Obesity in Washington DC

Health Promotion Proposal, Part 1 (Obesity in Washington DC)
Propose a health promotion program using an evidence-based intervention found in your
literature search to address the problem in the selected population/setting. Include a thorough
discussion of the specifics of this intervention which include resources necessary, those involved,
and feasibility for a nurse in an advanced role. Be certain to include a timeline
 Thoroughly describe the intended outcomes. Describe the outcomes in detail concurrent
with the SMART goal approach
 Provide a detailed plan for evaluation for each outcome
 Thoroughly describe possible barriers/challenges to implementing the proposed project as
well as strategies to address these barriers/challenges.

Obesity in Washington DC
Introduction

The health problem is obesity in Washington, District of Columbia. In the United States,
obesity and overweight are today so prevalent considering that 66 percent of Americans are
either obese or overweight. In Washington DC, the number of those who are obese exceeds those
who are overweight. Obesity remains one of the main public health problems, and is even
regarded as a long-standing epidemic by health officials. In 2012, the prevalence of obesity in
District of Columbia was 21.9 percent(Trust for America’s Health & Robert Wood Johnson
Foundation, 2014). In essence, Washington, D. C. is presently the 2 nd least obese

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
statecountrywide. The purpose of this proposal is to address existing nursing knowledge related
to health promotion of childhood obesity in Washington, D.C. A health promotion program is
developed in this proposal to meet the need of obese children in Washington, D.C.
Vulnerable population and setting: the vulnerable population is children and the setting is
schools and at homes. Currently, as regards childhood obesity in Washington, DC, and the
current obesity rate is 21.4% and it ranks 3 rd out of 51 states in the U.S. This rate is for 10 to 17
year old children (Trust for America’s Health & Robert Wood Johnson Foundation, 2014). In my
proposed health promotion program, what I will specifically address is diet and lifestyle. I will
seek to alter the diet of the 10-17 year olds and promote lifestyle changes by recommending
healthier lifestyles such as exercising and doing physical activity.The proposed outcome is to
reduce the rate of childhood obesity in Washington, D.C. to 12.5% or less within the next 12
months from the current 21.4%.

Risk factors for childhood obesity
The risk factors for childhood obesity include the following: (i) diet: consuming foods
with high-calories like vending machine snacks and baked foods, is a key risk factor in addition
to desserts, candy and soft drinks that have sugar (Pratt et al., 2013). (ii) Lack of physical
exercise: in essence, a child who does not exercise has a higher chance of gaining weight since
he/she does not burn calories by doing physical exercise. Playing video games and watching TV
are some of the inactive leisure activities which contribute to this health problem (Voigt,
Nicholls& Williams, 2014). (iii) Family history: a child is at a great risk of being obese if she/he
comes from a family of overweight children. The child might also have a higher likelihood of

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
becoming overweight particularly within an environment in which foods of high calorie are
available all the time and doing physical activity is not encouraged. (iv) Psychological factors: it
is notable that some children eat too much in order to deal with problems or cope with emotions
for instance stress, or just to deal with boredom (Schaub, 2014). (v) Socio-economic factors:Pratt
et al. (2013) stated that foodstuffs that will not spoil very fast, for instance cookies, crackers and
frozen meals usually have a lot of fats and salts. These types of foods are typically less costly
relative to healthier foods. They are also an easier option compared to healthier foods.
Literature Review – evidence-based interventions
Interventions for childhood obesity include the following: (i) weight-loss surgery: this
procedure could be an effective and safe option for very obese children who have not been able
to reduce their weight with the use of conventional methods of weight-loss. Nonetheless, just as
with any sort of surgery, there are possible long-lasting complications as well as risks associated
with weight-loss surgery (Schaub, 2014). This procedure is essential especially if the weight of
the child poses a greater threat to his/her health compared to the possible risks of surgery. (ii)
Healthy eating:parents are the people who purchase food, cook it and decide the place wherein
the food would be eaten. Even small changes in diet could make a significant difference in the
health of the child. Pratt et al. (2013) pointed out that vegetables and fruits should be chosen
when purchasing groceries, sweetened beverages should be reduced, the number of times a child
eats should be limited, the number of times the family eats out particularly at fast-food eateries
should be limited, and appropriate portions of food should be served.
(iii) Doing physical activity: physical activity is an essential part of weight for children.
This is primarily because it burns calories, builds strong muscles and bones, and assists the child

