Foundations of Public Health: Childhood Obesity Project Plan

This project plan, submitted for SOCF311 Foundations of Public Health, outlines a comprehensive strategy to combat childhood obesity among 8-12 year olds in Adelaide, Australia. The plan proposes a Complementary Medicine (CM) intervention utilizing the Xin-Ju-Xiao-Gao-Fang (XJXGF) herbal formulation to reduce obesity prevalence. The project includes a background on the global and local prevalence of childhood obesity, its contributing factors, and the rationale for using CM. The implementation section details the project's goal of reducing obesity rates, objectives to increase understanding of obesity and promote healthy lifestyles, and strategies involving convenience sampling, inclusion/exclusion criteria, and a 28-week intervention period. The plan also describes the measurement of BMI and waist circumference, and the weekly consumption of the herbal formulation. The project aims to provide a holistic approach to address childhood obesity, and includes an executive summary and table of contents.

Running head: PART C
SOCF311 Foundations of Public Health
Name of the Student
Name of the University
Author note

1PART C
Executive summary
Childhood obesity is an illness that exerts a negative consequence on people, owing to the
excess build-up of body fat. Taking into consideration the ever increasing occurrence of
childhood obesity, negative effects of the ailment have been acknowledged as an
intimidating public health concern. The project focused on the strategies that will be adopted
for implementation of Chinese herbal medicines, in the form of a CM treatment modality, with
the aim of decreasing childhood obesity prevalence among 8-12 years aged children in
Adelaide.

2PART C
Table of Contents
1. Background........................................................................................................................ 3
2. Purpose.............................................................................................................................. 5
3. Implementation...................................................................................................................6
Goal.................................................................................................................................... 6
Objectives........................................................................................................................... 7
Strategies........................................................................................................................... 7
Evaluation........................................................................................................................... 8
References............................................................................................................................. 9

3PART C
1. Background
The world is being subjected to a plethora of quick nutritional and epidemiological
transition that are typically characterized by obstinate nutritional deficits, as demonstrated by
the occurrence of anaemia, stunting, zinc, and iron deficiencies (Papas et al., 2016).
Concurrently, recent evidences have also confirmed the presence of a gradual increase in
the prevalence rates of diabetes mellitus, obesity, and nutrition associated chronic diseases
that also comprise of cardiovascular complications, and different types of cancer (Williams et
al., 2015). Obesity has been found to reach an epidemic level in most developing and
developed countries. In addition, maximum prevalence of childhood obesity are observed
amid people of developed countries. Nonetheless, the prevalence rates are rapidly
increasing among developing nations as well. According to Xu and Xue (2016) the condition
is characterised by the accumulation of excess fat in the body that exerts a negative impact
on the wellbeing and health of a child. In addition, children who are found to be obese
manifest body weight, which is higher than normal weight of their age-matched counterparts.
Time and again it has been confirmed that the problem of childhood obesity creates
particular problems owing the fact that the accumulation of extra pounds creates several
impediments in the pathway of attaining optimal health and wellbeing, and increases the
chances of the children of become obese adults as well. Hence, it can be suggested that
childhood obesity is a major public health concern in the 21st century and the problem is
prevalent on a global scale. In addition, the rates of obesity among children are increasing at
an alarming rate in urban settings and there were approximately 42 million overweight and/or
obese children, aged under five years in the year 2010 (Sahoo et al., 2015).
Further evidence for the high prevalence of childhood obesity can be accredited to
the fact that the proportion of obese and overweight young children and infants (aged 0-5
years) demonstrated an increase from 32 million in the year 1990, to 41 million in the year
2016. Moreover, it has been expected that the global prevalence rate of childhood obesity
will increase to an estimated 70 million by the year 2025, thereby establishing the public

