Select an existing health promotion intervention of your choice and, with reference to relevant

behavioural theory and evidence, critically report on its effectiveness in driving 3 positive changes in
health behaviours. In doing so explore its strengths and make recommendations to address its
weaknesses and limitations.

INTRODUCTION

The Household Obesity Prevention Intervention under review aimed at preventing weight

gain among American households. Weight gain is a health threat because it can result in

obesity. Being overweight or obese increases the risk of type 2 diabetes, cardiovascular

diseases, cancers and stroke (Khan et al., 2009). Obesity is an endemic public health problem

in America. According to Khan et al. (2009), about 33% of United States adults are

overweight while 34% are obese. The prevalence of overweight among United States

children and adolescents has increased significantly to 17%. From 1990 to 2018, the

prevalence of obesity in America increased from approximately 30.5% to 42.4% (Center for

Disease Control and Prevention, 2021). The annual medical cost of obesity in America was

about $147 billion. The current study to be reviewed is targeted at address the growing levels

of obesity in America. 

DISCUSSION

French and colleagues’ (2011) intervention adopted Prochaska and DiClemente’s

Transtheoretical Model and was effective. 

Pre-contemplation stage

Out of the 732 targeted households, 41 declined and 109 could not be traced. Eventually,

ninety households were enrolled on the program. The program recruited participants from all

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manner of places; grocery stores, clinics, religious bodies, recreation parks, libraries, schools

and worksites (French et al., 2011, p. 2882). This was a commendable approach to reach out

to participants that would be reflective of the general population.

However, some eligibility criteria skewed the population to consist mainly Caucasian middle-

class female earners who have higher education. French et al. (2011) reported that 79% of

household respondents were whites, 63% had at least one member with a college or advanced

degree. Again, all households had a minimum annual income of between $45,000 and

$100,000. Blank, Rebecca, and Michael (2009) points out that the middle-class bracket is

made up of households who earn between $40000 and $125000. Such criteria include (ii)

residence in a private house or apartment within 20 miles of the university; (iii) household

television viewing weekly average of less than or equal to10 hours per person. These criteria

limited the researchers from generalizing the study findings to the entire community.

Obesity varies by socio-economic factors; education, income, race, age and gender. Ogden et

al. (2017) observed a 45.3%, 35.5% obesity prevalence among females and males

(respectively) who were high school graduates and 27.8% [women], 27.9% [men] among

college graduates. Also, obesity prevalence was 29.7% among high-income class women,

42.9% in middle-class women and 45.2% in low-income class women. 

Contemplation stage

The contemplation stage saw 293 households satisfying the eligibility criteria. The baseline

data completion and clinic visits exposed 293 households to the pros and cons of the

program. Only ninety were willing to participate in the change program. These households

were grouped into the control group and intervention group.

French et al. (2011) trained household shoppers how to conduct a home food inventory was.

Weekly emailing of household receipt and annotation to research staff for a period of one

month served as the evidence to justify a household’s willingness to change. One hundred

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and six households completed the initial clinic visit of which ninety completed the one-month

receipt collection. These were later randomised into the program (French et al., 2011, p.

2084).

Preparation stage

Before the start of the intervention, all the intervention households received television

limiting devices, digital scale, designed home activities, training on how to record data for the

study’s measurable indicators and enrolled on a six-month face-to-face group sessions

(French et al., 2011, p. 2084). With help from the National Institute of Health/National

Cancer Institute, the research organizers provided all the necessary items that will enable the

program to run smoothly.

Action stage

The weekly group sessions lasted for six successive months. The sessions comprised

behavioural education, interactive activities, twenty to thirty minutes of physical education,

healthy snack and a $25.00 gift card. The activities during group sessions taught participants

practical means of reducing or maintaining body weight.

Research staffs could offer direct behavioural change assistance and monitoring to

households due to the sizeable number of attendees per session. The periodic home activities,

telephone support call, email newsletters and other behavioural strategies (such as individual

and family goal setting) fostered continual behavioural change throughout the intervention

period (French et al., 2011, p. 2884). Household members served as co-supervisors to the

credibility of data submitted to research staffs.

Providing digital scales to each participating household was an effective approach to instil

regular weight-check in participants. However, constant checking of weight with no

significant change in body weight is a behaviour that can create psychological disturbances

leading to obesity prognosis (Latner, 2008). Essayli et al. (2017) ascribed struggling in

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weight loss, body dissatisfaction, fear of gaining fat and lower self-esteem to frequent

checking of weight.

Pacanowski, Bertz, and Levitsky (2014) concluded in their review that adopting only a daily

weight check as a weight loss intervention is more effective compared to attaching a daily

weight check to traditional weight loss programs.

