Literature Review
The literature review was conducted in relevant academic journals that relate to elementary school-aged obesity. In essence, the review was carried out on home-based interventions, school-based interventions effectiveness, and sustainability of the methods adopted in curtailing obesity.
Obesity Epidemic
Childhood obesity is linked with severe health risks. Primarily, obesity is associated with diabetes mellitus, increased risk of coronary heart disease, orthopedic complications, and more stress on weight-bearing joints, and lastly, it is a cause of pediatric hypertension (CDC, 2016). Moreover, hospital costs associated with the treatment of obesity are dramatically high. Besides, being obese can set back children psychosocial status. In education and home settings, studies show that there is a relationship between childhood obesity, peer rejection, low self-esteem, stigmatization, and discrimination. Children in elementary school (6-11 years) are at a critical stage, as being overweight would persist even in adulthood (Showell et al., 2013; CDC, 2016). Thus, obesity requires sustainable interventions that would solve the epidemic.
Home-based Interventions
A home is an important setting in a school-aged child. In part, a home environment can either curtail obesity or make it severe. Kelishadi & Azizi-Soleiman (2014) ascertain that curtailing obesity cannot be achieved without involving a home setting. School-aged children need family support when making healthy lifestyle choices. Home-based interventions are imperative as they engage parents in making weight loss and dietary habits easier for children. The meta-analysis by Kelishadi & Azizi-Soleiman (2014) shows that families can construct lifestyle habits for their children through proper parenting and continuous family functioning. Significantly, the interventions reduce Body Mass Index (BMI) Z-score, limit sedentary behavior, and increase consumption of fiber. Nevertheless, little confidence on parents led to high dropout rates thus, restricted the efficacy of the intervention.
It is known that the home environment can influence a child growth, and studies show the importance of home influences on obesity treatment and prevention. According to Showell et al. (2013), home-based interventions offer significant benefits when reducing abnormal weight gain. For instance, there is sharing of experiences, it is cost-effective, and a possibility of smooth implementation of the goals to daily lives exists. Nevertheless, Showell et al. (2013) note that obesity is a global epidemic, but there is uncertainty on the effectiveness of home-based interventions despite research on the role of the family in limiting obesity. The study focused on the effectiveness of home-based interventions such as diet, physical fitness, and clinical outcomes. A favorable review supports the effect of parenting interventions and parental variables such as parenting style on weight-related outcome and risk behaviors in obese children. Nonetheless, the analysis conducted by Showell and colleagues (2013) found no significant effect of home-based interventions on weight and clinical outcome. However, some case studies showed significant increased in physical activity (PA) and diet outcome on the selected sample. The case studies focused on diet modification and physical environment with complete family involvement on a longer duration.
Children between the ages of 6-11 years spend most of their time in school, thus school-based interventions can help prevent the obesity menace. According to CDC (2016), schools are a critical component in children social environment as it shapes physical activity patterns and eating habits and offers a supportive environment. School-based interventions may affect an elementary student perception of dietary practices and physical activity, but there is a variability in theoretical underpinning of the approach. In other words, most researchers vary on ways of implementing school-based interventions. It is evident that school-based intervention studies have challenges due to high dropout rates and lack of a behavioral pattern that could halt obesity. Studies show that childhood obesity is a complex epidemic with different metabolic, genetic, behavioral, and environmental components that are confounding and potentially interrelated, making the definition of causal pathways complicated (Ling & Thomas, 2013). Remarkably, evidence supports preventive interventions that encourage a healthy diet and physical activity, behavioral support and restrictive sedentary activities as critical. Subsequently, this intervention should involve not only the obese participants but also schools, family, and the community.
Most school-based interventions aim at modifying guidelines of meals with some schools districts adopting a healthy diet plan. Moreover, schools that implement coordinated nutrition programs exhibit lower rates of overweight children and more physical activities than schools without the programs (Ling & Thomas, 2013). Hence, school-based interventions are effective in limiting childhood obesity but need support for the better implementation of the programs. Ling & Thomas (2013) note that successful school-based programs can reduce health care spending in the long term. However, even with nutrition guidelines, most students do not desire nutritional food options due to poor quality and undiversified food products. These interventions vary in term of the type, duration, outcome measures, and necessity of the results. Shaya et al. (2008) affirms there lacks an understanding on the efficacy and sustainability of different types of interventions. In part, school-aged children show poor health outcome. The study by Shaya et al. (2008) demonstrated PA programs efficacy in increasing the fitness of school-aged subjects and reducing obesity-related measures. However, it appeared that these PA were successful in halting adverse effects of sedentary lifestyle but failed to offer long-term outcome to short-term interventions.
