The Global Childhood Obesity Epidemic Health And Social Care Essay

The Global Childhood Obesity Epidemic wellness And Social tuition EssayIn this paper, the precedent will take the Byzantine interaction of affectionate, economic, biological and environmental determinants of wellness that may inform the recent explosion and shifts in demographic trends of this world wide problem and briefly explore purportstyle and behavioral factors that may create ill-tempered pre disposes. This will be followed by discussion about causes, complications and discussion options of puerility corpulency.The author will re sop up and analyse determinants and health policy initiatives, critically appraise motley global, topic and local strategies, initiatives and interventions which atomic number 18 aimed to prevent obesity in childishness and also examine how they be linked to formulaic health promotion simulations and theories.By critically examining the range of interactions and existing initiatives, the author seeks to propose appropriate inter ventions to tackle the growing challenge of childhood obesity. winder words childhood obesity, inequalities, policy, strategy, streak, health promotionDEFINITIONObesity/ prolifictiness is defined as a condition characterised by excessive consistence fat. Body fat can either be stored predominantly rough the waist or around the hips.Body Mass Index (BMI) is employ to measure obesity and defined asbody cargo(Kg) (Keys et al. 1972)height(m)2BMI is useful in clinical practice and in epidemiologic studies, only if has limitations and in his report (2004), Wang describe that although a high BMI-for- jump on is a good indicator of excess fat mass, BMI differences among thinner children can be largely ascribable to fat-free mass. dickens foreign datasets that are widely used to define cloggy and obesity in pre-school children are the Inter field Obesity Task Force (IOTF) lineament and WHO standard (WHO Child Growth Standards, 2006). None is superior to the new(prenominal) and twain tend to underestimate or everyplaceestimate the preponderance when used on the same population (Monasta et al. 2010).Thresholds for obesity in children in UK (and Scotland) are calculated by referring toUK national BMI classification system that uses reference curves found on data from several British studies between 1978 and 1990(ScotPHO 2007).Children are classified as corpulence or grievous using the 85th and 95th percentiles as cut points.PREVALENCE trendsObesity has become an epidemic in some(prenominal) mappings of the world and surveys over the last decade conduct enter the rapidly increasing prevalence of obesity and over fish among children a vast with wage hike socioeconomic inequalities (WHO factsheet 2006 Lobstein 2004).The latest WHO report (Mercedes, Monika and Elaine, 2010) found on surveys from 144 countries estimates that globally, 43 million children (including 35 million in exposeing countries) are over freight and obese and another 92 million are at risk of over angle. This corresponds to a prevalence transplant magnitude from 4.2% in 1990 to 6.7% in 2010.In England, 2008 figures showed 16.8% of boys sr. 2 to 15, and 15.2% of girls were classed as obese, an growing from 11.1% and 12.2% respectively in 1995(wellness and Social Care Information Centre, 2010).Scotland has one of the highest aims of obesity in OECD countries only the USA and Mexico having higher(prenominal) levels. In 2008, 15.1% children were obese and 31.7% were overweight. This is predicted to worsen even with current health procession efforts (Scottish Govt. report, 2010).Amidst this doom and gloom scenario are recent reports showing trends in overweight and obesity prevalence shake stabilized or reversed in France (Lioret et al.2009), Switzerland (Aeberli, 2008) and Sweden (girls 1011 eld) (Sjoberg et al. 2008). In the US too, the obesity epidemic may be beef up (US CDC Report, 2008 Ogden et al.2010) but it is too primeval to know whether the data do reverberate a true plateau (Cali and Caprio, 2008).Similarly, in England, trends in overweight and obesity prevalence have levellight-emitting diode off after 2002 (Stamatakis, Wardle and Cole 2010).COSTS healthcare be of obesity are only a fraction of general costs to society (McCormick 2007) cod to loss of employment, production levels and premature pensions and scanty outcomes on businesses.Obesity is responsible for 28% of health costs in Europe and other substantial countries (WHO 2007).Total cost to NHS Scotland of obesity in 2007/8 was about 175 million and expected to double by 2030. The total cost to Scottish society of obesity in 2007/8 was in excess of 457 million and expected rise to 0.9 billion-3 billion by 2030 (Scottish Govt. report 2010).In England, updated estimate of direct obesity-related costs to NHS is 4.2 billion and this may double by 2050. Cost to the wider economy is in the region of 16 billion, and will rise to 50 billion per year by 2050 if unexpended unchecked (UK Public health report).INEQUALITIESAlthough an earlier reexamine by Parsons et al.