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HNS AND CHILDREN OBESITY PREVENTION

Health Needs Assessment and Children Obesity Prevention in the U.K.

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PART 1

Childhood obesity is one of the most important health issues. Obesity has a profound

effect on a child's life and increases the risk of illness and it also causes mental and social

problems(Anon 2017). Obesity can affect a child's health, access to education, and quality of life.

Child obesity is one of the most important issues in today's society, especially in England(Wang

and Lobstein 2006). By the beginning of elementary school, about a quarter of all children in the

U.K are overweight or obese. Prevention and treatment of obesity require the full support of

governments, which consider health as an important principle and counteract the damaging

factors(Sonneville et al. 2009). As a result, using the appropriate prevention process helps to

promote community health.

Health Needs Assessment (HNA) is a systematic and practical 5-step process for

addressing health problems that aim to improve health and reduces inequalities. In other terms,

HNA contributes to negotiated health-improvement and elimination of inequality health needs

and resource allocation(Tobi 2016). HNA provides effective actions by prioritizing health issues

in a given target population. Increased public engagement, better use of resources and

coordination among factors involved in the problem are all of the advantages of using HNA.

(Hooper and Longworth 2002)

The definition of health is to enjoy complete physical, mental and social well-being, not

illness and disability(Huber et al. 2011). The World Health Organization's Ottawa Charter on the

Concept of Health states that health is the daily capital of humans, based on one's physical and

psychological characteristics. According to the World Health Organization(WHO), the definition

of health is an ideal and practically unattainable because one cannot find who a person is

perfectly healthy in all three aspects of physical, mental, and public health.
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According to the definition of health, we find that health is a multidimensional concept

Health can be divided into two main parts: physical health and mental health. Physical health is a

result of the proper functioning of the organs. Biologically appropriate function of cells and

organs and their harmony together signifies physical health for individuals and is the same good

physical condition that results from daily physical activities such as exercise, proper nutrition,

and adequate sleep and weight management. Mental health is considered to be a positive state

according to the World Health Organisation, in which the person is conscious of his or her

capacity, can face normal living pressures and is accepted in daily community work as a helpful

person. Good or bad health for people is determined by their environment and conditions. It

should be noted that health models influence one another. Physical problems besides having an

impact on physical health also affect mental health. In addition to the physical and mental model,

the social model is another model of health. Therefore, any defects that occur in any of the three

health models disturb the balance of the individual. According to the World Health Organization,

the health status of the environment and where people live is affecting their health.

Public health is a collection of knowledge and art of preventing disease and providing,

maintaining and promoting human health and empowerment by using collective efforts to

promote community development. Public health, such as a physician, analyzes the health of the

population and, after analyzing it, identifies a variety of problems and offers appropriate

solutions for their treatment(Anon n.d.). Public health underpins people, associations, and society

to handle preventable illness, mortality and the inability to utilize three sub-categories of

prevention, protection, and promotion. Health promotion is also one of the main public health

strategies for enhancing the quality of public health services.

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Health promotion emphasizes helping the community to improve health quality and plays

a crucial role in boosting broader and more fantastic definitions of health. Health promotion is a

way that is not just about the health sector, but beyond, and is about providing healthy

lifestyles(Nutbeam and Kickbusch 1998). health promotion activity helps with making ideal

conditions through supporting health and also aims to reduce the contradictions in the current

state of healthcare and create an equal opportunity for all members of society to benefit from

their health potential. A variety of different approaches to health promotion have been

established(Langford et al. 2014). Three are three models of health promotion that have been

recognized as influential key models over the last 30 years: the biomedical model, the social

model, and the ecological model. The biomedical model has been used by most physicians in

today's societies to diagnose diseases. According to the biomedical model, health is free from

disease, pain or deficiency. The treatments performed in such a way that the patient's condition

was considered independent of other external factors and they focused on the patient's individual

characteristics. Researchers have identified nine disciplines that are very effective in advancing

the theory and practice of health promotion, one of which is health education.

