Topic: Obesity targeting teenagers 11-15 years of age.
It is apparent from the recent developments in child health that obesity is a primary cause of problems in child healthcare. The rise in the levels of diabetics in the teenage years is becoming endemic of a growing level of lethargic and unexercised conscious teenagers who are living on diets of fast foods and soda pops. This has been highlighted in the trendy yet painful changes to the school meals system; in which we now see a withdrawl of the culture of chips with everything to a more switched on diet of five-a-day fruit and vegetable choices on our school menus.
The government legislation and directives have been developed to move our growing oversized school teenager population towards a healthier diet and exercise programme that prepares our teenage population for adulthood. In Measuring Childhood Obesity. Guidance to Primary Care Trusts DOH (2006), it states that:
The Public Service Agreement (PSA) target on obesity is the Governments first, high level response to the major public health problem posed by the continuing rise in obesity. The target is challenging halting the year on year rise in obesity among children aged under 11 by 2010 in the context of a broader strategy to tackle obesity in the population as a whole. Halting the rise in obesity goes against recent trends no other country has managed to achieve this and it will require a step change. DOH (2006).
This statement clearly acknowledges the value of this study and in part provides a view to the action plan required to ensure that targets and thresholds are reached to stem this endemic tide of obesity in our teenage population. The World Health Organisations report into obesity in young people during 2004 gave rise to concerns about this endemic problem, stating that:
WHO global strategy on diet, physical activity and health (2004): states that the role of government is crucial in achieving lasting change in public health. Governments have a primary steering and stewardship role in initiating and developing the strategy, ensuring that it is implemented and monitoring its impact in the long term.
This statement came well before the ongoing debate and crucial actions taken in UK Government circles. The Scottish Parliament took forward many of the WHO initiatives prior to its partner government of Westminster; in that the Scottish Intercollegiate Guidelines Network: publishes guidelines on the management of obesity in children and young people (Guideline 69) www.sign.ac.uk/guidelines/published/index.html#Child. This became the starting point for Scottish action on obesity in teenagers and younger children; which allowed for the development of: The Weight Management Learning Programme:
[This] is collaboration between the Health Education Board for Scotland (now NHS Health Scotland), the Scottish National Board for Nursing, Midwifery and Health Visiting, and the Scottish Council for Post-graduate Medical and Dental Education. It is a very practical and helpful site for planning a weight management programme. www.hebs.scot.nhs.uk/learningcentre/weightmanagement/childhood
Therefore, given this brief overview of core research it is a subject worthy of investigation and focus for a plan of action to provide some part answers to tackling obesity in teenagers.
In this study, I have decided to consider the Tannahill Model of health promotion as the main aspect of my preparation of an action plan. Having made some brief studies into the work of London boroughs I have decided to use the London borough of Waltham Forest; which through the medium of its literature shows clear partnership and collaboration with its Primary Health Care Agencies and other local target groups and sectors, in the tackling of teen and childhood obesity.
Therefore, firstly, this study will consider the Tannahill Model against the background of literature on health promotion models. Secondly, we will consider the subject of teenage obesity and the debate currently ongoing in literature with some reference to the demographic; sociological and physiological trends. Thirdly, we shall consider the current and planned documented work of the chosen borough with reference to its activities; partnerships and strategies implemented and being planned. There is also a brief discussion of evaluative methods that can and are used in this type of study and finally, I shall prepare an action plan, for action towards achieving health promotion in this endemic area of concern. The Action on Obesity states:
Childhood obesity is a serious problem with profound health and social consequences. It has received substantial media attention recently due partly to the rapid increase in prevalence across the UK as well as internationally. This rise in prevalence began to occur in the UK in the mid 1980s with a rapid escalation occurring most noticeably over the last 10 years. Current statistics suggest the prevalence of obesity in children is four times higher today than it was 30 years ago.
This statement is not isolated. We can see from the wealth of literature that there is a pandemic problem across the UK with regard to the levels of childhood obesity. This has been the subject of Government intervention, incentives and programmes that will be cited in this study. Caroline Flint, the Public Health Minister, said: We recognise we need to do more. We will continue to work across government and the public sector, and with the food, leisure and sports industries to ensure that we stay on track to meet our target. (The Times 2006). But, in the interim, we can cite other theorists who are raising concerns towards this ever-growing trend amongst our teenagers to maintain high levels of weight gain with little or no consequence of future health-related problems and illnesses. Caroline Swain, Executive Director of Weight Concern, said: If we are to preserve the health of the next generation, there is a desperate need for detailed research into what is triggering this rise, as well as practical action to encourage families to adopt healthier lifestyles.
