Obesity is a global public health problem. Prevalence of obesity is high in India and is rising at an alarming rate. It is seen across all age groups, but childhood and adolescent obesity is rising at an alarming rate. This requires urgent attention of healthcare professionals with appropriate skills, to impart knowledge and develop trans-disciplinary educational models to influence policy making at the national and global level. Non-formal education or community based education has been an effective way to spread knowledge and may show better compliance and may be more effective for compliance. It refers to a wide range of educational initiatives in the community, ranging from home-based learning to government schemes and community initiatives. It can provide a more practical approach than that available in formal schools. To educate the overweight and obese children and their parents to make wise food and lifestyle choices and practices it is essential to use human friendly aids1,2,3.
The goals of the High Five (Hi5) educational models are to conduct novel non formal education techniques to improve nutrition and activity related behaviour, attitudes and practises of overweight and obese children. A digital based learning model High Five can be developed. The education model for obese and at risk for obesity children to reduce the burden of childhood obesity in children. Efforts are ongoing to secure funding to sustain and expand this to deliver high quality nutrition education using information and communication technologies to reduce malnutrition and promote global health.
To bridge the gap between knowledge and actions of nutrition and activity related attitudes, behaviours and practises to prevent childhood obesity in Mumbai, India.
- To assess the nutritional status of the overweight and obese children in the age group of 5 – 10 years.
- To disseminate nutrition related knowledge, attitudes and dietary practises among the obese children at risk of obesity using information and communication technology HI5.
- To educate the participants and their parents about impact of behaviour and lifestyle modification.
- To assess the effectiveness and impact of HI5 educational model and the app on the nutritional status of the participants.
Target group: Overweight and obese children in the age group of 5 – 10 years.
Implementation of Non Formal Educational Model High Five
In an urban set up for developed countries with today’s world of digitalization and we becoming digital natives, understanding the need of the hour and newer technologies, use of screen games can be followed. While in rural set up of developing countries Hence, High Five could be a good model to spread nutrition related knowledge, attitudes and dietary practises among the obese children at risk of obesity. This educational model would include 3 stages: Pre assessment, High five model and Post assessment.
Stage 1: Pre Assessment
Children would be assessed for their nutritional status using anthropometric measures- height, weight, mid upper arm circumference and 24 dietary recall, food frequency questionnaire. Those who are overweight and obese would be asked to take a short pre-test to understand their knowledge, attitudes and dietary practises after this they would be asked to participate in High Five program with parental consent, after this program again a post test would be taken to assess the effectiveness of learning to assess short term effectiveness, and could be repeated again along with nutritional status after 3 months to assess long term effectiveness.
Stage 2: High Five (Hi5)
This is a proposed information and communication technology model.
In developed countries with sufficient funds an XBOX model with motion sensors to promote knowledge gaining and physical activity experience can be created where in sufficient financial funds and technology are reported.
Game 1: Snakes and ladders
In this section healthy and unhealthy habits are listed and with every healthy habit the child climbs the ladder and risk factors like fried food, inadequate sleep, using elevators over stairs can lead to going down via a snakes mouth, whereas eating fruits, drinking enough water, playing makes the child climb the ladder. For every climb the child scores a High Five emoticon
Game 2: 7 up and 7 down
In this section For every gain in pounds/kgs of a child’s weight this game can show an impact on physical health, mental and social health such as obesity and difficulty in managing day to day activities, lower self-esteem and impact on social life. For every correct learning about maintaining healthy weight range, the child scores a High Five.
Game 3: Sunny bites
A small animated short film of 5 mins on milk, fruit and vegetable, healthy oils can be easy for kids to grasp with greater meaning, and provide an insight on importance of nutrients during growth. Quick 5 questions can be asked on screen for each correct answer the child gets High Five emoticon.
Game 4: Bounce and Run
This is a competitive game between two-three participants. For every obstacle they have to jump and bounce and last bout of run. Winner would score a High Five emoticon.
Game 5: Santa’s Choice
In this section, the child is asked to make a choice with respect to healthy foods, eating patterns, activity patterns, portion size control, nutrition label reading, daily lifestyle management. Two options are given, for example: A fruit or a packet of French fries. For right choice of nutritious fruit, the child would score a High Five emoticon.
Stage 3: Post Assessment
Post implementation of this education model again a post test would be taken to assess the effectiveness of this program and learning of the children.
High Five Apps for Parental Guidance
For access, continuity and education of this program it is essential to focus on creating awareness amongst the parents of these children to improve their child’s nutrition and lifestyle. A high five app can be used for parental guidance of these children which would include frequently asked questions, easy nutritious recipes, involving kids in making healthy meals, importance of extracurricular activities in child’s overall development and preventing inactivity associated obesity. This app would aim at promote sections on understanding the nutritional quality of common foods, importance and nutritional quality of various locally available foods, recipes from locally available low cost foods, making wise choices while picking up foods at home, at grocery store or in the market importance of including milk, eggs, lean meat or pulses in sufficient quantities in the diet to enhance the net dietary protein value, importance of kitchen gardening and family cooking and eating times.
In rural set up of developing countries where in issues arise with respect to lack of monetary resources or funding, or lower socio-economic, language barriers this High Five model can be adapted in the form of nutrition and activity related snake and ladder board games based, kitchen gardening and home based cooking model (farm to plate model), digital videos as per the acceptable language, running games on field, use of flip charts for Santa’s choice, pictorial conversation maps, short stories, field games, nutrition awareness skits, small demos about importance of nutrition and fitness lifestyle.
A follow-up can be taken after three months with repeat post-test for both participants and their parents to understand the long term effectiveness of this model on nutritional status and lifestyle of children and impact on parenting skills.
This is expected to improve the knowledge, attitude and practises, behaviour and lifestyle practises for healthy living and in turn improve nutritional status of children, thereby having an impact on nutritional status at the country level and globally by controlling rising obesity pandemic.
This High Five educational model is a nutrition education and communication model can be thought of as an integral part of a country’s development plan. Changing food, nutrition and activity behaviour of children can improve nutritional status at a country level in a long run. This High Five model needs to be comprehensive and coordinated for effectiveness with respect to nutrition and activity related knowledge, attitude and practises.
- Limited financial resources.
- Language barriers in developing countries.
- Smaller sample size.
- Long term project can be conducted.
This can be pursued as an initial step to programme planning and launching of the implementation strategy. A cooperative exchange of information and resources should be emphasised on in nutrition and communication programmes. An effective combination of knowledge and technology can impart immense awareness and bring about a change in the global health.