Introduction
Obesity has become a major cause of concern for healthcare professionals in many countries, including Kuwait. The studies carried out in Kuwait indicate that more than 50 percent of the Kuwaiti population suffer from overweight, obesity, or metabolic syndrome (Al Rashdan & Nesef 2010, p. 42). It has also been noted that Kuwait is one of the leading countries in obesity rates (Jackson et al, 2001; Al-Isa, 2004; El-Bayoumy, Shady, and Lotfy, 2009). The underlying causes of these problems can vary; they can include unhealthy lifestyles, genetic predisposition to overweight, unavailability of healthy food, or stress (Simopoulos 2005, 9). Nonetheless, these causes vary in different countries and regions, and empirical studies are needed to show why Kuwaiti children suffer from being overweight. The prevalence of obesity has increased in a variety of developed countries, and it is often associated with high morbidity rates (Rubenstein 2005).
One of the principles of healthcare is that prevention is better than cure. This is why many scholars believe that many health risks can be averted provided that overweight problems are identified at an early age (El-Bayoumy, Shady, & Lotfy 2009, p. 154; Rubinstein, 2005, p. 103). Medical workers should focus their attention on childhood obesity because it is a good predictor and cause of dangerous diseases that can manifest themselves during adulthood, for example, hypertension, diabetes, respiratory disorders, or cardiovascular diseases (El-Bayoumy, Shady, & Lotfy 2009, p. 154). According to several studies parents often fail to report overweight and obesity problems in their children; moreover, they often assume that the condition is permanent and cannot be changed (Wake et al, 2002 p. 717; Jain et al, 2001, p. 1138). Parental neglect and their unwillingness to change the lifestyles of their children can be an underlying cause of overweight problems (Yu 2011, p. 105).
Overall, psychologists single out the following factors which increase the risk of obesity, namely, parental neglect, family dysfunction, and the psychiatric condition of parents (Tanasescu et al, 2000, p 1739). It has been observed that obesity can be sparked by various factors such as family relationships. Moreover, it is likely to occur during growth spurts (Giugliano & Carneiro, 2004, p. 17). Additionally, the increasing prevalence of obesity is often attributed to the changes in children’s diet and lack of physical exercise (El-Bayoumy, Shady, and Lotfy 2009). Therefore, there is a need to examine the prevalence and causes of obesity among Kuwaiti children. This knowledge is essential for helping those people who suffer from overweight problems. However, the associations between these variables have to be confirmed by empirical findings.
Purpose of the study
This study is aimed aims at exploring the prevalence of overweight and obesity among school children in Kuwait. The key problem is that not much attention has been paid to those factors which increase the risk of these health issues. The focus of the research will be children aged between 10 and 14 years. There are several objectives that this research has to attain:
- To establish the prevalence of overweight and obesity in children aged between 10 and 14 years in Kuwait;
- To explore the perceptions and attitudes of parents and teachers about childhood obesity in Kuwait;
- To determine the government policies aimed at addressing overweight and obesity among Kuwaiti school children;
- To assess the effectiveness of school health promotion programs in reducing childhood obesity and overweight among school children between 10 and 14 years.
In general, the purpose of this study is to offer a description of the prevalence of obesity and overweight in school-going children in Kuwait. These findings can help medical workers identify those children who are at a higher risk of developing overweight problems. Additionally, the study will be aimed at examining the perceptions and attitudes of both parents and teachers regarding childhood obesity. This information can be of crucial importance because very these health problems are often associated with a lack of parental awareness (Al-Kandari, 2006). The study will also offer recommendations for reducing the obesity epidemic in Kuwait.
Research Questions
The main research questions of this study are closely related to its major objectives. They are as follows:
- What is the prevalence of overweight and obesity among school children aged between 10 and 14 years in Kuwait?
- What are the perceptions and attitudes of parents and teachers about childhood obesity in Kuwait?
- What governmental health policies have been formulated to address overweight and obesity among Kuwaiti school children aged between 10 and 14 years?
- How effective is a school community health promotion program in reducing childhood obesity and overweight among school children aged between 10 and 14 years?
Theoretical framework
The theoretical framework adopted by this study is the ‘health promotion model’ that was developed by Nola J. Pender (1987). According to this model, health is defined as a positive dynamic state which is achieved through the conscious actions of a person (Hitchcock, Schubert, & Thomas 2003, p. 260). There are several reasons why this approach has been chosen. First, it emphasizes timely prevention of diseases which is often much more effective than treatment (Leddy 2006, p. 7). This approach seeks to identify health risks such as obesity and other diseases which can be associated with being overweight.
Nola Pender singles out health promotion or a set of measures aimed at reducing the possibility of diseases (Hitchcock, Schubert, & Thomas 2003, p. 260). Secondly, this approach emphasizes health promotion which is oriented toward improving the person’s mental and physiological state. These dimensions of the Pender model can be of great importance to medical workers who want to help people overcome obesity. The thing is that obesity can be explained by exposure to unhealthy food and genetic predisposition. Yet, at the same time, this health condition can be attributed to psychological disorders and unhealthy lifestyles (Jeor 1997, p. 471). Thus, Pender’s health promotion model can help medical professionals, teachers, and parents develop strategies for reducing obesity among children, adolescents, or adults. Nola Pender urges medical workers not to overlook psychological aspects of health, and they can be closely linked to obesity. Thus, some essential principles of Pender’s approach can be useful for investigating the causes of obesity and the development of healthcare plans for children.
Additionally, Nola Pender’s model is beneficial because it takes into account a variety of factors that can affect a person’s health, in particular, perceived health status, socioeconomic position, educational level, the level of social support, interpersonal influences (Polit and Beck, 2007, p. 119). Each of these factors can affect people’s attitude to their health. Therefore, healthcare professionals, as well as parents, have to modify these social and psychological variables to make a person pursue a healthy lifestyle.