Amanda Eden, Care Adviser at Diabetes UK, said: As obesity increases, the average age of the diagnosis of type 2 diabetes lowers. We will soon be seeing our children growing up losing limbs and becoming blind as they develop the serious complications of having the condition. The Times 2006.
This is stark reading within the body of a growing wealth of research that is not predominantly scaremongering in the wider medium; but on the contrary it reflects the growing concerns of both an academic and professional medical audience that is trying to facilitate a move towards defusing this growing health time-bomb.
There are a number of models that support the theoretical study of health promotion; they all have their own worth and standing in literature. In brief I shall describe and critically discuss those that are more pertinent to this area of study.
The Tannahill Model (1985). This is a theoretical process of enhancing health and reducing risk of ill-health through the overlapping spheres of health education, health protection, and disease prevention. These three spheres of activity are clearly remote from the treatment, or care, of the subject for a more action-based model of ensuring that where possible, care and treatment are not needed. Explained in reverse order and using obesity as an example subject, these Tannahill spheres would dictate: disease prevention through, for example, lifestyle changes such as diet; education that informs on the need for dietary changes to minimise the level of weight gain; health protection, in the intervention of government in the quality and content of school meals; school pupil dietary advice and food labelling. However, there is often a downside to such intervention at such a strategic level, in that young people may choose to boycott school meal services for outside catering services. Nevertheless, what is also clear from this model is that it does not label or make social statements regarding the subject or persons engaged in the area of health promotion activities. Therefore, it works provided that the encouragement towards healthy eating and lifestyle is maintained.
The Stages of Change Model, Prochaska and Diclemente (1984): this model relies on the level of interest in the desired outcome that the participant engages in the project being offered or the re-education of behaviour being planned. This model prepares the participant to consider the consequences of actions for changing behaviour, the desired outcome; this in turn leads to a contract commitment to make the changes. An example of this strategy can be seen in most anti-smoking programmes. For weight loss this is also a common commitment strategy for organisations that promote peer work or group dynamics, e.g. Weight Watchers, Slimmer World.
Health Belief Model, Janz and Becker 1984: this model relies on participants being engaged in real honest perceptions of their own situation, its cause, condition and effect on well-being. For example, someone who is obese takes a hard look at their weight problem and its effects on lifestyle. The model then engaged an aspect of education, in that the participants are able to consider the demographic and sociological impact of action and inaction; against the stark choice of inaction and consequences. The upside being the likelihood of action and the wider consequences for family/society.
The three models mentioned are all proven to work in the world of obesity and weight-loss programming. The interesting factor is that they all use levels of pursuit towards the participant in engaging an interest in welfare and re-appraisal of a related health problem. Furthermore, they also provide a level of education towards changing behaviour patterns and perceptions of oneself.
Whatever the model that is used, each has its own merits and distinct methods of working. In this study, the Tannahill Model has a far-reaching strategy that encompasses three levels of precise health promotion that are pertinent to the needs of teenagers who are obese in that it provides: a disease-prevention strategy and programme; education through documentation, health awareness events and classroom teaching; and health protection, through the involvement of government incentives, strategies and regulations that now govern our school meals services and those who provide them. The government incentive scheme to measure obesity in school-age children states that:
PCTs are free to develop a measuring model that fits their local circumstances, reflecting available resources and relationships. A variety of models of measurement have already been developed around the country. Some of these models are described later, along with the contact details of those involved. The examples are presented in order to share ideas, approaches and information about lessons learnt. DOH (2006).
Therefore, it is certain that although government has taken a clear lead to ensure the future of healthcare, through the target of tackling obesity, health organisations, local authorities and interest parties are free to develop models of measurement and strategy that inform and specifically address needs in their own geographical area.
In Forecasting Obesity to 2010 Joint Health Service Unit (2006) a clear guidance is given against the current and forecasted figures for obesity during the next four years. This report is stark reading and provides some clear pictures and appraisal of the demographic and sociological trends that are now endemic of obesity and its future trends in the UK.
