Challenging Dogma - Fall 2009

Thursday, December 17, 2009

Decreasing Childhood Obesity: A Critique and Restructuring of New York State’s Activ8kids Campaign- Tori Jensen

I. Introduction

In New York, the amount of childhood obesity has risen to a detrimental size (1). Regarding children, it is important to involve the social environments, the community, and the state when it comes to obesity. Monitoring the way children eat, play, and the amount of screen-time a child is allowed to watch while in school may subdue this issue. Unfortunately child obesity rates have not decreased by a significant amount.

In comparison, in 2003, New York State’s rate of obese children was 15.3% and in 2007 the obese rate was 17.1% (2). The numbers tell us that campaigns and programs, involved in child health awareness, have been unsuccessful in reducing the risk of overweight and obese children. Overweight preschool children are twice as likely to become obese as an adult (3). Teaching children ways to be healthy and active at a young age are key components to reducing the numbers of overweight or obese adults.

One out of every five children ages six to eleven are overweight and the numbers of obese children are increasing rapidly (4). Reducing the numbers of overweight children and potentially reducing the risk of becoming overweight, is a beginning to maintaining the dangers of child obesity. Changing the way children look at health may significantly change their future.

In 2008 Dr. Ludwig reported that the amount of childhood obesity has reached epidemic proportions and that the impact of this increase rate will be felt for several more years (5). Why is there such a dramatic change in the last 50 years? There has been an increase in the amount of hours of screen-time, the availability of food, and not paying attention to when they are full. Moreover, children may not have access to healthy food products. Healthier food tends to be more expensive, parents may not have the finances to purchase these products, and there may be a lack of facilities promoting physical activity in a community.

II. A Critique of New York State’s Acitv8kids Campaign

The Activ8kids campaign was launched in 2005 in New York to increase the amount of physical activity to one hour a day. The organization recommends five servings of fruits and vegetables, and limiting screen-time to two hours a day. The idea was to promote a healthy lifestyle for children under the age of eight (6). The planning behind Activ8kids was the beginning to a healthier lifestyle for children. Unfortunately, the program failed to mitigate the rate of childhood obesity from 2005 to 2009.

It is difficult to regulate the amount of screen-time, physical activity, and the amount of fruits and vegetables a child consumes at home. Engaging in physical activity for an hour a day is healthy for any individual, but extended periods of inactivity should be avoided (7). Once the children leave school for home, how can those who are in charge of the campaign regulate screen-time? After school television, physical activity, and healthy eating habits are maintained by the parent or guardian. The Activ8kids Campaign does not take into account the interpersonal level, assumes people behave rationally, and does not consider the public policy level of the children.

A. Activ8kids does not consider the social environment

The interpersonal level includes the primary social relationships of the children (8). Environment outside of the classroom and the cultural upbringing, including food availability, all play an important part in child obesity. The campaign fails to take into account the social environment of the children. One key component to decrease child obesity is the parent(s) setting a good example for their children by showing their own healthy habits (9, 10). If parents are not included in the process of living a healthy lifestyle, healthy habits may not be made.

In addition, there is a 50% chance a child will be obese if one parent is obese. The possibility of obesity in children increases to 80% if both parents are obese (9, 10). Parents should take care of themselves to show a positive and healthy way of living for their children. This could include eating healthy, being physically active, and regulating the amount of screen-time during a given day.

Convenience is one of the main criteria’s for food choices today in American children. More families are buying fast food, consuming restaurant food, and buying low-cost ready to eat meals that are quickly accessible to make at home (10). It is nearly impossible to regulate the amount of fruits and vegetables a child consumes at home. The campaign did not take into account that children may not have healthy options. Prepackaged food usually contains high amounts of fat and calories with little nutritional value. More over, 84% of children eat too much fat and more than 91% consume too much saturated fat (11). Parent involvement in their children’s lives is very important in adopting healthy eating and exercise habits. Children model their parent(s) behavior and if parent(s) are not eating healthy, then they are not being good role models for their children’s health (12).

