Running Head: REDUCING THE PROPORTION OF OBESE ADOLESCENTS 1

Reducing the Proportion of Adolescents Considered Obese

Audrey Vo

California State University, Long Beach

HSC 435 Sec 03 Health Promotion and Risk Reduction

Signature Assignment

October 25, 2018

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Obesity in Adolescents

In the United States, between the years of 2015 to 2016, the prevalence of obesity for

children between the ages of 2 and 19 years old was 18.5% and affected 13.7 million children

and adolescents (The Centers for Disease Control [CDC], 2018). The CDC states that obesity in

adolescents occurs when their weight is above the normal and healthy range for their age and

height. Specifically, being overweight is defined as having a BMI from the 85th percentile to the

95th percentile for adolescents of the same sex and age while obesity is having a BMI over the

95th percentile (CDC, 2016b). It is important that we examine obesity in children since it puts

adolescents at risk for poor health. Some causes of obesity include genetics and behavior of the

individual as well as the community environment. The community that a person lives in can

either support or discourage healthy decisions through the foods and drinks that are offered,

affordability of healthy foods, activities, social supports, and policies.

It is clear that obesity is more prevalent in certain populations. For kids between the ages

of 12 to 19 years old, obesity rates were 20.6% (CDC, 2018). Hispanics demonstrated the highest

prevalence of obesity with 25.8% while non-hispanic blacks demonstrated 22.0%, which are

both higher than non-hispanic whites, 14.1%, and non-hispanic Asians, 11.0%, the lowest of all

populations (CDC, 2018). As well as being more common in certain race populations, childhood

obesity is also more prevalent in the lower-income families. Low-income households have a

prevalence of 18.9% and middle-income households have a rate of 19.9%. The lowest prevalence

was in the high-income household, demonstrating a rate of 10.9% (CDC, 2018). Consequences

of staying obese and not actively working to change that may result in high blood pressure,

cardiovascular diseases, type 2 diabetes, low self-esteem, depression, poor mental health, and an
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overall lower quality of life (CDC, 2016a). Many programs and interventions have been

implemented in order to address the issue of high prevalence of obesity in adolescents.

Literature Review

The following sections will examine five interventions that aim to lower the proportion of

adolescents considered obese, all having subtly different target populations and aims​. ​The

success of these interventions as well as their target population, health promotion methods, and

outcomes will be examined.

Program 1: ​South County Food, Fitness, and Fun

The ​South County Food, Fitness, and Fun​ program (SCFFF) is community-based and

was developed due to the community’s desire for effective obesity prevention programs. The aim

of this study was to examine the effects of a multidisciplinary intervention BMI in children who

are overweight or obese, following them two years after the interventions (Xu et al.). Its

secondary aim was to access the effects that this intervention had on the children’s dietary intake,

physical fitness, and psychosocial functioning from baseline to post-intervention (Xu et al).

A total of 146 overweight or obese children between the ages of six to ten years old and

their caregivers were recruited to participate in the SCFFF programs. These programs were

recommended by physicians at no costs to the children as well as their caregivers. However, only

118 children and their caregivers enrolled in the programs, with only 97 completing it. The

intervention held 16 weekly sessions, each lasting about 75 minutes, at a community exercise

center that included group nutrition classes, which encouraged substituting for healthier foods,

and physical activity sessions that made being physically active enjoyable through games and
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fun activities (Xu et al). The activities encourage healthy behaviors in children through positive

interactions with their caregivers.

In this program, 65 out of the 97 children who finished the intervention and provided two

year follow up data revealed that there were reduced BMI z-scores, decreased fat, carbohydrates,

saturated fats, and sodium intakes as well as decreased energy intake. There was also an increase

in core body strength and endurance and a significant increase in the children’s emotional

functioning. Data revealed that this program was effective in reducing relative weight in children

who were overweight or obese.

Program 2: Physical Activity and Behavior Based Motivational Enhancement on BMI

The second intervention is an obesity intervention combining physical activity and

behavior-based motivational enhancement intervention. It targeted BMI, physical activity levels,

and psychological variables towards physical activity in obese male adolescents (Lee & Kim,

2015). The physical activity in this intervention consisted of various jump rope exercises, which

participants engaged in three times a week for 50 minutes each time. The behavior-based

motivational enhancement intervention included offering information on which of the

psychological variable influenced weight control and strategies to modify these variables (Lee &

Kim, 2015).

