Health Problem
Diabetes and obesity are life-long diseases that demand on-going medical care and continuing support and self-management education if acute and/or long-term complications are to be prevented. The United States is faced with an increasingly serious obesity epidemic, which is especially prevalent among poor children and youths. According to Levine (2011) the heightened reliance on energy-dense foods (snacks, fast foods and caloric beverages) by youths and children has been repeatedly associated with heightened risks of excessive weight gain and obesity. The prevalence of obesity in the US rose sharply between 1999 and 2000, during which time the number of overweight adults (above 20 years) rose to 64%, with 30% being classified as obese. The association between obesity and low socioeconomic status has been well established by empirical evidence (Levine, 2011; Ogden, Lamb, Carroll, & Flegal, 2010).
The high proportion of Americans living in poverty heightens the risk. According to Levine (2011), 15.1% of US citizens lived in poverty by the close of the year 2010. With the 2007 global economic crisis, the number of people that fell into poverty increased to 46 million, which is the highest rate over the previous five decades. In a review of 3,139 counties in the country showed that the most poverty-dense counties were associated with higher obesity prevalence rates. Counties that had poverty levels of more than 35% had obesity rates of 145% more than wealthier counties. Ogden, Lamb, Carroll, & Flegal (2010) also found that low-income adolescents and children are more likely to be obese or overweight compared to those from wealthier backgrounds despite the fact that the relationship was not consistent across race and ethnicity. Similarly, children living in households led by a college graduate were least likely to become obese compared to households led by individuals with lower education. This study estimated that between 1988-1998 and 2007 to 2008, the prevalence of obesity among children increased across all education and income groups. This health promotion campaign hopes to activate the low-income families ability to make decisions that foster good health, by reducing the time spend on sedentary activities and the amount of unhealthy foods intake.
Population Vulnerability & Setting
The vulnerability of low-income families to obesity stems from multiple causal factors. To begin with, these populations live in regions that have limited access to fresh food supplies. Impoverished regions often lack full-service grocery stores and markets for fresh fruit, vegetable, whole grain and dairy supplies, which in turn limit them to shopping at convenience stores. Whenever accessible, fresh and healthy foods are relatively expensive. According to Levine (2011), 43% of poor families (income of less than $21,756) faced food insecurity i.e. they had inadequate food or were incapable of securing sufficient food. To optimize their spending, the poor spend on low nutrient and energy-dense foods. Further, upwards of 14% of counties in the US had at least 1 in 5 people that relied on the Supplemental Nutrition Assistance programs, with the countywide utilization of the program correlating with the respective rates of poverty. Effectively, many poverty-dense counties have people who struggle against hunger, are unable of accessing healthy food and have financial constraints in accessing healthy food. Inaccessibility and unaffordability of food is, however, unlikely to be the only reasons for the high prevalence of obesity among low-income families.
There is also an empirically established link between sedentary lifestyles to among other health problems, obesity, diabetes, generally poor health, premature death and metabolic diseases. People who lead sedentary lifestyles spent at least two hours inactive compared to the active population and expended less energy compared to active individuals. The sedentary populations are more prone to chronic metabolic diseases, obesity and cardiovascular diseases. Poor people have no access to gyms, public parks and other amenities that could encourage physical fitness. Impoverished neighborhoods have higher rates of crime, violence, heavy traffic, few pedestrian walkways, unsafe playgrounds and other barriers, which discourage people from venturing outside or engaging in other forms of physical activities. Children are most likely to engage in indoor sedentary activities such as watching television and playing video games. Addition, Thorp, Owen, Neuhaus, & Dunstan (2011) found that low-income families are least likely to engage in organized physical activities such as sports. This is in part why more than 50% of the county-to-county variance in obesity may be explained by the variance in sedentary lifestyles. Relatively poorer counties have proportionately higher (Levine, 2011; Thorp, Owen, Neuhaus, & Dunstan, 2011).
