Nutrition Interventions For Childhood Obesity In Jakarta: A Digital-based Multicomponent Guidance System

Epidemiology of Child and Adolescent Obesity in Jakarta, Indonesia

Discuss About The Obesity Using Mobile Wireless Technologies?

Among the different health conditions making it to the headlines in recent times, childhood obesity is one. A considerable amount of concern is building up regarding the high prevalence rate of childhood obesity across the globe since the impact of obesity is adverse. Childhood obesity refers to the condition in which excess amount of body fat interferes with the health and well being of the child, leading to negative health outcomes (Cheung et al., 2016). Nutritional interventions have been in the limelight as a suitable approach towards this spurring epidemic. Though the introduction of a nutritional intervention would be marked by challenges, manipulation of the nutrient profile would be pivotal (Bailey et al., 2015). The present essay would focus on nutrition interventions to be delivered to the children of Jakarta, Indonesia, for addressing the emergence of obesity and diabetes as a health problem. The paper would describe the epidemiology of child and adolescent obesity and the present programs in the country. Strategies would be described, and a package of interventions would be outlined that would be implemented for reducing childhood obesity. The objectives and key elements of the intervention package would be mentioned along with the approach for implementing them. The effectiveness of such interventions would be supported  by literature. The development of the program would be guided by partnerships with the community to ensure its success.

The high prevalence of childhood obesity in Jakarta, Indonesia, a middle-income country, has sparked concerns. The number of children becoming overweight and obese due to an unhealthy diet has been raising concerns since the children are at high risk of long-term degenerative diseases. As per the reports of triennial research that was undertaken by the Health Ministry, there had been an increase in the rate of childhood obesity from 2010 to 2013.  In 2013, results of the survey indicated that prevalence of childhood obesity for children between 5-12 years was 30.1 percent which was quite shocking. This percentage was higher in comparison to the national average of 18.8 percent (Wardhani, 2014). According to Cahyaningrum et al., (2016) childhood obesity in Jakarta was not limited to children coming from the middle-class families and upper-class families. The lower-class families also engage in feeding unhealthy food to the children, and this is a rising trend at present.  The fact that excess body weight leads to diabetes and gallstones among other severe diseases such as brain disease and cardiovascular disease is undermined.

Proposed Intervention – A Digital-based Multicomponent Nutrition Guidance System

Indonesia has been taking steps in the past few years to combat the growing concerns of childhood obesity, but not much has been done. The nutrition status of children has drawn the focus for imparting education. The staged approaches have been a failure due to a number of reasons, though they have attempted to focus on the whole community. Future health interventions need to focus on broader aspects integrated into the community, and more specific approaches are required at present. More cost-effective approach is warranted that could reduce the burden (Rachmi et al., 2017).

Nutritional interventions for weight loss and prevention of obesity have been popular in research and practice and have generated a great interest of public health organisations. As energy balance is the cornerstone of weight control, nutritional uptake that limits certain macronutrients or food items are emerging. The basic premise is to have a balanced diet that meets the requirements for body functioning. The willingness to adopt diverse interventions are to be utilised for coming up with novice interventional strategies. As inadequately researched approaches underline the long-standing struggle for preventing obesity, more effective methods are required. It is imperative to have a proper understanding of the efficacy and long-term sustainability of approaches for preventing childhood and adolescent obesity (Spark et all., 2015).

A multicomponent nutrition guidance would be the suggested nutrition intervention for addressing childhood obesity in Jakarta. With the help of nutrition education theories, the suggested intervention would be a digital-based guidance system that would target first-time mothers to prevent obesity during the first two years. The multicomponent nutrition guidance system would include digitally based educational tools and content in addition to telephone-based professional support from registered dietitian nutritionists and certified lactation consultants. The educational content would be based on principles of nutrition that prevents childhood obesity. The content would aim at providing the much-required instruction and knowledge so that the facilitators and barriers associated with successful impartment of knowledge are addressed adequately. The tools would aim at helping mothers maintain behaviours within core nutritional messages. Telephone-based support would help mothers to reinforce content delivered to them and maintain these content. Contacting the dietician or lactation consultant through scheduling an appointment or calling up on the toll-free number would be a suitable approach. These components maintain consistency with the theoretical framework of behaviour change and the tools and educational content address the underlying theoretical constructs making a deep impact on behavioural adaptation (Turner et al., 2015).