Children may not have healthy food options due to the amount of time parents are away from home, which leads to convenient food options, food pricing, and accessibility. There have been studies to show that parents that try to limit foods with children may be actually promoting an increased preference and consumption of these foods (10). Parents need the knowledge and to be aware of the possible outcomes that may lead to an overweight or obese child. This being said, it is important to take into account the amount of screen-time and the physical activity allowed to the children at home.

In the United States, it is estimated that 25% of children’s time awake is spent watching television and that children who watch the most television have the highest probability of obesity (10). The campaign cannot regulate the amount of television children watch while at home. The inactivity, available snacks, and the advertising for unhealthy products are a quick way to an unhealthy lifestyle and could lead to bad habits and an unhealthy future. On average, children are involved in five to six hours of sedentary activities (13). If parents can regulate the amount of screen-time a child is allowed to watch, decreasing childhood obesity will be the result. If children have access to watch programs of their particular interest or play games on the computer, the campaign will not be making progress. Instead of watching television, playing video games, or playing on the computer, children should be active indoors and outdoors.

Children play with other kids in the neighborhood. Unfortunately, some children may be rejected or feel victimized by their peers if they are overweight or are different from the social norm leading to disengagement in the social environment (14). The negative feedback could lead the child to isolate themselves and only associate with those who seem to have similar problems (14). This could potentially cause barriers to the access of healthier options by avoiding participation in any physical activity (14).

Activ8kids campaign leaders should try to restructure the organization to develop new tactics influencing children to maintain a healthy way of life, incorporating social environments. The children’s family and peers are important factors when trying to decrease the prevalence of childhood obesity. Members in the campaign with the desire to decrease this high-risk disease will need to involve more parties other than educational facilities.

B. Assumes children behave rationally

The campaign assumes that children will behave rationally when they make decisions based on ownership and self-control. Children do not have ownership over their lives and begin to try to take control at a young age. If parents allow their children to choose what they like to eat and school systems attempt to take that choice away from them, the children will hold a higher regard for food products. Once a person has ownership or feels they have ownership over something, it is much harder for them to give it up.

The exchange will need to be much higher in order for the child to give up ownership. The campaign has provided the resources needed in schools to eat five fruits or vegetables a day, although this will not make a difference in the children’s lives if they have to give up the one thing they have control over.

A government study between the relationship of self-control and weight gain in young children concluded that the self-indulgence of children in regard to consuming everything in sight, may force children to obesity (14). In addition, research showed that children gained weight as their age increased due to the lack of self-control and the capability control indulgences.

In addition, eating behaviors may be due to lack of transportation in neighborhoods, causing fewer stores in the vicinity and resulting in a limited amount of food availability (15). Although, the campaign has made an effort to involve the community with building walking paths, the assumption may not be made that children use the resources given to them. Assuming children will use the resources provided to maintain an active lifestyle is not logical.

C. Does not take into account the public policy level

The Public Policy level involves advertising, public policy, and food access and availability (8). The leaders of the campaign should do what is needed to fix these problems on a wider scale. Governments should be involved in the planning of a campaign regarding child obesity and should take action to make healthy food more available and easily accessible to those families who do not have the finances to purchase healthy food (16).

Healthy foods include fruits and vegetables, whole grains, high-fiber foods, lean meats and poultry, and fish (17). Organic food is said to be more nutritious and safer to eat (18). The pricing for organic foods can about twice the amount of regular food options and often come in smaller packages (19). Many people tend to choose buying in bulk instead of opting to go to the grocery store. On average, the prices for bulk foods are 35% lower than other packaged food items (20).

As for advertising to children, a 2009 study shows that one-fifth of television commercials children watch are related to food and 70% of these advertisements are related to fast food or unhealthy snacks (21). Only 1.7% of commercials were advertisements for fruits, vegetables, and juices. Only one healthy ad is shown for every 63 unhealthy ads (21).