A total of 68 male Korean students with a BMI greater than 25 kg/m² from a junior high

school in Seoul were selected and participated in a 16-week obesity intervention. During this

period, the participants’ BMI, physical activity levels, self-efficacy, and perceived benefits and

barriers were measured at three time points, the first at baseline, the second at the eighth week,

and the final one at the end of the 16th week (Lee & Kim, 2015).
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Lee and Kim stated that results displayed a significant decrease in the adolescents’ BMI

and a significant increase in physical activity by the end of the intervention. Results also revealed

that exercise self-efficacy and perceived benefits towards physical activity significantly

increased while perceived barriers gradually decreased. The combined physical activity with

behavior-based motivational enhancement intervention was effective in lowering the proportions

of obese adolescents.

Program 3: Intensive and Interactive Nutritional Education Program

This school-based nutritional education program was designed in order to examine the

change of growth parameters among obese female adolescents after the completion of this

program, which was provided by a pediatrician (In-Iw, Saetae, & Manaboriboon, 2012). The

secondary aim of this program was to demonstrate the change on participants’ eating behavior.

This study used a prospective cohort and randomized controlled trial studying 49

participants that were eighth-grade female students with a calculated BMI of at least 25 kg/m²

(In-Iw et al, 2012). Each student was randomly assigned to either the control group or the

intervention group, with 24 students in the control and 25 in the intervention. Their body weight,

height, BMI, percentage of weight for height, health attitudes, and eating behavior were recorded

at baseline and four months after. The nutritional education program included interactive

lectures, which focused on making healthy food choices, lifestyle changes, and calorie

calculations, as well as food pamphlets that helped participants compare the calories in their

meals (In-Iw et al, 2012). The results of this study reveals that after a four-month period, the

intervention group displayed a significant decrease in BMI and an increase in healthy eating
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attitudes. The results highlights the efficacy of school-based interactive nutritional education

programs for obese adolescents.

Program 4: ​Healthy Children, Healthy Families

Healthy Children, Healthy Families​ is a community-based intervention that had goals of

improving parents’ food practices such as displaying healthy eating habits, encouraging a

balanced diet, involving their children in food decisions, and teaching them about nutrition

(Otterback, 2018). They aimed to assess changes in parent and child behaviors related to food

intake and physical activity. The target population were parents from the low-income Hispanic

population with at least one child aged 3-11 years old since parents have a big role in their

child’s health behaviors.

In this program, the intervention was delivered by five community paraprofessionals

called Navegantes, with two to three Navegantes facilitating each lesson. This intervention lasted

8 weeks and was delivered to nine groups of parents over a two-year period. Parents completed

pre- and post- surveys that consisted of 84 questions, ranging from demographics,

Comprehensive Feeding Practices, and the HCHF Behavior Checklist, and attended 90-minute

weekly sessions (Otterback, 2018). Children were taught a different but similar curriculum than

the parents. The parents learned about healthy nutrition and physical behaviors, strategies to

guide their families to partake in healthy behaviors, and several food parenting practices.

Of the 94 parents that consented to participate, only 52 participants completed both the

baseline and post-intervention data. The study revealed that for those that completed the

intervention, there was a significant increase in intake of fruits, vegetables, and low-fat dairy for

both parents and children. Parents had a decrease in soda intake and children had increased
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levels of physical activity. Overall, there was a decrease in fast food intake and energy dense

snacks as well as an increase in the availability of fruits and an increase in the encouragement of

a balanced diet with variety from the family.

Program 5:​ TEAM Mississippi Project

TEAM Mississippi Project ​took place in a rural southern community where the

prevalence of obesity ranked the highest. This school-based intervention targeted children from

the ages of six to ten years old and aimed to apply the Social Learning theory where healthy

lifestyle behaviors are promoted in early development (Greening, Harrel, Low, & Fielder, 2012).

They participate in monthly physical activity and nutritional events during the nine month

academic school year. These monthly family events, nutrition, and physical activities included

healthy tailgating, healthy recipes, and parent-child softball throw contests. A total of 405

children participated in this program, with 204 attending the intervention school and 246

attending the control school. At the baseline and post-intervention, the children’s nutritional

knowledge, number of engagement in different physical activities, fitness level, dietary habits,

waist circumference, BMI z-scores, and percentage body fat were measured. At the end of the

program, results demonstrated that the children in the intervention school had a significant

decline in percentage body fat, an increase in physical activity engagement, an improvement in

dietary fat intake, and an improvement in the performance of fitness tests.