4PART C
health problem as a matter of major concern (WHO, 2018). There is mounting evidence for
the fact that childhood obesity occurs due to a plethora of factors that act together. One of
the greatest risk factor for the condition is genetics that accounts for presence of obesity in
both parents (Waalen, 2014). Other factors have been associated with the body type of the
child and several psychological factors. The condition has also been established to be a
direct manifestation of interaction between features that favour people with parsimonious
energy metabolism. In addition, increased access to cheap and energy dense foods, along
with less energy necessities in day-to-day life increase the susceptibility of children to
become overweight or obese. Other contributing factors comprise of an increased access to
technology, increase in the portion size of snacks and meals, and reduction in physical
exercise of children (Baidal et al., 2016).
It has also been found that childhood obesity occurs due to interaction between
environmental and genetic factors. Presence of polymorphism in several genes that control
metabolism and appetite often increase the likelihood of children to suffer from obesity.
According to Loos and Yeo (2014) children who have two copies of the FTO allele are more
susceptible to suffer from diabetes and obesity. Furthermore, advertisements of unhealthy
food products such as, fast food, beverages, candy, are also correlated with increased
obesity rates. Interaction between parent and child at home also plays a crucial role in the
onset of obesity, owing to the fact that parents are primarily responsible for exerting a
positive influence on the food choices of their children, and are also imperative in motivating
their children in adopting a healthy lifestyle (Wolfson et al., 2015). Furthermore, children
generally spend maximum their time in their schools. Therefore, schools also have a vital
role in promoting adherence to physical activity and healthy food selections among the
children.
There is a need to implement proper strategies for controlling the rates of childhood
obesity among school children owing to the fact that health problems associated with
childhood obesity are not just restricted to physical ailments, but encompass social and

5PART C
psychological problems as well. Furthermore, in the words of Rankin et al. (2016) obese
children generally report presence of a negative perceptions, in relation to their appearance
and body-image, which in turn decreases their self-esteem. In addition, obese children
habitually feel depressed and often display nervousness about health issue, which in turn
creates a negative impact on their behaviour. This in turn generally gets reflected on their
social and academic progress. In other words, obese children typically report feelings of
social discrimination and stigmatisation by their adults and peers. Hence, the target
population to be selected for the project implementation comprises of children aged 8-12
years, who are overweight or obese, and study in schools located in the capital city of
Adelaide.
2. Purpose
Complementary medicine (CM) encompasses the branch of medicine and health
science that focuses on accomplishing healing impacts of medicine, however lacks the
necessary biological plausibility and is typically untestable (Micozzi, 2018). In other words,
the purpose of implementing complementary medicine strategies for treatment of the
growing problem of childhood obesity can be accredited to the fact that it encompasses the
application of treatment modalities that are used in combination with standard clinical
interventions. Time and again it has been found that CM is generally implemented with the
assumption that it will facilitate bringing about an improvement in the impact of standard
treatments (Reid et al., 2016). It has often been found that children who are identified to be
obese or overweight do not generally get necessary evidence-based treatment strategies for
tackling their health problem (Roberto et al. 2015). In addition, several insurers fail to provide
necessary coverage for treatment of childhood obesity, despite the presence of evidence
that the condition requires early intervention, and is authorised by the Medicare. The project
is based on the application of Chinese herbal medicine for the effective management of
childhood obesity among obese children aged 8-12 years, studying in Adelaide.

6PART C
This treatment modality can be traced back to 6,000 years and involves the usage of
more than 13,000 medicinal. Research evidences have elaborated on the fact that
hydroxycitric acid that is typically extracted from G. cambogia dehydrated rind acts in the
form of a dietary supplement and has been found beneficial in obesity management. The
basic mechanism of action of the herbal medicine comprises of exerting an inhibitory effect
on the activity of lyase enzyme that is an ATP-dependent citrate, which in turn stimulates
degradation of citrate to acetyl-CoA and oxaloacetate, thereby inducing a feeling of satiety
by reducing the appetite (Esteghamati et al., 2015). This is in accordance with the evidence
that application of a combination of pear pomace and G. cambogia extract has been found
to suppress adipogenesis, thereby enhancing the process of lipolysis in the 3T3-L1 cells
located in the body. The evidence supports the fact that implementation of this
complementary medicine modality helps in lowering expression of FAS, C/EBP-α and
PPAR-γ (Sharma et al., 2018). This in turn can be accredited to the fact that
adipogenesis inhibition has often been identified in the form of a major therapeutic target for
effective management of obesity and its associated comorbid disorders.
Furthermore, effectiveness of Chinese herbal medicine in the treatment of obesity
can also be associated with the fact that when herbal medicines have been co-administered
with probiotics, they have brought about significant effects on the rate of energy metabolism,
thus reducing body weight (Lee et al., 2014). Hence, the intervention that has been decided
for the project is based on the herbal formulation of Xin-Ju-Xiao-Gao-Fang (XJXGF) that
comprises of semen cassia, coptis, rhubarb, and Citrus Aurantium. This CM intervention is
expected to enhance the existing approaches that are currently in practice for obesity
management, owing to the fact that it will act in the form of a holistic therapy and will attempt
to address the children as complete individuals, and not a sick or diseased person.

