Introduction:
Childhood obesity is a severe problem that continues to
grow throughout the United States. Rates
of childhood obesity have nearly tripled since 1980 (1). Recent
studies show that nearly one in every three children is now considered obese (1).
Obesity can often last a lifetime, as obese teenagers are 70% more
likely to become obese adults (2). This translates to an increased
likelihood of negative health outcomes. Obesity severely raises the risk for
heart disease, stroke, hypertension, type two diabetes and various cancers (3–6). These healthcare outcomes result in
significant costs, with one study estimating that nearly 9.4% of national
healthcare expenditures are related to obesity and inactivity (7). The childhood obesity epidemic plaguing
America is very evident, and while the Country has attempted to alleviate this
issue, interventions have been fairly unsuccessful.
One such
failed intervention is the Play 60 movement sponsored by the NFL. This movement involves engaging children in
healthy activity within their school programs.
It is focused on empowering children to take control of their own health.
The goal of this movement is to help children live an active lifestyle year
round to combat childhood obesity. The
campaign provides outlines to nutritional knowledge and exercising activities.
While this campaign certainly has the right intentions, it suffers some serious
flaws. First, the movement fails to
recognize the role parents of parents in creating subjective norms which
influence a child’s behavior. Secondly,
the movement’s failure to consider the stages of behavioral change has
prevented adoption of the movement by children who don’t perceive the value of
healthy behavior. Finally, the
overemphasizing on winning awards has the potential to negatively impact the
self-esteem of many children in the program, preventing long-term success. It is these three flaws which will prevent
Play 60 from achieving peak success.
Play
60 Fails to Account for Subject Norms in the Household
A major
shortfall behind the Play 60 campaign is its assumption that healthy behavior
can be emphasized without encompassing the entirety of a child’s social circle. In particular, the initiative fails to
adequately incorporate parents. One can
argue parents are the greatest influence on a child’s behavior. Parents provide them shelter, love and
affection, and thus are greatly influential. Of all the people in a child’s
life, a parent is likely to have the most highly weighted opinion in the
child’s mind. Play 60’s inability to fully integrate parents within the program
reflects their lack of understanding the theory of reasoned action
According
to the theory of reasoned action, an individual constructs subjective norms
based on the opinions of those in their social environment (8).
The particular weight an individual places on each person’s opinion of a
given subject establishes the prevailing norm, which then influences the individual’s
behavior (8). One study has found that consumption of
unhealthy food was heavily correlated to held beliefs and ideas about the food
rather than nutritional knowledge (9).
Another study has found that healthy behavior is best achieved if an
individual is provided a health-promoting environment (10).
Both these studies show the influence that subject norms, established
within a child’s environment, have on their behavioral decisions. Surely these subjective norms are heavily
determined by parents. In fact, research
has shown that a child is more likely to engage in risky behavior, such as
eating unhealthy and being inactive, if parents condone the behavior through a
lack of awareness of the potential negative outcomes (11). Clearly children’s behavior is influenced by
their views of what is normal behavior, which is impacted by their parents.
As
the program now stands, a child may play for sixty minutes after school, but go
home to an environment that tends towards unhealthy eating and a sedentary
lifestyle, and thus all their achievement from the program will be negated. Play 60 fails to transform the attitudes of
both parents and children, which will allow the unhealthy subjective norms
established in households to remain and negatively impact the child’s fight against
obesity.
Play 60 Does Not Take Into Account the
Stages of Behavioral Change
The transtheoretical model features five
stages to behavioral change. The three
early stages are precontemplation, contemplation and preparation, while the
later stages are action and maintenance (12). In the early stages, an individual begins
to recognize the importance of a particular behavioral (12).
Once the individual is motivated enough by the necessity of the behavior,
he or she will move on to preparation, action and finally maintenance.
Unfortunately, the Play 60 campaign caters to individuals at the action and
maintenance stages.
Reading
through the campaign’s main website, it is well-apparent the program focuses on
maintenance, while lacking materials to educate children as to why being
healthy and active is important to begin. The homepage indicates that children
can win prizes for “good-for-you” behavior.
These prizes are clear form or reinforcement. Reinforce is one of the processes that leads
to maintenance, but according to the transtheoretical model, this will only be
successful if the individual has reached this stage of behavior (12).