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
to sleep well during the night. In essence, these kinds of habits established when the child is still
young will help them to maintain healthy weight regardless of the social influences, hormonal
alters, as well as rapid growth that usually result in overeating (Davison et al., 2013). (iv)
Medications: the prescription medicine for weight loss available in the United States presently is
orlistat/xenical. This drug is approved for children who are older than twelve years, and it serves
to prevent fat absorption in the intestines. In case the child has a high level of cholesterol, it is
recommended to provide him/her with a statin medication (Sung-chanet al., 2013).
Review of the strengths and weaknesses of the sources used
See Appendix 1
Implementation Plan
The proposed project would be carried out over a period of three months starting August
15, 2014 and ending October 25, 2014. The implementation will entail the following: (i)
communicating with partners in my state to support the provision of much healthier and high-
quality foods in schools; (ii) initiate promotional and marketing programs to encourage parents
to get their children physically active. (iii) Recommending to policy makers to reduce advertising
and marketing to children; and (iv) Providing resource opportunities and education for primary
care providers and other healthcare practitioners to promote prevention of childhood obesity. The
specific implementation plan table is included in Appendix 2.
Health promotion/disease prevention conceptual or theoretical model
The health promotion/disease prevention theoretical model applied is the Relapse
Prevention theoretical model. As per this theoretical model, people who are starting regular

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
physical activity as well as exercise programs may be helped by interventions which assist them
to expect factors or barriers that could contribute to relapse. The key concepts of this theoretical
model include lifestyle rebalancing, cognitive reframing, and skills training (Davison et al.,
2013). Relapse Prevention theoretical model is applied in the implementation and evaluation of
this proposal in that through training programs that would be offered to parents in Washington,
D. C, parents would obtain the skills necessary to promote health and prevent obesity in their
children and change their lifestyle. For instance, they will know which physical activities their
children can do or which foods and beverages to avoid in order to stay healthy.

PART 2

In this second part of the proposal, a health promotion program is proposed using an
evidence-based intervention found in the literature search to address the problem in the selected
population/setting – childhood obesity in schools and at homes. An in-depth discussion of the
specifics of the this intervention is provided which comprise resources necessary, those involved,
as well as the feasibility for a nurse in an advanced role. The intended outcomes are described
comprehensively concurrent with the SMART goal approach along with a detailed plan for
evaluation of each outcome. Lastly, the potential challenges/barriers to implementing the

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
proposed project in addition to strategies to address these barriers/challenges are thoroughly
described.
1.0 Health promotion program: lifestyle changes
The health promotion program for addressing the obesity in children is lifestyle changes, which
basically includes encouraging (i) health eating; and (ii) doing physical activity and exercises in
children.
1.1 Resources necessary
The key resources include: (i) personnel, 6 people would be hired to help me implement
this project; (ii) materials such as computers to prepare PowerPoint presentations to be used
during training programs; (iii) time, this project will take 12 months to complete; and (v) money.
This project proposal is estimated to cost $120,627 over the course of its implementation. This
figure is broken down as shown in Appendix 3.

1.2 People involved
To effectively address the problem of childhood obesity requires a multi-sectoral,
sustained response that involves the general public, non-governmental and health professional
sectors. It also includes visible leadership from ministers in Washington D.C. working together
(Gollust, Niederdeppe& Barry, 2013). Nonetheless, the key people who would be involved
include parents and caregivers in Washington, DC especially those with obese children. They
will be involved by taking part in symposiums that my 6 colleagues and I will hold to educate
them on appropriate diet and physical activity to prevent childhood obesity. In essence,

