Healthcare Report: Obesity in Australian Children and Adolescents

This report examines the public health issue of childhood obesity in Australia, focusing on the National Healthy School Canteen (NHSC) program. It begins with an introduction to the problem, outlining the prevalence of obesity among children and adolescents. The report then provides background information on the issue, including contributing factors such as diet, physical activity, and the obesogenic environment. The rationale for the NHSC program is discussed, highlighting the importance of school canteens in promoting healthy eating habits. The program's description, values, and public health principles are explored, including the categorization of foods into green, amber, and red categories. The report identifies stakeholders involved in the program, such as parents, teachers, and canteen staff. Strengths and limitations of the program are analyzed, including its cost-effectiveness and potential for influencing eating habits beyond school hours. The report concludes with recommendations for future studies and program implementation. References from relevant sources are provided.

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Table of Contents
Introduction......................................................................................................................................3
Background......................................................................................................................................3
Rationale for the Program................................................................................................................4
Description of program....................................................................................................................4
Values and public health principles.................................................................................................5
Stakeholders.....................................................................................................................................5
Strengths and Limitations of the Program.......................................................................................6
Conclusion and Recommendations..................................................................................................7
References........................................................................................................................................8

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Obesity in Children and Adolescents in Australia
Introduction
Obesity is a public health matter affecting Australian children and adolescents and is important
in the discipline of public health. School canteens are the most appropriate settings for promoting
healthy eating among children and adolescents because the school occupies most of their time
every day including lunch time. The National Healthy School Canteen (NHSC) Programme is
one of the programs that is being actualized in Australian Schools. This report aims at examining
obesity in school going children and adolescents in Australia, with a particular focus on the
HNSC intervention program. Some of the specific areas covered in this report include the
incidence of obesity in children and teenagers, the rationale for the development of the program,
its description, underlying principles, parties of interest and the strengths and weakness of the
program. For the purposes of this report, school going children and adolescents are those aged 5-
17 years.
Background
Over 27% of children and adolescents aged 5-17 years were found to be obese, 7% were obese,
and 20% overweight but not obese. There were incidences of equal percentages of overweight
and obesity among school going childen (28%) (ABS, 2018). 20% of the children aged between
2 to 4 years were overweight or obese. In other words, 1 out 5 children aged 2-4 years were
obese, with an equal percentage of boys and girls (9%) in that same age bracket being obese
(ABS, 2018). The survey shows that boys were at a higher risk (29%) of becoming overweight
and not obese at the age of 16-17 years, whereas girls aged 8-11 years were less likely to become
overweight. The high incidence of obesity was reported at 8% among youths aged 16-17 years
for boys and 12% for girls aged 5-7 years.
Obesity is affected by an elaborate association between individual, ecological, and social factors.
The determinants of obesity in school going children include food and nutrition, physical
exercise, and obesogenic environment. 10% of Australia’s total burden of disease was caused by
nutritional risk factors, with a diet low in fruits and vegetables being reported ate 2.0% and 1.4%
of the overall disease burden (AIHW, 2016, 2017). High consumption of energy obtained from
beverages and drinks lead to excessive energy intake and increase in body mass. These foods

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consist of high fat in addition to sugar (NHMRC, 2013). on the other hand, the consumption of
fruits and vegetables are associated with weight control and minimal risk of obesity. Multiple
physical activities have been associated with positive health impacts such as a reduction in body
fat (Okely et al., 2012), whereas the lack of expending adequate body energy through physical
activity contributes to obesity and weight gain. Obesity and overweight due to constant energy
disproportion can also be affected by ecological aspects. An obesogenic environment is that
which promotes obesity.
Rationale for the Program
Studies have indicated that school going children and adolescents spend more hours at school
every day including lunchtime (Jagadesan et al., 2014). The frequency of obesity among children
in Australia continues to grow at an alarming rate with 1 out of 4 children aged 2-17 years being
obese or overweight (AIHW, 2018). Moreover, school cafeterias have also been reported to be
selling junk foods such as candy bars and snacks. All these have contributed to the unhealthy
state of the school going children and adolescents, thus calling for the need for an intervention
that will address the diet of the children while at school. The NHSC project provides resources,
guidelines, and training to assist canteen managers in Australian schools to provide healthier
food and beverages in their canteens (The Department of Health, 2013a).
Description of program
The National Healthy School Canteens (NHSC) guidelines and resources offer countrywide
direction and training to aid canteen managers in Australia to provide nutritional diet for school
canteens to promote and encourage a healthy eating pattern. Foods and drinks have been grouped
based on the number of nutrients supplied and according to the Australian Guide to Healthy
Eating. The three categories of foods include green, amber and red. Foods and drinks under the
category of green are high in nutrients, amber consists of foods with some worthwhile nutrients,
but are also likely to have high energy, fat or salt. The red category contains foods low in
nutrients with excess energy or saturated fat and salt.
The foods and drinks in the green and amber categories can be sold in the school canteens. The
objective of all foods and drinks available in the school canteen should closely be in the green
category as much as is practical. Each extra greening of the foods in the amber category moves