In education settings, obesity interventions are influenced by economic and environmental factors, which may limit long-term success of physical fitness. Shaya et al., (2008) argues primary schools operate under fixed budgets, and monetary cuts can reduce the duration of physical education classes. The efficacy to participate in physical activities can be influenced by environment factors such as limited extracurricular sports program, lack of parks and limited public funding (Ling & Thomas, 2013). Moreover, educational intervention aiming towards modification of health-related behaviors and dietary guidelines still had short-term results but limited long-term outcomes. This particular intervention focuses on curricula as the primary objective and continuous behavior change as the secondary purpose. Overall, school-based programs have positive results as they increase PA; reduce diastolic blood pressure and triceps skin folds of the participants. Nonetheless, persistent positive results (modified dietary intake and sustained PA levels) cannot be accounted for in school-based interventions. Even though long-term interventions are not feasible in most school districts, there is need to ensure continued physical education and reiteration of nutritional programs. Additionally, it is critical for studies to focus on qualitative measures when strengthening educational interventions.
Home vs. School-based Interventions
Elementary school-aged children could benefit from school policies as they can implement the skills learned in school. Most researchers are of the view that if obesity is to stopped it requires well-designed and large-scale prevention studies within home setting and school settings. Additionally, monitoring of the strategies for continued sustainability is also crucial for the prevention of elementary school-aged obesity. Central to the review is that parent involvement in obesity treatment is essential; without parental effort, results of treatment would be transitory. Kothandan (2014) find that combating the obesity epidemic is possible by combining preventive and treatment initiatives in school and family settings. Although it is hard to determine which intervention, (School or Family) is more efficient due to the heterogeneity of data in the study. In part, the data was heterogeneous because the two approaches showed similar results and lack of follow-up making it difficult to tell which intervention is more efficient. Nonetheless, reporting and understanding of findings of the two methods could inform strategies and guide public health measures in the treatment of childhood obesity.
Notably, Kothandan (2014) systematic review concludes that there is a considerable difference in theoretical framework of each intervention. A family-based intervention employs behavioral models, social cognitive theory, and trans-theoretical model in treating obese children. In contrast, school-based interventions lack theoretical models in most of their policies and strategies of reducing obesity. Hence, parents play a significant role, and that is why school-based interventions with parental involvement had some beneficial outcome. From the study by Kothandan (2014), school-based interventions showed ineffective long-term results whereas family-based have long-term efficacy for overweight children.
Sustainability
For sustainability, it is critical to include parents especially in nutritional programs (Kelishadi & Azizi-Soleiman, 2014). For long-term intervention (more than six years with follow-up) school-parent-educational partnership is paramount. The collaboration can include integration of home and school dietary modification and physical activity together. Beyond physical fitness, there are opportunities such as home economics subject that encourage healthy living to children. Additionally, peer intervention programs can be crucial in sustainable school-based interventions. The latter can include peer-led education, peer-assessment, competition, and teamwork for efficacy.
In addition, secondary school objectives can be cemented through collaborations among elementary schools. Competition is an excellent strategy when increasing student involvement in the school-based intervention measures. Activities such as mentorship and health fairs between schools can motivate student’s participation, which in turn maximizes long-term success of school-based interventions.
Conclusion
The review of the literature shows there is a critical role of parents and teachers in combating the obesity epidemic. Home and school setting can accustom children to PA, behavioral habits like right attitude towards play, enough sleep, more water, and healthy diets. It appears that parents and teachers are the best role model to school-aged children. Central to the findings is that school-based intervention cannot be effective without parental involvement. Hence, for sustainability, there is need to incorporate PA, nutritional programs in the education system, and behavior change within the home setting. In addition, the interventions need to have a longer duration and follow up for a sustainable outcome.
References
CDC, (2016). Obesity Prevention | Healthy Schools | CDC. Cdc.gov. Retrieved 1 July 2016, from https://www.cdc.gov/healthyschools/obesity/facts.htm
Kelishadi, R. & Azizi-Soleiman, F. (2014). Controlling childhood obesity: A systematic review on strategies and challenges. Journal Of Research In Medical Sciences : The Official Journal Of Isfahan University Of Medical Sciences, 19(10), 993-1008. http://dx.doi.org/PMC4274579
Kothandan, S. (2014). School based interventions versus family based interventions in the treatment of childhood obesity- a systematic review. Arch Public Health, 72(1), 3. http://dx.doi.org/10.1186/2049-3258-72-3
Ling, Z. & Thomas, B. (2013). School-Based Obesity Policy, Social Capital, and Gender Differences in Weight Control Behaviors. Am J Public Health, 103(6), 1067-1073. http://dx.doi.org/10.2105/ajph.2012.301033
Shaya, F., Flores, D., Gbarayor, C., & Wang, J. (2008). School-Based Obesity Interventions: A Literature Review. J School Health, 78(4), 189-196. http://dx.doi.org/10.1111/j.1746-1561.2008.00285.x
Showell, N., Fawole, O., Segal, J., Wilson, R., Cheskin, L., & Bleich, S. et al. (2013). A Systematic Review of Home-Based Childhood Obesity Prevention Studies. PEDIATRICS, 132(1), e193-e200. http://dx.doi.org/10.1542/peds.2013-0786
