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1 Joanne Gryn HSC 435 April 15, 2013 Obesity Interventions

Obesity has become a serious public health concern because so many people throughout the industrialized world are more overweight today than ever before, especially with a focus on children. Obesity has negative short term and long term consequences that can affect these people later in life. If children are overweight at a young age they are more likely to be obese when they are adults this is why prevention and intervention needs to be implemented at a young age. There are many intervention and prevention programs available to help prevent obesity in the United States, but it is very hard to change peoples behaviors so that is why it is still a topic of concern. According to the CDC (2012), The dietary and physical activity behaviors of children and adolescents are influenced by many sectors of society, including families, communities, schools, child care settings, medical care providers, faith-based institutions, government agencies, the media, and the food and beverage industries and entertainment industries (CDC). There are many factors that affect obesity and this is why many intervention programs focus on parental involvement as the most important factor. Many public health professionals aim towards prevention of obesity, but there is a great need for intervention programs. The problem with children and adolescents in todays American society is that there has been a huge reduction of physical activity and huge amounts of increased caloric intake.

Hospital Group vs. Home Group Intervention Since obesity is still a growing problem all throughout the world, many interventions have

2 been implemented to try and change an individuals behavior. This first article, Exercise Intervention in Childhood Obesity: A Randomized Controlled Trial Comparing Hospital-Versus Home-Based Groups describes an intervention program that consists of a hospital group vs. home group combined exercise and diet program for the treatment of children and adolescents with obesity. The main purpose behind this intervention was to compare BMI and body composition scores between a hospital clinic group and a home based combined exercise diet program to see which outcomes were more significant (Lison et al., 2012). Many people probably believe that intervention programs within a hospital will have greater outcomes than a home based program, but the results of this study proved that assumption to be false. This intervention took place in Spain and the sample included 110 overweight/obese children and adolescents between the ages of 6-16. Lison stated (2012), The participants were randomly assigned to into a 6-month combined exercise program, which included aerobic and resistance training and a Mediterranean diet which consists of vegetables, fresh fruit, olive oil as primary source of fat, dairy, fish and poultry consumed in moderate amounts, and reduced amounts of red meat (p. 320). For the purpose of this intervention, body weight, height, BMI and waist circumference were measured before and after the intervention took place for each participant. The results of this study showed a dramatic reduction in percentage body fat and BMI between both groups of participants. The home based group saw a significant reduction in waist circumference compared to the hospital group. It is important to note that attendance was the same for both of the groups because that proves that both of the groups were exposed to the same program in equal amounts.

3 This study proved that a home-based combined exercise and Mediterranean diet program may be effective among overweight and obese children and adolescents in Spain because it improves body composition and is possible and can also be introduced on a large scale without too much substantial expenses on the participants part. This study showed that changing your diet and increasing physical activity can be done at the comfort of a persons home and that a program does not need to be implemented in a hospital to be successful. This intervention was good because of the thorough comparison between the hospital based and home based. Since there were no significant differences between the results of the hospital based compared to the home based groups, it is accurate to assume that adolescents and children can do this combined diet and exercise program at home with little expense. If adolescents and children can do this program, then adults may be able to complete the program as well. The program consisted of a diet change and increasing a persons physical activity, those are hard behaviors to change so that could be the biggest challenge of this intervention.

Behavioral Family Intervention The second article, A Pilot Study Examining a Group-Based Behavioral Family Intervention for Obese Children Enrolled in Medicaid: Differential Outcomes used Behavioral Family Intervention to address weight management in obese children from economically disadvantaged families (Janicke et al., 2011). All types of behavioral family interventions have been studied in regards to obesity and weight management because families are believed to have contributed to the epidemic of obesity in the Untied States. Many people believe that it is the parents fault if their child is overweight or obese, especially those children that are in elementary school. These interventions are also believed to be the most effective because of the short term

