Obesity Prevention Activities: Implementation and Evaluation

Introduction

Obesity among adolescents is one of the most severe issues in the present-day USA healthcare system. Not only does this disease affect young people at the moment but it can also lead to serious complications in the future. In order to minimize the risk for adolescents, public health nurses need to come up with effective activities for the prevention and health promotion of the target population.

The Public Health Theory to Support the Implementation

The public health theory to be employed in the process of implementing preventative and promotional activities is the theory of health behavior change. This approach is the most suitable since it involves the direct engagement of the target population in activities aimed at improving their health. In particular, to alter adolescents’ attitude towards their eating habits, a public health nurse might make use of various monitoring devices that are becoming more and more popular at the present time (Glanz, Rimer, & Viswanath, 2015). The use of such applications as calorie trackers, mile counters, activity logs, and others is a particularly advantageous option for promoting health behavior change among young people since they enjoy using gadgets.

Environment-Based Approaches to Health Behavior Change

Approaches to health behavior change can be of various types, such as environment-based, technology-based, or policy-based. Prestwich, Kentworthy, and Conner (2018) remark that the environmental impact on the willingness to alter one’s health behavior is rather crucial. For instance, when there is a lack of appropriate facilities for exercises, even “the most fervent exerciser” will have no opportunity to work out (p. 205). Likewise, when one does not have enough money, he or she cannot afford to buy healthier foods that are too expensive. Such issues may affect a person’s behavior directly or indirectly (Prestwich et al., 2018). Health cognition models are closely associated with the environment, which presupposes that without adjusting the reinforcement schedule, no positive change can be reached (Prestwich et al., 2018). Therefore, scholars and public health practitioners pay attention to the investigation of environmental factors’ role in the process of health behavior change.

When analyzing the direct environmental effect on behavior, Prestwich et al. (2018) discuss the nudge theory and choice architecture. The creators of the nudge theory, Thaler and Sunstein, argue that people make choices not “in a vacuum” but in the environment the numerous aspects of which can influence individuals’ decisions (Prestwich et al., 2018, p. 207). The term “choice architecture” is employed to denote the creation or adjustment of the environment’s features that impact choices. Meanwhile, “nudge” indicates the possible application of the choice architecture in the process of making a decision regarding one’s health behavior (Prestwich et al., 2018, p. 207). Research results indicate that some people do not feel comfortable about being nudged to do some things and avoid others since such pushing may limit personal freedom and autonomy. However, when considering adolescents, it seems a viable option since this population group needs to be reminded of positive health behavior due to not being able to control their choices by themselves.

When using environment-based approaches to implement health behavior change, two kinds of social norms are employed: injunctive and descriptive. Descriptive norms are concerned with “who is doing what” (Prestwich et al., 2018, p. 211). Injunctive norms are related to what other people view as satisfactory or unsatisfactory demeanor. Thus, these regulations can guide individuals’ behavior by indicating what is appropriate or acceptable. Also, these norms may involve consequences of joining or refusing to participate in some behaviors.

Policy-Based Approaches to Health Behavior Change

An important constituent of developing behavior-changing tendencies is presented by the government’s regulations. Policy-based approaches to behavior change include making some types of conduct illegal, requiring health warnings, and altering prices (Prestwich et al., 2018). With the help of such measures, it is possible to gain positive healthcare results. What concerns adolescent obesity, the following policy-based approaches to health behavior change may be offered: increasing prices, attaching warning labels, and employing social marketing techniques. Increased costs and taxation, as well as the use of warning labels, can be used to reduce the consumption of such unhealthy products as sugared beverages. Research indicated that raised prices on tobacco products in some US states lead to the decreased consumption of cigarettes (Prestwich et al., 2018). Similarly, if producers of sugar-sweetened drinks informed their potential consumers about the drastic health effect or if they had to pay more taxes on their products, fewer adolescents would purchase them.

Technology-Based Approaches to Health Behavior Change

As it has been mentioned before, young people constitute a population group perfect for promoting health change by means of technology. Such approaches are easy to implement and use, and the target group members can exploit their devices to reach the desired change in health demeanor. The most popular health cognition models that might be useful in the context of the current project are gamification and the theory of self-determination (Prestwich et al., 2018). Gamification involves the use of game-like components such as points, prizes, competitions, and rewards to non-game contexts. In the applications focused on losing weight, such features as competition might be employed to promote young people’s willingness to engage in health-promotion activities. The self-determination theory presupposes the increased autonomous motivation is more likely to encourage people’s health behavior change than the pressure (Prestwich et al., 2018). Therefore, the use of technology, as well as positive impacts of environment and policies, can promote healthy habits among the target population.

Evidence to Support the Use of the Theory

Many researchers have focused their studies on the analysis of the health behavior change theory within the scope of adolescent obesity prevention. Some of the recent articles are focused on the technology-based approach to promoting behavior change in young people. Chen and Wilkozs (2014) evaluate the efficacy of technology-based interventions for obesity avoidance in adolescents. Having reviewed 14 scholarly papers focused on this problem, scholars note that behavior change theory is highly effective in the process of preventing adolescent obesity and promoting healthy behaviors through change (Chen & Wilkozs, 2014). The authors remark that in many of the reviewed sources, lifestyle change interventions are described as a positive approach to reaching health goals associated with obesity.

