Introduction
According to Public Health England (2016), childhood obesity is one of the most compelling public health issues of the 21st century, both globally and locally. In the last decades, the rate of childhood obesity in the UK has been increasing drastically, and it is expected to continue rising in the future. The prevalence of obesity among young children has practically doubled and children in the age range between 4-11 years seem to be the most affected. Obesity and overweight are defined as the accumulation of excessive fat. Children are getting excessive body fat at a very young age, which often persists into their adulthood, leading to various health risks. Therefore, childhood obesity is a high-priority issue that needs to be addressed (Public Health England, 2016).
Several studies conducted in the recent years have proven that prevention is the most feasible response to childhood obesity. Despite the fact that parents play a primary role in preventing their children from getting obese, schools represent the most suitable setting where obesity prevention programmes can be implemented. The school environment is considered an appropriate place where children can learn how to adopt healthy eating behaviours and a healthy lifestyle (Waters et al., 2014).
This research paper seeks to examine the role that primary schools prevention programmes play in tackling childhood obesity by undertaking a literature review. Chapter 1 provides background to the topic and subsequently states the research questions followed by the aims and objectives of this study. The second chapter presents in detail the research methodology applied to identify and synthesize research literature material relevant to the study and offers a rationale for its selection. Chapter 3 outlines the findings. The fourth chapter discusses and analyses the findings and states the strengths and limitations of this research study. A conclusion is then drawn followed by recommendations.
Background
Childhood obesity remains a major challenge in the world with regard to public health concerns of the 21st century. According to World Health Organization (WHO) (2012), childhood obesity has become a major health concern worldwide. In fact, children that are classified as obese are considered at risk of developing health conditions such as cardiovascular disease, type II diabetes, hypertension, some types of cancer, and psychosocial problems in later years. Moreover, childhood obesity is considered one of the indicators of adult obesity. In fact, 60% of children that are obese before puberty are likely to become overweight or obese in their adulthood (WHO, 2012).
According to the National Child Measurement Programme (NCMP), the situation in the UK regarding child obesity is quite alarming. In fact, data from 2016 show that 19.1% of children of 10-11years were obese and 14.3% were overweight, whereas 9.1% of 4-5 year-olds were obese and 12.8% were overweight. This means that in the UK nearly one-third of children aged 4 to 11 are overweight or obese, and younger generations are becoming obese at earlier ages and staying obese for longer. The National Child Measurement Program (NCMP) is a nationally mandated public health programme that provides data on child obesity, which is part of the government’s approach to tackling the problem.
Childhood obesity is the result of the caloric imbalance, where the consumption of calories exceeds the amount of what is burnt (energy output). This imbalance leads to accumulation of excessive fat. The body mass index (BMI) is used to measure the level of overweight and obesity. BMI is a globally used metric used to determine whether a child has a healthy weight for his/her height. The calculation for the BMI is performed by dividing the weight of the child by their height and taking into consideration the gender and the age of the subject. If a child has a BMI that exceeds the age- and gender-specific 95th percentile, he/she is considered obese and prone to obesity-related co-morbidities. On the other hand, if the BMI is more than 85th percentile but lower than 95th percentile, the child is classified as overweight (CDC, 2015).
According to Public Health England (PHE) (2016), the UK has (8,7%) obesity-related mortality compared to the average of 7.7% across other European Regions. Failing to address the obesity epidemic and related health consequences substantially increase health care costs for the NHS (PHE 2016).It is estimated that the NHS in England spent £6.1 billion on overweight- and obesity-related health issues between 2014 and 2015. The UK-wide NHS costs attributable to overweight and obesity are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year.
Reducing obesity, particularly among children, is one of the priorities of Public Health England (PHE). The aim is to increase the proportion of children leaving primary school with a healthy weight. According to Clarke et al. (2015) schools are major settings where obesity prevention can be achieved, especially where in-depth and long-term contact is needed. Schools present the opportunities to observe the main behaviours that lead to child obesity. In addition, they allow implementing the strategies that encourage children to be physically active and adopt healthy eating behaviours. Moreover, the school environment provides policies, curriculum, and extra-curricular activities that have a high potential and positive influence on the lifestyle of the children. The behaviour change that the children learn at this stage is later translated into their adult life, preventing them from becoming obese adults (Clarke et al., 2015).
