Weight control does not seem to be an effective answer to the increasing incidence of obesity as studies have shown that within five years most people have regained whatever weight they lost. Finding a solution to childhood overweight/obesity is especially challenging because of a child's vulnerability to the stigmatization that all fat people experience. Suggesting, forcing, cajoling, or asking a child to lose weight emphasizes that the child is not acceptable as she or he is. The solution to this problem is to focus on health and the acceptance of the person that the child is. This frees the child to change his or her behavior. We understand that the increased incidence of obesity stems from the collective acceptance of (1) government policies favoring the use of private automobiles instead of multiple transportation options, which include walking or biking, (2) advertisements by multinational companies which create a globally shared consensus of what constitutes beauty and the good life, and (3) the desire to look and act the way the users of advertized products are shown to look and act. Working symbiotically all three negatively affect the health of children. Participatory Action Research (PAR), a specific form of Community Based Participatory Research, enables researchers to enter a community with an idea, convince the people that the idea is important for them to work on, and then help them develop sufficient collective efficacy to solve the problem. Our hypothesis is that PAR will improve the attitudes, norms and self-efficacy of adults and children so that the health of children in the community is improved.
Specific Aim 1, reduce stigmatization of overweight children, focuses on """"""""You're a great person. What you look like is not important"""""""".
Specific Aim 2, get adults and children to move more, capitalizes on the fact that children naturally want to run, jump, squirm, and play.
Specific Aim 3, eat more fruits, vegetables, and low-fat milk, is based on findings that focusing on increasing these three groups, as opposed to focusing on reducing high-fat-high-sugar foods, resulted in decreased restraints on child eating, decreased weight concerns, and increased acceptance of the child by his/her parent. We will do a quasi-experimental two-sample, pre-post design pilot study using 2 intervened and 2 comparison communities in the Caguas Region of Puerto Rico (PR). We will measure the following intermediate dependent variables in 3rd to 6th graders: attitudes, self-esteem, acceptance or lack of acceptance of body size, and self efficacy;and in adults we will measure stigmatization. To evaluate the status of the children we will use the following baseline and outcome dependent variables: height and weight to calculate the Body Mass Index (BMI), skinfolds, blood pressure, a Self Administered Physical Activity Checklist, step counts, and 24-hour Dietary Recalls. An outside evaluator will do continuous process evaluation to assess the level of application of PAR. Our long term goal is to establish programs to ameliorate the social, psychological, and physical environments of the community that lead to poor health in children
Finding an effective solution to childhood obesity is challenging because dieting behaviors in children result in unanticipated weight gain. Since all fat people experience stigmatization, asking a child to lose weight emphasizes that a she or he has to change to be acceptable which produces a long term negative effect on a child's self-esteem. We will use Community Based Participatory Research to improve the attitudes, norms and self-efficacy of adults and children so that social and psychological environment in the community promotes (a) reduction of the stigmatization of fat children, (b) getting children and adults to move more, and (c) eating more fruits, vegetables and low fat milk.
| Macpherson-Sánchez, Ann E (2015) Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic. Am J Public Health 105:e71-85 |
