the policy makers. For this reason, policies cannot be made to cripple the economy and save an individual (Lawrence, Gootman & Sim, 2009). Another obstacle will be the reduced returns that will accompany such policies. Policies that reduce taxes on healthy foods, banning the less healthy foods such as beverages, incentives to farmers to enhance production of natural foods and closing fast food venues will mean that the government may lose sources of income that fund major projects. Incentives will only make the government spend more on less economic benefits (Lawrence et al., 2009).

Ethical issues are also an obstacle to implementation of such issues. The issue here is a contest raises between an individual’s autonomy, freedom, and privacy over the authority of the state to formulate and implement policies (Lawrence et al., 2009).

Ethical Dilemmas and Resolution Strategies

One fundamental ethical issue that arises is the controversy between an individual’s autonomy and the authority of the state. If a libertarian approach is to be considered, the power of the state is limited in a bid to ensure the individual has maximum freedom to choose what to eat from the variety available (American Medical Association, 2013). The utilitarian and social contact theory perspective, however, looks at the overall welfare chiefly. The individual demands are of a lesser priority (American Medical Association, 2013)

The Stuart Mill principle could be used where the state is allowed to intercept an individual action if the decision tends to harm others or harms oneself. The state is thus viewed as a steward for societies and individuals. Every action that is done is for the benefit of the citizens and can be logically justified. This approach is the stewardship model. Hence, the interventions directed at containing childhood obesity can be justified using this model (American Medical Association, 2013).

Such programs, however, should not force individuals to live the perfect healthy lives; policy makers should also not propose interventions without engaging the consent or knowledge of the individuals affected. Similarly, such interventions should be non-intrusive and should not conflict with individual or society values (Laureate Education, 2012a).

Ethics Laws and Reporting Requirements for this Campaign

The American Nursing Association (ANA) has a code of ethical conduct that are also to be observed here. Provisions 7,8 and 9 are especially relevant in the process. Provision 7 emphasizes on the need to continue developing the nursing profession through the development of knowledge, service and administration. Provision 8 focuses on collaboration and teamwork among nurses and other professionals to ensure that program implementation is a success. Provision 9 summarizes the need for integrity in the nursing profession (ANA, n.d). All these are what is expected of the nurse during the formation, implementation, and execution of the knowledge program. The campaign plan works within the proper frame. Each activity has specific behavioral activities that accompany it. Respect to all individuals of various social, economic, political and physical classes is upheld (Milstead, 2013).

The approach to addressing the issue of childhood obesity has particular ethical concerns that need addressing. Since this is a public health issue, it should attempt (1) To decrease the prevalence of obesity that the populations might pass to each other. (2) To reduce the etiologies of obesity through appropriate legislation. (3) To put emphasis on children's health and the other susceptible populations. (4) To promote health not only through education but also encouraging healthy diet and exercise. (5) To ensure that the health lifestyle is affordable. (6) To emphasize on easy access to services offered, and above all ensure there is justice in managing the health of these individuals (Crippen & Barnato, 2011)

Ethical Challenges Unique to the Population

Children with obesity have various problems. They usually have negative psychosocial consequences. There is uncertainty, fear, worry, stigmatization, blaming and finally unjust discrimination by their peers (CDC, 2010). Their liberty is always mostly infringed in every environment. Such infringement may be through regulation and laws that ban trans-fat on hotel menus, ban soda, and other junk food from vending machines, fat tax and even foster care for obese children give them less liberty. Others also include changes in their physical environment that may target them and cause them to struggle to adapt. Such include banning of vehicles from city centers or school premises, slowing down elevators for the storied building (Knickman & Kovner, 2015). Financial triggers like fat tax also seem to target them (Crippen & Barnato, 2011). Such individuals tend to be isolated and are soon victims of depression and other mental disorders. Eating disorders may also come in worsening the obesity.

Summary

Childhood obesity hence is an issue of concern in this age. The statistics available indicate that the situation is getting out of hand. The logical approach to containing this menace is through the eradication of unhealthy foods and encouraging the consumption of the natural, safe and healthy foods. Another approach is through promoting physical activity by the creation of recreation center, encouraging walking, bicycling, aerobic exercises in the gymnasium and at the same time reducing inactivity (CDC, 2010). The legislations are the most useful tool in addressing this because most socioeconomic factors promoting obesity are inclined to the laws that allow certain practices to go on. Taxes on healthy foods and their prices should be reduced to enhance consumption; farmers need to be given incentives and infrastructure too to improve production of fruits and vegetables (CDC, 2010). Policy makers finally need to make sound decisions in passing certain policies. Such policies may directly or indirectly affect the prevalence of obesity. Sharing the responsibility is crucial in the management of childhood obesity since this menace is not exclusively individual based.