Primary schools offer a positive infrastructure that ensures a physically safe and supportive environment backed by policies, as well as members of staff that have intimate and intensive contact with the children (Brown and Summerbell, 2009). Involving school nurse in school-based intervention is essential in fighting childhood obesity. This is because of their ongoing connection with students at cost-free accessibility. School nurses work closely with children and are typically the first person to contact the parents in case of emerging concerns regarding the child’s weight (Ford et al., 2004). Recently, the Royal College of Nursing has revealed that the number of school nurses has reduced by 13% since 2016 (Royal College Nursing, 2016). In this light, reducing funding for school nursing can be one of the biggest challenges and could lead to health crisis among children (Edward et al., 2016).
The prevalence of obesity has also been linked to social inequality where greater inequality results in higher risk of becoming obese, especially among children. This factor becomes especially relevant once we acknowledge that school environments include students with widely ranging socioeconomic backgrounds. As a result, to school-based prevention programmes, more children from different ethnic and socioeconomic groups can be easily reached (Lycett, 2015).
The Department of Education highlights the importance of a healthy diet for children’s growth and development and recognizes the fact that an inadequate diet can have a negative impact on the school achievement of the children. Considering that children spend in school 6 hours per day and 190 days in a year, school environment is a suitable setting to educate and guide children on how to make healthy nutrition choices. The Department of Education also recognises the potential of schools for promoting health policies. The use of school-based approach could ensure a reduction in child obesity rate as it provides knowledge on healthy eating habits and physical activity which can be applied throughout students’ lives (GOV.UK, 2015).
Aims and Objectives
This research study aims to locate and review research literature on school-based obesity preventive approaches. The second goal of the study is to identify and address possible gaps in the knowledge of school-based child obesity prevention that could establish the direction for further research.
The objective of this study is to examine the effectiveness of obesity prevention programmes and to determine to what extent children’s home environment can influence the implementation and success of these programmes.
Research Question
What is the role of primary school-based approaches, parental involvement, home environment, socioeconomic, and cultural factors in the prevention of obesity among children in the UK?
Methods
A narrative literature review is considered the most appropriate methodology for this study as it involves searching for published studies and consequently reviewing them to report their findings (Green et al., 2006). Considering that research has already been carried out on the topic of this study, a literature review will have the benefit of drawing new findings by analysing and reviewing the existing research. Moreover, searching and analyzing relevant literature will assist the researcher to answer the research question. In fact, a literature review sets the background of what the researcher wants to investigate, and it provides a platform to recognize possible gaps and establish what the contribution of their study will be to the existing knowledge (Bryman, 2016).
Health-related and general databases were used for the literature search. The focus of the study was the information on school-based prevention programmes and the influence of food environments associated with schools. Relevant websites were also searched, such as Department of Education website, Public Health website and government websites.
When conducting a literature search, it is very important to select the right databases. However, in order to access the most relevant studies, one has to choose the most appropriate search terms (Coughlan and Cronin, 2016). For this study, the following search terms were used: child obesity, diet, eating habits, physical activity, schools, school meals, food environment, food outlets, obesity prevention and school policies. Boolean search operators such as AND, OR were also used. According to Delaney (2009), Boolean search operators assist researchers to narrow down the research of relevant studies and to get more accurate results (Delaney, 2009).
Inclusion and exclusion criteria were applied in this research to make the procedure clear and precise (Jones, 2007). The inclusion and exclusion criteria were mainly based on whether the studies focused on childhood obesity in the UK, specifically on primary school-based obesity prevention programmes.
Inclusion Criteria
- Articles published between 2007-2018
- Articles written in English
- Literature reviews, secondary research articles and books on childhood obesity between the year 2007 and 2018
- Studies conducted in the UK
Exclusion Criteria
- Studies that focused on the treatment of children with obesity were not used in this review due to the focus on prevention programmes instituted by primary schools
- Studies conducted outside the UK
- Studies conducted in the UK focusing on the population of unsuitable age group
- Studies conducted before 2007, which are considered old and outdated
- Studies written in languages other than English to avoid translation issues
- Studies on adult obesity
The search strategy that was used in this research involved a literature search from a range of electronic databases. Peer-reviewed publications were retrieved from the following databases: PubMed, Google Scholar, Medline and EBSCOHost. A total of 8495 references were identified from electronic databases and other relevant publications.
The first 200 results were reviewed, and all the duplicated studies were deleted. This was done by screening all the titles of the identified literature materials and their abstracts. This initial screening of titles and abstracts produced 72 potentially relevant articles. These papers were further screened using their full text. The studies were then reviewed, and a post-screening of all the full texts of possibly relevant studies was conducted to ensure that the materials were consistent with all inclusion criteria. In the end, 14 studies met the inclusion criteria. Search results are summarised in the flow chart below.
