Introduction
Childhood obesity and overweight are one of the major public health issues not only witnessed in Kuwait but also in major developed countries. Besides, the complications resulting from childhood obesity are severe. Moreover, there is the likelihood that obesity can continue affecting the child during adulthood (Barlow, 2007; Hagarty, Schmidt, Bernaix & Clement, 2004; Karnik & Kanekar, 2012). As such, there is a greater need to look into the issue at all levels through the application of actual intermediations and inspirational approaches. Further, there is a need for collaborative efforts from various government agencies, schools, families and health professionals to provide measures that enhance prevention, control and management of overweight and obesity among schoolchildren (Karnik & Kanekar, 2012). In this discussion, the focus will be on various intervention strategies, including government-based approaches, family based interventions, school nurse-based methods and school-based approaches.
Government-focused Approach
Governments have full responsibility for providing measures that promote a healthy environment, nutrition as well as other measures that reduce the prevalence of overweight and obesity among schoolchildren (Blackburn & Walker, 2005). Essentially, recognising the most effective and efficient intervention approaches directed towards the enhancement of physical activities as well as providing nutritious diets in schools to reduce the prevalence of obesity and overweight among the schoolchildren are critical (Blackburn & Walker, 2005; Kann, Telljohann & Wooley, 2007). As such, the government has the obligation of encouraging evidence-based programmes aimed at improving physical activities and providing healthy foods to schoolchildren. For instance, in the US, the government has ensured a healthy environment both in school and at the family levels through encouraging evidence-based programmes (Cullen, Watson, Zakeri & Ralston, 2006). Besides, the government can contribute positively to the prevention of obesity through policy interventions as well as other programmes that educate the public on the possible effects of obesity and overweight (Justus, Ryan, Rockenbach, Katterapalli & Card-Higginson, 2007).
A study conducted by Mitchell, Cowburn & Foster (2011) indicated that governments ranging from local to national levels have legal areas for reduction of obesity in UK schools. The study identified restrictions on traffic and promotion of active travel, increased access to healthy food and creation of a sustainable and active environment. The study indicated that the government attains the objective through policy formulation, planning, licensing, legislation and training and increased awareness programmes.
Another study conducted by Shill, Mavoa, Allender, Lawrence, Sacks, Peeters, Crammond and Swinburn (2012) assessed the Australian government food policy interventions as well as other interventions that can create positive change in environments where students increases in weight. The study found that the most supported interventions relate to food marketing and prices.
A similar study by Steven, Erin, Brad, Gary, Mark, Anna and Boyd (2012) identified some critical policy intervention areas walking environment and government food programmes towards schools. The study recommended that government provide an environment that supports physical activities such as recreational areas walk and bike paths to the community schools.
In terms of physical education and programmes, Lee, Burgeson, Fulton, and Spain (2007) conducted a study to determine the effects of government programmes in physical activities and education in schools. The results indicated that most schools do not meet the terms of the policy guidelines on physical education and activities, which contribute to the increased prevalence of obesity and overweight among schoolchildren. Moreover, the study indicated that the guidelines on physical education are outdated and need to be upgraded in order to attain the major goals. Besides, the study pointed out a feeble link between the government policy guidelines and the inclusion in the curriculum. As such, the study suggested that governments should enhance their obligations of providing guidelines via integrating the current needs of physical activities and education to promote a healthy environment in all aspects of school extra-curricular activities.
Family-focused Approach
Family ties are one of the better structures in which offspring are brought up, and better behaviours are imparted (Kuo, Voorhees, Haythornthwaite & Young, 2007). Besides, the parents and family relations have greater influences on the children’s behaviours, including eating habits and lifestyles (Pott, Albayrak, Hebebrand & Pauli-Pott, 2009). As such, interventions to reduce obesity due to unacceptable eating habits at family echelons are necessary. In other words, effective interventions at the level of the family are of greater benefit to the children’s change of overeating and morbid selection of food behaviours (Kuo et al., 2007; Pott et al., 2009).
A study by Müllersdorf, Zuccato, Nimborg and Eriksson (2010) suggests that families should provide first response to the potential risks faced by children due to increased overweight and obesity and take the required actions to control the malady. For instance, parents can take certain actions that promote physical activities, including encouraging children to walk instead of using family cars, as well as utilising the stairs instead of elevators. The study specified that the application of family interventions are the most effective means through which obesity can be prevented and reduced among children. In addition, the study signposted that family-based weight-control involvement is essential in the reduction of overweight cases among the offspring. In principle, providing good support to parents is a critical strategy.
Another study by Rodearmel, Wyatt, Barry, Dong, Pan, Israel, Cho, McBurney and Hill (2006) indicated that family interventions are the most effective in the control and management of childhood unhealthy weight gain. Further, the study revealed that parents, particularly mothers, have a greater influence on their children. As such, family interventions targeting mothers are better strategies in controlling and management of childhood obesity.