Components of the Proposed Intervention

The proposed intervention would have a content team that would comprise paediatricians, researchers in nutrition, registered dietician nutritionists who would be experts is childhood nutrition for the formulation of the content and delivery of the digital-based intervention. Inputs are to be taken from the consumer communication professionals, academic advisory board and creative agency. Collaboration between the cited professionals would be pivotal for the success of the intervention. Clear communication between the experts for appropriate exchange of ideas and information is crucial. The registered dietician nutritionists would be working in a preventive role for combating obesity and be responsible for overseeing the complete intervention package. Inimitably, dietitians are known to utilise the recent and evidence-based public health research on food and health from which practical guidance tools are developed. The aim they have is to help individuals make appropriate food choices.The interaction with the professionals would be beneficial for the mothers as they would get the counselling and support require for acquiring skills in relation to child feeding and development of food habits. The recruitment of the professionals would be based on their academic qualifications, experiences, skills and aptitude. Leadership skills are to be demonstrated throughout the intervention process, therefore, resources are to be allocated to enable the professionals to showcase the same (Dooley et al., 2017).

The tools and content would include emails, videos, articles, infographics, quizzes, interactive and printable trackers and a tool for goal setting. Content needs to be divided into different modules and be delivered in a continuous manner over the two years time frame. Theoretical constructs would include social norms and behaviour beliefs; outcome evaluation and attitudes; self-efficacy and improvement through social modelling; relevant knowledge; behavioural capability. The successive step would to prioritise the most significant messages, and each of these are to be presented at each stage of intervention. The last stage would be to create the final copies of educational material with suitable headings, photo images to be imparted. Emails are to be sent to the mothers to notify them about the timing of the next module to be delivered. Periodical reminders would assist in using the websites in which the materials would be available. Text messages are also to be sent, and both emails and text messages would be sent to those who would opt to receive them on the basis of the birthdate of the baby.

The interactive digital tools would include a menu planner and a growth tracker. The growth tracker would have the aim of supporting a self-monitoring approach and for this case, a maternal monitoring approach. The mothers would be able to input the weight of the child at any point in time and track the weight-for-length percentile. The goal setting tool would help mothers to achieve the self-directed larger goals through performing smaller tasks. The menu planner would enable mothers to plan the meals given to the babies as per a list of the nutritious meal provided. The menu planner could be changed from an infant only use one to family use one so that parents can mode healthy eating for their babies. Printable, non-interactive tool would also be available together with a breastfeeding tracker and taste tracker (Eldredge et al., 2017).

Content Team and Partnership with the Community

On the basis of the anticipatory guidance framework, an anticipatory and sequential timing of delivery would be incorporated. The educational tools and content would be delivered every two months for the compete set of modules which can be termed as ‘Buillding Blocks’. These Buiding Blocks would be delivered at the time of the third trimester of pregnancy, just after delivery, at every 2 months until the child is 22 months of age. When a mother enrols herself in the intervention, the upcoming Buiding Blocks are locked from being viewed until the appropriate age is attained. The valuable option of consulting a lactation consultant or a dietician would be encouraged throughout the time frame. The nutrition guidance system would utilise only vehicles based on digital technology for delivery of tools and content on nutrition education. A website would be the ordnance of the tools  and content and would house the online-scheduling system so that mothers can make appointments with the support team. In addition, the website would be optimised for application on the mobile device (Hebden et al., 2014). 

Thakkar et al., (2017) opined that person-to-person intervention formats, such as home-based consultation, group education and clinic-based consultations had been widely used till date for the promotion of healthy growth and dietary patterns of children. Though some studies have shown the success of these types of interventions, the limitations of these have been widely discussed. Weight status changes have been marked in some studies; however, the delivery formats have the restrictions that lead to global and national scale-up resource draining, time-consuming and less effective thereby. Ruel et al., (2013) point out that interventions that are clinic-based are limited by the absence of provider time. In addition, insufficient provider training is a problem as nutrition counselling is ineffective. Some individuals might also have the preconceived notion that education as a public health approach is not a part of the scope of work of the provider. Group education settings are continuously been criticised since they ar plagued by poor attendance, the reasons for which include childcare responsibilities and transport facility. Lastly, home-based interventions might have a nurse who is trained in the field visiting the homes of new mothers, the resources required for this purpose need special hiring and training for utilisation. A large pool of staff is to be trained and the cost of travelling to the homes are also high. Therefore scale-up entails a higher cost for overcoming the limitations and achieving sufficient dose, coverage, and fidelity. Maintainance of the interventions is a complicated matter, therefore.

