In the past two decades, the prevalence of obesity in the United States has skyrocketed to epidemic proportions. Since 1980, the percentage of children and adolescents suffering from obesity has more than tripled; currently, 25% of children in the United States are overweight and 11% are obese (“Overweight and Obesity,” 2018). Of these cases, around 70% will grow up to become obese adults with an elevated risk of chronic disease (Dehghan et al, 2013). While these numbers are shocking, upon closer examination they reveal even more staggering realities about the disparity in obesity risk between high and low-income socio-economic brackets. Studies show that children from low-income communities are far more prone to obesity than those from higher-income communities (Townsend, 2006).
Less advantaged communities have disproportionately higher numbers of ethnic and racial minorities, and therefore, children from these subgroups also show greater rates of obesity—sometimes exceeding the rates of white children by 10 to 12 percentage points (Kumanyika, 2006). Though science states that excessive weight gain is caused by eating too much and moving too little, deeply-rooted structural imbalances in education, environment, and socio-economic status also play a major, and often unavoidable, role in disease development. In order to reduce the overall prevalence of childhood obesity in the United States, it is crucial for public health officials to address these imbalances and work towards developing more equitable and targeted interventions for disadvantaged populations.
While the saying goes “a chubby baby is a healthy baby,” excessive adiposity in infants and children is actually a leading cause of chronic health problems, such as high cholesterol and high blood pressure, and can lead to serious physical and psychological complications in adulthood. Type 2 Diabetes, which was once virtually absent in adolescence, has now become a major concern and is almost entirely attributable to pediatric obesity (Ebbeling, et al, 2002). Childhood obesity is defined by the Childhood Obesity Foundation as “abnormal or excessive fat accumulation that may impair health,” and is determined by measuring Body Mass Index, or BMI, for age percentiles. If a child’s BMI-for-age percentile is greater than 95%, he or she is considered “obese” (“What is Childhood Obesity,” 2015). Common risk factors for obesity include poor nutrition, inadequate exercise, and genetic predisposition, but these factors can be greatly influenced by a child’s environment. Both physical and social environments are hugely important in shaping children’s habits and perceptions, and studies have shown that disadvantaged and minority children are far more impacted by their environment than are their advantaged white peers (Kumanyika, 2006). Not only is childhood obesity a major problem in this country, but it is also a multifactorial one, and therefore we must consider the myriad factors that play a role in behavior change when designing interventions.
Social Cognitive Theory – Description and Assumptions
When working with patients suffering from Ophidiophobia in the 1960s, psychologist Albert Bandura discovered the importance and effectiveness of behavioral models; and thus, the Social Learning Theory was born. In 1986, Bandura further developed this theoretical framework into the Social Cognitive Theory (SCT), a “multifaceted causal structure” in which behavioral change is believed to be made possible by a “personal sense of control” (Bandura, 1999). SCT posits that learning takes place in a “social context with a dynamic and reciprocal interaction of the person, environment, and behavior” (LaMonte, 2018). According to the theory, the factors that dictate behavior change can be broken down into three main categories: individual factors, environmental factors, and reciprocal determination (Edberg, 2007). Individual, or “internal,” factors include; self-efficacy, the belief in one’s ability to achieve a certain goal or outcome; behavioral capability, one’s level of knowledge and skill with relation to a new behavior; expectations and expectancies about the “costs and benefits” for different behaviors; self-control when it comes to actually making the change; and the emotional coping ability to handle the emotions that come with behavior change (Edberg, 2007).
Environmental, or “external,” factors refer to an individual’s physical and social environment, the behavior of the people surrounding the individual (modeling) and the vicarious learning that follows as a result (observational learning); the situation in which the behavior occurs; the way an individual perceives said situation; and the positive and negative reinforcements doled out in response to the behavior (Edberg, 2007). Finally, reciprocal determinism, the central construct of SCT, describes the dynamic interaction between an individual’s personal factors, their environment, and their behavior (LaMonte, 2018). By evaluating this relationship, SCT provides a theoretical framework for designing and implementing programs that prove extremely useful in the field of public health.
