Addressing Childhood Obesity in Jakarta

This assignment delves into developing a mobile health intervention to tackle the issue of childhood obesity in urban Jakarta. It requires an analysis of existing research on obesity prevalence and interventions, specifically focusing on those targeting 12-23 month old children. The assignment emphasizes applying program design principles like Intervention Mapping and considering digital tools for patient engagement. Students are encouraged to draw upon relevant literature and case studies to formulate a comprehensive and practical intervention plan.

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Running head: NUTRITION IN INTERNATIONAL SETTINGS
Nutrition In International Settings
Name of student:
Name of university:
Author note:

NUTRITION IN INTERNATIONAL SETTINGS
Among the different health conditions making it to the headlines in recent times,
childhood obesity is one. A considerable amount of concern is building up regarding the high
prevalence rate of childhood obesity across the globe since the impact of obesity is adverse.
Childhood obesity refers to the condition in which excess amount of body fat interferes with
the health and well being of the child, leading to negative health outcomes (Cheung et al.,
2016). Nutritional interventions have been in the limelight as a suitable approach towards this
spurring epidemic. Though the introduction of a nutritional intervention would be marked by
challenges, manipulation of the nutrient profile would be pivotal (Bailey et al., 2015). The
present essay would focus on nutrition interventions to be delivered to the children of Jakarta,
Indonesia, for addressing the emergence of obesity and diabetes as a health problem. The
paper would describe the epidemiology of child and adolescent obesity and the present
programs in the country. Strategies would be described, and a package of interventions would
be outlined that would be implemented for reducing childhood obesity. The objectives and
key elements of the intervention package would be mentioned along with the approach for
implementing them. The effectiveness of such interventions would be supported by
literature. The development of the program would be guided by partnerships with the
community to ensure its success.
The high prevalence of childhood obesity in Jakarta, Indonesia, a middle-income
country, has sparked concerns. The number of children becoming overweight and obese due
to an unhealthy diet has been raising concerns since the children are at high risk of long-term
degenerative diseases. As per the reports of triennial research that was undertaken by the
Health Ministry, there had been an increase in the rate of childhood obesity from 2010 to
2013. In 2013, results of the survey indicated that prevalence of childhood obesity for
children between 5-12 years was 30.1 percent which was quite shocking. This percentage was
higher in comparison to the national average of 18.8 percent (Wardhani, 2014). According to

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Cahyaningrum et al., (2016) childhood obesity in Jakarta was not limited to children coming
from the middle-class families and upper-class families. The lower-class families also engage
in feeding unhealthy food to the children, and this is a rising trend at present. The fact that
excess body weight leads to diabetes and gallstones among other severe diseases such as
brain disease and cardiovascular disease is undermined.
Indonesia has been taking steps in the past few years to combat the growing concerns
of childhood obesity, but not much has been done. The nutrition status of children has drawn
the focus for imparting education. The staged approaches have been a failure due to a number
of reasons, though they have attempted to focus on the whole community. Future health
interventions need to focus on broader aspects integrated into the community, and more
specific approaches are required at present. More cost-effective approach is warranted that
could reduce the burden (Rachmi et al., 2017).
Nutritional interventions for weight loss and prevention of obesity have been popular
in research and practice and have generated a great interest of public health organisations. As
energy balance is the cornerstone of weight control, nutritional uptake that limits certain
macronutrients or food items are emerging. The basic premise is to have a balanced diet that
meets the requirements for body functioning. The willingness to adopt diverse interventions
are to be utilised for coming up with novice interventional strategies. As inadequately
researched approaches underline the long-standing struggle for preventing obesity, more
effective methods are required. It is imperative to have a proper understanding of the efficacy
and long-term sustainability of approaches for preventing childhood and adolescent obesity
(Spark et all., 2015).
A multicomponent nutrition guidance would be the suggested nutrition intervention
for addressing childhood obesity in Jakarta. With the help of nutrition education theories, the