References

American Diabetes Association. Type 2 diabetes in children and adolescents. Pediatrics. 2000;105(3 Pt 1):671–80. Retrieved from:

http://pediatrics.aappublications.org/content/105/3/671

American Medical Association: Is Obesity a Disease? (Resolution 115-A-12) 2013. Report of the Council on Science and Public Health, 2013, pp 14. Retrieved from: http://www.sugarshutout.org/AMA%20Report%20on%20Obesity.pdf

American Nurses Association (n.d). Code of Ethics. Retrieved from http://www.nursingworld.org/Mobile/Code-of-Ethics

Centers for Disease Control and Prevention. (2010). State Indicator Report on Physical Activity, 2010 National Action Guide. Retrieved from: http://www.cdc.gov/physicalactivity/downloads/PA_State_Indicator_Report_2010_Action_Guide.pdf

Centers for Disease Control and Prevention. NHANES surveys (1976–1980 and 2003–2006) [Internet]. Atlanta (GA): CDC; 2012 [cited 29 Jan 2016]. Available from: http://www.cdc.gov/obesity/childhood/prevalence.html

Crippen, D., & Barnato, A. E. (2011). The ethical implications of health spending: Death and other expensive conditions. Journal of Law, Medicine & Ethics, 39(2), 121–129. doi: 10.1111/j.1748-720X.2011.00582

Davis-Alldritt, L. (2011). Presidential inaugural address: Advocacy, access, and achievement. Journal of School Nursing, 27(4), 249–251. doi: 10.1177/1059840511416205

Deyton, L., Hess, W. J., & Jackonis, M. J. (2008, Winter). War, its aftermath, and U.S. health policy: Toward a comprehensive health program for America’s military personnel, veterans, and their families. Journal of Law, Medicine, & Ethics, 36(4), 677-689. doi:10.1111/j.1748-720X.2008.00322.x.

Federal Trade Commission.(2010) Marketing Food to Children and Adolescents: AReview of Industry Expenditures, Activities, and Self-Regulation. Washington, D.C.: Federal Trade Commission.Retrieved from: http://www.ftc.gov/os/2008/07/P064504foodmktingreport.pdf, at ES-1.

International Council of Nurses. (2008). Promoting health: Advocacy guide for health professionals. Retrieved from http://www.whpa.org/PPE_Advocacy_Guide.pdf

Karpf, T., Ferguson, J. T., & Swift, R. (2010). Light still shines in the darkness: Decent care for all. Journal of Holistic Nursing, 28(4), 266–274. doi: 10.1177/0898010109359310

Knickman, J. R., & Kovner, A. R. (Eds.). (2015). Healthcare delivery in the United States (11th ed.). New York, NY: Springer Publishing

Laureate Education, Inc. (Executive Producer). (2012f). Legal and ethical aspects of healthcare delivery. Baltimore, MD: Author.

Laureate Education, Inc. (Executive Producer). (2012a). Ethics and advocacy. Baltimore, MD: Author.

Lawrence, R., Gootman, J. & Sim, L. (2009). Adolescent health services missing opportunities. Washington, D.C: National Academies Press. Available from: http://www.ncbi.nlm.nih.gov/books/NBK215415/

Mahlin, M. (2010). Individual patient advocacy, collective responsibility, and activism within professional nursing associations. Nursing Ethics, 17(2), 247-254. doi:10.1177/0969733009351949

Milstead, J. A. (2013). Health policy and politics: A nurse's guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers

Vancouver Coastal Health. (n.d.). Vancouver Coastal Health Population Health: Advocacy guidelines and resources. Retrieved from http://www.vch.ca/media/Population Health_Advocacy Guideline and Resources.pdf

World Health Organization (2012). Prioritizing areas for action in the field of population-based prevention of Childhood Obesity.WHO Document Production Services, Geneva, Switzerland. Retrieved from: http://www.who.int/dietphysicalactivity/childhood/WHO_new_childhoodobesity_PREVENTION_27nov_HR_PRINT_OK.pdf