Below is the evidence table of the 14 articles included in this study.
Evidence Table
Findings
A total of 14 studies were included in this project for being reviewed and synthesised in order to answer the research question.
School Policy on Diet and Physical Activity
Healthy balanced diet is vital for children’s’ growth and development. In addition, a poor diet can have negative implications on school achievement of the children. The Foods in School Policy was introduced in 2013 in order to tackle the continuous rise of child obesity. A whole school approach was incorporated which ensured that all foods and drinks consumed in schools (school meals, foods brought in school by pupils, foods and drinks available in vending machines and tuck shops) are expected to meet the Nutritional Standards for School Lunches (GOV.UK, 2015).
According to Owen et al. (2010) there is a relationship between physical inactivity and childhood obesity, as well as increased cardiometabolic risk. A randomized control trial conducted with 2,049 primary school children showed that an increased level of physical activity in the affected groups would have positive effects on their general health. Physical activity is important for maintaining good health. Therefore, policymakers and researchers have focused on the amount of time that a child spends on physical activity in order to address prevention of obesity in primary schools. Low levels of physical activity have been identified as a risk factor for obesity and several other health conditions (Owen et al., 2010).
Young children above the age of five should do vigorous exercises for 60 minutes a, an amount that exceeds the time spent on transportation and school physical education classes. Physical activity policies that involve a curriculum, time allocation strategies, and infrastructure resources are an important factor in ensuring that the school environment is an adequate space for children to participate in physical activities (Visscher and Kremers, 2015).
Effectiveness of School Based Programmes
A cluster-randomized trial conducted by Adab et al. (2015), aimed to assess the clinical significance and cost-effectiveness of a 12-month obesity prevention programme that took place in primary schools in the West Midlands. The results of this study suggest that school-based interventions can prevent childhood obesity and could be more cost-effective in relation to NHS obesity prevention practices (Adab et al., 2015).
According to the study conducted by Adab et al. (2017), a 12-month WAVES intervention that presented an opportunity for pupils to take part in 30-minute physical activity, interactive skill-based programmes for six weeks, and a partnership with a football club was used in the prevention of obesity. The WAVES (West Midlands Active lifestyle and healthy Eating in School) study also incorporated local families into the physical activity opportunities in the form of healthy skills workshops. The participants in the study from 54 schools had their weight, height, body fat percentage, waist circumference, blood pressure, and their skinfold thickness measured and recorded. The results were then compared to those of students who did not take part in the intervention. The study revealed that there were no significant changes in the weight status of the participants. This study revealed that schools could not lead the childhood prevention agenda without collaboration with outside parties and stakeholders (Adab et al., 2017).
A study by Martin et al. (2018) proved that the combination of school-based education and nutrition interventions has the capacity to positively influence school achievement in general. The results obtained by the research team suggest improvement in the domain of executive cognitive function associated with physical-only interventions. On the other hand, no improvement was observed in achievement on specific subjects, such as mathematics and reading. A moderate difference in the average achievement was observed in environments aimed at dietary improvements of the school environment. However, this study also revealed that there were no significant changes in the weight status of the participants (Martin et al., 2018). Therefore, activity- and diet-based interventions have an additional beneficial effect that should be acknowledged by policymakers and school administration.
The study by Clarke et al. (2015) aimed to analyse the perception of parents and their children on the role of schools in preventing child obesity. 30 parents and 62 children took part in the WAVES, a school-based obesity prevention programme. The study showed that participants were supportive of the programme. However, despite the fact that they recognized the important role played by schools in preventing childhood obesity, they considered parental involvement equally vital to the success of school-based obesity prevention programmes (Clarke et al., 2015).
Parental Level of Involvement
A randomized controlled trial (RCT) by Kipping et al. (2011) aimed to implement a programme for 9 years old children that combines healthy eating lessons and increased physical activity. It also aimed to explore possible methods that could facilitate parents’ involvement in the programme. Parents respond positively to collaboration with schools. Newsletters and homework activities were considered the most suitable ways in developing parental involvement in the programme and facilitating home-school collaboration (Kipping et al., 2011).