Social Cognitive Theory— Practical Implications
We can see a practical application of Social Cognitive Theory in a 2016 study entitled “Development and Feasibility of a Childhood Obesity Prevention Program for Rural Families: Application of the Social Cognitive Theory.” In the study, researchers examined the development and feasibility of Home Sweet Home (HSH), a home environment focused obesity prevention program designed specifically for the parents and grandparents of preschool aged children in low-income, rural communities. HSH, which incorporates Mindful Eating (ME) practices, was developed using community-based participatory research as well as constructs of SCT (Knol, et al, 2017). Employing ME as an intervention tool was a strategic and targeted decision as it offers an alternative approach to reducing caloric intake and eliminates some socio-economic and environmental barriers that can prevent weight loss (Birch, 2001).
Preschool aged children spend the majority of their day at home, and therefore it is important to understand how certain aspects of the home environment may influence their behavior and consequent obesity risk. Research has shown that parental behaviors and the home environment can directly affect a child’s weight and health habits (Knol, et al, 2017). Through constructs of SCT, we can observe how the behaviors of the preschoolers in this study shifted for the better as a result of a mutual positive shift in the behavior of their parents and grandparents. Researchers worked to improve families’ behavioral capability by offering educational sessions on the practices of Mindful Eating, and parents and grandparents were encouraged to model ME behaviors, such as slowing the pace of eating and listening to proper eating cues, so that their children could learn these behaviors through observation. Family members were also instructed to offer children rewards for performing health promoting behaviors, thus reinforcing the belief that such behaviors would elicit a positive outcome. By gradually implementing these shifts in eating habits, children were able to build their skills over time, and ultimately strengthen their self-efficacy. NEEDS WORK
Health Belief Model—Description and Assumptions
Since its inception in the 1950s, the Health Belief Model (HBM) has remained one of the most widely used conceptual frameworks for understanding health related-behaviors. The model helps to explain the ways in which health behaviors change and are maintained and serves as a “guiding framework for health behavior interventions” (Champion, 1984). HBM was originally developed as a tool to explain the widespread failure of people to participate in a free tuberculosis screening offered by the U.S. Public Health Service (Edberg, 2007). In conducting this research, social psychologist Godfrey Hochbaum discovered that the root cause of the low turnout was motivation, or lack thereof. Hochbaum began to investigate what motivates people to take action to screen for, control, or prevent disease and ultimately concluded that these health behaviors are motivated by four factors: 1) perceived susceptibility, a person’s perception of their own risk for a health problem, 2) perceived severity, a person’s perception of the degree of that risk, 3) perceived benefits, the positive benefits a person believes they will see as a result of action, 4) and perceived barriers, the negative effects a person believes they will see as a result of action. In later years, two more components were added; the idea of cues to action, the external events that motivate people’s actions; and self-efficacy, which we have already discussed (Edberg, 2007). The Health Belief Model is a valuable tool in public health practice as it helps us to recognize what motivates people into health positive action and how we can translate this information into more effective programs from health promotion and disease prevention.
Health Belief Model- Practical Implications
In early adolescence, children begin to gain more autonomy over their food choices, and therefore, this is a prime time to implement health behavior change. With the help of the Health Belief Model, I would like to design an obesity prevention program specifically targeted to Westlake Middle, a middle school in Oakland, which is heavily populated by low-income and minority students. The intervention would aim to reduce students’ sugary drink consumption, as it is a major contributor to the rise in obesity. In order to convey the perceived risk and severity of risk, I may opt to hand out informative cartoon pamphlets or hold interactive assemblies that would layout the consequences of excessive sugary drink intake. In terms of perceived benefits, I would love to contract a well-known athlete to record a promotional video that emphasizes the importance of good nutrition and the integral role it plays in success. It is likely that students will refuse to abandon their beloved artificially sweetened beverages, so in order to address perceived barriers, I would ask that the athlete suggests other “treat” options he or she enjoys that are palatable less packed with sugar. Finally, I would urge the school to offer healthier drink alternatives in vending machines as a cue to action and ask teachers to demonstrate healthy drinking behaviors so as to improve students’ self-efficacy potential. LOLZ this paragraph is tragic
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