Childhood obesity has become a widespread epidemic, especially in the United States. Twenty five percent of children in the United States are overweight and eleven percent are obese (Dehghan, et al, 2005). On top of that, about seventy percent of those children will grow up to be obese adults (Dehgan, et al, 2005). There are many different causes that can be attributed to the childhood obesity. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide (Dehghan, et al, 2005). Because there are so many different factors that can cause obesity in children, interventions need to be developed based on several different health behavioral theories. To create specific interventions for childhood obesity, the theories used should be either intrapersonal, in which theories focus on factors within the person that influence behavior, such as knowledge, attitudes, beliefs, motivation, and skills (Hayden, 2019), or interpersonal, in which theories operate on the assumption that other people influence our behavior (Hayden, 2019). In relation to childhood obesity, intrapersonal theories would be directed at the children themselves. Interpersonal theories would be directed at the parents or guardians of these children, as they have a large degree of control over their child’s food intake and physical activity levels. Both the children and their parents would be members of the target audience for this specific intervention. Before interventions can be discussed, the health issue, childhood obesity, must be defined.
What is Childhood Obesity?
There are two different terms that the Center for Disease Control (CDC) uses when discussing excess weight in children: overweight and obese. The CDC defines overweight in children and young people as a BMI at or above the 85th percentile and less than the 95th percentile for young people of the same age and sex (CDC, 2018). The CDC defines obesity in children and young people as BMI at or above the 95th percentile for young people of the same age and sex (CDC, 2018). In short, childhood obesity can be described as an excess of body fat in a child or young adult. Because of the rate at which the number of obese children has grown over the years, there has been plenty of research done to uncover what exactly is the root cause of the problem.
Causes of Childhood Obesity
There can be many different causes attributed to the rise of childhood obesity. One of the biggest factors that have been examined is genetics. There are various studies that have found that BMI (body mass index) is 25-40 % heritable (Sahoo et al, 2015). However, genetics alone cannot be attributed to the fast rise of childhood obesity. Genetic susceptibility often needs to be coupled with contributing environmental and behavioral factors in order to affect weight (Sahoo et al, 2015).The genetic factor accounts for less than 5% of cases of childhood obesity (Sahoo et al, 2015).
One factor that has been studied at great lengths is the diet of these children. Not only what is consumed, but the portion sizes of the meals. Fast food intake, especially among adolescents, has increased dramatically over the past decade. This can be seen quite frequently in families that have two working parents, as fast food options are convenient and inexpensive (Sahoo et al, 2015). The issue with most of these fast food establishments is that the food offered is very high in caloric value, while not having any nutritional value to it. Another issue with fast food options is the low prices of soft drinks available to customers. Many studies have examined the link between sugary drink consumption and weight and it has been continually found to be a contributing factor to being overweight (Sahoo et al, 2015). Sugary drinks are less filling than food and can be consumed quicker, which results in a higher caloric intake (Sahoo et al, 2015). These locations also offer large quantities of food for very little money. Portion sizes have increased exponentially over the past decade. Consuming large amounts of high caloric food, along with sugary drinks, creates an energy imbalance, which leads to weight gain and obesity.
The third factor that can be attributed to the rise of childhood obesity is activity level. Living life without engaging in the proper amount of physical activity is linked directly to becoming obese. In recent years, the amount of time spent by children partaking in sedentary behavior has increased, while there has been a decrease in the amount of time spent partaking in physical activities (Sahoo et al, 2015). By not staying active, these children maintain an excessive caloric diet, which becomes body fat over time, causing obesity and other health problems.
Other causes of childhood obesity can range from environmental factors, socio-cultural factors, to even family factors. In regards to environmental factors, many children in the past walked or rode their bikes to school, where nowadays parents drive their children because of no safe walking routes, fear of child predators, or for the convenience of the child (Sahoo et al, 2015). Socio-cultural factors, or the factors that are created by our culture and society, have also been shown to have links to increasing obesity rates. In our culture, food is often used as a reward, as a way to control others, and as a means of socializing (Sahoo et al, 2015). Finally, family factors can have a prevalent influence on a child’s risk of obesity. If parents neglect to keep healthy food options available in their households, the children will have no choice but to consume unhealthy foods. Also, the times at which meals are consumed can have an influence on what is consumed, and the amount consumed at each meal (Sahoo et al, 2015). Not only can family have an impact on a child’s diet, but also their activity level. If children see their parents or siblings engaging in sedentary behaviors, they are going to emulate and copy their elders (Sahoo et al, 2015).
Health belief model, protection motivation theory, social cognitive theory
The creation of this specific intervention will be based on three health behavior theories: the Health Belief Model, Protection Motivation Theory, and Social Cognitive Theory. There are three different theories being used because the intervention will be delivered in two distinct sections, a portion where both the children and their parents are present and another in which the parents and the children will be talked to separately, about different topics.
