The problem of obesity in children did not just happen by accident, fundamental changes in society are the main causes of the increase in incidences. Similarly, there is a recorded increase in incidences of cardiovascular diseases and type II diabetes mellitus among children with obesity being the leading predisposing factor. Intervention programs to prevent complications associated with childhood obesity are increasingly becoming a public health priority. A multidisciplinary approach is indeed necessary for an intervention program to be successful.
To reduce the health burden brought about by unhealthy living, the problem must be mitigated early in a child’s life. The intervention should take a public health approach. This would lead to a significant difference in morbidity and yield practical and sustainable benefits over a long period. As indicated earlier obesity is the major predisposing factor of type II diabetes in children. In theory, therefore, adopting a lifestyle that reduces your chance of gaining excess weight would significantly lower your chances of getting type II diabetes. The challenge, however, is how to transform the theoretical perception into practice. This is essentially the reason why a community/public health nurse is important in the intervention.
The specific objectives of the program 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
Based on existing theories and empirical data, an intervention mapping protocol was adopted in this program. The strategy involved six key steps: the first was a review of existing literature to assess the population dynamics, environmental factors and the health-seeking behavior; the second step involved exploring the specific objectives of the program; the third step involved laying out the method and strategies for intervention; the fourth step was the development of the program; while the fifth step involved adoption and implementation of the strategies and the last step is the evaluation of evidence gathered.
The intervention mapping protocol was adopted because it is systematic and provides a clear and well-defined planning, implementation and evaluation strategy.
The program was designed for a primary-level intervention. It involved lifestyle education sessions to address the health needs. A cohort of children and their families was 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. 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 a three-month interval. Measurements of the basic indicators were repeated to assess the impact of the intervention.
As a community/public health nurse, I was involved in all aspects of the program from development to implementation and evaluation. My team and I were in charge of recruiting participants, initial evaluations for indicators of obesity and type II diabetes, follow-ups, as well as the final evaluation. However, a multi-disciplinary team involving clinicians and nutritionists was also involved in various aspects of this project.
As indicated earlier the program adopted an intervention mapping protocol, and was fully funded by the Institute for Education in Public Health and the Department of Public Health and Sanitation. Minimal challenges were experienced in the development of the program, the major one was arriving at a consensus on the best strategy to use to deliver the best result, the other was 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 schedule for the checkups for body mass index (BMI), total cholesterol level, glucose, and insulin. Consistent follow-ups had to be carried out.
At the point of recruitment, there was generally a high prevalence of the risk factors for type II diabetes. The Body Mass Index (BMI) of most of the participants was substantially high (average BMI 31.6 kilograms per square meter), 46.3 percent had elevated total cholesterol, and 56.8 percent exhibited hyperinsulinemia. At end of the program, there was a mean reduction of 18.6 percent in all the parameters among the participants who completed the program.
Based on the outcome of this program, there is a clear indication that community/public health intervention strategy is feasible in reducing incidences of obesity and by extension type II diabetes and other morbidity associated with overweight. However, considering the small cohort that was involved in this program there is a need to escalate the number to involve a more diverse population in different settings.