Again, the researchers did not allow children and adolescents to check their weight. They

believed that weight gain is a usual occurrence in adolescents and children (French, S.A. et

al., 2011 p. 2884). This belief may not be entirely true as Ogden, et al. (2012) reported that

about 16.9% of United States children and adolescents were obese. The research design

should have monitored the weight of the children and adolescents as some could be obese.

Over the years, the efforts of the National Health and Nutrition Examination Survey

(NHANES) to monitor obesity among the youth has helped maintain the prevalence rate

around 17% since the 1980s (Ogden et al.,  2012)

The introduction of television limiting devices was a great approach to reduce television

viewing hours and its related sedentary lifestyle. At the end of the intervention, French et al.

(2011) observed a successful reduction of television viewing hours from 52.8 hours weekly to

29.8 hours. Excessive viewing of television reduces energy metabolism rate, increases

snacking and consumption of non-nutritious food (Dietz and Gortmaker, 1985, p. 807). 

Physical activity and proper eating habits are effective behaviours for weight loss and

preventing weight gain (Jakicic, 2002. P. 3826S). Successful weight-loss interventions that

achieved significant weight loss adopted strengthened physical activity and proper eating

habit approaches. Epstein et al. (1985) intensified adherence of participants to recommended

exercises guideless and the traffic light diet control system to achieve significant weight loss

in obese children after two months.

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One weakness of French et al. (2011) intervention was allowing participants set their own

behavioural goals for diet and exercise. The thirty minutes of physical activity included in the

monthly group sessions did not meet the minimum weekly exercise duration (150 minutes)

associated with weight loss (Jakicic, 2002).

Maintenance stage

The intervention failed to assess program effectiveness after six months instead, it assessed

program impact at the end of the stipulated one-year duration. According to Butryn, Webb,

and Wadden (2011), weight loss interventions obtain peaked weight loss in the sixth month

while weight regain sets in after one to five years. In their study, about one-third of

participants regained lost weight at the end of the year while half returned to their original

weight in five years.  

The Household Obesity Prevention program did not have any termination stage. Participants

were not allowed to quit the program voluntarily. Once the duration was exhausted, all

participants had to quit. No wonder twenty-eight of the forty-two intervention household

group opted to keep using their television limiting device at the end of the program.

IMPLICATIONS

Socio-economic factors like education, income, and age are likely to affect the results of a

family-based weight-loss intervention. A more effective approach will be; to stratify study

participants under the prominent influencing factors and design appropriate interventions that

focus on each age bracket. Bouchard, Baillargeon, and Langlois (2013), un-stratified weight-

loss interventions tend to benefit the adults more than the children. French et al. (2011) did

not record any significant change in BMI or BMIz score. Interventions that focused on only

children or only adults are more successful. According to Snethen, Broome and Cashin

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(2006) concluded that all the seven reviewed interventions for obesity in children were

effective irrespective of the approach. 

Future interventions should set stricter intervention goals together with the participants.

Interventions should set more strict goals such as meeting minimum exercise hours for

obesity, removing high calorie from a shopping list, or recommend minimum vegetables and

fruit purchase per week. Significant weight loss was observed in studies that met the

minimum public health 150 minutes weekly exercise guideless (Jakicic, 2002). In Williamson

et al. (1993), men and women who engaged in exercise below the minimum optimal exercise

hours gained 3.9kg and 7.1kg respectively.

In further studies, researchers should consider daily weight checking as a stand-alone

intervention to reducing weight. Optionally, researchers should reduce the rate of weight

checking in interventions where weight-checking will be run alongside other weight-reducing

approaches. This is to minimize the adverse psychological disturbance of daily weight

checking. According to Steinberg et al. (2015), daily checking of body weight, as a sole

intervention program improved a person’s likelihood to adhere to weight control behaviours.

In their study, daily weight check yielded a loss of 6.1kg body weight in study participants

and a 17.6% increased adoption to weight control behaviours.

Future interventions should conduct monthly analysis of collected data. This will help keep

track of when a significant change from baseline measurements occur. Butryn, Webb, and

Wadden (2011), did monthly data analysis. Comparing the monthly analysis revealed that

weight loss peaked in the sixth month.

Researchers should stay in touch with participants for more years and provide continual

support. This will improve the maintenance and termination stages of the transtheoretical

model. Look AHEAD Research Group (2006) maintained physical contact with participants

for four years and observed a 4.7% weight loss in the fourth year.