Advertisers try to manipulate children through their vulnerability by putting in unhealthy food advertisements not only through the television, but through computers and video games (22). It is not enough to decrease the screen-time to two hours a day. The government has a social responsibility to lend a hand in decreasing childhood obesity.

III. Restructuring of New York State’s Activ8kids Campaign: Use of the social ecological model

After going through the critiques of Activ8kids, it is important to restructure the campaign. The new intervention addresses the flaws of the Activ8kids campaign and how these flaws can be corrected with the support needed.

A. The Use of the Ecological Model: Probable Intervention

The restructuring of the Activ8kids campaign uses the social ecological model to strengthen the campaign to reduce child obesity. This multifaceted approach is needed to address child obesity and to achieve a healthy weight successfully (15, 23). The social ecological model has four layers that work together. The model focuses on the interactions between the intrapersonal, interpersonal, community, and the macro system levels (8). Trying to reduce child obesity will involve more than the individual level to see significant results.

The new intervention takes in consideration the social and environmental factors of the children, by doing so will enable a wider audience and social group to assist in the problem. Involvement from the parents is the main key to healthy diets in children. An intervention including the parents and educating them about a healthy lifestyle is beneficial (13). Education will explain to parents the resources needed to be successful, how to provide healthy foods if they are from a low-income family, and allow them access to the foods and facilities for a healthier lifestyle.

The new intervention will assume children behave irrationally, in regards to ownership. Authority figures will frame the situation in a gaining frame when regarding food intake. In return for eating healthy and listening to the lifestyle changes, children will receive positive reinforcement and believe they have control to make healthy choices.

The new intervention for public policy will open the gates to potentially reducing the rate of child obesity significantly. Involving the government could potentially get neighborhoods to have easier access to stores, create policies to influence food pricing, and limit advertising of unhealthy food. Establishing policies in the community to promote healthier products and services can address the barriers and increase a healthier lifestyle (24).

1. The intervention takes in account the social environment of the children

The ecological models base is the intrapersonal level. In order to take in the social and environmental factors, it is important to touch base with the individual. The Activ8kids campaign follows the intrapersonal factors including the low nutritional knowledge of the children, in-taking five fruits and vegetables daily, and motivating physical activity (15).

The intrapersonal and interpersonal levels work together. The children are at ages of being under parental guidance when it comes to nutrition, physical activities, and screen-time (25). When looking into prevention and treatment strategies for childhood obesity, it is important to realize one of the strongest strategies to weight loss is praise and recognition from peers and family members (25). To see weight loss in children, parents will need to be active participants (26, science). Involving the parents and the family will help the treatment of obesity and the prevention of obesity in children (26).

In this new intervention the schools will involve the family members by sending them information weekly and offering classes about nutritional values, physical activity, and what they can do at home to help reduce the risk of child obesity. For example, parents could eat dinner at the table instead of in front of the television, limit the amount of junk food in the home, and try to take family walks to create a more active lifestyle (26). Six hundred calories a day are consumed by the average child while watching television. If parents help their children by cutting the amount of food consumed in half, they will be getting rid of five pounds per year (26).

Families with a social disadvantage may not have an interest in, or the level of nutritional knowledge other families may have. These families may have poor nutrition and not as many opportunities for physical activity (27). Taking families from all spectrums will help to create and implement a successful intervention.

When there are two active parents in the family, the children are six times more likely to exercise than children with two parents who are inactive (27). In addition, parents can also set specific snack times and eat together as a family (28, department). If parents can involve their children in the planning, shopping, and the preparation of the meal, children will have the opportunity to learn about nutrition and try a variety of nutritional meal options (28).

There are barriers to eating a nutritional meal at a younger age. Children tend to associate fast food and unhealthy choices with pleasure, friendship, and socializing (29). They believe they will have negative reactions from their social group if they choose healthier options. It is important to add the peer support when creating an intervention for child obesity.