Although
the campaign aims to fight obesity, processes of change provided by Play 60 are
likely to attract individuals whom are already healthy, and value an active
lifestyle, rather than those children who are struggling to recognize this
concept. Therefore, the early adopters
to this program are healthy children, while obese children remain on the
sidelines. The one-size-fits-all approach of Play 60 goes against proven
research that to maximize effectiveness of an intervention, a tailored
approached must be offered which can appeal the given stage of behavior for
each individual (13). This requires early stage processes of
change to be utilized. Consciousness-raising
and self-reevaluation to understand the importance of a healthy lifestyle are
two great ways to help develop healthy behavior for children precontemplation
and contemplation stages. Unfortunately,
these early processes of change are not apparent in Play 60. The Play 60 campaign has thus failed to
address the concept of behavioral change stages.
Play
60’s Overemphasis on Winning May be a Deterrent to Establishing Self-esteem
Self-esteem
is key to successfully achieving behavioral change. Play 60 does not exactly
address this issue. The concept of self-esteem is concretely described in
Maslow’s Hierarchy of Needs. According
to Maslow, self-actualization, or the reaching of one’s full potential, can
only be achieved if four levels of specific needs are met (14).
One such level of needs is self-esteem, which can be produced via
achievement, recognition and respect from others (14).
Attainment of self-esteem is critical, because it is the fourth and
final level before reaching self-actualization. One particular study has found
that a decrease in self-esteem can result in increased sadness and loneliness
in children, leading to an increase in risky, unhealthy behaviors (15).
Play 60
offers very limited opportunities for achievement and recognition within its
program, inhibiting growth of self-esteem.
The program offers tips and guidelines to succeed, but only infrequently
offers praise and recognition for achievement. A small number of children will
be recognized by winning awards and contests, thus boosting their self-esteem,
but the achievement of most children will go unannounced, potentially leading
to riskier behavior
Additionally,
the messages conveyed by the program’s initiatives may actually be a deterrent altogether
for self-esteem building. For example,
the program offers chances for children to win super bowl tickets, meet NFL players
and attend cool conferences. The more
healthy activities a child performs, the greater their odds to win these
prizes. However, the prizes are very
limitedly, and ultimately the majority of children will engage in activities
but not win. Even though a child may
have made achievements with the physically activity, he or she may assume that
since they lost the contest, they were unsuccessful, thus leading to a loss of
self-esteem. This is all perpetuated by the
inability of Play 60 to identify the critical need of self-esteem.
Implementing
A Family-based Intervention
As a
new intervention to fight childhood obesity, I suggest an approach which I will
call the Holistic Family-centered Activity Movement (H-FAM). The concept behind this intervention is to
use a holistic approach the overcome obesity.
The approach will target both the mind and the body, emphasizing healthy
eating, physical activity and relaxation.
The goal of this program will be for families to work together to
establish a healthy, active household.
The underlying premise of this program is that obesity is best overcome
if a family acts as one cohesive unit.
Children are not independent and are heavily reliant on their parents
care. Parents shape their children, and
if children are to be successful at achieving a particular behavior, parents
must be committed to the achievement as well.
There
will be two components to the program. The
first will be to employ a strong advertising campaign. There will be two phases
of commercials in the advertising campaign.
One phase will portray the struggles of children with obesity, while the
other type will profile the success of families who work together to live a
healthy, active lifestyle.
The
second component will be titled “For me, For the Family”, and will focus on
homemade meals and outdoor activities that resonate with the whole family. Families will be asked to sign-up online, and
each family member will be asked to answer a questionnaire. The survey results of all family members will
be applied in an algorithm to develop a list of suggested recipes and
activities that are a fit for the entire family. In addition, the individual
results of each member will also produce a list of suggested recipes and
activities. The “For the Family” ideas will be suggest dinner recipes to eat in
the evening, and suggested family activities to do on the weekend. The “For Me” results will provide nutritious
snack ideas and exciting activities for each child individually. “For Me” personalization is important because
while sports are typically emphasized as the mains to be active, not all
children enjoy sports. However, with
this questionnaire, children will be offered options such as nature walks or learning
to cook. Further, parents will better
understand their children’s desires, not forcing them to participate in sports
or activities that the child doesn’t enjoy. Lastly, parents and children will have the
ability to constantly readjust their likes and dislikes, as well as indicate
which activities they have performed and meals they have prepared, so that new
ideas can constantly be generated based on recent behavioral choices. Overall,
I believe the outlined H-FAM approach will be a more successful intervention
for childhood obesity than Play 60.
Involving
the Family Will Produce Healthy Subjective Norms
A family-centered
intervention will develop active and healthy norms to influence children’s
behavior. Studies have proven that
subjective norms drive an individual’s intention to engage in exercise and
healthy eating behaviors (16)
Another study has found that parental support can be very influential
factor in food and exercise choice (11,17). In
tandem, these studies build the connection between subjective norms and
children’s behavior, while also indicating parents are a huge influence a
child’s social circle. Clearly, parents
need to get involved with their children to articulate what is the most
appropriate normal behavior for one’s wellbeing. This can drive the child to eat what is
necessary, increase activity and reach or remain at a targeted weight level.