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
caregivers and parents would be provided with nutrition education which will help develop and
awareness of health eating habits and nutrition.
It is of note that caregivers and parents could help in preventing obesity in children
simply by providing healthy snacks and meals, as well as daily physical activity (Rudolf, 2013).
They will be encouraged to reduce sedentary activities of children by limiting amount of time
that children play video games and watch TV. School heads in Washington D.C would be
encouraged to increase the amount of time children engage in active play and to provide
healthier foods.This strategy is essential considering that children spend a significant amount of
their time in schools.
1.3 Feasibility for a nurse in an advanced role
An advanced practice nurse would be required in order to provide preventative care,
treatment, as well as management of obesity in children with the use of advanced diagnostic
reasoning, clinical skills, and advanced therapeutic interventions. It is of note that an Advanced
Practice Nurse assesses and documents progress of the patient towards achievement of
anticipated outcomes and offers consultation to other healthcare providers in order to optimize
the plan of care and effect system of change (Pearson, 2011). The Advanced Practice Nurse will
be a Nurse Practitioner who will address the weight of the patient and encourage them to lose
weight.
1.4 Timeline
This program would be implemented over a period of 12 months. See the table showing timeline
in Appendix 4.

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
2.0 Intended Outcomes
The following are the intended outcomes of the health promotion program:
Intended Outcome 1: To reduce the overall rate of childhood obesity in Washington, D.C. to
12.5% or less within the next 12 months from the current 21.4%.
Intended Outcome 2: to increase the accessibility of nutritious foods and reduce the marketing,
accessibility and availability of beverages and foods which are high in sugar, fat and/or sodium
to children by February 2015.
Intended Outcome 3: To make physical and social environments in Washington, D.C. wherein
children learn, play and live more supportive of healthy eating and physical activity by April
2015.

3.0 Plan for evaluation of each outcome
Evaluating Intended Outcome 1: the first intended outcome would be evaluated by analyzing it
to determine whether or not the overall rate of childhood obesity in Washington D.C has actually
reduced to at least 12.5% by August 2015.
Evaluating Intended Outcome 2: analyzing to determine the extent with which beverages and
foods high in sugar, fat and/or sodium are accessed, available to, and marketed to children in
Washington, D.C by February 2015.

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
Evaluating Intended Outcome 3: ensuring that there are more physical and social environments
in Washington, D.C in which children live, play and learn that are more supportive of healthy
eating as well as physical activity by April 2015.
4.0 Barriers to implementing the proposed project and strategies to address them
Resistance and lack of cooperation from some parents and schools: this project will entail
suggesting to schools, as well as parents and caregivers to provide healthier, nutritious meals and
physical activity to children. School heads and parents may resist this project citing high costs of
foods which are more nutritious. Generally, more nutritious and healthier foods are more costly
compared to less healthy foods such as cookies, crackers and frozen meals which usually have a
lot of fats and salts. As such, some parents and schools may find healthier foods to be cost-
prohibitive (Phillips, 2012). To address this barrier, I will inform them of the benefits of
providing healthier foods and physical activity to children by informing that it is imperative in
fighting the epidemic of childhood obesity.
Inadequate financial resources: this proposed project is estimated to cost a total of $120,627,
which is a substantial amount and I cannot raise the whole of this amount by myself. Personally,
I can only raise $2,043 leaving a huge deficit. I will overcome this challenge by seeking financial
assistance from friends, family members, government and non-governmental agencies, as well as
corporate and individual sponsors.

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)

References

Davison, K. K., Jurkowski, J. M., Li, K., Kranz, S., & Lawson, H. A. (2013). A Childhood
Obesity Intervention Developed by Families: Results from a Pilot Study. International
Journal of Behavioral Nutrition and Physical Activity; 10: 3.

Gollust, S. E., Niederdeppe, J., & Barry, C. L. (2013).Framing the Consequences of Childhood
Obesity to Increase Public Support for Obesity Prevention Policy.American Journal Of
Public Health, 103(11), e96-e102. doi:10.2105/AJPH.2013.301271

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
Pearson, K. (2011). Starter Knowledge for Childhood Obesity: Tackling Childhood Obesity as a
New Clinician. Advanced Healthcare Network.Available at http://nurse-practitioners-
and-physician-assistants.advanceweb.com/Features/Articles/Starter-Knowledge-for-
Childhood-Obesity.aspx (Accessed August 1, 2014).