It is important for children to have peer relationships to learn social skills, to build self-esteem, and to encourage psychological well-being (29). This is not always the case. Peer relationships can be great for children and for others it could be detrimental. Parents should drive their children to be involved in team sports, after school activities, or other social groups. Allowing children the option to be in social groups and to include them in activities may reduce the risk of backing away from social norms feeling isolated.

This being said, parents should teach their children that exercise is a positive way to feel better and stay healthy. If a family does not live in a neighborhood with easy access of facilities where children can play and be safe, they could take it upon themselves to speak as the community leader and try to make changes for children in the community.

2. The intervention considers that children behave irrationally when ownership is involved

The proposed intervention assumes children behave irrationally and involves a trade from authority figure to the child. The transfer of ownership from the child includes something worth more than the food items. It is important to give the children a sense of control. If they believe they have control when choosing food items to consume, they will be more likely to follow a healthy diet.

The intervention will allow children to make a choice, therefore allotting them control. Children want to feel they have some control of their lives and hold onto the bit of ownership they possess. Choices in life, even when they are small, makes children feel they have little power and control (30). This will give them the opportunity to begin to think for themselves and have a sense of independence. (30).

Taking a closer look at children’s irrational behavior will allow authority figures to work around potential obstacles. In regards to getting the children to take walking paths to school, it is not realistic for children under the age of eight to walk to school by themselves and most of them do not have parents who have time to walk them to school every morning. The intervention will give teachers the option to meet the children before school at a predetermined location on walking paths to walk together. This process will involve teachers, families, and communities to work together to make sure their children will arrive safely.

3. The intervention believes the use of the public policy level will help to decrease childhood obesity

The reformation of the Activ8kids campaign will include the public policy level to broaden the scale in decreasing child obesity. The public policy level includes the policies from the local, state, and federal governments (15). Involving the government through policies could improve the access in low-income neighborhoods for healthier food items, pass new taxes and limit advertising to children as well as create or improve the amount of parks, sidewalks and recreational facilities (31, 32).

Through the education process of the families involved in the communities, they will learn more about food pricing and the policies that influence them (15). If the families have limited resources, they will be taught how to choose healthier food products with what they have (15). It is not enough to educate the families and by implementing taxes may help reduce the risk of childhood obesity.

If the amounts of soft drinks increase by ten percent, this could potentially reduce the amount consumed by eight to ten percent (33). A child obesity report came out in September of 2009, which highly recommended the use of taxes on junk food and soda drinks (33). If taxes pass for these items, it could significantly reduce the amount consumed. If governments reduce the amount of advertising processed foods to children, it could increase the amount of healthy children.

Food advertisements for children and food policies at school can be mandated by Governments (16). Children who watch television are flooded with ads from fast-food restaurants and other sources of unhealthy diets, including high in fat and sugar foods (13). Children, ages two to six are more likely, than those who do not watch television, to choose food items from advertisements. Combining the unhealthy advertisements with sedentary movement has created a generation of children with a high possibility of medical conditions resulting from obesity (13). The involvement of the government could help limit the amount of advertisements to children on television, video games, and internet sites for children.

Many communities have the facilities needed for a healthy lifestyle, although if there is not easy access to the facility, people may not use them (34). In 1991, the Intermodal Surface Transportation Efficiency Act was passed. This act makes funds available to build or improve walkways and bicycle paths. How the money is used is based locally through the local departments, such as transportation, health, and parks (35). This being said, if the local communities and public policies work together, they can create an active lifestyle for children.

IV. Conclusion: Activ8kids is a great start to a program, although restructuring the campaign with the Social Ecological Model will assist the program to potentially succeed in its goals

New York’s Activ8kids campaign has been around since 2005 and has not made a significant difference in child obesity rate. The campaign failed to address the social and environmental factors, assumed behavior is rational, and did not take into account the public policy level. By restructuring the campaign as a result of the social ecological model, the outcome will potentially increase the rate of healthy children.


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