Another study by Katz et al. (2008) was conducted in order to assess the effectiveness of school-based prevention strategies. This review showed similar results whereby school-based strategies are effective in promoting healthy nutrition and physical activities. However, family involvement was essential to the success of this prevention programme (Katz et al., 2008). The research team also evaluated the effectiveness of specific strategies, both separately and in combination. The obtained results suggest that nutrition-focused interventions, TV and sedentary lifestyle reduction, and combined interventions differ insignificantly in their effectiveness. However, further disaggregation of results revealed that studies focusing on interventions with parental involvement produced greater improvement in school children’s body weight (Katz et al., 2008). Thus, the latter can be identified as a key component recommended for inclusion in other school-based programmes.
Family Socioeconomic Status
A cross-sectional study carried out by Goisis et al. (2015) on (11, 965) 5-year-old and (9384) 11-year-old children agreed that children from low-income families were at a higher risk of obesity and overweight. The results obtained from this study revealed that there was a link between income inequalities and the risk of obesity in children since children in the low-income families were at higher risk of being obese compared to peers from high-income group (Goisis et al., 2015).
A further health survey study conducted by Stamatakis et al. (2010) showed similar results, whereby children from families with lower socio-economic status were more affected by obesity. The relationship was established using BMI of 15271 children and a composite socioeconomic position (SEP) score. Children with lower SEP scores were better represented in each of the four target groups (Stamatakis et al., 2010). It is also necessary to acknowledge that the trend was more prominent in the recent years, indicating the urgent nature of the issue. In order to effectively tackle childhood overweight and obesity, there is a need to reduce the socio-economic disparities. Urgent action to tackle socioeconomic inequalities in children’s health is a crucial step in the fight against obesity (Stamatakis et al., 2010).
Family Eating Habits and Culture
Savage et al. (2007) carried out a literature review on parental influence on eating behaviour. The aim of the review was to analyze the factors that shaped the development of children’s food preferences and eating behaviours in the first years of their lives. The findings revealed that factors such as parental feeding practices, culture, and tradition have a massive influence on the children’s eating behaviour. According to the review, the most significant factors influencing the formation of dietary habits included breastfeeding practices, genetic predisposition, repeated exposure to different types of food, and the transition to an adult diet, among others. Parents, who cover the roles of providers and models, constitute a major influence on child’s behaviour. Finally, cultural and socioeconomic context needs to be taken into account to establish an appropriate perception of healthy weight.
Recent studies conducted in the UK and in the US showed that children from minority ethnic groups are more vulnerable to obesity and overweight. Maynard et al. (2009) aimed to understand what could be done to promote healthy eating and active lifestyle among children with the ethnic minority background. The findings from this study suggested that schools represent the best setting to implement obesity prevention programmes. However, this study showed that places of worship could also provide valuable opportunities to involve the entire family and community. This could assist policymakers in developing specific culturally acceptable programmes that would be more effective to reduce child obesity rate among ethnic minorities (Maynard et al., 2009).
Kipping et al. (2010) conducted a pilot cluster randomized trial on schoolchildren aged 9-10. The aim of the study was to increase fruit and vegetable intake as well as increase the preference and knowledge about vegetables and fruits among the children. A similar study was conducted in the US and was able to achieve a positive result. Therefore, Kipping et al. (2010) decided to conduct a similar study with the hope of getting similar results.
Discussion
Source Analysis
The study by Adab et al. (2015) used a cluster randomised controlled trial, which is among the most reliable approaches to obtaining quantitative data. The paper contains a detailed account of the data collection, allocation, blinding, and analysis. It is important to point out that the authors did not formulate research hypotheses and did not specify limitations of the study, introducing the possibility of bias. Nevertheless, the findings are relevant to the research question.
The paper by Adab et al. (2017) relied on the same selection of tools and strategies. However, it introduced a number of improvements beneficial for the quality of results. The expected outcomes of the study were specified in the Methodology section, mitigating the absence of a research hypothesis. Each section of the results was accompanied by a table summarizing the findings. Selected participant feedback was added to the Results section, providing additional insights. Finally, the strengths and weaknesses of the study were acknowledged in a separate section. Overall, the evidence offered by the study can be considered of the highest quality and relevant to the formulated research question.
The report by Public Health England offered a comprehensive snapshot of the current understanding of childhood obesity. Importantly, the report did not specify the methodology used to obtain the data included in the document. Similarly, no research question was used in the document. Nevertheless, it is possible to assume that the majority of sources used by the authors underwent a rigorous verification process prior to the inclusion into the official guidelines. Thus, it can be considered an authoritative source.