(1999) describe no clear descent between socio-economic status (SES) in early life and childhood obesity (but confirmed a strong kind with change magnitude fatness in adulthood), a more recent organized review (Shrewsbury Wardle 2008) guards the view that overweight and obesity tend to be more prevalent among socio-economically disadvantaged children in highly-developed countries.Similar patterns are shown in data from England (Stamatakis, Wardle and Cole 2010 police, 2007) and Scotland (Scottish Govt. report, 2010).However, trends vary at heart different ethnic populations (Wang and Zhang 2006) e.g., a review by Caprio et al. (2008) concluded higher prevalence in non-Caucasian populations in US.Earlier reports (Wang, 2001) revealed that the burden of this problem was mainly in wealthier sections of the population in developing nations. In contrast, later(prenomina l) reports (Lobstein, Baur and Uauy 2004 Wang and Lobstein 2006) indicate that prevalence is rise among the urban poor in these countries, possibly due to their exposure to Westernized diets overlapping with a history of undernutrition.The reasons for the differences in prevalence of childhood obesity among population groups are building complex, involving race, ethnicity, inheritables, physiology, culture, SES including parental didactics, environment, and interactions among these determinants (Law et al.2007 Sonia et al. 2008 Townsend and Ridler, 2009).CAUSES and COMPLICATIONSThe ontogenesis of obesity in childhood and subsequently in adulthood involves interactions among multiple factors (the obesogenic environment)* personal (e.g., dietetic and physical exercise patterns preferences disability)* environmental (e.g., home, school, and community)* societal (e.g., provender publicizing, kindly network, and peer sets)* healthcare-related (access accessibility)* physiolog ical (e.g. genetics, race and ethnic, psychological, metabolic)Although genetic factors can have an effect on exclusive predisposition (Rankinen et al 2002), rapidly rising prevalence rates are formulateed by perinatal and environmental factors (Wojcik Mayer-Davis 2010).Key perinatal factors for childhood obesity are agnatic overweight before, during and after pregnancy (Oken at al. 2007 Whitaker and Dietz 1998), smoking (von Kries et al. 2002) and bottle-feeding (Gillman et al. 2001). The mothers dietary habits and level of physical action at law are also important factors (Wojcik Mayer-Davis 2010).The First Law of Thermodynamics implies that weight gain is secondary to increased caloric intake and/or decreased zip expenditure (Anderson and Butcher 2006).Decreased physical activity levels associated with sedentary recreation (video and computer games), mechanised transportation (less walking), and increasing urbanization (limited opportunity to physical activity) (Trost et al. 2001 Gordon-Larsen, McMurray and Popkin 2000) are associated with increased risk of obesity.Children with disability are at a greater risk to develop obesity (Reinehr et al. 2010) due to several reasons including health issues and restricted access to physical activity.Television view is thought to promote weight gain not only by decreasing physical activity, but also by increasing vitality intake (Epstein et al. 2008). Also, television advertising could adversely affect dietary patterns at other times throughout the day (Lewis and Hill, 1998).Psychosocial factors are linked to dietary and physical activity demeanours that define readiness balance. Children who suffer from neglect and falloff are at increased risk for obesity during childhood and later in life (Johnson GJ et al. 2002 Pine DS et al. 2001). On the other hand, social support from parents and others increases participation in physical activity of children and adolescents (Sallis, Prochaska, Taylor 2000).There is test that breast milk in infancy may moderately nurse against overweight in childhood (Davis 2001) while intake of foods with high glycemic index, scratch sweetened soft drinks and fast foods are associated with increased risk and prevalence of childhood obesity (Ludwig et al. 1999 Ludwig et al. 2001 French 2001) however, long term trials are necessitate to corroborate this association. Also, eating out (Zoumas-Morse et al. 2001) appears to be an important contributory life style factor.Excessive fat in the diet is believed to cause weight gain (Jequier 2001) however, this association is not consistently shown in epidemiological studies (Atkin L-M Davies 2000 Troiano 2000). Moreover, the fount of dietary fat consumed more important than total fat outlay (Kris-Etherton P et al. 2001).Lustig (2006) proposes that the relationship between shifts in the environment and neuroendocrinology of human energy balance is complex. The author explains that behaviors of increased calori c intake and decreased energy expenditure are secondary to obligate weight gain that is due to associated hyperinsulinemia, leptin antagonism and interference with normal satiety.Childhood obesity is a multisystem distemper with potentially serious complications* Cardiovascular risk factors along with insulin resistance have been documented in children as young as five years old (Young-Hyman et al. 2001).