4 and long-term positive behavior changes because of the family aspect. According to Janicke et al. (2011), This intervention focuses on families enrolled in Medicaid with obese children. The interventions combined nutrition education and behavioral modication techniques to help children and parents work together to gradually decrease caloric intake, maintain adequate nutrient intake, and increase physical activity to encourage long-term maintenance of weight reduction in children (p.213). Families were recruited during primary care visits to their physicians, distribution of brochures through local schools, newspaper articles, and community presentations. The intervention was promoted as a healthy lifestyle program to help establish effective weightmanagement strategies for children and families. The in-person screening consisted of the children and their parents filling out consent forms and measures of their height and weight. Those that were eligible to participate were scheduled for a baseline assessment. The child and parent were assigned to the group-based behavioral family intervention and participated in 12 weekly, 90-min sessions over the course of 3 months. Each week there was a new knowledge and skill that was encouraged to change the current unhealthy lifestyle. For all participants, the primary treatment objectives were to decrease caloric intake and increase moderately intensive exercises, which was promoted through a pedometer-based step program. They were asked to monitor everything they ate and drank using a daily food log. Children were asked to decrease sedentary activities so they spent no more than 2 hr per day watching television, playing computer games, or playing video games (Janicke et al., 2011, p. 217). Children and parents were brought together to set goals for the week, which focused on developing specic plans for making healthy alternatives and environmental changes. Children discussed the progress achieved and challenges encountered since the previous meeting and then

5 participated in a fun exercise or game. Children prepared and sampled healthy snacks and enjoyed playing fun, educational activities that were used to teach them about nutrition, strategies to increase physical activity, and strategies to cope with psychosocial concerns. The idea of a parent-child program is great because parent involvement is important in every aspect of a childs life. Parents contribute greatly to a childs diet and exercise on a daily basis because most of the time children model after their parents behaviors. If the childs parent does not eat healthy or exercise, how is a child supposed to know what is right and what is wrong. This intervention seemed to be the most logical intervention that was researched.

Childhood Obesity Intervention As discussed in the previous intervention, it is extremely important to engage parents in interventions directed towards childhood obesity. The third article, A childhood obesity intervention developed by families for families: results from a pilot study called Head Start focused primarily on parent engagement and it is a family-centered intervention for low-income families with preschool-aged children. According to Davison et al., The Family Centered Action Model of Intervention Layout and Implementation (FAMILI) theory, the Family Ecological Model (FEM), and the Empowerment Theory are the theories that are used to guide this intervention program (2013, p.2). The intervention had 4 components: revisions to letters sent home to families reporting child body mass index, a communication campaign to raise parents awareness of their childs weight status, the integration of nutrition counseling into Head Start family engagement activities, and a 6-week parent-led program to strengthen parents communication skills, conflict resolution, resource-related empowerment for healthy lifestyles, social networks, and media

6 literacy. A total of 423 children ages 25 years, from five Head Start centers in upstate New York, and their families were exposed to the intervention and 154 families participated in its evaluation. Compared to before the intervention took place, children after the intervention showed significant improvements in their decreased rates of obesity, increased physical activity, less daily TV viewing, and healthier diets. Parents at post intervention reported significantly greater self-efficacy to promote healthy eating in children and increased support for childrens physical activity. This intervention program primary focused on family support and interaction in a childs life and targeted to reduce the rate of obesity in the participants. Interventions like these have been proven to be successful because when a parent is actively participating in the same activities that their child is, the child will be happier and communicate more with their parents.

Healthy Buddies Intervention The fourth article, Healthy Buddies: A Novel, Peer-Led Health Promotion Program for the Prevention of Obesity and Eating Disorders in Children in Elementary School uses a peerteaching model for health promotion. These studies have shown to be successful for health promotion because positive effects and studies show participating students highly value the peerteaching experience. Healthy Buddies was designed for elementary schools and peer teaching would consists of older to younger schoolchildren. This study 23 hours/week, 21 weeks took place in 2 Canadian elementary schools. The experimental group consisted of 232 children, and the control group consisted of 151 children. Older students from 4th-7th grade were given direct

7 instruction from 1 intervention teacher and were paired with younger students (kindergarten through 3rd grade) for the whole school year (Stock et al., 2007). The older students were supposed to act as teachers and role models for their younger buddies. Each lesson included 3 components of healthy living: nutrition, physical activity, and healthy body image. The students learned how to be positive buddies and then learned the 3 components of a healthy life. They also learned how to overcome challenges to living a healthy life. Compared with control students, both older and younger intervention students showed an increase in healthy-living knowledge, behavior, and attitude scores. BMI and weight increased less in the intervention students in 4th through 7th grade and height more in the intervention students in kindergarten through 3rd grade. Our student-led curriculum improved knowledge not only in older schoolchildren but also in their younger buddies. Student-led teaching may be an efficient, easy-to-implement way of promoting a healthy lifestyle from kindergarten to 7th grade. Although the study took place in Canada, the healthy buddies intervention program has potential to be successful in all elementary schools throughout the Untied States. Students look up to their peers and often times give in to peer pressure and influence in school so this program seems relatively easy to implement. Many times younger students have older siblings at school who they see on a daily basis, so their siblings may be the ones teaching them about these healthier behaviors and they will model after them.