Literature Review
Behavioral change campaigns that create awareness about obesity and the effectiveness of lifestyle changes in preventing the diseases is an effective intervention that has been used previously in many other contexts. According to Salmon, et al (2011), promotion of healthy lifestyles among children had statistically significant effect on the children’s self-efficacy in cutting back television viewing as well as their behavioural capability or TV viewing styles. This study sought to evaluate the effectiveness of strategies to encourage healthy behaviours involved teachers delivering lessons to discourage computer use and television viewing in favour of physical activity and other potentially mediating behaviours that resulted in behaviour change. Fifteen schools drawn from social-economically disadvantaged areas of Melbourne participated in a randomized controlled trial with teachers delivering six lessons to the treatment group. The lessons included strategies like self-monitoring, screen time budgeting and behavioural contracting, with the students completing self-report surveys both before and after the intervention. The results point to the effectiveness of different strategies in reducing unhealthy lifestyle elements.
National Obesity Observatory (2010) recommends a combination of multi-component interventions that focus on both activities and dietary changes in order to prevent and manage obesity. This report includes a range of the empirical research evidence to the effect that weight management strategies must include behavioural change that will lead to a reduction in sedentary lifestyles, better eating behaviour, and reduced energy intake. Further, it is recommended that dietary interventions are tailored to the individual needs and include on-going support by health care professionals. On the other hand, the physical activity component must emphasize activities that easily fit into the people’s daily activities (including cycling, dancing and walking) and tailored to the individuals’ preferences. Such interventions must be focussed on reinforcing the people’s capacity to change. The recommendations by the National Obesity Observatory (2010) are in line with Dorothea Orem’s self-care theory of nursing, which emphasize the individuals’ desire and capacity to take care of themselves. According to Orem, people have an inherent capacity to take care of themselves, with external care becoming necessary only when there is a deficit in their ability due to age, disease and other such factors.
The Guide to Community Preventive Services (2014) included a systematic study of behavioural interventions geared at reducing sedentary recreational activities among children below 13 years. The study found that the interventions resulted in a reduction in the total energy intake, reduced screen by a median of 82.2 minutes and increase physical activity considerably. The body mass index decreased with the obesity prevalence reducing by a median of 2.3 percentage points. However, the sources included in this review, as indeed many other past studies ignore the fact that individual differences that affect behaviour, besides the fack that they tend to use the same methods. For instance, in Salmon, et al. (2011), the teachers that delivered the interventions modified materials to suit their contexts with potential consequences on the effectiveness of the strategies, despite the fact that these differences are not specifically addressed. Qualitative research methods are best placed to determine the individual differences that affect eating behaviours.
Implementation Timeline
Health Promotion Theory
The health promotion campaign draws on the self-determination theory, which focusses on the intrinsic motivations behind choices made by individuals. This theory asserts that people are driven to achieve external rewards, which in turn fosters motivation that creates a sense of relatedness and security. They need a measure of competence, relatedness and autonomy that fosters self-initiated decision-making that would in turn lead to optimal functioning and growth. The needs by the low-income families to lead healthy and fulfilling lives are innate and transcend culture, race, gender and other characteristics. By equipping them with information on the danger that obesity presents and practical ways to overcome the danger, it is expected that the targeted population would have both the motivation and the competency to make effective decisions.
References
Guide to Community Preventive Services. (2014). Obesity Prevention and Control: Behavioral Interventions that Aim to Reduce Recreational Sedentary Screen Time Among Children. Washington, DC: Guide to Community Preventive Services.
Levine, J. (2011). Poverty and Obesity in the U.S. Diabetes November vol. 60 no. 11 2667-2668.
Masters, K. (2011). Nursing Theories: A Framework for Professional Practice (Masters, Nursing Theories). Boston: Jones & Bartlett Learning.
National Obesity Observatory. (2010). Treating adult obesity throughlifestyle change interventions. NHS, www.thecommunityguide.org/obesity/RRbehavioral.html.
Ogden, C., Lamb, M. M., Carroll, M., & Flegal, K. (2010). Obesity and socioeconomic status in children: United States 1988-1994 and 2005-2008. NCHS data brief no 51. Hyattsville: National Center for Health Statistics.
Raingruber, B. (2012). Health Promotion Theories. Nw York: Jones & Bartlett Learning.
Salmon, J., Jorna, M., Hume, C., Arundell, L., Chahine, N., Tienstra, M., et al. (2011). A translational research intervention to reduce screen behaviours and promote physical activity among children: Switch-2-Activity. Health Promotion International 26(3), 311-321.
Thorp, A. A., Owen, N., Neuhaus, M., & Dunstan, D. (2011). Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011. Am J Prev 41, 207–215.