In order to understand the figurative aspect of this report, and to enable further understanding of this study, we must cite the percentage formula used within the context of this report:
Among children, this report has used the UK National Body Mass Index (BMI) percentile classification to describe childhood overweight and obesity among children aged 2-15:
Description BMI centile for childs exact age Not overweight/obese 5th centile or below Overweight Over 85th to 95th centile Obese Over 95th centile
Forecasting Obesity to 2010 Joint Health Service Unit (2006)
This report is by far the widest survey of obesity in children in the UK; and as such is worthy of direct citation to impart a further understanding of the endemic and steadily growing problem of obesity in teenagers in the UK. Therefore, I have deliberately cited three specific areas that are currently engaging the wider debate: gender; ethnicity and social class, which will have important implications for the action plan being prepared.
The estimated number of children aged 2-15 by their BMI status. Approximately, 643,513 boys and 613,048 girls were overweight in 2003 with a further 746,662 boys and 675,983 girls who were obese.
Within non-white ethnic groups, it is estimated that 128,443 boys and 101,496 girls in 2003 were obese (22% and 18% of non-white ethnic groups respectively). However, caution should be taken with these figures as the base sizes for boys and girls within non-white ethnic groups were small.
Among all boys who were classified obese, a greater number lived in non-manual households than manual households: 382,253 compared with 345,909. The reverse was true for girls, whereby a greater number who were categorised as obese lived in manual rather than non-manual households (337,199 and 328,365 respectively). It is also important to note that the proportion of girls who were obese was significantly higher among those from manual households (19%) than non-manual households (14%). Among boys, no significant difference was detected.
Forecasting Obesity to 2010 Joint Health Service Unit (2006)
We can now move to discuss the measures that are being implemented in the London borough of Waltham Forest. This borough is working in partnership with a number of organisations including its local PCT and its many integrated partners.
But before we move on to discuss the ongoing direction of the borough and its impact work with teenage obesity we must firstly link local authority to national government directives and incentives. In this respect, it is worth noting that the Office of the Deputy Prime Minister (now Department for Communities) has produced a toolkit for local authorities to ensure good practice in developing partnership links in its local area. This mandatory tool, when used correctly, will produce a measurable set of strategic targets that can be measured and added to the wider central government targets for the communities programmes.
This Local Area Agreement Toolkit provides good advice, guidance and model documentation to ensure that local authorities and their respective partners formalise and strategise in accordance with national frameworks and directives, all of which can be measured and retraced into statistical data for further analysis and planning opportunities.
Stated in the body of this toolkit is clear evidence that: The core of the Children and Young People’s Block is the Every Child Matters: Change for Children framework.
Furthermore this is clearly supported in the Governments strategic aims that, every child, whatever their background is to have the support they need to be healthy; stay safe; enjoy and achieve through learning; make a positive contribution to society and achieve economic well being. This core aim also focuses on the needs of teenagers whose needs are to be strategised separately from those of earlier years.
The core emphasis of the whole LAA Toolkit is the requirements for funding and the obtaining of such funding under the government targets, and strategies. In so doing local authorities and their partner organisations should allow for the crossing of target areas to ensure that the outcomes for strategic impact in reducing child obesity, youth crime etc to ensure the best fit solutions for their authorities.
The London borough of Waltham Forest has been engaged in the strategic planning of incentives for the reduction in childhood obesity in its area; this has been seen in the reports, minutes and strategies being deployed across the borough with its partner agencies. In this respect we can cite from the councils minutes such emphasis and directions being taken by the Waltham Forest Working Together Partnership LSP Group which met in March 2006 to discuss the development of a strategy for reducing obesity in school-age children.
At this meeting they discussed the DOH Guidelines, (cited above), recommending that children of all ages are measured for their BMI, until the year 2010. In this respect, as directed, the Department of Health would engage a suitable measuring system that would suit the needs of the borough. The partnership had written to EduAction, another programme of engaging the health and welfare of young people in the borough, to ascertain their involvement.
Citing from the minutes of that meeting, we can see three specific areas that have been taken forward in the development of a strategic action plan to target obesity in teenagers and younger children in the borough and these are:
Support from governors and PTAs would be valuable to gain agreement for population surveillance on child obesity.
