Introduction
Obesity among children in America has increasingly become a major public health concern. According to the America Obesity Association, approximately 15 percent of children between the ages 6 – 11 years and adolescents aged between 12 – 19 years are obese. The problem of obesity in children did not just happen by accident; fundamental changes in the society have contributed significantly to the increase in incidences. Obesity is the main predisposing factor to type II diabetes and other comorbidities like cardiovascular diseases. A number of intervention programs have been adopted in various settings to mitigate the problem of obesity with the overall goal of reducing type II diabetes
Brief description of the program
The New Jersey Diabetes Prevention and Control program has initiated a public health initiative that seeks to address the problem of obesity and by extension type II diabetes through a primary level intervention targeting mainly young people in 4th to 6th grade. The initiative was basically a primary level intervention program targeting a cohort of obese children in North West side of New Jersey. The area was chosen because of its apparent high-level obese population. The program involved lifestyle education sessions to address the health needs. A cohort of children and their families were systematically identified within the program area. An initial evaluation of basic indicators of obesity and type II diabetes were done; these included, body mass index (BMI), total cholesterol level, glucose, and insulin. Subsequently the identified subjects were then taken through education sessions delivered to them in groups. The education sessions addressed the following: nutrition, physical activity, behavioral change and obesity related morbidity. The sessions were repeated for a year at three monthly intervals. Measurements of the basic indicators were taken over time to assess the impact of the intervention.
Objective of the program
The overall objective of the program was to mitigate the high level of type II diabetes in the target population, through education on lifestyle. Specific objectives included:
- to enhance the level of knowledge and awareness of the risk factors associated with diabetes among children with obesity
- to highlight obesity related morbidity including type II diabetes
- to impact behavioral change in children for healthy living
Planning and implementation
This initiative involved health promotion programs designed using the guideline of intervention mapping protocol as illustrated by Bartholomew, L. Kay, et al, (2006). Six key steps were followed which involved: ( i) review of existing literature to assess the population dynamics, environmental factors and the health seeking behavior; (ii) exploring the specific objectives of the program; (iii) laying out the methods and strategies for intervention; (iv) developing the program; (v) adoption and implementation of the strategies; and (vi) evaluation of evidence gathered.
The implementation process involved an initial evaluation of basic indicators of obesity and type II diabetes; these included, body mass index (BMI), total cholesterol level, glucose, and insulin.
Role of community nurse
Though the program had a multidisciplinary approach, public health nurses played the most important role. They were involved in all aspects of the entire program, however, their main roles were in the implementation process. They recruited participants, undertook the initial clinical evaluation for indicators of obesity and type II diabetes, carried out follow ups as well as the final evaluation.
Outcomes
At the point of recruitment, there was generally a high prevalence of the risk factors for type II diabetes. The key indicators were all elevated: the Body Mass Index (BMI) of most of the participants was substantially high (average BMI 31.6 kilograms per square meter); approximately 46.3 percent had elevated total cholesterol; while about 56.8 percent exhibited hyperinsulinemia. By the end of the program there was a mean reduction of 18.6 percent in the all the key parameters among the participants who successfully completed the program.
Generally, success in a program of this nature is gauged by the percentage of reduction in the risk factors and continued evidence of the disease or lack of it thereof. This however, may not be optimal or may be completely incorrect. The evaluation stage is critical since it will determine if the correct guidelines were followed in each mapping stage.
Conclusion of the most important factor to consider
Minimal challenges were experienced in the development of the program. However, setbacks included funding. Identification and segmentation of the population was also a bit difficult. The other major problem experienced was arriving at a consensus on the best strategy to use to deliver the best result and the availability of staff. In the implementation/management stage, the main setback was compliance among the participants. A number of the participants missed education sessions and defaulted on their schedules for the checkups for body mass index (BMI), total cholesterol level, glucose, and insulin. Consistent follow-ups had to be carried out. These challenges provided a valuable lesson to be considered when planning for such an intervention program.
Comparison of this approach and other interventions
According to Torrance (1986), health intervention programs outcomes should be expressed in common units to enable clear comparison to be made. The analysis should begin with some units such as morbidity and health seeking behaviors. Kalz (2009) argues that there are persistent controversy regarding school based health intervention program. Kalz indicates that there is limited evidence to show reduction in obesity for school based programs. However, Carmina et al disagrees with Kalz assertions in their article School-based Obesity and Type 2 Diabetes
Prevention Programs: A Public Health Perspective, they suggest that school based programs yielded good results. They identified three key outcomes: reduced incidences of obesity, significant behavioral change in terms of nutritional intake and increase physical activity, and the feasibility of the program. Therefore, intervention programs should be integrated to have the maximum effects.
Reference
Bartholomew, L. Kay, et al, (2006) Planning health promotion programs: an intervention mapping approach, San Francisco : Jossey-Bass,
Carmina, N.et al, School-based Obesity and Type 2 Diabetes Prevention Programs: A Public Health Perspective,2. Web.
Katz, D.L. (2009) School-Based Interventions for Health Promotion and Weight Control: Not Just Waiting on the World to Change Annual Review of Public Health Vol. 30: 253-272
Torrance, GW. (1986) Measurement of health state utilities for economic appraisal: A review, Journal of Health Economics. Vol 5:1-30.