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suggested intervention would be a digital-based guidance system that would target first-time
mothers to prevent obesity during the first two years. The multicomponent nutrition guidance
system would include digitally based educational tools and content in addition to telephone-
based professional support from registered dietitian nutritionists and certified lactation
consultants. The educational content would be based on principles of nutrition that prevents
childhood obesity. The content would aim at providing the much-required instruction and
knowledge so that the facilitators and barriers associated with successful impartment of
knowledge are addressed adequately. The tools would aim at helping mothers maintain
behaviours within core nutritional messages. Telephone-based support would help mothers to
reinforce content delivered to them and maintain these content. Contacting the dietician or
lactation consultant through scheduling an appointment or calling up on the toll-free number
would be a suitable approach. These components maintain consistency with the theoretical
framework of behaviour change and the tools and educational content address the underlying
theoretical constructs making a deep impact on behavioural adaptation (Turner et al., 2015).
The proposed intervention would have a content team that would comprise
paediatricians, researchers in nutrition, registered dietician nutritionists who would be experts
is childhood nutrition for the formulation of the content and delivery of the digital-based
intervention. Inputs are to be taken from the consumer communication professionals,
academic advisory board and creative agency. Collaboration between the cited professionals
would be pivotal for the success of the intervention. Clear communication between the
experts for appropriate exchange of ideas and information is crucial. The registered dietician
nutritionists would be working in a preventive role for combating obesity and be responsible
for overseeing the complete intervention package. Inimitably, dietitians are known to utilise
the recent and evidence-based public health research on food and health from which practical
guidance tools are developed. The aim they have is to help individuals make appropriate food

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choices.The interaction with the professionals would be beneficial for the mothers as they
would get the counselling and support require for acquiring skills in relation to child feeding
and development of food habits. The recruitment of the professionals would be based on their
academic qualifications, experiences, skills and aptitude. Leadership skills are to be
demonstrated throughout the intervention process, therefore, resources are to be allocated to
enable the professionals to showcase the same (Dooley et al., 2017).
The tools and content would include emails, videos, articles, infographics, quizzes,
interactive and printable trackers and a tool for goal setting. Content needs to be divided into
different modules and be delivered in a continuous manner over the two years time frame.
Theoretical constructs would include social norms and behaviour beliefs; outcome evaluation
and attitudes; self-efficacy and improvement through social modelling; relevant knowledge;
behavioural capability. The successive step would to prioritise the most significant messages,
and each of these are to be presented at each stage of intervention. The last stage would be to
create the final copies of educational material with suitable headings, photo images to be
imparted. Emails are to be sent to the mothers to notify them about the timing of the next
module to be delivered. Periodical reminders would assist in using the websites in which the
materials would be available. Text messages are also to be sent, and both emails and text
messages would be sent to those who would opt to receive them on the basis of the birthdate
of the baby.
The interactive digital tools would include a menu planner and a growth tracker. The
growth tracker would have the aim of supporting a self-monitoring approach and for this
case, a maternal monitoring approach. The mothers would be able to input the weight of the
child at any point in time and track the weight-for-length percentile. The goal setting tool
would help mothers to achieve the self-directed larger goals through performing smaller

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tasks. The menu planner would enable mothers to plan the meals given to the babies as per a
list of the nutritious meal provided. The menu planner could be changed from an infant only
use one to family use one so that parents can mode healthy eating for their babies. Printable,
non-interactive tool would also be available together with a breastfeeding tracker and taste
tracker (Eldredge et al., 2017).
On the basis of the anticipatory guidance framework, an anticipatory and sequential
timing of delivery would be incorporated. The educational tools and content would be
delivered every two months for the compete set of modules which can be termed as
‘Buillding Blocks’. These Buiding Blocks would be delivered at the time of the third
trimester of pregnancy, just after delivery, at every 2 months until the child is 22 months of
age. When a mother enrols herself in the intervention, the upcoming Buiding Blocks are
locked from being viewed until the appropriate age is attained. The valuable option of
consulting a lactation consultant or a dietician would be encouraged throughout the time
frame. The nutrition guidance system would utilise only vehicles based on digital technology
for delivery of tools and content on nutrition education. A website would be the ordnance of
the tools and content and would house the online-scheduling system so that mothers can
make appointments with the support team. In addition, the website would be optimised for
application on the mobile device (Hebden et al., 2014).
Thakkar et al., (2017) opined that person-to-person intervention formats, such as
home-based consultation, group education and clinic-based consultations had been widely
used till date for the promotion of healthy growth and dietary patterns of children. Though
some studies have shown the success of these types of interventions, the limitations of these
have been widely discussed. Weight status changes have been marked in some studies;
however, the delivery formats have the restrictions that lead to global and national scale-up