Delivery of Educational Content and Tools

Milani et al., (2017) have highlighted that interventions, when delivered on the digital platform, are more accepted and are more effective for the population being targeted. Digital-based interventions are useful for bringing about behavioural modifications in populations in relation to weight and physical activity. The authors tested a smartphone and website based intervention for improving parenting behaviours, and breastfeeding found the effectiveness of the same. The major areas where improvements have been marked are newborn care, parenting style in relation to feeding habits, toddler safety and maternal education level of nutrition. Digital-based education is also present in maternal and chid health program in the US and Netherlands such as Supplemental Nutrition Program for Women, Infants, and Children (WIC) and the Text4Baby program, and HelloWorld email-based program in the two countries respectively. Media trends at the contemporary society indicate a shift towards the use of digital media from the use of print media. Internet media has been proved to be the only media among newspaper, TV, radio, email and cell phone, whose use increases after a woman becomes a mother. Mothers tend to spend more time on the internet in comparison to the general population.

Research also indicates that greater health information seeking attitude can be seen online. If a survey is to be conducted, the results would indicate that half of the total number of mothers would report seeking parenting related information including nutrition from different internet sources. Advice on how to develop proper nutritional habits in children are sought using the tablet or mobile phone. A digital intervention that is well-designed has all the possibility of being a cost-effective intervention when compared to other formats of intervention delivery (Brownson et al., 2017). The likelihood that the presently proposed intervention would be effective in engaging the targeted population is therefore high. The achievement of behavioural adoption is likely. In addition, most of the cost for developing the digital-based intervention is non-recurring, therefore the costs of maintaining them is minimal. When the intervention is scaled up and the number of members increases, the additional cost is negligible.

The target for the proposed intervention in the form of nutrition guidance system would be first-time mothers in Jakarta. The system would be such made that it would be applicable to individuals coming from a wide range of income groups as well as educational levels. Socioeconomic groups have diversity in them, and this aspect would also be addressed. The multicomponent nutrition guidance system proposed hereby would have the capacity to be disseminated to diverse global contexts.

Theoretical Constructs and Prioritization of Messages

Funding is an essential component of all intervention programs across communities. In Indonesia, the government has shown a proactiveness in funding programs that target a wider audience for a serious public health concern. Though there are different possible funding sources, access to funds has been a major problem. Given that the proposed intervention has a number of advantages and key benefits, financial aid is expected from the government so that the implementation phase is successful. As a response to the rapidly increasing prevalence of childhood obesity, budgetary allocations would be the cornerstone of bringing about the expected positive change. Convergence and complementation of resources and efforts among the different stakeholders would be highly solicited. Evaluation of the program can be done with a robustly designed clinical trial. If the evaluation is successful in extracting maximal information aligned with the objectives of the intervention, the proposed system can be scaled up to the proportions that is deemed fit for impacting a sustainable change in the objectives of the intervention pertaining to promotion of healthy nutrition in the first 1000 days (Brownson et a, 2017).

From the above discussion, it is found that childhood obesity is a key problem faced by Jakarta, the capital city of Indonesia, as the prevalence rate is growing significantly. Interventions delivered at present have not bene successful to the desirable extent to lower the rate of childhood obesity. The outlines strategies would produce noteworthy weight loss and improvements in metabolic risk factors among the children and adolescents. The tools and the content that has been suggested above would be applicable to diverse audiences, making the impact more profound as compared to the present interventions of the country. The multicomponent features would be appropriate to different contexts and would foster a heathy growth for children. It can be expected that with the proposed intervention delivered in a timely manner and with adequate resource allocation childhood obesity would be better handled in the near future. Reduced healthcare costs and patient outcomes would reflect this drastic positive change that is much awaited.

References

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