Proposed Intervention

In this proposed intervention, the target population will be middle and high school

students with Hispanic, low-income backgrounds in the Los Angeles County. This program will

be focused on decreasing the BMI of this target population and increasing their knowledge on
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how to obtain and maintain a healthy weight. This intervention will be school-based and will

include both physical activities and educational classes on topics such as healthy eating habits,

nutrition, and causes of obesity. These sessions will be culturally competent by providing

sessions in both English and Spanish and considering the culture’s dietary habits, such as the

increased consumption of tortillas, dairy, cheeses, and chilis. It must be taken into consideration

for participants to still be able to incorporate the foods essential to their culture for the

participants to connect with the program. These classes will occur after school every semester for

a year, with each class lasting an hour long, two times a week. The first class, occuring on

Mondays, will be the educational class. The second class occurs on Thursdays and will focus on

physical activity, applying the knowledge that the participants will learn in the educational

classes. This program will be provided at the participants’ schools in order to make it easily

accessible. A pre- and post-intervention survey will measure their BMI, dietary behaviors, and

nutritional knowledge.

This intervention will apply the Health Belief Model in order to decrease the proportion

of obese adolescents. The Health Belief Model states that a person’s action to change their

behavior results from their evaluation of their perceived susceptibility, perceived severity

perceived benefits, perceived barriers, cues to action, and self-efficacy. For this program, the

perceived benefits, susceptibility, and severity as well as self-efficacy will be accessed. Through

the educational classes, causes and consequences of obesity will reveal to the participants that

genetics, unhealthy habits, and sedentary lifestyles increases the susceptibility of obesity. Data

and statistics for the severity of obesity in the United States and specifically in the LA county

may cause participants to have an increase in perceived susceptibility and severity. After this
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gained knowledge and more attended educational classes, participants will see the perceived

benefits of taking action to combat obesity. The physical activity sessions will help decrease

perceived barriers since the program will be available to them after school with provided

knowledge on how to effectively exercise and increase caloric expenditure. Because the

participants are attending the sessions that the program provides, it must mean that they believe

they have the capabilities to change their BMI and weight.

Just like any intervention, barriers and limitations will occur. In this program, possible

barriers may be that adolescents won’t be able to attend these programs due to the time of the

program. They may have family duties that must be fulfilled at home after school ends. Lack of

transportation after the intervention ends to go home may also hinder participation if students

only have rides arranged for right when school ends. A limitation of this intervention is that if

students do not fully complete the program, data will be missing and the study will not be fully

representative and demonstrate the true results. Another limitation is the inability to accurately

apply this study to other populations since this program is specifically designed for adolescents

from low-income, Hispanic population of the Los Angeles county.

Conclusion

Five successful interventions were evaluated, each having different aims and goals. All

had an overarching goal of reducing the proportion of adolescents considered obese. After

examining these programs, a proposed intervention was provided for the reduction of obesity in

adolescents in middle and high school with a Hispanic and low-income background in the LA

county. Through the results of these interventions, it is clear that nutritional classes and increased

physical activity help obese adolescents lower their BMI and gain healthy dietary behaviors.
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References

Childhood obesity causes & consequences. (2016a). ​Centers for Disease Control and

Prevention. ​Retrieved from ​https://www.cdc.gov/obesity/childhood/causes.html

​ etrieved from
Childhood obesity facts. (2018). ​Centers for Disease Control and Prevention. R

https://www.cdc.gov/obesity/data/childhood.html

Defining childhood obesity. (2016b). ​Centers for Disease Control and Prevention. ​Retrieved

from ​https://www.cdc.gov/obesity/childhood/defining.html

Greening, L., Harrel, K.T., Low, A.K., & Fielder, C. E. (2012). Efficacy of a school-based

childhood obesity intervention program in a rural southern community: TEAM Mississippi

project. ​Obesity, 19(​ 6). doi:10.1038/oby.2010.329

In-Iw, S., Saetae, T., & Manaboriboon, B. (2012). The effectiveness of school-based nutritional

education program among obese adolescents: a randomized controlled study. ​International

Journal Of Pediatrics,​ 1-5. doi:10.1155/2012/608920

Lee, H., & Kim, Y. (2015). Effects of an obesity intervention integrating physical activity and

psychological strategy on BMI, physical activity, and psychological variables in male obese

adolescents. ​Behavioral Medicine,​ ​41(​ 4), 195-202. doi:10.1080/08964289.2014.914463

Otterbach, L., Mena, N. Z., Greene, G., Redding, C. A., De Groot, A., & Tovar, A. (2018).

Community-based childhood obesity prevention intervention for parents improves health

behaviors and food parenting practices among Hispanic, low-income parents. ​BMC Obesity,​

5​1. doi:10.1186/s40608-018-0188-2

Xu, F., Marchand, S., Corcoran, C., DiBiasio, H., Clough, R., Dyer, C. S., & ... Greene, G. W.

(2017). A community-based nutrition and physical activity intervention for children who are
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overweight or obese and their caregivers. ​Journal Of Obesity,​ 1-9.

doi:10.1155/2017/2746595