Preventing Child Obesity With Munch And Move Intervention Program In Australia

The Problem of Child Obesity in Australia

Discuss about the Health Promotion for Munch and Move Intervention Among Children.

In Australia, child obesity has become one of the most concerning public health issues with reports indicating that overweight and obese cases among children between the ages of 2 and 3 and those between the ages of 4 and 5 have arisen to 23% and 21% respectively. Obesity prevention initiatives should therefore be implemented at an early age and should primarily aim to change the physical as well as eating behaviors among children (AIHW, 2016). Notably, unhealthy weight gain and unhealthy food intake among children are the chief causal factors for obesity (Bell et al, 2015, p. 1611). In light of such considerations, the NSW health initiative has developed an intervention program (munch and move) that supports healthy development among children under the age of 5 by focusing and promoting healthy eating, physical activity and reducing small screen time which arises from activities such as watching TV and playing video games (NSW Ministry of Health, 2015, p. 5).

This health promotion (HP) intervention provides training and resources for childhood professionals or educators who work in NSW early childhood care services and educational settings. The offered training enables these educators to implement an approach that focuses on fun and play in supporting healthy eating as well as promoting physical activity among children who are under their care (NSW Ministry of Health, 2015, p. 5). This paper therefore analyzes this intervention in light of various aspects including; health promotion framework, social determinates of health, informed systems thinking approach and promotion of health equity and action on environmental sustainability. 

The prevalence of obesity and overweight cases among children in Australia necessitates the need for early childhood interventions in order to promote healthy eating and physical activity behaviors. Furthermore, evidence indicates the importance of such early intervention and specifically the effectiveness of center-based early childhood services in promoting healthy behaviors (Zask et al, 2012, p. 2). In this light, munch and move intervention was therefore specifically developed for purposes of supporting early childhood professionals to enhance physical activity among children and also promote healthy eating habits among this population group (NSW.gov, 2018). Available research indicating the effectiveness of this program in the prevention of obesity indicates that the intervention is essential in improving weight related behaviors as well as mitigating risk factors of obesity that could be detrimental to the overall well-being of a child (Lubans et al, 2010, p. 1020).

Munch and Move Intervention Program

A child’s wellbeing is put at great risk with the consequences that are associated with obesity in the short and long terms. As evidenced by research, children who are obese are more likely to remain obese into their adulthood and consequently developed associated health risks in the form of chronic illnesses such as diabetes and cardiovascular diseases even at a young age (Salmon et al, 2008, p. 602). Evidence also suggests that children who are obese are at an increased risk of succumbing to premature deaths or disability as they develop into adulthood (NSW ministry of Health, 2015, p. 4).

Aside from the health risks associated with obesity, there are a number of social-economic impacts that are associated with obesity in young children. Research indicates that children who come from social and economically disadvantaged communities or families are more likely to be overweight or obese when compared to their counterparts who come from families or communities that are more economically advantaged. Furthermore, such conditions may create socio-economic inequalities and segregation among children which may natively impact on the disadvantaged group (NSW ministry of Health, 2015, p. 5). In consideration of such factors, studies have therefore focused on reducing sedentary lifestyle behaviors as well as promoting physical activity and healthy eating habits.

Studies indicate that the success of intervention plans is dependent on the intervention’s capacity to implement physical activity initiatives and healthy dietary habits simultaneously. Moreover, there is also need to implement a policy that develops a healthy early childhood environment. To massively realize the benefits of such interventions, it is also essential that the HP intervention be implemented in public settings such as child care where most children are found (Hector et al, 2012, p. 3). Munch and move intervention has therefore been essential in meeting these requirements as evidenced by the program’s success in reducing the prevalence of overweight and obesity primarily by producing changes in food intake and increasing motor skills (NSW ministry of Health, 2015, p. 6).