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CONCLUSION

Obesity is endemic in America, with more than sixty per cent of its population being obese or

overweight. French et al. (2011) aims at addressing this crucial public health problem using a

family setting. The study adopted the Transtheoretical model to achieve effectiveness.

The intervention's strengths included; providing all resources before the start of the program,

limiting television viewing hours with a television limiting device, monthly group sessions

and telephone support calls were the strength approaches of the intervention.

The intervention's weaknesses included; a bias inclusion and exclusion criteria, daily weight

checks, failure to monitor weight in children and adolescents, multiple weight loss

approaches that were not forceful enough to elicit significant changes and the absence of a

termination plan.

For a more effective intervention in the future, the House Obesity Prevention program should

stratify study participants according to relevant social determinants of health. Researchers

should set stricter intervention goals that meet the minimum recommended standards (for

weight loss) for study participants. Again, future intervention should consider daily weight

checking as a stand-alone intervention, or drastically reduce the rate of checking weight if it

will be in combination with other weight-loss strategies. Further interventions should have a

termination or exit plan.

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REFERENCES

1. Blank, Rebecca M., and Michael S. Barr. (2009) ‘Insufficient funds: Savings, assets,

credit, and banking among low-income households’, Russell Sage Foundation.

2. Bouchard, D.R., Baillargeon, J.P. and Langlois, M.F. (2013) ‘The Independent Effect

of Age Groups on the Effectiveness of Lifestyle Intervention’, Current Obesity

Reports, 2(2), pp.107-119.

3. Butryn, M.L., Webb, V. and Wadden, T.A. (2011) ‘Behavioral treatment of obesity’,

Psychiatric Clinics, 34(4), pp.841-859.

4. Center for Disease Control and prevention (2021) Adult Obesity Facts. Available at:

https://www.cdc.gov/obesity/data/adult.html (Accessed; 4 April 2021).

5. Dietz, W.H. and Gortmaker, S.L. (1985) ‘Do we fatten our children at the television

set? Obesity and television viewing in children and adolescents’, Pediatrics, 75(5),

pp.807-812.

6. Epstein, L.H. et al. (1985) ‘Effect of diet and controlled exercise on weight loss in

obese children’, The Journal of pediatrics, 107(3), pp.358-361.

7. Essayli, J.H. et al. (2017) ‘The impact of weight labels on body image, internalized

weight stigma, affect, perceived health, and intended weight loss behaviors in normal-

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 weight and overweight college women’ American Journal of Health Promotion,

31(6), pp.484-490.

8. French, S.A. et al. ( 2011) ‘Household obesity prevention: take action—a group‐

randomized trial’, Obesity, 19(10), pp.2082-2088.

9. Jakicic, J.M. (2002) ‘The role of physical activity in prevention and treatment of body

weight gain in adults’, The Journal of Nutrition, 132(12), pp.3826S-3829S.

10. Khan, L.K. et al. (2009) ‘Recommended community strategies and measurements to

prevent obesity in the United States’, Morbidity and Mortality Weekly Report:

Recommendations and Reports, 58(7), pp.1-29.

11. Latner, J.D. (2008) ‘Body checking and avoidance among behavioral weight-loss

participants’, Body image, 5(1), pp.91-98.

12. Look AHEAD Research Group. (2006) ‘The Look AHEAD study: a description of

the lifestyle intervention and the evidence supporting it’, Obesity, 14(5), pp.737-752.

13. Ogden, C.L. et al. (2012) ‘Prevalence of obesity and trends in body mass index

among US children and adolescents, 1999-2010’, Jama, 307(5), pp.483-490.

14. Ogden, C.Let al. (2017) ‘Prevalence of obesity among adults, by household income

and education—United States, 2011–2014’, MMWR. Morbidity and mortality weekly

report, 66(50), p.1369.

15. Pacanowski, C.R., Bertz, F. and Levitsky, D.A. (2014) ‘Daily self-weighing to control

body weight in adults: a critical review of the literature’’ Sage Open, 4(4),

p.2158244014556992.

16. Snethen, J.A., Broome, M.E. and Cashin, S.E. (2006) ‘Effective weight loss for

overweight children: a meta-analysis of intervention studies’, Journal of Pediatric

Nursing, 21(1), pp.45-56.

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 17. Steinberg, D.M. et al. (2015), ‘Weighing every day matters: daily weighing improves

weight loss and adoption of weight control behaviors’, Journal of the Academy of

Nutrition and Dietetics, 115(4), pp.511-518.

18. Williamson, D.F. et al. (1993) ‘Recreational physical activity and ten-year weight

change in a US national cohort’, International journal of obesity and related

metabolic disorders: journal of the International Association for the Study of

Obesity, 17(5), pp.279-286.

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