Group-Based Weight-Control Intervention The final article, The Effect of a Group-Based Weight-Control Intervention on Adolescent Psychosocial Outcomes: Perceived Peer Rejection, Social Anxiety, and Self-Concept describes

8 an intervention that focuses on weight control treatment on adolescent social functioning (Jelalian, 2011). Eighty-nine adolescents were randomly assigned to group-based cognitive behavioral treatment with aerobic exercise or peer-enhanced adventure therapy; completed measures of social functioning at baseline, end of treatment, and at a 12-month follow up. Results showed signicant reductions in adolescent perceptions of peer rejection and social anxiety over time. There were improvements in social functioning in the adolescents and were related to increases in self-concept dimensions. Group-based weight-control treatment for enhancing adolescent self-perceived social functioning across multiple domains seemed beneficial to adolescents. Eligibility for the study were: 13 to 16 years old, English speaking, 30% to 90% overweight according to BMI for gender and age, and at least one parent available to participate in the intervention. The group-based cognitive behavioral treatment (CBT) with aerobic exercise involved supervised aerobic activity once per week within the clinic setting. The second groupbased CBT with peer-enhanced adventure therapy included CBT plus peer-based activity sessions. This condition included group activities developed to foster positive peer relationships within the group and develop social skills, self-condence, and problem solving. The CBT component, which remained the same for both conditions, incorporated a range of behavioral topics including goal setting, self-monitoring, stimulus control, motivation, and relapse prevention. The use of group-based cognitive behavioral treatment is an accurate approach to help adolescents overcome obesity. It is good for adolescents to work with other peers so that they can build confidence and reduce social pressures. The study showed an increase in social functioning between the adolescents and that is important for a growing adolescent.

9 Overall, all five of the intervention programs researched were effective in reducing the amounts of overweight and obese children and adolescents in the United States. The most effective interventions that showed the most significant results were the ones that included parent involvement. It is important to reduce the rates of overweight and obese people throughout the world so that people can live healthier lives. Obesity is considered an epidemic in the United States and this is due to the significant reduction of physical activity and an increase in caloric intake.

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References CDC - Obesity - Facts - Adolescent and School Health. (2013, February 19). Centers for Disease Control and Prevention. Retrieved April 17, 2013, from http://www.cdc.gov/healthyyouth/obesity/facts.htm Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A childhood obesity intervention developed by families for families: results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity, 10, 1-11. Lison, J. F., Real-Montes, J. M., Torro, I., Arguisuelas, M. D., Alvarez-Pitti, J., MartinezGramage, J., et al. (2012). Exercise Intervention in Childhood Obesity: A Randomized Controlled Trial Comparing Hospital-Versus Home-Based Groups. Academic Pediatrics, 12(4), 319-325. Janicke, D. M., Gray, W. N., Mathews, A. E., Simon, S. L., Lim, C. S., Dumont-Driscoll, M., et al. (2011). A Pilot Study Examining a Group-Based Behavioral Family Intervention for Obese Children Enrolled in Medicaid: Differential Outcomes by Race . Children's Health Care, 40, 212-231. Jelalian, E., Sato, A., & Hart, C. N. (2011). The Effect of Group-Based Weight-Control Intervention on Adolescent Psychosocial Outcomes: Perceived Peer Rejection, Social Anxiety, and Self-Concept. Children's Health Care, 40, 197-211. Stock, S., Miranda, C., Evans, S., Plessis, S., Ridley, J., Yeh, S., et al. (2007). Healthy Buddies: A Novel, Peer-Led Health Promotion Program for the Prevention of Obesity and Eating Disorders in Children in Elementary School. Journal of the American Academy of Pediatrics, 120(4), 1059-1068.

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