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the food much closer to the green category. However, foods in the red category should not be on
the school canteen menu. The Green Category foods should always be on the school canteen
menu, and examples include bread, rice, pasta, fruits and vegetables, plain water, lean meat, milk
among others. The supply of most of the foods and drinks from the green category will ensure
that the children and adolescents have all the necessary nutrients for good health. The foods and
drinks in this group should be presented in an attractive and appealing manner and promoted as
being tasty and worthwhile. The foods in the Amber Category should be carefully selected
against the criteria to ensure that only the healthiest choices are made, the server size is small,
and they do not override the canteen menu. The red category should never appear on the school
menu. Examples include soft drinks, energy drinks, artificially sweetened foods, deep fried foods
among others (The Department of Health, 2013b).
Values and public health principles
One of the principles underpinned in the NHSC program is the impact of the environment on
food choices and eating behaviour. Decision making on food choices can either be impulsive or
reflective, and the environmental cues are significant in influencing individual’s decisions and
behaviour especially when they make such decisions through the impulsive system (Li,
Ashkanasy, & Ahlstrom, 2014). The NHSC program promotes healthy eating by determining the
nature of foods and drinks the children and adolescents are accessible by recommending the
appropriate foods for the canteen menu. Moreover, the aspect of empowerment is clearly
demonstrated in the program whereby the children and adolescents are provided with a variety of
healthy foods in different categories for them to choose. Research on the formation of habits has
shown that when behaviours become habitual and people are not motivated to be involved in
effortful thinking and consideration, then decision making is likely to be influenced by the
impulsive system (Wood & Neal, 2016; Ottar Olsen, Alina Tudoran, Brunsø, & Verbeke, 2013).
This means that the children are likely to maintain their healthy eating habits throughout their
adulthood (Madruga, Araújo, Bertoldi, & Neutzling, 2012). Additionally, this also implies that
no amount of promotions on unhealthful food will significantly affect the healthful choices of the
children and adolescents

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Stakeholders
The NHSC program is a community intervention program that involves a range of stakeholders
namely parents, children and adolescents, teachers, school boards, canteen staff, and Municipal
Health Services. The students are the major focus of the NHSC program and their health with
regards to obesity prevention is critical in the implementation of the NHSC intervention. The
parents are also key stakeholders as well. The program is only implemented in the school
environment and therefore the choice of foods outside the school compound is at the discretion
of the parents. The program is focusing on children and adolescents and therefore the consent of
the parents must be obtained prior to its actualization. The teachers are the enforcers of the
program and are to ensure that the NHSC guideline is followed to the latter. The canteen
employees are the ones to actually implement the NHSC recommended menus. They are to
ensure that the green category foods are ever on the canteen menus with sparing portions of the
amber category and the exclusion of the red category foods. Municipal Health Services are
significant in offering guidance to school through the process of change (The Department of
Health, 2013b).
Strengths and Limitations of the Program
The NHSC program promotes healthy eating habits to the children and adolescents because the
students are allowed to choose for themselves their preferred food choices. The program only
conditions the types of foods available to them. This is significant because habits formed in early
childhood are difficult to break whether good or bad. Studies have shown that childhood obesity
is also influenced by dietary habits during childhood (Sahoo et al., 2015). Therefore, it is likely
that the children under the NHSC program will develop healthy eating habits up to their
adulthood. The approach is also cost-effective because it only emphasizes on the appropriate
selection of diet. In other words, it uses readily available foods to prevent obesity and improve
health. this implies that it can be implemented in all schools without financial barriers.
However, the project is only limited to the school environment and therefore the eating habits of
the students outside the school hours may change depending on the influence and the parent’s
involvement. If the parents are not actively involved in the choice of healthy food choices for
their children, then the influence might counteract that which is already formed at the school.
The success of the program is dependent on the warm reception of the school administration,

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failure of which it will be impossible to implement it (Mensink, Schwinghammer, & Smeets,
2012).
Conclusion and Recommendations
Obesity in children and adolescents in Australia is affected by an intricate relationship between
individual, ecological, and social factors. However, dietary factors are the most common factors
that influence obesity. Canteens stand at a vantage ground in the prevention of obesity and
promotion of healthful habits students spend most of the time at school. The NHSC program is
ideal because it addresses the nutritional aspect of children by focusing on the menu list of
canteens. The consumption of fruits and vegetables are encouraged while foods with high energy
and salt are discouraged as much as possible. The success of the program requires the
cooperation of the potential stakeholders such as parents, canteen management among others.
The program promotes healthy eating habits, it's cost effective but depends on the reception of
the school administration. There is a need for future studies on how the program can be
implemented outside school hours to influence their choice of foods outside the school hours and
to actively incorporate parents

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