Similarly, a cross sectional study conducted by Ben-Sefer, Ben-Natan and Ehrenfeld (2009) revealed that parents, families and peers have a greater influence on the eating behaviours of children. The study indicated that poor maternal diet is one of the risk factors for the development of obesity among children. Further, the study revealed that family interventions focusing on nutrition and dietary behaviours have a greater influence on the management and reduction of childhood obesity.
Another controlled longitudinal study conducted by Smith, 2006 to determine the parental influences on adolescents’ physical activity and sedentary behaviour revealed that families supportive of their children being involved in active lifestyle result in their children developing healthy weight during their adolescent stages of life developments. The results of Smith’s 2006 study coincided with the findings of Rodearmel et al.’s (2006) study that in family environments where physical activities are encouraged, children have decreased chances of developing unhealthy weights.
School-focused Approach
Studies indicate that schools provide the best setting for creating increased health awareness regarding childhood obesity (Hutchinson, 2010; Story, Nanney & Schwartz, 2009; Rahman, Cushing & Jackson, 2011; Trudeau & Shephard, 2008; Menschik, Ahmed, Alexander & Blum, 2008). Conversely, schools are not the only place where actions geared towards increased awareness can be undertaken (Hartstein, Cullen, Reynolds, Harrell, Resnicow & Kennel, 2008; Menschik et al., 2008). However, intervention programs aimed at creating changes in behaviours considered risk factors in weight gain can be incorporated within the school environment. Most of the interventions focus on the integrated primary roles of all the schools’ stakeholders, including the parents, school nurses, staff, administrators and the students. Further, schools have been identified as ideal in establishing programmes aimed at promoting Healthy Eating (HE) and Physical Activity (PA). Most importantly, schools that have to work with parents should also adopt parents’ programmes in their endeavour in reducing the level of obesity among schoolchildren. Besides, leadership and government support are greatly needed to enhance the implementation of school-based programmes and policies aimed at enhancing dietary patterns.
Clarke, Fletcher, Lancashire, Pallan and Adab (2013) examined the perspectives of the school personnel on the manner school environment contributes to the control, prevention and management of childhood obesity. According to the study, all the staff that were interviewed indicated obesity as one of the major problems facing elementary school children. Further, the study indicated that home upbringing, leisure or sedentary lifestyle, deprived nourishment, child physical inactivity and child’s directions on dietary choices were the major causes of the prevalence of obesity among the schoolchildren. Moreover, the study concluded that the control of child dietary choices both at school and at home settings contributes to the problem of unhealthy weight gain.
Odum, Tisone and Outley (2013) conducted a review of the studies conducted to evaluate the prevalence of obesity and weight gain among Latin American youths. The review indicated that ten studies school-based interventions component. Besides, the study indicated that the best school-based intrusions emphasised prevention instead of treatment. Additionally, the most successful school-based intrusions had long follow-ups, consisted of multidisciplinary teams and fewer restrictions on implementations. Odum, Tisone and Outley (2013) study concluded that schools present better settings for the control and management of obesity. Further, the study recommends that evidence-based integrated intervention programmes and strategies within the schools’ settings should be enhanced as a critical component monitoring framework put in place to prevent childhood obesity among the schoolchildren.
A study by Lobelo, Isabel, Holub, Nagle, Arredondo, Barquera and Elder (2013) examined the perceptions of parents of the child’s weight gain and the roles of schools in the avoidance and management of childhood obesity. In the study, over eighty per cent of the respondents identified poor eating habits, physical inactivity, and deficiency in the parental control of the child’s eating behaviour as well as over intake of calories to be the major cause of obesity among schoolchildren. According to the study, schools should include physical education in classes, and children should be taught lessons regarding nutrition and weight control. Moreover, the study indicated that parents also supported the elimination of the provision of food containing low calories and the elimination of meals with high sugar and fat contents.
Murphy and Polivka (2007) investigated the effect of family-based behaviour on obesity among schoolchildren in the UK. The study indicated a significant decrease in abnormal dieting behaviour dejection due to weight gain, bulimia and food preoccupation, as well as an increase in self-esteem due to improved physical appearances resulting from reduced incidences of overweight and obesity in schools. Further, the study indicated the importance of family programs aimed at the prevention and control of childhood obesity in schools. The study concluded that the positive changes in behaviour and psychology of children in school suggest the significance of such programmes.
Studies conducted by Hartstein et al. (2008) designated that offspring consume no less than a single repast at school. As such, learning institutions have significant obligations aimed at educating children on the right choices of food. Actually, learning institutions have been at the forefront of manipulating the intake of beverages, including carbonated drinks and other sugary foods, among school going children. Conversely, the study disclosed that inspiring children to consume healthy food substances is a critical function of schools in reducing obesity cases. Moreover, the study revealed that healthy, nutritious food items in the diet of children and stressing on a balanced diet by schools are important interventions that reduce the prevalence of obesity.