The study by Owen et al. (2010) was based on primary data obtained via standardised clinical methods. All sampling procedures and tools selected by the researchers were defined with sufficient clarity. It should be mentioned that the applicability of the findings to the current study is limited due to its focus on the differences between ethnic groups. Nevertheless, it serves as a reliable source of information on the impact of physical activity on obesity-related risks. The article fully answers the research question.
The article by Savage et al. (2007) provides an exploratory account of factors responsible for dietary preferences development in children. No research question is formulated by the authors, which is permissible for an exploratory study. The methods of data collection and analysis utilized by the research team are not explicitly stated. Thus, the results are prone to bias, which should be acknowledged during the development of interventions.
The study by Stamakis et al. (2010) used the data obtained from a number of nationwide health surveys. The data was analyzed using multiple logistic regression, which is sufficiently accurate for the purpose. All of the documented practices are appropriate and suitable for the study purposes. The obtained result is relevant to the research question. No biases identified in the study despite the absence of the Limitations section.
The article by Visscher and Kremers (2015) is an exploratory study of the issue of obesity prevention. It does not utilize a systematic approach. Thus, it does not rely on a clearly formulated research question and does not list study methods. Nevertheless, the article provides a comprehensive overview of available knowledge on obesity prevention by incorporating and referencing reliable sources. No indications of bias or methodological inconsistencies were located during the review.
The paper by Martin et al. (2018) obtained data from 17 databases for the study. The paper also included a detailed description of the intervention along with the hypothesised mechanism responsible for its effectiveness. Inclusion and exclusion criteria were described in detail and disaggregated into subgroups for additional clarity. Separate subsections were dedicated to the description of issues encountered in the process, adding to the credibility of the findings. All potential sources of bias were acknowledged and addressed. The paper fully answers the research question and demonstrates adherence to highest academic standards.
The article by Kipping et al. (2011) is a qualitative study of an obesity prevention intervention. Data collection, data analysis, and process evaluation were conducted using standardized quantitative and qualitative tools (Strata and Vivo, respectively). Ethical approval was given by a Committee for Ethics and the faculty of medicine. The consent was obtained from participants or their parents. The study had low response rate and was based on a relatively small sample, which was acknowledged in the Limitations section. The obtained findings answer the research question.
The article by Clarke et al. (2015) is an exploratory study of the role played by schools in obesity prevention. Primary data was obtained from headteachers of selected schools and analyzed using NVivo, which is an appropriate qualitative tool. The responses were anonymized in accordance with the recommended procedures. Importantly the conclusions were based on personal perceptions and are thus of limited validity. Nevertheless, the findings are relevant to the research question.
The study by Maynard et al. (2009) explored the efficacy and feasibility of a specific obesity prevention intervention. Due to the exploratory nature of the study, no research question was explicitly formulated. The study was consistent with ethical and methodological standards and relied on the sample of sufficient size. Each of the variables was measured by an appropriate data collection tool. All of the limitations typical for qualitative studies were acknowledged.
The source by Kipping et al. (2010) assessed the effect of the intervention on dietary outcomes of schoolchildren using a quantitative approach. The authors clearly formulate and fully address the research question. Data collection and analysis methods used by the team were done in accordance with CONSORT guidelines, adding credibility to results. However, the selected sample is not fully representative of the target audience, which is pointed out in the Limitations section.
The article by Katz et al. (2008) uses literature search as a data collection method. The search was conducted in accordance with the academic requirements to systematic reviews. Data was collected and processed by two research team members independently to minimize bias. The analysis was done using statistical software. The authors do not acknowledge other possible limitations. The obtained results are sufficient to sufficiently cover the research question.
The study by Goisis et al. (2015) used multinomial logistic regression to quantify the effect of inequality and socioeconomic status on risk of obesity and overweight among children. All modifiable risk factors were identified and incorporated into the study design. The main limitations of the study, such as the subjective nature of some of the submitted data, were acknowledged by the authors. The study’s research question is answered in detail in the respective section.
Summary of Findings
The present review has provided the systematic analysis of the synthesised literature on school-based approaches towards preventing childhood obesity. The findings from the literature review provide an answer to the research question. The findings have shown that primary schools successfully meet their goal of preventing obesity among children attending school. Moreover, school policies have been identified to ensure that schools continually promote long-term healthy eating habits and physical activity for the children. Nevertheless, policies alone are insufficient for addressing the physical inactivity and unhealthy diet among school-going children (Sommer et al., 2016). It is not possible for schools to succeed in preventing childhood obesity solely by ensuring the availability of healthy food, education, and physical activity (University of Birmingham, 2018). Considering that recent studies have shown that 80% of children with obese parents are more likely to become obese as well, the involvement of parents in tackling child obesity is vital (Kipping et al., 2011).