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resource draining, time-consuming and less effective thereby. Ruel et al., (2013) point out
that interventions that are clinic-based are limited by the absence of provider time. In
addition, insufficient provider training is a problem as nutrition counselling is ineffective.
Some individuals might also have the preconceived notion that education as a public health
approach is not a part of the scope of work of the provider. Group education settings are
continuously been criticised since they ar plagued by poor attendance, the reasons for which
include childcare responsibilities and transport facility. Lastly, home-based interventions
might have a nurse who is trained in the field visiting the homes of new mothers, the
resources required for this purpose need special hiring and training for utilisation. A large
pool of staff is to be trained and the cost of travelling to the homes are also high. Therefore
scale-up entails a higher cost for overcoming the limitations and achieving sufficient dose,
coverage, and fidelity. Maintainance of the interventions is a complicated matter, therefore.
Milani et al., (2017) have highlighted that interventions, when delivered on the digital
platform, are more accepted and are more effective for the population being targeted. Digital-
based interventions are useful for bringing about behavioural modifications in populations in
relation to weight and physical activity. The authors tested a smartphone and website based
intervention for improving parenting behaviours, and breastfeeding found the effectiveness of
the same. The major areas where improvements have been marked are newborn care,
parenting style in relation to feeding habits, toddler safety and maternal education level of
nutrition. Digital-based education is also present in maternal and chid health program in the
US and Netherlands such as Supplemental Nutrition Program for Women, Infants, and
Children (WIC) and the Text4Baby program, and HelloWorld email-based program in the
two countries respectively. Media trends at the contemporary society indicate a shift towards
the use of digital media from the use of print media. Internet media has been proved to be the
only media among newspaper, TV, radio, email and cell phone, whose use increases after a

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woman becomes a mother. Mothers tend to spend more time on the internet in comparison to
the general population.
Research also indicates that greater health information seeking attitude can be seen
online. If a survey is to be conducted, the results would indicate that half of the total number
of mothers would report seeking parenting related information including nutrition from
different internet sources. Advice on how to develop proper nutritional habits in children are
sought using the tablet or mobile phone. A digital intervention that is well-designed has all
the possibility of being a cost-effective intervention when compared to other formats of
intervention delivery (Brownson et al., 2017). The likelihood that the presently proposed
intervention would be effective in engaging the targeted population is therefore high. The
achievement of behavioural adoption is likely. In addition, most of the cost for developing the
digital-based intervention is non-recurring, therefore the costs of maintaining them is
minimal. When the intervention is scaled up and the number of members increases, the
additional cost is negligible.
The target for the proposed intervention in the form of nutrition guidance system
would be first-time mothers in Jakarta. The system would be such made that it would be
applicable to individuals coming from a wide range of income groups as well as educational
levels. Socioeconomic groups have diversity in them, and this aspect would also be
addressed. The multicomponent nutrition guidance system proposed hereby would have the
capacity to be disseminated to diverse global contexts.
Funding is an essential component of all intervention programs across communities.
In Indonesia, the government has shown a proactiveness in funding programs that target a
wider audience for a serious public health concern. Though there are different possible
funding sources, access to funds has been a major problem. Given that the proposed

NUTRITION IN INTERNATIONAL SETTINGS
intervention has a number of advantages and key benefits, financial aid is expected from the
government so that the implementation phase is successful. As a response to the rapidly
increasing prevalence of childhood obesity, budgetary allocations would be the cornerstone
of bringing about the expected positive change. Convergence and complementation of
resources and efforts among the different stakeholders would be highly solicited. Evaluation
of the program can be done with a robustly designed clinical trial. If the evaluation is
successful in extracting maximal information aligned with the objectives of the intervention,
the proposed system can be scaled up to the proportions that is deemed fit for impacting a
sustainable change in the objectives of the intervention pertaining to promotion of healthy
nutrition in the first 1000 days (Brownson et a, 2017).
From the above discussion, it is found that childhood obesity is a key problem faced
by Jakarta, the capital city of Indonesia, as the prevalence rate is growing significantly.
Interventions delivered at present have not bene successful to the desirable extent to lower the
rate of childhood obesity. The outlines strategies would produce noteworthy weight loss and
improvements in metabolic risk factors among the children and adolescents. The tools and the
content that has been suggested above would be applicable to diverse audiences, making the
impact more profound as compared to the present interventions of the country. The
multicomponent features would be appropriate to different contexts and would foster a heathy
growth for children. It can be expected that with the proposed intervention delivered in a
timely manner and with adequate resource allocation childhood obesity would be better
handled in the near future. Reduced healthcare costs and patient outcomes would reflect this
drastic positive change that is much awaited.

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