In particular, six articles indicate that there has been a decrease in body fat and body mass index (BMI) as a result of implementing a technology-based approach. Several other articles demonstrate that there has been an improvement in adolescents’ physical activity outcomes due to using applications (Chen & Wilkozs, 2014). What is more, almost all of the articles that evaluated dietary outcomes report the enhancement in the dietary behavior of the target population. The use of technology has also been noted as a trigger to improve the adolescents’ psychosocial functions, such as increased self-esteem, reduced depression, and better results on Behavior Assessment Scale (Chen & Wilkozs, 2014). Thus, the evidence from this study testifies the positive effect of the health behavior change theory on health outcomes of the target group.

Another study focused on the use of the health behavior change theory has been performed by Whittemore, Jeon, and Grey (2013). Scholars investigate the effectiveness of the Internet obesity prevention program for adolescent patients. Results of this research are particularly beneficial in relation to health behavior since they demonstrate the positive impact of technology-based programs on adolescents’ healthy choices. Scholars conclude that while the body mass index of the participants has not improved significantly, there were crucial advancements in their health behaviors and self-efficacy. In particular, the cessation of sedentary behavior, the initiation if healthy eating and physical activity, the decrease in sugared drinks and junk food consumption, and the increase in fruit and vegetable intake have been recorded (Whittemore at al., 2013). Scholars remark that Internet obesity prevention programs have a beneficial effect on school students.

Apart from investigating the role of technological innovations in the prevention of adolescent obesity, researchers also pay attention to the quality of applications offered for use. For instance, Schoffman, Turner-McGrievy, Jones, and Wilcox (2013) investigate the effectiveness of mobile apps for childhood obesity prevention and treatment. Schoffman et al. (2013) have included 57 applications in their analysis. With the help of independent rates, several features have been tested, the major one being the inclusion of the eight strategies and seven targets recommended by the Expert Committee for Pediatric Obesity Prevention’s. Other elements under analysis have been the use of gaming elements and the apps’ characteristics in general (Schoffman et al., 2013).

As a result of the investigation, scholars have come to the conclusion that almost all applications lack any expert recommendations, which is regarded as a serious limitation. Schoffman et al. (2013) remark that while mobile applications have a great potential to improve adolescents’ eating habits, these technological approaches should be reinforced by expert advice and comprehensive data about health behavior change. Thus, this is evidence of inefficiencies in the system of technology-based applications. It is necessary to strengthen such programs by expert opinions and recommendations so that they could lead to the best outcomes for the target population.

Activities to Decrease the Health Risk Among the Population

In order to reduce the health risk among adolescents, the following activities might be offered:

Activity Rationale
A set of physical exercises that will be performed under the teachers’ or parents’ supervision This measure is necessary for the youngest representatives of the target group. Although some children aged 12-14 reach puberty, they still need emotional and psychological support and encouragement.
Physical exercises based in a mobile application This approach will be useful for those adolescents whom their caregivers consider responsible enough to control their behavior by themselves. Still, if a public health nurse or parents are not sure that the child adheres to the program’s requirements, they will be able to check the results on the child’s phone or even receive a copy to their devices.
Dietary change base on an application Using this kind of change is expected to promote healthy eating habits among the target population. With the help of such apps, adolescents will be able to see how much harm some foods may cause and, at the same time, they will be recommended the healthiest food choices.
Regular self-assessment: calculating the BMI This activity will enable the young person to remain aware of the severity of his or her obesity. Adolescents will know that if their BMI is becoming higher, it is the indication that they should be more cautious concerning their physical activity and diet.

The Evaluation Program

To determine the efficacy of the set health promotion activities, the following measures will be taken:

  1. calculating the BMI of adolescents regularly to check whether their weight is approaching the normal measurement;
  2. surveying the target population systematically to find out which of the activities they consider the most effective and the easiest to follow;
  3. interviewing parents and teachers to identify whether the participants’ health behavior has changed to the desired extent.

Conclusion

The public health theory selected for the current project is the theory of health behavior change. This approach presupposes implementing positive adjustments to health demeanor of the target population, which is composed of adolescents. This age group’s representatives are rather vulnerable since obesity affects not only their physical condition but also their psychological state. Therefore, it is essential to implement the most effective activities and measures to help young people to get rid of excess weight in the most convenient and friendly way. Public health nurses, parents, and teachers should combine their efforts in the process of promoting health behavior change among the target population. With the careful choice of health promotion activities, the ultimate goal of reducing the target population’s obesity level will be reached.

References

Chen, J.-L., & Wilkosz, M. E. (2014). Efficacy of technology-based interventions for obesity prevention in adolescents: A systematic review. Adolescent Health, Medicine, and Therapeutics, 5, 159-170.

Glanz, K., Rimer, B. K., & Viswanath, K. (2015). The scope of health behavior. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health behavior: Theory, research, and practice (5th ed.) (pp. 3-22). San Francisco, CA: Jossey-Bass.

Prestwich, A., Kenworthy, J., & Conner, M. (2018). Health behavior change: Theories, methods and interventions. New York, NY: Routledge.

Schoffman, D. E., Turner-McGrievy, G., Jones, S. J., & Wilcox, S. (2013). Mobile apps for pediatric obesity prevention and treatment, healthy eating, and physical activity promotion: Just fun and games? Translational Behavioral Medicine, 3(3), 320-325.

Whittemore, R., Jeon, S., & Grey, M. (2013). An Internet obesity prevention program for adolescents. Journal of Adolescent Health, 52(4), 439-447.