Health and Clinical Psychology: Case Study
Background to the Problem
This case study is based on Zak, a 10-year-old boy diagnosed as obese by his GP. Zak spends his free time watching television or playing computer games, instead of playing outside with his friends. His single mother, who also has to take care of his two siblings and work on weekends, struggles to manage his lifestyle. Zak avoids PE time in school because it requires significant effort for him. His weight has also affected his self-esteem; for example, he hates swimming because he dislikes how he looks in swim trunks. He appears withdrawn and unhappy and rarely makes friends.
The World Health Organization (2017) has identified childhood obesity as a key public health challenge of the 21st century. Globally, the prevalence of childhood obesity is rising at an alarming rate, particularly in middle- and low-income countries, especially in urban settings. In the UK, childhood obesity levels are increasing, with estimates suggesting that by 2050, nearly a quarter (25%) of all children in the country will be obese, and 40% will be overweight. Statistics from the 2014/15 NCMP (National Child Measurement Programme) showed that a third of the children in Year 6 (33%) were either overweight or obese, compared to 32% in 2006/07.
Childhood obesity is influenced by environmental, social, and psychological factors. Increased caloric intake and reduced physical activity are significant risk factors. The increased use of automated transport and the reduction of physical education programs in schools contribute to this issue. Socio-economic status also plays a crucial role, as low-income families often face challenges in accessing healthy foods and physical activity opportunities.
Obese children are more likely to experience various psychological problems, including low self-esteem and social withdrawal, which further contribute to a sedentary lifestyle and ongoing obesity. Additionally, childhood obesity rates are higher among non-white populations due to factors such as socio-economic status, culture, genetics, environment, and physiology.
Design of Intervention
There are two broad levels of interventions to prevent childhood obesity: primary and secondary interventions. Primary interventions include universal or targeted community-level efforts, such as school-based programs aimed at reducing or stabilizing BMI. Selective interventions, such as family-based programs, target high-risk individuals, focusing on improving personal skills and knowledge to manage weight.
A home-based intervention program would be ideal for Zak, as the home environment significantly impacts a child's physical activity and dietary behavior. However, due to limited evidence on its effectiveness, a multi-component school-based approach is proposed. This approach integrates environmental, educational, and behavioral components, promoting healthy eating habits, increased physical activity, and health education.
School-based interventions are effective in tackling childhood obesity, as schools provide a supportive environment, established infrastructure, curricula, staff, and policies that facilitate ongoing contact with children. They reach at-risk children from various socioeconomic and ethnic backgrounds and can promote food literacy and physical activity.
Social and Psychological Factors Relevant to the Intervention
While implementing a school-based intervention, it is important to consider social and psychological aspects to avoid unintended harm. The program should promote a positive body image and provide mental health, social, and health services to support physical activity and healthy eating habits. Regular assessments should ensure that the program's outcomes are supportive and not stigmatizing.
Description of the Intervention
The intervention will be implemented at Zak's primary school, led by a health promotion agent with assistance from selected teachers. It will include physical activity and dietary interventions, targeting Zak and other obese children aged 6 to 12, as well as the entire school community.
The intervention has three components:
- Classroom activities emphasizing healthy eating habits.
- Use of teaching aids such as charts and booklets to reinforce lifestyle topics.
- Parental involvement in physical and educational activities to support healthy choices at home.
Each educational activity will be conducted for one hour every two weeks over two school terms. The health promotion agent will assess Zak’s progress and develop home activities involving Zak’s mother to promote healthy interactions and lifestyle choices.
Effectiveness of Interventions
This intervention is expected to be effective in helping Zak manage his weight, involving various stakeholders in the school community. Increased physical activity and healthy eating habits are associated with reduced BMI and weight gain. Parental involvement will likely encourage healthier food choices and more physical activities at home.
Expected Outcomes
The intervention is expected to help Zak manage his weight and reduce the risks associated with childhood obesity. It aims to change the lifestyle of children aged 6 to 12, promoting healthy eating and increased physical activity. Parents, including Zak's mother, will be encouraged to support these changes at home.
Problems Envisaged in Implementing the Intervention
Despite the benefits of school-based programs, they can strain school budgets and require teacher training and execution. There is also a risk of fostering negative body image and stigmatization. However, the proposed intervention promotes positive health behaviors and involves the national government to support relevant policies and campaigns.
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