Congratulations on completing all four parts of the course project and submitting your action plan!
Now it's time to recap what you have learned about preventing childhood obesity using an ecological approach. This approach is time consuming, yet—a growing number of researchers believe—much more likely to be effective than traditional individual interventions, because it gets at the underlying causes of the problem instead of just treating the symptoms.
We all know that obesity is increasing rapidly in the U.S. as well as globally. In just 30 years, the prevalence of overweight children and teens in the U.S. has tripled. What has changed to create this dramatic increase in childhood obesity?
We, and many others, argue that it isn't the children, or their parents, that have changed so much, but their environment. Therefore, we need to look at the bigger picture and focus on changing that environment.
And changing the environment requires a collaborative, broad-based ecological approach to intervention.
We know excessive child weight gain is a problem and, of course, that the basic issue is an imbalance between how much kids eat and how much they move their bodies. But what are the exact behaviors we want to target? Are kids eating too much candy? Do they watch too much TV? Are parents too permissive or overly restrictive?
Certain behaviors are key contributors to child overweight. These include television viewing; physical inactivity; consumption of sweetened beverages; excessive portion sizes; not eating breakfast; eating too much high-fat and fast foods; and not eating enough fruits, vegetables, dairy foods, and fiber. Parent and other adult behaviors are also important to consider.
An ecological approach involves identifying and prioritizing key behaviors that contribute to a problem and then assessing the factors contributing to these behaviors.
Eating and activity behaviors are not simply the result of individual choice. Research suggests that one contributor to the obesity problem in the U.S. is the fact that we live in an obesogenic environment—one that encourages us to eat too much and exercise too little. We need to examine what factors in the built, social, economic, and policy environments are influencing the behaviors contributing to childhood obesity. For example, children do not eat a lot of fruits and vegetables, but it may not be because their parents won't offer them, but rather because high-quality, reasonably priced fruits and vegetables may not be available in their neighborhood stores.
Traditionally, health professionals have focused on individuals and changing their behaviors. An environment that makes it easier to eat well and be active has the potential to prevent obesity in many members of a community, not just a few individuals. Understanding the environmental factors that contribute to eating and activity behaviors is an important part of taking an ecological approach. Since we can't tackle every environmental factor, we also need to set some priorities based on which factors are changeable and most likely to make a difference.
Identifying the key behaviors or environmental characteristics we want to change is still not enough. We need to dig even deeper and figure out what factors must be changed in order to initiate or sustain the changes we've identified. In other words, we need to assess the underlying causes, so we can target our intervention to these causes, and not to symptoms.
The underlying causes are known as the predisposing, enabling, and reinforcing factors, or P.E.R. factors, as we've called them here.
Predisposing factors include an individual's knowledge, attitudes, beliefs, values, and self-efficacy. These relate to what individuals know, believe, and feel.
Enabling factors are the skills, resources, and barriers that help or hinder a given behavioral or environmental change. These factors include the availability and accessibility of resources; laws, rules, regulations, and policies; as well as the skills of individuals.
Reinforcing factors are feedback, positive or negative, that follows a particular behavior. These include the attitudes of peers and adults, the individual's physical or emotional feelings after the behavior, the economic impacts of the behavior, and perceived social acceptance.
As we did with behavioral and environmental factors, we need to prioritize the P.E.R. factors we identify based on their importance and changeability. Because enabling factors tend to impact the environment so strongly, they often tend to be the most important type of factor. That said, a successful intervention usually needs to target all three categories of P.E.R. factors.
Building Community Collaborations
Childhood obesity is a complex problem and requires multiple innovative approaches if we are to be effective in addressing it. No one person or agency can hope to have a significant impact on factors that predispose, enable, and reinforce children's food consumption and activity behavior. To recognize and address the underlying causes of the problem, community stakeholders need to be involved. Using an ecological approach and working as part of a community collaboration increase your chances of performing a successful intervention.
Collaborations work best when they include members representing all stakeholder groups. There should be a core group of 3-5 community partners who can provide leadership and who are willing to dedicate time and resources to the issue. Ideally, these partners should work together as part of a larger 12-15 member collaboration to assess the behavioral, environmental, and P.E.R. factors and to set objectives. The group may need to be expanded to include any additional community members necessary to effectively implement an action plan to meet those objectives.
In developing an action plan, the first step is to decide what intervention method you and your collaboration partners will use. This means deciding what general process will be used to address the top-ranked P.E.R. factors. The method should be matched to the type of P.E.R. factors you've prioritized. The next step is to select the specific technique or intervention strategy for applying the method.
Also, part of the action plan includes identifying and delegating the required actions. In other words, you need to specifically state who will do what and by when.
Finally, you need to plan a process evaluation, which includes assessing how well your collaboration is working, and an outcome evaluation to measure how well you are meeting your long-term objectives.
Preventing childhood obesity is not something that is going to be accomplished overnight. It requires teams of dedicated people working together in collaborative partnerships. You've already shown your interest in addressing the problem by taking this course, but taking an ecological approach may also seem like an overwhelming process. Rest assured, the time you invest in the short run assessing and prioritizing the various factors involved increases your chances of making a successful intervention in the long run.
Thank you for taking this course. We hope you will stay in touch with us and let us know about your successes and challenges. As nutrition and health professionals, we can make a difference in preventing childhood obesity by implementing an ecological approach.
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