The findings of Hardy et al (2010) indicated that children subjected to this form of intervention significantly increased their fundamental movement skills (FMS) compared to their counterparts in the control group. Furthermore, it was realized that the effectiveness of this intervention, or rather, the increment in the FMS scores was dependent on the intervention sessions established within a week in such a way that the FMS scores increased with increased sessions per week while the converse was also true. In regards to the healthy eating habits, the study also denoted that children within the intervention group reduced their intake for sweetened drinks compared to their counterparts (Hardy et al, 2010, p. 80). Such studies have therefore provided credible evidence indicating the effectiveness of the HP intervention in managing weight among children.

Effectiveness of Munch and Move Intervention Program

Predominantly implemented in childhood education and care services, the much and move intervention has continued to maintain its purpose of encouraging and promoting healthy eating and physical activity behaviors as well as reducing small screen recreation among children. The program also provides six key principles to their population group including; getting active every day, choosing water as a drink, choosing healthier snacks, encouraging breastfeeding, eating more fruits and vegetables, and turning off the TV and computer in order to get active (NSW ministry of Health, 2015, p. 9).

Health Promotion Intervention against a Health Promotion Framework

Health Framework
BAEW (Be Active Eat Well)	Active After School
1.      Ottawa charter	1. The program focuses on education and care services for children. As such, children are subjected to at least twice a week learning experiences involving health eating. By educating children on the best possible courses of action regarding their eating habits, it is expected that children will take up such habits and incorporate them in their daily lives 9Green, Hughes & Rissel, 2017, p. 3).
2.      Ottawa charter	2. Similarly, the learning outcomes are expected to yield strong sense of well-being for children subjected to this program. This is realized when children take more responsibility regarding their physical well-being and their overall health. This factor ideally encompasses the health prerequisite involving education and raising awareness
3.      HP Spectrum	3. Evidence building and performance frameworks where the program implementation is confounded on evidence building that translates research into practice.
4.      Integrated health promotion	4. Monitoring framework that encompasses the collaboration from LHD and their professionals as well as the childhood educators associated with the HP intervention.

In accordance with the Ottawa Charter, the HP intervention advocates for good health and also promotes the general health of children through education of the childhood professionals as well as the children. In doing so, the program conducts training workshops for more than half of the associated health professionals (WHO, 2017). Most importantly, it ensures that children are educated on healthy eating behaviors twice in a week. It is thus expected that such education is essential in the well-being of the children since they are likely to inculcate the healthy eating behaviors that are taught.

The intervention follows a structural hierarchy in accordance with the HP program in such a way that the implementation of the program should premise on the need to identify and employ evidence-based practice. In this case, the existing evidence base was reviewed and early childhood interventions were identified as the most probable solution to resolve the health issue concerning obesity in children.

Integrated health promotion emphasizes on the need to incorporate a wide range of agencies and organizations who work in collaborations to enhance health promotions and capacity building strategies that address well-being challenges as well as prioritize health (Department of Human Services, 2008, p. 9). In this light, munch and move intervention, has encompassed a monitoring framework that has engulfed the LHDs within NSW. The program has specifically provided additional funding to LHD which has in turn provided relentless support to the intervention through their health professionals and assisted in the reporting of the effectiveness of the program in reducing sedentary lifestyle while at the same time promoting healthy eating and physical activities (NSW ministry of Health, 2015, p. 15). 

The HP intervention is fun-based and play-based and as such, it promotes healthy eating and active play, and also reduces small screen recreation. These incentives by themselves help to improve the daily life conditions of children in NSW. The much and move intervention is also predominantly implemented in early childhood services and care services (Green, Hughes & Rissel, 2017, p. 3). Aside from being inhabited with the largest population of children in NSW, available research indicates that children who inculcate a healthy eating habit as well as develop early physical activity habits are more likely to maintain these habits for a long term and even throughout their lifetime. Such practices enable children in their childhood and as they transition into adulthood, maintain a healthy lifestyle that contributes to their ongoing well-being. As denoted by CSDH, these conditions comprise an improvement in an individual’s circumstances in which they are born, grow, live and age (CSDH, 2008, P. 43).