The simplest definition of health education is education that promotes one's health

behavior. Although health education often begins with the provision of health information, its

success is when it can replace misbehavior with good health and individual. Therefore, the

"behavior" aspect of health education is very important and without proper health behavior,

health education will not be complete(Boucher 2011). Health education has two main functions:

The first function is to increase public awareness of the impact of the environment on health or

unhealthiness and inequality in the distribution of health resources. The second function involves
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empowering people’s ability to make decisions about their health, their families and the society

by increasing their knowledge and skills

For the health needs assessment, Hooper and Longworth explain five steps. These include

determining the target population, identifying health priorities, evaluation of health priority for

action, planning for change and measuring impact and outcomes.

In the first step, some obese children in Primary schools in southwest England were

chosen as a target population. In 2011, World Health Organization(WHO) report showed that

childhood obesity is one of the most serious public health problems for the 21st century. The

physical and mental health of a child can have significant effects, which would last on in

adulthood(Morgan and Hansen 2008). The major public health concern is the number of children

with excessive and dangerous weight(Stamatakis, Wardle, and Cole 2010). By the end of six

years, this proportion will increase to more than one-third. Naturally, the treatment and

prevention of this issue are of particular importance to the government. Obesity in children and

overweight can be considered as one of the major health issues for children and parents.

The National Children’s Measurement Program (NCMP) reveals that in 2017/18, 9.5

percent of UK children between the ages of 4 and 5 were obese and 12.8 percent overweight.

Such rates were higher for children aged 6 (10 to 10 years), with 20.1% obese and 14.2%

overweight. In order to determine overweight and obesity rates in children within primary

schools, The National Children's Measurement Program (NCMP) assesses child height and

weight in ages 4 to 10. This program is internationally regarded as a statistical source of public

health information in Britain(Baker 2019).

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There are many stakeholders that would be required to effectively carry out a health

needs assessment and establish interventions. HNA stakeholders can include members from the

National Service Framework for Children U.K, health select committee, National Healthy

Schools, National Health Service, Schools, and children's family. HNA process aims at

investigating obesity prevention solutions with the help of the relationship between children and

their parents and school leaders(Ells et al. 2005).

The second step of the HNA as outlined by Hooper and Longworth includes

identification of the health priorities. It is necessary to develop a health profile of the target

population before identifying priorities. The health profile was formed through the analysis of

previous studies and findings(Hooper and Longworth 2002).

Obesity in children exists for many reasons. Doctors say obese parents are more likely to

have obese children than other people, which is due to the wrong habits of their lives. They are

also susceptible to heart disease, diabetes, and poor well-being(Goran, Ball, and Cruz 2003).

There has been a lot of criticism of the British government that the government's measures to

tackle childhood obesity are inadequate and that the government cannot protect children from

unhealthy advertisements and harmful foods(Story, Nanney, and Schwartz 2009). The

advertisement for unhealthy products, like fast-food, is one of the most effective ways to cause

childhood obesity and overweight.

The determinants which could influence health condition can be described as economic,

social and biological factors. According to statistics, 80% of obese children in adulthood will

also have problems that can reduce life expectancy by up to 10 years and in special

circumstances by up to 20 years(Excellence 2006). Childhood obesity problems like cancer and

diabetes alone cost the UK economy $ 35 billion dollars and cost the national health
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system(NHS) 6.6 billion dollars per year. One of the common social problems among obese

children is their low self-esteem, which plays an important role in the development of depression

and makes them prone to drug abuse. Also, obesity in children is one of the most common causes

of a risk of mental illness which can continue into adulthood and decrease the quality of

life(Singh et al. 2008).

The Healthy Lifestyles programme (HeLP) has been used as a prevention method for

obesity in schools. The program aims to build a positive atmosphere to change the unhealthy

habits of children by changing the relationships among children, teachers, and families.

Part 2

According to Hooper and Longworth, the third stage in HNA is to assessing the health

priority for action. This next step is to evaluate the improvements in any health condition. The

evaluation should be focused on impact, availability of resources, changeability, acceptability,

and feasibility(Hooper and Longworth 2002).