It should be noted that this model pays close attention to the motivators which prompt a person to pursue a healthy lifestyle. The key problem is that many children and teenagers do not believe that they are exposed to health risks (Hitchcock, Schubert, & Thomas 2003, p. 260). Children and adolescents may not be aware of the dangers of overweight and obesity; this is why they do not regard it as an immediate threat to their health. Pender’s model emphasizes the benefits which can be gained through pursuing a healthy lifestyle. In this way, it is possible to better motivate children and adolescents, especially if they tend to have gained extra weight. The chosen health promotion model regards health as a means of fulfilling one’s potential or self-actualization (Ivanov & Blue 2008, p. 257). Its main advantage is that it focuses not on the threat of a disease, but on the benefits that health can bring to a person. This is why it can apply to obesity problems among children. On the whole, Pender’s model emphasizes the importance of motivation. This is why it can be used for the prevention of obesity among children. Based on this model, we will be able to work out a set of strategies that can help children overcome obesity problems. Yet, appropriate recommendations can be made only at the point when relevant data is available
Research Design
This study will be conducted in public schools that are based in Al Farwaniyah province in Kuwait. It will apply quantitative and qualitative designs that will be implemented on a sample of school-going children, parents, and teachers.
First of all, permission will have to be gained from governmental officials, teachers, and parents. Apart from that, the Ministry of Health will have to arrange for a female nurse and a male staff who will help in facilitating the research process. The female nurse will be in charge of the girls whereas the male staff will take charge of the boys in taking the anthropometric measurements. After gaining permission for the study, the research team will arrange with school principals the time when interviews and surveys will be held.
The following section will describe the main methodological aspects of this study.
Quantitative research
Quantitative research methods will be applied to gather information about children, their lifestyles, family, and the perception of parents about health and overweight. The questionnaires will be used for students and their parents. A quantitative framework will enable us to identify several independent variables which can affect children’s nutrition and lifestyles; among them, we can single outage, sex, family, the degree of parent’s awareness about health risks. This approach will show the prevalence of overweight and obesity among school children aged between 10 and 14 years.
It is also necessary to take anthropometric measurements of children, including their height, weight, skinfold measurements, waist circumference, hip circumference, and arm circumference. This information will be essential in calculating the Body Mass Index of the participants. Additionally, it is important to record the age of every participant since it can also be a determinant of a child’s health behavior. Anthropometric information will show whether the participants are likely to have problems with extra weight.
The survey, which will be designed for parents, will require them to provide information on demographic characteristics of the family, namely family structure, the number of children within the family. These questionnaires will also gather information on children’s diet and their participation in physical activities. In part, these questions will show whether parents understand various risks associated with unhealthy behavior. Based on these data, it will be possible to trace the relations between family status, diet, and physical activities on the one hand, and the child’s propensity to be overweight. The use of quantitative methods will enable us to measure the importance of various factors that contribute to obesity among children
Qualitative research
Qualitative research will be used to gather descriptive data for the study. The interviews shall have guiding questions which will aim at exposing more information about the problem of overweight among children. The interviews will be conducted with various stakeholders including teachers, school principals, and government officials. The interview questions intended for teachers will seek information about those physical activities which are available to children and their nutrition in school. At this point, the main task will be to find out how often children can take part in various physical activities in school.
In turn, while interviewing school principles, we will focus on those initiatives which are aimed at promoting a healthy lifestyle and solving overweight problems among children aged between 10 and 14. Moreover, they will have to tell whether these initiatives have been effective and how they can be improved. They will be encouraged to offer their recommendations.
In turn, by interviewing governmental officials, we will be able to learn more about the policies and strategies implemented by the government to reduce overweight in children. In particular, it is necessary to ask them about short and long-term strategies that can reduce the risk of obesity at a national level. These people will also have to speak about the current situation in Kuwait and some key factors which could have led to the increasing prevalence of overweight among Kuwaiti children as well as adults. The qualitative design of the study will rely on a phenomenological approach (Moran, 2002; Merleau-Ponty 2002). This means that the participants will be asked to describe a certain phenomenon and express their views about it.
The rationale for a mixed approach to the study of obesity in Kuwaiti children
There are several reasons why this study will apply both quantitative and qualitative methods. First, a great number of studies done in this area focus primarily on different variables affecting children’s health, for example, age, sex, family income, or educational level of parents. For instance, it is possible to mention the study by Al-Isa and Moussa (1995) who examined the impact of these factors. However, not much attention has been paid to those obstacles which can prevent children from adopting healthy lifestyles. This question is particularly important for the study of obesity in Kuwaiti children. A mixed research design can answer these questions. First, this study will rely on such qualitative methods as unstructured interviews because it enables people to better express their views about a specific problem. They will not be bound by forced-choice questions which do not normally allow people to provide their recommendations. The conversation between a researcher and a participant can throw light on some underlying causes of obesity among Kuwaiti children.
In turn, quantitative tools will identify the complex relations between family composition, age, sex, and obesity. Quantitative analysis of data will show whether there are any factors such as the structure of the family that can increase the risk of obesity among children. The combined use of both quantitative and qualitative approaches in the study will enable the researchers to better understand various aspects of overweight and obesity among children in Kuwait.
Summary
The increasing rate of obesity in Kuwait among schoolchildren has raised the concern of many healthcare professionals. This trend is often attributed to changes in dietary patterns and lifestyles. The proposed study will examine the factors which can contribute to obesity and children aged between 10 and 14. This study will rely on the health promotion model developed by Nola Pender. This framework will help us in analyzing the causes of overweight and formulating recommendations. This study will use a mixed combination of qualitative and quantitative methods of collecting and analyzing data.
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