* some(prenominal) studies suggest that childhood overweight/ obesity is associated with increased mortality risk in later life (Gunnell 1998 Dietz 1998).* The rapidly rising prevalence of type 2 diabetes in obese children is worrying in view of the vascular complications (heart disease, stroke, limb amputation, kidney failure, blindness) (Ludwig and Ebbeling 2001 Sinha et al. 2002). These risks appear to be higher in non-Caucasians (Goran , Ball and Cruz 2000)* Adverse psychosocial effects more severe in white girls (Richard 2000). discussionEffective intervention is essential be cause obese children are resemblingly to smell substantial health risks as they mature (Cali and Caprio 2008 Speiser et al.2005). Further, as healthcare costs of this problem are rising (Wang and Dietz 2002) intervention is required to prevent morbidness in adulthood while effective whoresons for firsthand prevention are being developed.Spear et al. (2007) reviewed the turn out about the treatment options in primary care, community, and tertiary care settings and proposed a comprehensive 4-step approach for weight management. This view is supported by a similar review by Uli, Sundarajan and Cuttler (2008).Several large reviews of life style (i.e. dietary, physical activity and/or behavioral therapy) interventions for treating childhood obesity (Luttikhuis et al. 2008 Freeman 2008 Epstein et al. 1985) concluded that family based combined conductal and lifestyle interventions can produce significant reduction in overweight in children and adolescents.Although Golan et al. (19 98) suggested that targeting exclusively parents for change was superior to targeting only children for change, deportmental approaches involving both parents and children in the framework of a combined lifestyle intervention appear to be more effective (Wilfley et al. 2007 Epstein 1994 Bronwell 1983).Moreover, intensive lifestyle intervention (with mandatory caloric restriction, multiple counselling sessions and clinic visits and daily exercise) appears to be more effective (Nemet at al. 2005) than standard lifestyle intervention (Epstein et al. 1980).Although there is no consistent license to show the effectiveness of decreasing sedentary demeanour in ground of reducing television viewing (Dennison et al. 2004 Gortmaker et al. 1999), restricting TV food advertising to children may be one of the most cost-effective population-based interventions (Magnus et al. 2009).In obese adolescents, treatment with orlistat or sibutramine is sometimes used as adjunct to lifestyle interventi ons. However, these drugs have the potential for significant side effects and this approach inevitably close monitor and follow-up (Freemark 2007).Data indicate substantial weight loss after bariatric surgery in morbidly obese adolescents but potential serious complications (Lawson et al. 2006 Uli et al. 2008) necessitating close follow-up and dedication to a specialised dietary regimen (Shen, Dugay Rajaram 2004) for successful results.Role of schoolsSystematic reviews of random controlled trials (RCT) by Reilly and McDowell (2003) and Summerbell et al. (2005) concluded that the evidence base for interventions in childhood activity or school-based initiatives for prevention of obesity remains limited.In contrast, Thomas et al. (2004) in their review put forward a more unequivocal conclusion. Similarly, Flynn et al. (2006) and Doak et al. (2006) reported affirmatory outcomes in nearly all trials they reviewed.Interestingly, in an analysis of school-based platforms, authors from National bring for Health and Clinical Excellence (NICE), UK (2006) indicated that the evidence does not convincingly support the multidisciplinary whole school approach advocated by UK National Healthy Schools Program.Nonetheless, Connelly, Duaso pantryman (2007) in their review of RCTs have supported a decisive single-valued function for obligatory cookery of aerobic physical activity in schools bring together with nutritional education and skills training. Finally, Kropski, Keckley Jensens review (2008) concludes that although evidence is limited, schools play an important use in prevention strategies and different techniques directed at boys and girls for a program may have more impact.HEALTH PROMOTION MODELS RELATED TO legal profession OF CHILDHOOD OBESITYKnowledgeAttitude-Behaviour manakin proposes that as knowledge accumulates, changes in post are set off resulting in gradual change in behaviour. The model assumes that a person is acute (Barnowski 1997). However, evidence shows that most mickle in most situations do not exhibit objectively rational behaviour (Shafir LeBeouf 2002).The commonest application for promoting change by use of this model has been the provision of information in school curricula.Although knowledge partially mediates a relationship between goal setting and self-efficacy, it is not related to a change in the behaviour (Schnoll Zimmermann 2001) or to changes in physical activity behaviour (Rimal 2001) except perhaps in limited subsets of people (Wang Biddle 2001). Besides, no explore has demonstrated that knowledge-based intervention programs lead to behavioural change (Contento et al.1995).Thus, the