It may be possible to map the ethnicity of school children in the obesity study by using the school roll for that cohort.
There is a reward grant target around physical activity in the LAA and discussion needs to take place with the Councils Leisure Services department with regard to delivery.
A sensible approach to planning may be to differentiate between activity targets and outcome targets, and to use pre-existing indicators wherever possible.
It was AGREED that the draft action plan should be worked up into a Completed document.
WALTHAM FOREST WORKING TOGETHER LSP PUBLIC HEALTH EXECUTIVE PARTNERSHIP FRIDAY 31st MARCH 2006
The minutes show that the Local Authority and its Health Partners have clearly understood the strategic strategy and guidance of the Department of Health directives in that they have discussed and agreed on the implementation of a measurement strategy; a planning incentive towards the procurement and formal understanding of the raw data once analysed for its own health needs. It also shows forward thinking and teamwork in partnering and delivering the necessary data streaming of services to inform future health needs. This in itself gives an indicator that this borough has, in some part, the Tannahill Model in place in that it is providing clear strategy for health promotion.
The other interesting aspect of this set of minutes reflects the reward incentive grant aspect of the discussion in involving the leisure services department in promoting physical activities amongst young people who are, or may be, obese.
In this respect, in a further authority document this involvement is taken further into a project. The council has started to consider a pilot scheme of bike riding and training for school-age children and young people, improving, health and fitness through walking and cycling, reducing the risks of sedentary illnesses and obesity. Waltham Forest School Travel plans Strategy (2006).
This project also has a unique aspect in that it will provide maintain bikes and training in their use for those interested. The STPS states that it:
Provides on road cycle training at all secondary schools within Waltham Forest. Participation varies from year to year and will depend on the enthusiasm of teachers or ‘champions’ in the school. As of spring 2005, the Council employs 5 cycle trainers who work directly with schools to set up programmes of training.
This is also to be extended to parents to encourage further low usage of cars and allied vehicles to move pupils to and from schools across the borough.
But, what is of note in all the council�s strategies across its departments is its clear desire to be young-people friendly, targeting all aspects of their needs, but primarily encouraging a growth in healthy lifestyles for the future of its residents and services. This is summed up by the emphasis of the Schools Travel Plan Strategy:
The Council will encourage all schools to adopt the healthy school award and introduce healthier school meals. Providing children with a healthy, nutritious diet is an essential requirement for children to enjoy an active healthy lifestyle. STPS (2006)
This brings us back to a theme borne out in the literature that we as a nation need to encourage and sustain exercise among our young people to stem the direction of obesity within the growing younger population. This is reflected in a report cited in The Times:
Cycling England released a survey yesterday showing that almost three-quarters of parents do not think that their children do enough exercise at school. Phillip Darnton, its chairman, said: Bike to School Week, which starts on Monday, is a great opportunity for young people to give cycling a go. Cycling to school is not only fun and inexpensive, it is also a great way of introducing exercise into your childs daily routine and establishing a good habit of activity for later life. The Times (2006).
This clearly shows that the borough chosen for this study is clearly at the forefront of strategies to move its borough towards a healthier lifestyle and culture.
Evaluation of any strategy is clearly important. In this respect, there are many evaluative formulae that can be used to measure the ongoing focus and strategic impact of a given study area. Obesity, as we have seen, is measured in many different ways; this includes the collection of quantitative data, as in the government collation of obesity trends in young people, which can be an indicator of trends: social, demographic, ethnicity and age related. Alternatively, it can include qualitative data that involves the wider sociological and psychological impact of this area of study. This may include, but is not exhaustive, case studies, written data analysis, interviews, questionnaires, workshops and symposiums.
In studying obesity it is clear that it is considered that a mix of both quantitative data and qualitative methods bring together a wider understanding of the subject area of teen obesity. We can see this from the data clean in many of the studies referenced for this study, including the government statistics and findings of years of research and investigation.
However, within the context of the action plan being prepared, I would consider a mix of methodologies to reflect the wealth of literature that informs the subject of obesity and the many aspects of gathering data ongoing in this subject area.
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WALTHAM FOREST WORKING TOGETHER LSP PUBLIC HEALTH EXECUTIVE PARTNERSHIP FRIDAY 31st MARCH 2006
Watham Forest School Travel Plan Strategy EDUACTION (2006).