Obesity is a medical condition where the body mass index of the person is greater than 30. Morbid obesity hampers the normal physiological functioning of the body and predisposes one to other related illnesses and conditions. Obesity is a major public health concern in Australia; over 60 % of the country’s adult population is obese (Hartmann-Boyce, Jebb, Fletcher, & Aveyard 2015). 10 of these individuals are severely obese. More than half of the country’s general population is overweight. The state of South Australia is the most affected. In 2018, 65.4% of adult South Australians were reported as either overweight or obese. The Local Health Network estimates that the Northern Adelaide accounts for most of the cases of obesity in South Australia with a prevalence of 70.7% (ObeNghiem & Khanam 2016). There have been interventions and health promotion initiatives in the state of South Australia such as OPAL which targets obesity control and prevention but the success rate has been minimal. This paper intends to bridge the gap by conducting a needs analysis leading to development of a health promotion proposal to curb obesity in South Australia, specifically in Northern Adelaide. The objectives of the plan are outlined in the paper alongside the action plan for realizing the set goals. An evaluation plan for the intervention is the presented.
Approximately 70% of Australia’s’ obese adult population is suffering from one or the other weight related complication, diseases and conditions (Malakellis et al., 2017). As a result the cost of healthcare for these individuals is increased by more than 30 % due to the high rates of illnesses such as cardiac problems, cardiovascular diseases, diabetes, hypertension, high blood pressure and musculoskeletal diseases (Sainsbury, Hendy, Magnusson, & Colagiuri, 2018). The leading cause of death in Australia is cardiovascular conditions; 22 % of Australians suffer from the condition. In effect, obesity is a leading cause for morbidity in the country and claims more lives than any other condition. The risk of developing obesity in Australian men is 14.5% higher than that of women which stands at 56.3% (McNaughton 2015).
The rates of obesity among Australian children are appalling. Between the ages of 5 and 17, 1 in every 4 children is reported obese or overweight. The prevalence of obesity in South Australia is worse than the national average. Over 63.7% of the state’s adult population is obese. The metropolitan area of Northern Adelaide leads South Australia State with prevalence of 65.4% (Demaio 2018). The last two decades have seen the rise in the prevalence of obesity in both the state of South Australia and the metropolitan Northern Adelaide as reported by the Local Health Network. So what is the cause of this problem? According to the Heart Foundation, 72.5% of the residents of the Metropolitan Northern Adelaide do not exercise at all. Their access to healthy foods is limited and more importantly, most people simply do not make healthy eating decisions (Sturgiss & van Boven, 2018). The foundation has called on the state and federal governments to intervene in the inactivity of the state as it is causing unprecedented health risks.
This paper notes that there is sufficient scholarly work that has been undertaken with a view to establishing the rates of obesity among Australians and Southern Australians in particular. However, there is a gap of knowledge with regards to the health promotion interventions to bring down the prevalence of obesity in this community (MacKay 2011). This paper targets to bridge this gap by looking at existing literature on obesity control and prevention so as to design an intervention that responds to the gaps. The paper also discusses a mechanism for evaluating the effectiveness of the intervention in controlling obesity.
The needs analysis presents the need for this health promotion intervention. It derives from the situation of obesity which then creates the need to control the condition. A few fast facts about obesity in Australia are testament to the need for a health promotion intervention. The starting point is the national average prevalence of the country which stands at 63% of the adult population making Australia one of the countries with the highest obese populations (Lacy et al., 2015). This represents about 11.2 million obese people. The proportion of obese adults has increased with time. Children are not doing any better; about 1.2 million of them are obese too. Recent studies show that among the OECD countries, Australia’s fast food consumption patterns and trends are some of the highest. South Australia leads with the highest prevalence and some of the most inactive people in the country reside in the metropolitan area of Northern Adelaide (Phillipov 2013).
There have been a number of interventions in the state of South Australia just like most parts of the country to bring down the rates of obesity. Examples like the Obesity Prevention and Lifestyle program can be mentioned. It is noteworthy that despite the efforts of these interventions, the prevalence of obesity continues to be high in the state of South Australia (Sonntag, Sweeney, Litaker, & Moodie, 2018). There is therefore need for coming up with an intervention that does not merely respond to the problem, but puts in place proactive measures to prevent the development of obesity in South Australia.
The broad aim of this grant proposal for health promotion intervention is to reduce the occurrence of obesity among South Australians living in Northern Adelaide and help individuals who are already obese to control the condition.
The specific objectives of the intervention are:
The first objective that must be met by this intervention for obesity control is to create awareness about the problem. Many people see obese people and probably know a number of obese persons in their lives, or are obese themselves but in order to draw attention to the fact that obesity is a matter of public health concern, awareness creation is imperative. As posited by (Hendrie et al., (2015) creating awareness around the matter will involve crafting salient messages which are informative in nature and that communicate the statistics on obesity nationally and in the state with ease. The other component of this is communicating the health risks that are posed by being overweight and obese as well as the benefits of maintaining a healthy weight, this information will then be disseminated through the mainstream media platform as well as the non-formal media.