Social-Economic Impacts of Child Obesity

The HP intervention helps to address the issues of socio-economic inequalities that exist among families and communities that have children who are obesity and those that comprise children who are not obese. Moreover, the intervention offers practical resources that support the development and implementation of practices and policies in addition to the ongoing support that is received from the Local Health District (LHD) health professionals. Ideally, these incentives conform to WHO structural drivers of those conditions of daily life both globally and nationally (CSDH, 2008, P. 43).

Evidence indicates that more than 70% of children in NSW attend long day care, preschool and family day. This setting therefore provides the most ideal place where the largest groups of children can be reached. In this case, it becomes affirmative that the HP intervention is successful in reaching a large public domain and thereby raising awareness through its educational programs. The intervention trains and educates childhood professionals as evidenced by the more than 90% of their staff who have attended center-based services training (Green, Hughes & Rissel, 2017, p. 8). The HP program is also based on current practice and support their educators to expand their knowledge on healthy behaviors among children. In these cases therefore, the HP intervention succeeds in developing its workforce and raising awareness about the social determinants of health (CSDH, 2008, P. 43). 

Kickbusch (2012) views health as a social investment given the rapid changes in society and technology, and the economic downturn. Health is further repositioned in terms of the social relationships and risks that emanate rapid skill depletion, work-life imbalance, and inadequate health coverage. Most worryingly is the unsustainable lifestyle that has been taken up by resulting to obesity epidemic thereby compounding on the already realized health challenges (Kickbusch, 2012, p. 6).

The much and move intervention also takes into consideration these determinants of health in the sense that, massive investments have been made on training and education which further improves the skill sets of childhood educators. Training is provided to professionals who are found in centre-based services as well as family day care schemes. Precisely, it is estimated that 50% of the program’s educators are trained on healthy eating and physical activity with information being relayed through LHD support visits. A more comprehensive performance management framework is also used to report physical activity and healthy eating habits that have been achieved on an annual basis (Green, Hughes & Rissel, 2017, p. 7). In doing so, it can be affirmed that the intervention has fulfilled the need to improve the skill sets of health professionals and also promote healthy lifestyles as opposed to the growing unsustainable lifestyles that is exhibited in various population groups in the 21^st century.

Health Promotion Intervention against Health Promotion Framework

Politically, health presents a societal problem that cannot be managed professionally but rather should be addressed through health promotion initiatives. In this light, politicians have been mandated to identify the faced problems in healthcare and thereby formulate and attempt theoretical solutions which should further be realized in their actual solutions (Kickbusch & Gleicher, 2012, p. 4). Likewise and as provided by the much and move intervention, a clearly identified health problem was defined in the form of prevalence of obesity. Moreover, solutions to the problem were identified and actualized as evidenced by development of childhood interventions and the promotion of healthy eating habits, enhanced physical activity and reduced recreation events (Green, Hughes & Rissel, 2017, p. 8).

Allender et al (2015) denotes that community based prevention is essentially confounded on the application of system thinking to the development, execution and assessment of childhood obesity deterrence efforts. In accordance to the identified community perceptions, social influences, physical activity, participation in sports, and fast and junk food were found to be the main causal factors regarding the causes and determinants of obesity among children. These domains as identified by Allender et al causal loop diagram should ideally provide the framework for planning and developing a prevention response program implemented in various settings as well as systems (Allender et al, 2015).

Similarly, munch and move intervention program has primarily focused on increasing daily movement skills among children between the ages of 3 and 5. Their menu includes a daily fruit and vegetables intake, and children are also encouraged to take healthy snacks thereby reducing the intake of fast food and junk food (Green, Hughes & Rissel, 2017, p. 6). Hence, these initiatives indicate that the HP intervention is confounded on Allender’s CLD causal factors.

Allender et al (2015) also used the causal loop diagrams (CLD) to visually represent the factors that affected energy balance among individuals. In this process, it was realized that the complexity of the factors affecting the energy balances among individuals encompassed more than 100 variables that either directly or indirectly influenced the energy balances (Allender et al, 2015). In light of this, the systems thinking approach to the prevention of obesity should engage the complexity of the causal factors through policy settings that are individual-based.