The main focus of National Health Service in England was on formulating a children’s

obesity prevention program to increase the participation of schools, children and their families

during the intervention because children's behavioral modifications require behavioral

assessments of all influencing factors. The role of teachers in communicating with children and

enhancing their physical activity is critical to increasing the effectiveness of the obesity

prevention program(Davidson 2007). The HeLP plan (Healthy Lifestyles programme) is utilized

to provide the necessary health action in order to adjust the established need(Lloyd, Wyatt, and

Creanor 2012).
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The HeLP is a feasible plan that provides the best intervention in light of theories of

behavior change among teachers, families, and children involved in the obesity problem. This

stage of the health need assessment is evaluated to identify the changes needed to prevent

obesity(Wyatt et al. 2011). In recent years, the proportion of obese children in the UK has

doubled, and many children are suffering from obesity. According to the proposed programs for

this need, the use of the HeLP is the most comprehensive obesity prevention trial to date, which

includes a large national sample of children and the use of preapproved standard methods for

analysis. Social interaction has been an important factor in fostering child health and education

and the performance of the HeLP plan has been effective in improving the quality of children's

social interaction with family and school members. The HeLP program developed a solution to

the prevention of obesity, which focuses on improving the interaction between schools, children

and their families during the intervention(Sahota et al. 2001). Also, it has been highly effective

and is believed to have changed the behavior of children. The HeLP system as a way to prevent

obesity enhances the physical activity and mental health. Therefore, it can be concluded that the

evidence from this project applies to many targets(Lloyd and Wyatt 2015).

The National Institute for Health and Care Excellence (NICE) primarily tried to establish

positive and trustworthy interactions by hiring suppliers with unique skills and competences.

Previous studies on obesity prevention in children had shown that parental involvement in

improving children's behavior was poor. It was found that the conventional approaches like

lessons on the importance of healthy food children used in the school setting were not

sufficiently diverse, innovative and encouraging for children to speak with their parents about

obesity issues at home. The researchers concluded that further analysis of both educational and

environmental elements was required in order to develop a new program. Therefore, HeLP was
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introduced as an identified feasible and effective intervention that played a reinforcing role in

relationships between school and child and family. Moreover, the HeLP program will help in

solving health inequalities(Lloyd and Wyatt 2014).

The Healthy Lifestyles programme has created a new intervention in English schools

based on the theory of behavioral change as well as the widespread use of stakeholders(Lloyd et

al. 2017). It also aims to encourage children to have a better lifestyle and increase the role of the

family to support them. In order to include and encourage children and their families in the

positive lifestyles, the Healthy Lifestyles Programme (HeLP) has been used. HeLP consists of

four stages, each with several subcategories.

Changeability is the next criterion for determining a health priority and focuses on

successful intervention at different rates of disease prevention. HeLP program gives children

with obesity the ability to make changes in preparation for their real-life situations, and empower

themselves. This intervention targets a variety of populations and is carried out over multiple

periods. HeLP program performs three important steps to promote a healthy life balance and

reduce the problems associated with childhood obesity. The three steps are decreasing the

consumption Soft drinks such as sugary drinks and artificial sweeteners; Adding healthy snacks

to diet and reducing the activities that keep children inactive(Lloyd et al. 2011).

This program builds interdependent relationships between the school, children and their

family members and is a positive step in creating opportunities for comprehensive local

community support for obese children. The results have shown how this program has led the

intervention process and has a maximizing role in family participation and made it acceptable for

the school’s leader and children. Implementation of health changes will require time and
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someone's commitment to the program (HeLP coordinate). Time and HeLP coordinates are

known as the resources needed for priority health actions.

The fourth step in assessing health needs is to prepare an appropriate strategy for health

operation. After evaluating the health priority, potential actions for health needs assessment

should be specified. As a result, the plans that are needed to succeed should be stated and risks

and potential problems should be managed by stakeholders. The aim of this health needs

assessment is to implement a healthy lifestyles programme to prevent obesity and its problems

and to be able to engage their parents to intervention's goal(Hooper and Longworth 2002).