As already noted in the background of the study, the reason for the increase in weight of most Australians is the lack of physical activity. Most people live a lifestyle that is characterized by less physical movement. In the Northern Adelaide metropolitan area for instance the Heart Foundation reports that more than 72% of the population is inactive and do not take part in any physical fitness activities of any form (Lacy et al., 2012). The initiative objectifies to get obese persons to sign up for physical activities to reduce their weights. These could be in the form of sporting activities such a bike riding, yoga or zumba classes, aerobic and strength training, gym lifting any other games that the participants could be interested in.
This paper has reported that among the OECD countries Australia leads with trends indicating poor choices of food. The average Australian is likely to prefer fast foods loaded with calories, fat and refined grain over a healthy meal with plenty of vegetables and fruits (MacKay 2011). One of the major goals of this intervention is to champion the access to healthy foods at all places from schools to workplaces. Locating healthy food joints at strategic places in the workplace and schools for example is an effective way of ensuring access. The intervention can also work around getting the prices of healthy foods in the workplace and learning institutions to be reduced in order to encourage obese as well as persons of normal weight to buy.
All strategies aimed at controlling and reducing overweight and obesity can only be sustained if the people are sufficiently sensitized and educated to change their attitude and behavior towards their role in the quality of life that they want to live (Thomas, Lewis, Hyde, Castle, & Komesaroff, 2010). In order that this is realized, the intervention will pursue individualized as well as group counseling for persons so as to inspire change of behavior. This will involve teaching the participants how to set goals in life and how to follow up on achieving those goals. The obesity prevention initiative will employ professional support for guidance of behavior changes alongside the use of individualized behavior change approaches.
This section of the proposal outlines the intended plan for intervention and how this will be used in the achievement of the identified goals. The action plan summarizes the approaches that will be employed in meeting the challenges of controlling obesity among residents of South Australia living within the Northern Adelaide metropolitan area. The intervention has 3 action plans which when implemented interactively will yield meaningful results for the obesity control program; a multi-component approach, a multi-sectorial approach and a whole-of community approach. They are discussed in detail as follows:
If the battle against the rising rates of obesity and overweight is to be won, obesity must be perceived in a different manner. It must be perceived beyond just being a matter of the wellbeing and health of the individual to the wellbeing and health of the whole community. The import of this is that in order to successfully reduce the prevalence of obesity in the community, all members of the community must be involved because it is a societal problem (Martin 2018). Consequently, this intervention will seek the participation of all members of the Northern Adelaide metropolitan community beginning from the home, to the learning institutions, the workplaces, neighbors and community members in general. It is necessary that the members of the family and friends are capacitated to be able to provide support for persons known to them to regain normal weight. According to Obesity Hitting Crisis Point (2014The involvement of the colleagues at learning institutions and the workplace is also crucial so that they can provide the enabling environment for recovery to occur. According to the action plan these members of the community must be sensitized in order that they may be aware how to handle those who are overweight and obese among them and provide necessary support.
The efforts of one sector alone cannot successfully bring down the high prevalence of obesity in Northern Adelaide, South Australia. Other interventions that have had meaningful results in obesity control have had to pursue a multi-sectorial approach. Health practitioners will of course be involved as the principal partners in the initiative. However in order to have an approach that deals with all the facets of the problem, more partners from a variety of sectors must be sought by a health promotion initiative (Newman, Ludford, Williams, & Herriot, 2016). This intervention will bring on board partners from the National Health Services as well as the Local Health Network in Adelaide because they have a major role to play in improving the well-being of the resident s of the area. Community health volunteers will work alongside the nutritionists, nurses and clinicians in order to offer nutrition classes on better and healthier diet options for individuals depending on their BMI. As posited by Montgomerie, Chittleborough & Taylor (2014) the partnership of the social welfare services will also be sought; social workers will work with communities in providing support; counseling and behavior change follow up programs at home. Funding for this initiative will be sought from the state government of South Australia and the federal government as well.
As has been canvassed in the background of this paper, there are many underlying issues and facets of the problem of overweight and obesity. It follows therefore that for an initiative to meet the challenge of mitigating obesity, it must address the various components of the problem. As posited by Sartorius, Veerman, Manyema, Chola, & Hofman (2015) a multi component approach that incorporates nutrition programs with a physical fitness and behavior change follow ups is effective in obesity control. Borrowing from this, the intervention will prioritize the provisions of education to the participants in need of making decisions of proper diet and will help them to come up with food timetables to ensure they take healthy foods regularly.
Making healthy food choices alone is not enough in regaining healthy weight; an effective weigh loss regime must involve physical exercises (Hendrie et al., 2015). Owing to this, the initiative will engage the services of fitness program providers such as zumba and yoga. As part of weight loss regime, aerobics and strength classes will also be involved. These are aimed at helping participants to lose weight. After attaining the healthy weight and the medically healthy BMI, the next essential part is maintaining it to avoid a relapse of obesity. This component of the approach involves a lot of follow up and support by social welfare and community health volunteers to help the participants to stick to healthy dietary habits and maintain a healthy BMI.