Another study by Briefel, Wilson & Gleason (2009) indicated that schools offer numerous prospects that aid in framing plans aimed at controlling and preventing weight gain and obesity through the generation of settings where children eat healthy meals and frequently participate in physical activities. In addition, the study findings indicated that students regularly engage in eating competitive food due to their wide availability around schools, particularly the government reimbursed institutions. In this study, the competitive foods included refreshments such as soft drinks that contain increased energy content. Moreover, foods full of sugar whole and inundated fats are included in this category. Furthermore, the incidence of high-calorie food products augments the children taking amplified energies in diet and stumpy consumption of vegetables and fruits.
The findings of the study confirmed the results of the studies conducted by Trudeau and Shephard (2008) as well as Joshi, Howat and Bryan (2011), indicating that physical activity programmes can be added to the school curriculum without interfering with the academic qualifications of the students and offer physical, emotional as well as social benefits to the students. Further, the study by Trudeau and Shephard (2008) indicated that the school-based programmes focusing on physical activities and nutrition should be supported by policies majorly from government agencies in charge of education. Moreover, the study by Briefel et al. (2009) indicated that school-based programmes are more effective in public schools as opposed to private schools where the government policies have little control on school meals and food items children take.
School Nurse-based Approach
School nurses have increased responsibilities in fighting childhood obesity and another related unhealthy weight gain in schools through the realisation of diverse interventions (Bryan, Broussard & Bellar, 2013). In other words, school nurses have increased opportunities in generating an atmosphere where children can live healthy lifestyles. Besides, children taking school meals consume over fifty per cent of their daily calories in school (Della-Torre-Swiss, Akre & Suris, 2010). Under such circumstances, schools become an ideal situation where healthy food intake behaviours can be promoted (Della-Torre-Swiss et al., 2010; Moyers, Bugle & Jackson, 2005). As such, within the school environment, school nurses play a critical role in educating the school kids on a healthier diet and collaborate with the school administration in ensuring the meals provided meet the required guidelines for nutrition (Bryan, Broussard & Bellar, 2013; Moyers et al., 2005).
A study conducted by Magnusson, Kjellgren and Winkvist (2012) indicated that school nurses are at exceptional positions within the school hierarchy and, as such, should help out the other stakeholders, including parents and personnel in ways through which the prevalence of obesity and weight gain in schoolchildren can be addressed. In addition, the study noted that school nurses have the knowledge and skills that are required in promoting actions supportive in the management of overweight and obesity as well as capable of dealing with the requirements of overweight and obese children in schools.
A study by Kubik and Lee (2014) examined the parents’ interest in participating in programmes that enhance the school nurses’ roles in the promotion of normal weight among the school children. Further, the study investigated the relationship between the parent and child characteristics as well as school nurse-led after school weight management programmes for children. In addition, the study explored the role of parent support groups and the school nurse meeting with parents and children on the issues of weight gain management education. In the study, all the correlations were assessed using multivariate logistic regression. The study indicated that parents, particularly those girls, were significantly likely to express interest in school nurse programmes that support the prevention and control of childhood obesity.
Further, the school nurses should provide joint initiatives through collaborating with all the stakeholders and other healthcare providers to encourage procedures that give confidence on healthy weight among the schoolchildren (Morberg, Lagerstrom & Dellve, 2009). Moreover, a study by Florin, Ehrenberg & Ehnfors (2008) indicated that school nurses have a greater responsibility of categorising the obese and overweight schoolchildren who might be at risk for health problems related to the conditions. In addition, Florin et al. (2008) study extended the role of the school nurse to include referrals and follow-ups with other health care providers for students who may need further attention. Further, the study indicated that school nurses have the responsibility of educating and advocating for appropriate transformations that support healthy lifestyles in schools.
Besides, school nurses have the responsibility of utilising the know-how to aid in determining the Body Mass Index (BMI) and blood-pressure screening as well as support continuing follow-ups for children and their families (King, Meadows, Engelke & Swanson, 2006). More specific, discovery, recognition and timely intervention, as well as enlightening the families and other school stakeholders in relation to the issues of childhood obesity and weight gain, are significant roles and ways through which school nurses can help in reducing the prevalence of obesity and overweight in schoolchildren (King et al., 2006; Della-Torre-Swiss et al., 2010). Moreover, the school nurse has the responsibility of developing interventions that work for all students in their various schools. However, school nurses are often underutilised in terms of provision of education to the parents and students on food choices and physical activity (Nauta, Byrne & Wesley, 2009; Maenpaa, Paavilainen & Astedt-Kurki, 2007)
A study conducted by Nauta et al. (2009) indicated that school nurses are eagerly knowledgeable on the influences the inactive lifestyles and over caloric consumption have on obesity. Besides, the study by Nauta et al. (2009) showed that over fifty per cent of school nurses uphold the importance of including weight control within the curriculum and full implementation within the school system.
Vital (2010) study indicated that school nurse is a significant partner in the control and prevention of the prevalence of obesity and overweight in schools. In addition, the study indicated that schools nurses are responsible for advocacy and information provision to children since they have the necessary proficiency that enables appropriate advice as well as develop direct contact with parents, guardians and other health professionals. Moreover, the study noted that school nurses, because of their expertise, have the capability of influencing policy and decision-making within the school administration as well as management processes outside the school environment.
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