KAB model, independently, is an inadequate tool in promoting dietary or physical activity-related behavioural change.Behaviour teaching Theory (BLT) According to BLT, behaviours are performed in response to stimuli, and the frequency of such behaviour after a stimulus will increase if the behaviour is reinforced (Sk inner 1938).A modern version of BLT, the Behavioural Economics model (Epstein 1999) suggests behaviour is the result of benefits and costs where benefits are reinforcers. Obese people convey more reinforcing value from food than others (Saelens Epstein 1996) whereas physical activity was found to be more reinforcing among non-obese people (Epstein et al.1991).Further, the distance to a preferred physical activity reduced the reinforcing value of the preferred activity (Raynor, Coleman Epstein, 1998). Thus, obese people tend to find behaviours that lead to obesity more reinforcing.Saelens Epstein (1988) utilize the model successfully in obtaining increased physical activity. However, application of reinforcers procedures on controlling behaviour is challenging and not all parents may be able to do it.HEALTH BELIEF MODEL The Health Belief Model helps explain utility of health services and has been widely applied to health-related behaviours (Rosenstock 1966 Janz, Champion Strech er 2002). The model explains health actions through the interaction of sets of beliefs perceive cleverness, perceived seriousness perceived benefits and disadvantages and cues to action.There is evidence that promptness to cues varies depending on their source (Jones, Fowler Hubbard 2000) and perceived vastness (Strychar et al 1998). Perception of susceptibility also varies between populations and may not translate into intention to change behaviour (Humphries Krummel 1998) or may do so only weakly (Leventhal, Kelly Leventhal 1999).A meta-analysis study by Witte and Allan (2000) of fear-based communications revealed that they can induce behavioural change by affecting individuals sensing of threat. However, because children and adolescents tend to see themselves as immortal, the concept of fear and threat and perceived risk, susceptibility and seriousness are not useful in this age group. HBM may become more relevant if the perceived seriousness of and susceptibility to obesi ty becomes alarming (Baranowski 2003).Social Cognitive Theory (SCT) proposes (Bandura 1986) that behaviour is a function of continuous mutual interaction between the environment and the person. changing behaviour revolves around the ability to exert self-control which is motivated by outcome expectancies because people desire to achieve positive outcomes and avoid shun outcomes.The theory has been tested with a number of behaviours and number of target populations (Bandura 2004 Sharma, Wagner Wilkerson 2006).Programs based on SCT have resulted in some changes as reported in a review by Sharma (2005) of school-based interventions for preventing childhood obesity where SCT was the most pop basis of intervention. However, the predictability of SCT concepts for intelligence diet and physical activity among children (Baranowski, Cullen Baranowski 1999) is poor it could be that the concepts are too complex to influence the behaviours of children. Children may not be expected to or able to exercise much control over their diet or physical activity and therefore environmental variables like parenting (Cullen et al.2003) and availability of food and physical equipment (Hearn et al. 1999) are more significant.Theory of profound Action (TRA) or Theory of Planned Behaviour (TPB) (Fishbein and Ajzen 1975 Madden Ajzen 1986) has been applied in many health behaviours (Sutton 1997). It proposes that attitudes, perceived social norms and perceived behavioural control predict behavioural intentions which in turn influence behaviour (Armitage Conner 2001). However, some behaviours are not under a persons control (e.g., better food choices may not be available at locality stores) which is a limitation of TRA. Further, it may be difficult to predict social norms (Terry Hogg 1996). Goding Koks review (1996) reported that the efficiency of the theory varies between health-related behaviour categories. TPB model has been applied to childhood obesity prevention programs with results showing both good (Andrews, Silk Eneli 2010) and immixed (Fila Smith 2006) predictability.Transtheoretical model (T)This model proposes that health behaviour change involves progress through six stages of change precontemplation, contemplation, preparation, action, maintenance, and termination and describes 10 processes that enable this change (Prochaska et al.1992). The model has been successfully applied in addictive disorders like smoking (Velicer at al. 1998) but has limitations when applied in the treatment of eating and weight disorders (Wilson Schlam2004).T has been applied to obesity with studies reporting both good (Sarkin et al. 2001) and poor predictability (Macqueen, Brynes, and Frost 2002).Ecological and Social Ecological ModelsThe complex etiopathogenesis of childhood obesity suggests that social ecological (SE) models may yield original lasting solutions (Huang and Glass 2008).The SE model initiated by Bronfenbrenner (1977) and subsequently develope d for understanding obesity by Davison and Birch (2001) and Story et al. (2008) propose that the individual is shown as contributing their cognitions, skills and behaviours, lifestyle, biology and demographics, while embedded in other circles representing the social, physical and macro-level environments to which they are exposed including families, neighbourhoods and the larger cultural environment.Swinburn, Egger Raza (1999) have described the ANGELO (analysis grid for environments linked to obesity) framework which is an ecological model for understanding the obesogenicity of environments.The International Obesity Task Forces model is also based on this theory and describes societal policies and processes with direct and indirect influences on body weight (Kumanyika et al. 2002) as shown hereAn ecological approach is also the basis of the Canadian model the Child Health Ecological Surveillance System (CHESS) represents a prototype for addressing childhood obesity through a local approach, with thinkable generic applications and global implications (Plotnikoff 2010).Global, regional and national prevention strategiesAs part of the response to fight the childhood obesity epidemic, WHO (2004) developed the Global strategy for Diet, Physical Activity and Health (DPAS) and produced a range of tools to assist subdivision States and stakeholders to implement DPAS. It emphasised that National plans should have achievable short-term and intercede goals.A schematic model developed by WHO (2008) for implementation and monitoring of DPAS provides the basis for a framework for action and explains how supportive environments, policies and programmes can influence behaviour changes in a population and have lasting environmental, social, health and economic benefits. The monitoring and evaluation component provides the foundation for promotion, policy ripening and action.Figure 2 seeation framework for the Global Strategy on Diet, Physical Activity and HealthThe mod el emphasises the need of right mix of upstream (socio-ecological) approaches aim to shape the economic, social and physical (built and natural) environments, midstream ( lifestyle) approaches aim to outright influence behaviour (reducing energy intake and increasing physical activity), and downstream (health services) approaches support health services and clinical interventions (Sacks, Swinburn and Lawrence 2008).Population-based prevention strategies developed in the context of a social determinants-of-health approach and use both at the national level and locally in school and community-based programmes help to change the social norm by encouraging healthy behaviours. Further, the responsibility of tackling health risks when transferred from the individual to governments (and decision-makers) helps to address associated socio-economic inequalities (WHO 2009). To be successful, action by multiple stakeholders, organize by strategic leadership is vital.Global surveillance tools recommended for growth judicial decision are Child Growth Standards (WHO 2006) and the Global School-based Student Health behold (GSHS) (WHO 2009).WHO has identified key challenges of population based prevention strategies* Globalization of food systems creating economic and social drivers of obesity through changes in the food yield and peoples diets,* Poorly designed urbanization* Deepening socioeconomic inequalities* Obesity in those with physical and/ or mental disabilities.* Cost-effectiveness A model-based analysis by the administration for Economic Cooperation and Development (OECD) and WHO, suggests that combined approaches which address multiple determinants can alter efficiency of intervention programmes (Sassi 2009).Based on The Ottawa Charter for Health Promotion (WHO 1986), key elements of global prevention strategies based are* engagement at multiple settings schools, after-school programmes, homes and communities and clinical settings* Identify and embarrass threatened groups.* Use of correct approach, or better, a mix of approaches for a give situation is crucial along with concern of country- and community-specific factors, such as availability of resources and/or socioeconomic disparities.* Set priorities and targets and engage with all stakeholders in a transparent manner.* Allow public access to information on partnerships and die potential conflicts of interest to minimize conflicts of interest.* Effective programme implementation and sustainability long term planning and budgeting, as well as reporting cost-effective interventions such as the ACE-Obesity project (Carter et al. 2009) is vital..