This portion of the proposal highlights the outcomes or results that are anticipated from the health promotion and how they will be significant to the implementation of the health promotion initiative. The outcomes are direct consequences of the objectives and the action plans
Healthy Food Choices
The anticipation of this health promotion proposal is that it helps the residents of Northern Adelaide, South Australia to make better decisions when it comes to diet options. The proposal hopes that it will alter the current inclination of most people towards refined grains, high fat and high calorie foods to more healthy food choices with less fat and calories but more vegetables and fruits. As submitted by Feng et al., (2017) the anticipation stems from the objective which seeks to increase access to better, healthier food options at the workplace, home and school. Increasing access to healthy food joints in workplaces and schools in particular will be a major boost towards this outcome. The significance of this outcome is self-explanatory. Statistically, Australians are top consumers of refined and fast foods among the OECD countries (Atlantis et al., 2018). A shift in the taste and preferences from the fast foods to healthy foods will mean that the first obstacle to a healthy weight and a normal BMI is eliminated.
A More Active Lifestyle
Any health promotion initiative targeting reduction of obesity would anticipate a more active lifestyle as a first priority. From the literature, watching the normal weight and normal BMI demands not only eating what the body needs, but also doing physical exercises to ensure any excess calories and fat are combusted (Atlantis, Goldney, Eckert, & Taylor, 2012). The Heart Foundation estimated in a recent study that 72% of residents of Adelaide South Australia do not engage in physical exercise. This kind of sedentary lifestyle is to blame for the rising prevalence of obesity and the weight related conditions, fact that underscores the significance of achieving this outcome. Most people live life characterized by using cars to work and long sitting hours at work. Getting this community to adapt a more active lifestyle through activities such as zumba and yoga would help those who are overweight to burn the extra calories and fat. In the long run, the initiative will have met its objectives.
This segment of the paper is going to look at the development of a strategy to conduct the monitoring and assessment of the activities that will be carried out as part of the initiative for prevention and control of obesity among the Northern Adelaide residents of South Australia. To set the pace for the evaluation of the intervention plan, the evaluation plan outlines the key aspects of the evaluation as adopted from (Warin, Zivkovic, Moore, Ward, & Jones, 2015).
Besides that, the evaluation plan is also structured along a set of questions that will help the program implementers to measure the effectiveness of the strategies employed in the intervention. The questions are formulated to address various aspects of the health promotion initiative from the design to process, implementation, impacts and outcomes as well as its implications for the future and policy.
Figure 1: Summary of evaluation questions addressed by evaluation plan (Sokol et al 2017).
Beyond the formulation of the questions to be addressed by the evaluation plan, there is the actual evaluation of the design, process, impacts and outcomes as well as the implications of the initiative on future programs and policy. In assessing the effectiveness of the design and process of the intervention, policy guidelines provided by the National Health Services on the prevention and control of obesity will be instrumental. In assessing the reach of the impacts and outcomes, the key performance indicators provided by the Local Health Network as well as other policy papers will be handy. As posited by Kwan Chiu Wong et al (2011) the evaluation will also make use of qualitative date collection methods. Qualitative data analysis methods are usually applied in research to establish trends and patterns in phenomenon or behavior. By use of qualitative data collection methods such as in depth interviews and questionnaires, vital information regarding the success of the initiative can be gathered (Lee & Cassell 2013). In this respect, the evaluation will through program persons conduct interviews with key stakeholders of the initiative so as to collect their assessment of the intervention.
Participants in the initiative will be provided with structured questionnaires that they would be required to fill out and return to program officers. As contained in Fotu et al (2011) the questionnaires would contain structured questions framed to elicit responses that grade the quality of services that were offered to the participants by the personnel working in the initiative. Overall, the program reach will remain a major yardstick for measuring the success of the intervention. Program reach here makes reference to the number of persons that will have participated in the program activities to the end (Backholer et al., 2014).
Figure 2: Major Outcomes and Indictors of Program Reach Used in Evaluation (Sokol et al 2017).
Figure 3: Continuation of Outcomes and Indicators of Program Reach (Sokol et al 2017).
As covered in the report, the prevalence of obesity in South Australia is a fundamental public health issue. Approximately 70% of South Australia’s obese adult population is suffering from one or the other weight related complication. The rates of obesity related morbidity and mortality is high raising the cost of healthcare by more than 30 % due to the high rates of illnesses related to obesity and overweight. This paper has presented a need analysis for this health promotion intervention. It derives from the situation of obesity which then creates the need to control the condition. The facts about obesity in Australia are testament to the need for a health promotion intervention. Coupled with this is the fact that most initiatives to control and prevent obesity have recorded low success. This paper has presented a new action plan with three approaches; multi sectorial, multi-component and whole of community approach which when integrated into the intervention will lead to the realization of the aims and objectives of the initiative. The aim of the intervention is to achieve a reduction in the incidence of obesity among South Australians. The expected outcome of the health promotion initiative is to influence a behavior change from refined foods to healthier choices and a more active lifestyle in place of the sedentary one. The evaluation plan to gauge the effectiveness of the initiative in the achievement of set goals makes this intervention practicable and actionable.
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