The HeLP is a four-stage program that follows the Information, motivation and

behavioral(IMB) model. The IMB model explicates the psychological functional features of

activities capable of enhancing health outcomes and improving problems(Fisher, Fisher, and

Harman 2009). The extension of the IMB model is intended to reduce the limitations of existing

theory in social and health psychology(Craig et al. 2008). Most of these limitations are due to the

lack of interactions among the factors affecting health, which are known as important factors for

interpreting and modifying health behaviors(Craig et al. 2008). Proper modeling of the IMB

provides an appropriate framework for converting the outcomes of the program into behavioral

theory models.

Phase 1, called Creating a Supportive Context, provides a positive state for future actions

by building relationships between children and team members and also raising awareness of

HeLP. The purpose of this step is to reinforce the relationships between all stakeholders (e.g.,

headteachers, teachers, government staff, children and parents). Professional staff performs

supportive relationships to motivate and demonstrate the importance of a healthy lifestyle and

strive to create a promising atmosphere for the next steps. At the end of this phase children share
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the abilities they have learned with their parents, and the HeLP program helps them make better

planning decisions(Lloyd et al. 2018).

Phase 2 is known as intensive Healthy Lifestyles Week includes education lessons that

aid children with learning how to change and modify their behavior. Lessons are taught each

morning by the class teacher, and at the end of each session, children are provided with a number

of tasks that they must complete by the start of the next session. The assignments are designed to

reflect the three main behaviors of the obesity prevention program. Also during the week, there

are special drama programs that children can interact with. The content of the drama is based on

the three obesity prevention behaviors.

Phase 3 is recognized as Personal Goal Setting with parental support, making children's

goals (predicted by HeLP) consistent with parental goals. In this regard, each child meets with

the person whose task is to analyze the goal-based HeLP. The person has the task of sending a

leaflet containing the child's personal information to his or her parents and working with them to

achieve the goals. Another Copy of this information is also kept at the children's school.

Finally, Phase 4 consists of factors that focus on the activities of children and parents in

accordance with the objectives of the program.

This program, with the support of the British Government through the use of motivation

intervention and psychological skills, seeks to adopt mediation behaviors to prevent overweight

by improving diet and increasing physical activity(Molnar and Livingstone 2000). In addition,

improving the bond between children and their parents to address the issue of obesity during the

intervention phase is another advantage of the program. Also, this program will have an effective

impact on the school environment(Kropski, Keckley, and Jensen 2008). The four-step HeLP
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specifies the school and family setting to get an overall target and teaches them strategies for

achieving the triple steps (Healthy Snack-Physical activity and sugar drinks).

Over a specified 24-month period, 36 schools were identified to enter the program, four of which

were on the waiting list. In other words, 32 schools with 1371 eligible children were declared

ready, of which 1324 participated in the study. To evaluate the results, two groups were divided

into 16 groups (676 children) in the intervention group and 16 schools (648 children) in the

control group. In the intervention group, the program was tested on obese children and the

control group continued their daily activities. The results were measured with specific indices at

18 and 24-month intervals. BMI index and BMI SDS were used to measure body weight loss and

were converted to the normalized standard using the LMS method(Cole 1990). Body mass index

is a common index for measuring adult weight that is dependent on human height. it is one of the

most widely used tests for children obesity evaluation. Also, BMI determines the relative weight

of a child based on the age of sex of the child(Brown and Summerbell 2009). Having overweight

parents and diverse ethnicity among children are among the most significant risks of this project.

Stakeholders can determine a person who has knowledge of managing risk(Chinn, Hughes, and

Rona 1998).

The final step of the health needs assessment process includes proving the achieved

outcomes and objectives of the project. The plan needs to be analyzed carefully. It should also be

determined whether the actions have shown acceptable performance. There might be additional

challenges that should be evaluated by the team. The intervention's key accomplishments should

be explicitly mentioned(Hooper and Longworth 2002).