The munch and move intervention has mainly achieved this provision through the initiation of written food policy as well as written policy on physical activity and small screen recreation to support healthy eating and physical activity habits among children (NSW Ministry of Health, 2015). In addition, the much and move intervention is aligned with Allender’s systems approach by ensuring that it is process driven where the intervention activities have primarily focused on increasing community participation as well as fostering ownership and capacity (Carey et al, 2015).

The HP intervention is also informed by the systems approach developed by Bloch et al (2014). In this case, the much and move intervention is a super setting approach applicable in the community as well as preschools and in which diverse and valuable resources are effectively utilized while local and social interactions through engagement in physical or daily fundamental movement skills are primarily used as the drivers of change (Bloch et al, 2014). 

Baum & Fisher (2010) outline the importance of developing a modern model that incorporates the need for economic development and growth in order to meet the objective of reducing global warming. On an environmental basis, the authors propose economic reforms that should be considered as being imperative to reversing climate change (Baum & Fisher, 2010, p. 311). Nonetheless, the HP intervention fell short in accommodating such requirements given that there is lack of evidence that links the program to substantial advantages to the environment.

The intervention has however been essential in promoting health equity. As provided by the program’s evidence and evaluation summary, it is well documented that the program was cognizant of the prevalence of obesity in socio-economically disadvantaged communities. In this light, the intervention therefore identified children coming from these communities as priority groups in their care. Accordingly, the HP intervention increased the proportion of services to these priority groups with 70% of the total services of the intervention being accorded to priority population groups (NSW Ministry of Health, 2015). This gesture by the HP intervention clearly illustrates the initiatives taken to enhance health equity across diverse population groups (WHO, 2010).

Conclusion

Overweight and obesity cases provide majo0r public health concerns especially when the prevalence and the health risks associated with these conditions are reviewed. With the number of children who are either overweight or obese increasing, there are a number of health risks that this population group face as they age including; disability, increased risk of obesity in adulthood, and increased risk of diabetes and cardiovascular diseases. It has therefore become imperative that early childhood interventions be established. One of the HP interventions that have been successful in addressing this condition has been NSW much and move intervention that has been implemented in center-based services and child care.

This initiative has fitted in almost succeeded in fitting into the three determinants of health as provided by CSDH (2008). In this case, the HP intervention has enhanced the daily living conditions of individuals by supporting healthy eating and physical activity behaviors at a young age, a practice which is likely to be taken up by individuals as they age. The intervention has also addressed issues of power and resources by mitigating the socio-economic impacts that are associated with obesity and also availing sufficient resources to be utilized by childhood educators.

The program has finally developed its workers through massive training and education of childhood professionals and also targeting public settings in order to raise awareness of the health issues associated with obesity. For these reasons also, the intervention has managed to address the social and political determinants of health for the 21^st century primarily by focusing on healthy behaviors to reduce obesity prevalence among children. It is also worthy to note that this intervention is well informed by Allender’s and Bloch’s information systems as evidenced by the intervention’s emphasis on healthy eating habits, enhancement of physical or sport activities, and fostering a policy that promotes a healthy environment with reduced recreation activities for children. 

References

Allender, S., Owen, B., Kuhlberg, J., Lowe, J., Smith, P. N., & Bell, C. (2015) A Community Based Systems Diagram of Obesity Causes. PLoS ONE. 10(7). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4496094/ [Accessed 26 May 2018]

Australian Institute of Health and Welfare (AIHW) (2016) Australia’s Health 2016. Available from: https://www.aihw.gov.au/getmedia/9844cefb-7745-4dd8-9ee2-f4d1c3d6a727/19787-AH16.pdf.aspx?inline=true [Accessed 26 May 2018]

Baum, F., & Fisher, M. (2010) Health Equity and Sustainability: Extending the Work of the Commision on the Social Determinants of Health. Critical Public Health. 20(3), pp. 311-322.

Bell, A. C., Davies, L., Finch, M., & Wolfenden, L. (2015) An Implementation Intervention to Encourage Healthy Eating in Centre-Based Child-Care Services: Impact of the Good for Kids Good for Life Programme. Public Health Nutrition. 18(9), pp. 1610-1619.