7PART C
3. Implementation
Goal
The primary goal of this project is to reduce the rates of childhood obesity among
children aged 8-12 years, studying in schools located across the capital city of Adelaide.
While the primary goal focuses on obesity management, reducing the prevalence of
childhood obesity in the target population will also prove effective in enhancing their overall
health and wellbeing, thus lowering their chances of suffering from chronic health disorders
in the long run. Hence, the general health of the community will also get enhanced.
Objectives
 To reduce the prevalence of obesity among children aged 8-12 years, studying in
schools located in Adelaide, through implementation of complementary medicine.
 To increase their understanding on obesity and its self-management.
 To help the children adhere to healthy lifestyle habits.
Strategies
With the aim of lowering childhood obesity prevalence rates in the target population
of school going children, aged 8-12 years, and the primary strategy would focus on
subjecting them to a CM intervention that is based on the application of Xin-Ju-Xiao-Gao-
Fang (XJXGF) herbal formulation. The children will be selected based on the method of
convenience sampling, whereby their selection will be determined by their accessibility and
proximity to the site of research in Adelaide. The reason behind using this sampling strategy
can be associated to the fact that it is time and cost-effective, and requires small number of
participants, when compared to other probability sampling methods (Etikan, Musa &
Alkassim, 2016). Determination of inclusion and exclusion criteria is imperative in research
and helps in selecting prospective research participants. Children studying across the
schools located in Adelaide, who have a BMI >28 kg/m2, and follow a sedentary lifestyle will
be selected for the project. In addition, children will be excluded if they report weight loss in
the last three months, or participate in moderate to vigorous physical activity. The project will

8PART C
be organised at a community centre that can be easily accessed by all participants, and will
be conducted over a period of 28 weeks. Participant selection will be done after collecting
informed consent from their parents about the project. The parents will be informed about
the potential advantages and side effects of the herbal formulation (if any) (Hardicre, 2014).
Following participant recruitment, the children will be subjected to a herbal
formulation of XJXGF that would principally comprise of rhubarb, semen cassia, coptis, and
Citrus Aurantium. Some of the principal extracts of this herbal formulation would include
geniposidic acid, gallic acid, verbascoside, berberine, naringin, aloeemodin, emodin,
aurantio-obtusin, chrysophanol, and rhein (Liu et al., 2017). Prior to administering the herbal
formulation, the BMI and waist circumference will be measured. The children will be asked to
consume the herbal formulation each day, and visit the community centres every week,
following which, their body parameters will be measured.
In order to increase their awareness on obesity and its self-management, during their
visit to the community centre, the children and their parents will be distributed pamphlets and
taught about the harmful impacts that childhood obesity creates on the health and wellbeing.
In addition, patient education sessions would also comprise of teaching about the benefits of
the herbal formulation, and the risk factors that increase the likelihood of the children from
acquiring childhood obesity (Hung et al., 2015). In addition, the parents will also be
subjected to counselling sessions in the community centre for motivating their children to
make healthy food choices, and participate in physical exercise. They will also be provided
contact and helpline numbers for complementary medicine clinics in the district. The
aforementioned intervention will be a novel model of healthcare delivery in the community.
Evaluation
The effectiveness of the implemented strategies can be measured by assessing the
BMI and health parameters of the children, prior to, during, and after the completion of the
project. A decrease in BMI from the value of 28 kg/m2 would suggest that the herbal
formulation has been effective in managing childhood obesity rates. Furthermore, increased

9PART C
understanding among parents and children on obesity risks and its management, and
demonstration of enthusiasm amid the children to adapt healthy lifestyle habits would also
suggest that the project has been successful in addressing the public health issue.