* Creative funding to warrant long-term sustainability this ability include the development of strategies to uncouple funding by the private sphere from direction setting and intervention selection.The International Obesity Taskforce (IOTF) have developed in consultation with WHO a set of (Sydney) principles defined to cover the comme rcialized promotions of foods and beverages to children and guide action on changing marketing practices them (2007). The principles aim to project a degree of protection for children against obesogenic foods and beverages.In November 2006, European Union (EU) penis States adopted the European Charter on Counteracting Obesity, which defines WHO policies and action areas at the local, regional, national and international levels for all stakeholders in government and private sector (food manufacturers, advertisers and traders) and professional, consumers, international and intergovernmental organizations.To encourage individual behavioural change, the strategy Healthy Weight, Healthy Lives A Cross- governing Strategy for England (2008) has been developed with following key features* Children, healthy growth and weight* Promoting healthy food choices* Building physical activity into peoples lives (Healthy towns build on the EPODE model ( Borys 2006)* Creating incentives for better h ealth* Personalised advice and supportPolicy drivers include national policy changes (e.g. increased support for surveillance, promotion of breast feeding, bans on unhealthy food advertisements, social marketing campaigns) changes to the food supply (e.g. development of a healthy food code, introduction of front-of-pack labelling, limits on fast-food restaurants near schools and parks, increased supply of fresh fruit and vegetables to stores in deprived areas) development of a national physical activity plan in part (tied to the 2012 Olympics with the usage of improving built environments) and improved nutrition-related health service provision). The project is led by an intergovernmental team, and has provided resources for local authorities and National Health Service (NHS) and effected knowledge-sharing points. Partnerships within government have been strengthened in order to supplement funds and to integrate projects into existing strategies and programmes.* Facilitate a nati onal confabulation on societys response to the epidemic of excess weight* Develop a comprehensive marketing programme* National prioritisation and clear accountability within Government* Build up Staff skills and capabilities* Extensive support and counsel for PCTs and local authorities* Clear Whitehall decision-making and setting aside financial resourcesThe Government and Convention of Scottish Local Authorities (COSLA) have developed a Route Map to prevent overweight and obesity (2010) for decision-makers working with their partners, NHS Scotland and businesses to develop and subsequently deliver lasting solutions. The Government has targets to reduce the rate of increase in the proportion of children with unhealthy BMI by 2018 but none to that extent for obesity or weight management.Policies for prevention are directed at reducing energy consumption, increasing physical activity and minimising sedentary behaviour, creating positive health behaviour through early life interven tions and building healthier work place environments.Policy drivers include1. For obesity management* The incite (health improvement, efficiency, access, treatment) H3 target for child healthy weight intervention programmes* Counterweight (evidence based obesity management in Primary Care)* Scottish Enhanced go for childhood obesity in the Western Isles2. For obesity prevention* Implement initiatives in Lets Make Scotland More Active* Recipe for Success Scotlands National Food and Drink Policy* Eight Healthy Weight Communities programmes crossways Scotland* Seven Smarter Choices Smarter Places active travel demonstration towns* The Take Life On national social marketing campaign aims* Beyond the School portal and NHS Health Scotlands Healthy Weight Outcomes Framework will provide pleader to help create health-promoting communitiesIn addition, there are several national programs directed to a Greener, Healthier, Smarter, Safer and Stronger Scotland which are likely to have indir ect piece to tackle overweight and obesity.CONCLUSIONThe essay emphasises the rapidly increasing burden of childhood obesity with associated population profile changes and increasing social inequalities. It explains the complex multifaceted and interlinked causal pathways that form the obesogenic environment.Community and school-based obesity intervention and prevention programmes are described and the role of research protocols in gathering evidence for such interventions and their usefulness is briefly explored. Existing global, regional and national prevention and implementation strategies to fight childhood obesity are specified.The author has reviewed and compared various forms of prevention strategies and interventions (singly and in combination) that are in practice and in which conditions they are effective. The important role of socio-economic development and government policies on urban planning, environment, transport, and education and vitally, the agriculture and food industry can be designed and implemented to achieve reduction of obesity is emphasised.Evidence for effective prevention of childhood obesity is strongly challenged at present. Further research is required to identify best practice procedures for public health policies that are cost-effective, culturally sensitive, bridge player