Bloch, P., Toft, U., Reinbach, H. C., Clausen, L. T., Mikkelsen, B. E., Poulsen, K., & Jensen, B. B. (2014) Revitalizing the Setting Approach: Supersettings for Sustainable Impact in Community Health Promotion. International Journal of Behavioral Nutrition and Physical Activity. 11, pp. 118.

Carey, G., Malbon, E., Carey, N., Joyce, A., Crammond, B., & Carey, A. (2015) Systems Science and Systems Thinking for Public Health: A Systematic Review of the Field. BMJ Open. July 30, 2015.

Commision on the Social Determinants of Health (CSDH) (2008) Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on the Social Determinants of Health. Geneva, World Health Organization. Available from: https://apps.who.int/iris/bitstream/handle/10665/43943/9789241563703_eng.pdf;jsessionid=63266667609317D3F6CC062B90A694D3?sequence=1 [Accessed 26 May 2018]

Department of Human Services, (2008) Integrated Health Promotion: A Practice Guide for Service Providers. Available from: https://docs2.health.vic.gov.au/docs/doc/8196B97B654C907BCA257A7F001DF6E4/$FILE/integrated_health_promo.pdf  [Accessed 26 May 2018]

Green, A., Hughes, C. I., & Rissel, C. (2017) Driving Obesity Prevention in the Early Childhood Setting: Implementing Much and Move in NSW Early Childhood Services. Available from: https://livelighter.com.au/Assets/resource/researchevidence/Social-Marketing-Review-Bauman-Bellew-Heart-Foundation-WA.pdf  [Accessed 26 May 2018]

Hardy, L. L., King, L., Kelly, B., & Howlett, S. (2010) Munch and Move: Evaluation of Preschool Healthy Eating and Movement Skill Program. International Journal of Behavioral Nutrition and Physical Activity. 7, pp. 80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2988057/ [Accessed 26 May 2018]

Hector, D., King, L., Hardy, L., St George, A., Henden, L., & Rissel, C. (2012) Evidence Update on Obesity Prevention: Across the Life-Course.

Kickbusch, I. (2012) 21^ST Century Determinants of Health and Well-being: A New Challenge for Health Promotion. Global Health Promotion. 19(3), pp. 5-7.

Kickbusch, I., & Gleicher, D. (2012) Governance for Health in the 21^st Century Geneva, Switzerland.  

Lubans, D, R., Morgan, P. J., Cliff, D. P., Barnett, L. M., & Okely, A. D. (2010) Review of the Benefits Associated with Fundamental Movement Skill Competency in Youth. Sports Med. 40, pp. 1019-1035.

NSW Ministry of Health (2015) Munch and Move: Evidence and Evaluation Summary. Available from: https://www.health.nsw.gov.au/heal/Pages/Munch-Move-Evaluation-Summary.aspx [Accessed 26 May 2018]

NSW.gov (2018) About Much and Move. Available from: https://www.healthykids.nsw.gov.au/campaigns-programs/about-munch-move.aspx [Accessed 26 May 2018]

Salmon, J., Ball. K., Hume, C., Booth, M., & Crawford, D. (2008) Outcomes of a Group Randomized Trial to Prevent Excess Weight Gain, Reduce Screen Behaviors and Promote Physical Activity in 10 Year Old Children. International Journal of Obesity. 32, pp. 601-612.

World Health Organization (WHO), (2017) The Ottawa Charter for Health Promotion. Available from: https://www.who.int/healthpromotion/conferences/previous/ottawa/en/ [Accessed 26 May 2018]

World Health Organization (WHO), (2010) A Conceptual Framework for Action on the Social Determinants of Health. Available from: https://www.who.int/sdhconference/resources/ConceptualframeworkforactiononSDH_eng.pdf  [Accessed 26 May 2018]

Zask, A., Barnett, L. M., Brooks, L., Lyndon, O., & Salmon, J. (2012) Three Year Follow-Up on Early Childhood Intervention: Is Movement Skill Sustained? International Journal of Behavioral Nutrition and Physical Activity. 9(127), pp. 1-9.