The first theory to be utilized is the Health Belief Model. This theory states that health behavior is determined by personal beliefs or perceptions about a disease and the strategies available to decrease its occurrence (Hayden, 2019). Many people do not understand what exactly childhood obesity is and what causes it. In the intervention, this theory will be used to explain different aspects of childhood obesity, risks and concerns about present and future possibilities, and the benefits that come from changing the behavior. This theory uses four constructs in order to be effective. The first is perceived seriousness. Both the children and their parents may not have any education on obesity, or how it can affect the child later on in life. The second construct is perceived susceptibility. There are a number of signs whether or not a child is at risk of obesity. As mentioned before, genetics can play a role in determining BMI. So if there has been generations of family members with above average BMI, it could be a sign that a child would be more susceptible to becoming obese in their early age. The third construct is perceived benefits, which is what many people are mostly concerned about. They wish to know how changing their behavior will benefit them. There are many benefits to changing unhealthy behaviors to healthier ones, such as controlling weight, improving mood, combating diseases, and boosting energy (Healthline, 2016).
The second theory to be used in this intervention is the Protection Motivation Theory. This theory states that fear causes thought processes that motivate us to protect ourselves and others from the threat and feared outcome by adopting recommended health protective actions (Hayden, 2019). This theory uses two constructs: threat appraisal and coping appraisal. Threat appraisal is similar to perceived seriousness and susceptibility, in that different factors can be examined to determine whether or not a child is more prone to becoming obese. Coping appraisal is how the recommended action is assessed in terms of effectiveness, personal ability to carry out the action, and cost (Hayden, 2019). For this intervention, the target audience will be given ample evidence of the effectiveness of different weight loss strategies, such as proper dieting and exercise for children. The parents of these children may have concerns about whether or not they will have the time or the resources to prepare healthy meals for their children. In that respect, simple meal plans will be discussed, along with ways to purchase healthy groceries, even while on a budget.
The final theory that will be used is the Social Cognitive Theory. This theory is based on the concept of reciprocal determinism or the dynamic interplay among personal factors, the environment, and behavior (Hayden, 2019). There are three constructs that will be used for the purpose of the intervention. The first is observational learning, which is learning by watching others and copying their behavior (Hayden, 2019). This construct will apply to both the children and their parents. Children watch their parents and tend to emulate their behavior. So when one parent decides to eat healthy or unhealthy, the child will normally perform the same activity. By extension, the parents will be told to always strive to set better examples for their children by eating healthy foods and engaging in regular physical activity. The second construct is reinforcement, or a system of rewards or punishments in response to a behavior (Hayden, 2019). For this intervention, a system of positive rewards would be the most useful for influencing a behavior change in obese children. For example, parents can reward their child with a sweet as long as they finished an entire serving of vegetables first. Another option would be to allow a child to play an hour of video games, as long as they would stay outside and play for an hour first. This would give the children more of an incentive to spend time outside and engage in activity. The final construct is behavioral capability, which states that before people can perform a certain behavior, they must have knowledge of the behavior and the skills to perform it (Hayden, 2019). This construct would be implemented at the start of the intervention, with the explanation of childhood obesity, and near the end, to help both the parents and children learn different strategies to help control weight and to maintain healthier lifestyles.
The intervention will be divided into three different sections over the course of the time allotted. During the first segment, both the parents and children will be seated together for an overview of childhood obesity. This segment will cover what exactly childhood obesity is, what causes it, and the physical and psychological effects that it can have on children currently and in their future. This will be done through the Health Belief Model constructs of perceived seriousness, perceived susceptibility, and perceived benefits, as well as the Social Cognitive Theory construct of behavioral capability, all of which apply to help explain general information about childhood obesity.
During the second part of the intervention, the children and the parents will be separated and talked to in different rooms, about different topics. Using the Protection Motivation Theory construct of coping appraisal, the parents would be lectured on the effectiveness of different weight loss strategies for children, such as playing games or sports for physical activity and learning different healthy snack food options for kids. Money and time are two very big concerns of many parents, specifically not having money to purchase healthy foods, and not having the time to prepare healthy meals. Simple, cheap, and healthy meal ideas will be shared with the parents to help ease their concerns. While this is happening, the children will be learning more about the benefits of eating healthy foods and getting regular exercise.
During the final segment of the intervention, the children and their parents would be brought back together for a final lecture. The Social Cognitive Theory constructs will be used in this segment, with different strategies will be explored for children and their parents to work together to change the health behavior. This will conclude the intervention, in which the floor will open up to any questions or concerns by the parents or the children.
There are a few different things that will come from the creation of this intervention. The first is the hope that more people are made aware of what exactly childhood obesity is and that it is a very serious epidemic. Not only can it have negative side effects on children now, but as these children age, other health concerns can emerge if the issue is not taken seriously. The second is that some of the misconceptions about eating healthy are wiped away. Many people believe that it is extremely expensive and time consuming to prepare healthy meals. If one does the proper research, this can be a relatively quick and cheap process. Finally, this intervention should provide different solutions that can be used indefinitely and throughout childhood. One of the major issues with any diet plans is that they set unrealistic expectations of what and when people should eat. This intervention should show the children and parents that it is ok to consume junk food, as long as it is done moderation. If these three things happen by the end of the intervention, then it should be considered a success.