This
intervention works to bridge the gap of that missing piece. With this new
intervention, parents will be directly involved with their children’s behavior,
as the “For the family” activities will allow parents to show their support of
active, healthy habits. The child’s
norms will change from the previously accepted unhealthy behavior to these
improved norms. It is my hope that the
advertising campaign will continually focus parents’ efforts to ensure the
right norms are transparently messaged in the home. Using a family-centered approach is a step in
the right direction to generate these new subjective norms that lead to healthy
behavior.
H-FAM
Acknowledges All Stages of Behavioral Change
Not every child, nor
every family, will be ready to engage in nutritional changes and increased
physical activity. Recognizing that each
individual and each family is at a different stage of behavioral change will be
the key to maximizing the number of individuals that will be impacted by a
given intervention. Tailoring a program
to emphasize adoption and adherence to exercise and nutrition is critical (18).
There are numerous ways this can be achieved. For instance, generating self-efficacy will
lead to the confidence booster necessary to propel individuals above the
contemplation and preparation humps (18). Likewise, fun, new activities and ideas can
prolong maintenance.
A strong advertising campaign will relate to families at the
early stages of behavioral change. As discussed, the H-FAM commercials will
document the struggles and successes of children and their families as they
attempt to combat obesity. These
commercials will display health facts about obesity. The idea is that they will
provide families with the information necessary to recognize obesity is a
serious health issue. Additionally, this
will provide a motivational cue. The
commercials will also show people overcoming obesity. This will show healthy behaviors as an
achievable goal, which will hopefully provide a level of self-efficacy. In all, this combination of motivation and
self-efficacy will drive more family to act on behavioral change to live a fit
lifestyle.
The online website will have the ability to track children’s
interest and enjoyment of various activities and produce new activity lists
that mesh with the individual’s preferences.
This will be essential to influence children at the action and
maintenance stage. Similarly, new family activity lists can be generated. The concept behind this aspect of the
intervention is the idea boredom may lead to a decline in healthy behavior. Boredom
has been show to increase eating amongst both obese and normal weight
individuals (19).
Therefore avoiding boredom is important to reduce the likelihood of
increased food consumption. This
intervention will constantly provide new ideas of activities to avoid
boredom. A second way to drive
maintenance is to provide new challenges that raise the bar. The online website will track children’s
activity statistics, and suggest new target goals, which will at as stimulus
controls to drive adherence to healthy behavior. The main components of this intervention
definitely target all stages of behavioral change.
H-FAM’s
Involvement of Family Members Will Improve Self-Esteem
Self-esteem is important for kids to exhibit healthy
behaviors. It is particularly important
for obese children, whom may be embarrassed or insecure to begin physical
exercise. For children to develop and maintain self-esteem, they must
constantly be praised and recognized. By
bringing parents and families into the equation, self-esteem is much more likely
to be boosted for every child (20,21). Play 60 utilizes teachers to implement
its programs. These teachers have to
overlook a number of children, and likely don’t praise every single child for
his achievement, nor even notice every child’s achievements. In other words, there is little opportunity
for one on one relationships within this program, where an older influential
individual can provide a child with reassurance and self-esteem boosts when he
or she achieves. With H-FAM, parents
will be selecting activities, participating activities and will be witness to
much more of their child’s success than any third-party could possibly. Therefore, this will increase the opportunity
for parents to congratulation their son for doing his push-ups or praising
their daughter for eating a healthy dinner.
Once the self-esteem begins to be raised, it will be a positive feedback
system. The child will see be more apt
to eat well and exercise thorough, which will allow them to develop more
self-esteem. Undoubtedly, H-FAM’s
incorporation of parents provides a great opportunity for children be praised
and recognized, leading to high levels of self-esteem which will aid in the
children’s pursuit of healthy behavior.
Conclusion
To conclude, while the
Play 60 program is a valiant attempt to fight obesity, its failure to address a
few social behavioral theory principles has led to major flaws which compromise
its success. The Play 60 program fails
to acknowledge the subject norms children derive from their parents,
inadequately addresses the entire spectrum of behavior change stages and lacks
the ability to generate sufficient self-esteem.
On the other hand, the Holistic Family-centered Activity Movement is
designed to overcome these flaws by engaging the entire family through an
individualized intervention. With the
H-FAM intervention the fight against childhood obesity finally begins.
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