10PART C
References
Baidal, J. A. W., Locks, L. M., Cheng, E. R., Blake-Lamb, T. L., Perkins, M. E., & Taveras, E.
M. (2016). Risk factors for childhood obesity in the first 1,000 days: a systematic
review. American journal of preventive medicine, 50(6), 761-779.
Esteghamati, A., Mazaheri, T., Rad, M. V., & Noshad, S. (2015). Complementary and
alternative medicine for the treatment of obesity: a critical review. International
journal of endocrinology and metabolism, 13(2).
Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and
purposive sampling. American journal of theoretical and applied statistics, 5(1), 1-4.
Hardicre, J. (2014). Valid informed consent in research: An introduction. British Journal of
Nursing, 23(11), 564-567.
Hung, L. S., Tidwell, D. K., Hall, M. E., Lee, M. L., Briley, C. A., & Hunt, B. P. (2015). A meta-
analysis of school-based obesity prevention programs demonstrates limited efficacy
of decreasing childhood obesity. Nutrition Research, 35(3), 229-240.
Lee, S. J., Bose, S., Seo, J. G., Chung, W. S., Lim, C. Y., & Kim, H. (2014). The effects of
co-administration of probiotics with herbal medicine on obesity, metabolic
endotoxemia and dysbiosis: a randomized double-blind controlled clinical
trial. Clinical nutrition, 33(6), 973-981.
Liu, Y., Sun, M., Yao, H., Liu, Y., & Gao, R. (2017). Herbal medicine for the treatment of
obesity: An overview of scientific evidence from 2007 to 2017. Evidence-Based
Complementary and Alternative Medicine, 2017.
Loos, R. J., & Yeo, G. S. (2014). The bigger picture of FTO—the first GWAS-identified
obesity gene. Nature Reviews Endocrinology, 10(1), 51.
Micozzi, M. S. (2018). Fundamentals of Complementary, Alternative, and Integrative
Medicine-E-Book. Elsevier Health Sciences.

11PART C
Papas, M. A., Trabulsi, J. C., Dahl, A., & Dominick, G. (2016). Food insecurity increases the
odds of obesity among young Hispanic children. Journal of immigrant and minority
health, 18(5), 1046-1052.
Rankin, J., Matthews, L., Cobley, S., Han, A., Sanders, R., Wiltshire, H. D., & Baker, J. S.
(2016). Psychological consequences of childhood obesity: psychiatric comorbidity
and prevention. Adolescent health, medicine and therapeutics, 7, 125.
Reid, R., Steel, A., Wardle, J., Trubody, A., & Adams, J. (2016). Complementary medicine
use by the Australian population: a critical mixed studies systematic review of
utilisation, perceptions and factors associated with use. BMC complementary and
alternative medicine, 16(1), 176.
Roberto, C. A., Swinburn, B., Hawkes, C., Huang, T. T., Costa, S. A., Ashe, M., ... &
Brownell, K. D. (2015). Patchy progress on obesity prevention: emerging examples,
entrenched barriers, and new thinking. The Lancet, 385(9985), 2400-2409.
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015).
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primary care, 4(2), 187.
Sharma, K., Kang, S., Gong, D., Oh, S. H., Park, E. Y., Oak, M. H., & Yi, E. (2018).
Combination of Garcinia cambogia extract and pear pomace extract additively
suppresses adipogenesis and enhances lipolysis in 3T3-L1 cells. Pharmacognosy
magazine, 14(54), 220.
Waalen, J. (2014). The genetics of human obesity. Translational Research, 164(4), 293-301.
Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2015). Overweight
and obesity: prevalence, consequences, and causes of a growing public health
problem. Current obesity reports, 4(3), 363-370.