This project has largely achieved its goals. The results can be examined from several

approaches. From a physiological point of view, the children in the intervention group who
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followed the HeLP program remained obese over an 18-month period and lost weight at the end

of the program period. In contrast, for the control group, no significant improvement was

observed, and it can be stated that the HeLP program had a positive effect on the intervention

group. Also, the percentage of children in the control group who watched television and did on-

screen activities was higher than the children in the intervention group. The children in the

intervention group consumed fewer drinks than their counterparts in the control group in terms of

sweet and fatty drinks. Also, the level of physical activity was increased for the intervention

group.

The project has demonstrated that HeLP has been significantly effective in engaging

school members with children and their families and also is recognized as a feasible and

acceptable method to them. A small sample of English schools was chosen for population target,

and it is clear that this intervention cannot be fully stated. However, the results show that

improvements have been made in the physical and mental health of obese children as well as in

their involvement with school and family. While assessments of the disparities between

intervention and control groups remain a little inaccurate, it is promising to see that there has

been a relatively positive effect on the actions of the target goals. This finding is encouraging

that the program is capable of creating supportive actions for children and their families to bring

about new changes in their lifestyles and remain in the longer term.

Providing the HeLP program as cost-effectiveness of a new plan to tackle the problem of

childhood obesity alone does not accomplish all of its goals. This program contains unique

features that use children's behavioral and motivational approaches to create a better life

message. But it is essential for all school leaders to have the same motivation as children. In the

future, the impact of other environmental and psychological factors should be taken into account.
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Part 3

Obesity has physical and psychological consequences during childhood, adolescence, and

adulthood. Obesity itself is one of the direct causes of childhood illnesses, including

gastrointestinal, musculoskeletal and orthopedic problems, sleep apnea, early cardiovascular

disease, and type 2 diabetes.

Obesity in children is one of the key issues in society today, especially in England.

Childhood obesity can lead to behavioral and emotional problems such as depression, as well as

inappropriate social relationships and reduced academic success. Childhood obesity is one of the

major causes of adult obesity, which has known health and economic consequences for both the

individual and the community. Studies are underway about the costs that childhood obesity will

bring. Further studies have addressed the economic costs of childhood obesity. Prevention of

childhood obesity leads to significant economic and physical benefits for the present and future

generations. A comprehensive and effective method for the prevention of childhood obesity must

be designed and examined.

Health Needs Assessment is a process in which people's health problems are identified

and prioritized for implementation based on criteria that lead to productivity improvement.

Although identifying needs and measuring them accurately is essential to increase and improve

the quality of medical education and health, implementing needs assessment projects at each

level requires clear actions and interventions. In short, the most essential step in planning any

health promotion solution is the health need assessment process, which utilizes complete

information about the target population, the program is designed and then implemented, and the

resulting is evaluated. A four-step plan that sought to increase participation by promoting

relationships between families, children, and the school. The main goal of the plan is to create a
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supportive environment for children to replace unhealthy behaviors in their lives with healthy

behaviors. The HeLP programm takes three crucial steps to encourage a balanced lifestyle

balance and reduce childhood obesity-related problems. The HELP program puts children in the

habit of consuming less sugary drinks, adding nutritious snacks to their diet, and doing more

physical activity.

An evaluation was carried out based on various parameters and described how to plan it.

Two equal groups of children were selected and the results of the program were reported on

different time periods. In addition to the physical approach, their social and psychological

approaches were discussed. The HeLP program had a positive effect on preventing obesity for

the intervention group. Also, the group's physical activity was increased compared to the control

group and they ate more healthy meals. The parents 'involvement in solving the children's'

problems and creating a stronger relationship between them and the school members were all

positive effects of the program. However, there are barriers to better outcomes and the impact of

environmental behavioral factors such as ethnicity must be considered.

Finally, stakeholders, groups, and families need concerted action to encourage positive

messages among children in collaboration with the school leaders. The Health Lifestyles

programme allows these children with obesity to strengthen social interactions and their

wellbeing and demonstrates significant results in support of intervention in defined

achievements.
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