The findings have also highlighted that some children are more likely to become overweight or obese than others. Families with low-income status, social deprivation, and ethnicity have a considerable impact on the likelihood of children for becoming obese or overweight. These factors also have a significant impact on school obesity prevention programmes. Socioeconomic status is one of the factors that can influence children’s dietary patterns. Lack of funds is one of the barriers to healthy eating. Findings have highlighted that socioeconomic disadvantage plays a significant role, as families with a low-income struggle to buy healthy foods to prepare for their children and end up resorting to unhealthy foods. There is also a correlation between deprivation and childhood obesity. The National Child Measurement Program data analysis shows that children living in the most deprived areas have a higher incidence of obesity. Ethnicity also seems to have an effect on childhood obesity, whereby children from ethnic minorities are more prone to the condition.
Strength and Weaknesses of This Study
In order to ensure the relevance and applicability of evidence, the sources included in the sample were examined and assessed on an individual basis. Sufficient diversification of approaches was ensured by including both qualitative and quantitative studies incorporating different study designs. The obtained results were verified for consistency by comparing them to conclusions made by other researchers in the field. The alignment of findings with the current scientific understanding signifies is strength from an academic standpoint.
Despite strengths of this study associated with providing relevant evidence to examine the role of school-based prevention programmes in the UK, it also presents some limitations. A major limitation is that this study is not based on primary research due to the lack of time for the completion of this project. However, it should be understood that this limitation is only relevant for certain domains of healthcare studies, such as determining the effectiveness of treatment options. School-based interventions constitute a more complex entity that requires acknowledgement of a multitude of factors, the exact effect of which is still undetermined. Therefore, this limitation is acceptable at this stage of the inquiry.
It is also necessary to point out that the design of the study did not allow accounting for the design of the studies included in the sample. As was mentioned above, the sample features a number of quantitative, qualitative, and mixed-method designs. While each of these studies was individually reviewed for validity, it is not possible to determine the overall quality of evidence obtained in this way with a reasonable degree of certainty. Thus, it is possible that some of the findings are supported by sufficient scientific evidence whereas others are based on unreliable information. While it was possible to disaggregate the findings by the quality of evidence, this step was not performed due to limited time and resources available to the research team. In addition, it can be argued that such degree of accuracy is permissible given the exploratory nature of the research at hand.
Conclusion
The rate of childhood obesity seems to increase steadily. Therefore, PHE urges the necessity of a comprehensive intervention. Changes in healthy habits, such as a decrease in sedentary lifestyle, low intake of calories, and increased physical activities, are recommended in schools as methods of preventing the childhood obesity.
The main point that came up in the research study is that school-based obesity prevention programmes are considered a key strategy in tackling this issue. Schools represent a suitable setting for educating children on healthy eating habits and physical activity. Additionally, in comparison with NHS interventions, school-based ones are more cost-effective and have the opportunity to come in contact with a larger number of children from different backgrounds. School policies on diet and physical activity have brought huge improvements to the nutritional standard of food and drinks consumed on the school premises. Therefore, it can be concluded that schools play a strategic role in the prevention of childhood obesity. However, this study indicates that the success and implementation of school-based interventions are influenced by the home environment of the children. Factors such as family eating habits, culture, and socioeconomic status have a great impact on the outcome of the prevention programmes.
Recommendations
There is a need for collaboration between a wide range of stakeholders both at the community level and at the national levels in order to manage childhood obesity (Redsell et al., 2011). Such collaboration can be coordinated and managed if schools taking up the role of preventing childhood obesity have parental involvement in their programmes.
Further research should also be conducted on prevention programmes that address obesity among children from ethnic minority groups. Further research is also needed on policy diversification whereby local communities can take independent responsibilities to tackle obesity with programmes more suitable to their population.
There is also a need to institute a widespread policy change to the broader family, community and food industry contexts through collaboration with health coordinators from schools (Heise et al., 2016).
Finally, the use of school gardens could also have the potential of reducing obesity among young children since they increase access to fruits and vegetables. Schools policy could include school gardening as an integral part of the curriculum. However, further research might be necessary to examine the effectiveness of the proposed solution.
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