Phillips, F. (2012).Facing up to childhood obesity.Practice Nurse, 42(11), 14-17.

Pratt, C. A., Boyington, J., Esposito, L., Pemberton, V. L., Bonds, D., Kelley, M., & … Stevens,
J. (2013). Childhood Obesity Prevention and Treatment Research (COPTR):
Interventions addressing multiple influences in childhood and adolescent obesity.
Contemporary Clinical Trials, 36(2), 406-413. doi:10.1016/j.cct.2013.08.010

Rudolf, M. (2013). Tackling Obesity Through the Healthy Child Programme: A Framework for
Action. Leeds Community Healthcare.

Schaub, J. P. (2014). Childhood Obesity: Solutions to a Growing Problem. Integrative Weight
Management, 123.doi:10.1007/978-1-4939-0548-5_9

Sung-Chan, P. P., Sung, Y. W., Zhao, X. X., &Brownson, R. C. (2013). Family-based models for
childhood-obesity intervention: a systematic review of randomized controlled trials.
Obesity Reviews, 14(4), 265-278. doi:10.1111/obr.12000

Trust for America’s Health & Robert Wood Johnson Foundation. (2014). The State of Obesity:
Washington, DC.Available at http://www.fasinfat.org/states/dc/ (Accessed July 20,
2014).

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
Voigt, K., Nicholls, S. G., & Williams, G. (2014).Childhood Obesity Interventions, Equity, and
Social Justice.Oxford University Press.
doi:10.1093/acprof:oso/9780199964482.003.0005

Appendix 1: Review of the strengths and weaknesses of the sources used

Source Strength Weakness
1 Davison, K. K., Jurkowski, J. M., Li, K., Kranz,
S., & Lawson, H. A. (2013). A Childhood
Obesity Intervention Developed by Families:
Results from a Pilot Study. International Journal
of Behavioral Nutrition and Physical Activity;

Source is up-to-
date and relevant

Does not describe
the causes or risk
factors

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
10: 3.
2 Pratt, C. A., Boyington, J., Esposito, L.,
Pemberton, V. L., Bonds, D., Kelley, M., &
Stevens, J. (2013). Childhood Obesity
Prevention and Treatment Research (COPTR):
Interventions addressing multiple influences in
childhood and adolescent obesity. Contemporary
Clinical Trials, 36(2), 406-413.
doi:10.1016/j.cct.2013.08.010

Source is up-to-
date.
Properly
describes the
interventions for
childhood obesity
It is research-
based

Does not describe
pharmacological
interventions

3 Schaub, J. P. (2014). Childhood Obesity:
Solutions to a Growing Problem. Integrative
Weight Management, 123. doi:10.1007/978-1-
4939-0548-5_9

Source is up-to-
date and provides
a clear description
of the health
problem along
with apt
interventions

Does not specify
what policy makers
can do to prevent
the health problem

4 Sung-Chan, P. P., Sung, Y. W., Zhao, X. X.,
&Brownson, R. C. (2013). Family-based models
for childhood-obesity intervention: a systematic
review of randomized controlled trials. Obesity
Reviews, 14(4), 265-278. doi:10.1111/obr.12000

Source is up-to-
date
Is research-based

Does not describe
what schools can do
to provide healthier
meals for children

5 Voigt, K., Nicholls, S. G., & Williams, G.
(2014). Childhood Obesity Interventions, Equity,
and Social Justice. Oxford University Press.
doi:10.1093/acprofoso/9780199964482.003.000
5

Source is up-to-
date
Clearly describes
the interventions
for childhood
obesity

Does not clearly
describe the causes
or risk factors

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
Appendix 2: The implementation plan is as follows:
Communication idea Timeline
1 Communicate with partners in Washington, DC about
increasing meal reimbursement in order to support the
provision of high-quality and much healthier foods in
Washington DC schools

August 15, 2014 to August 22,
2014

2 Begin and expand promotional and marketing
programs to encourage parents in Washington DC to
get their children physically active.

August 23, 2014 – August 30,
2014

3 Encourage the increase of healthy and fresh foods in
Washington, DC by supporting farmers markets in
Washington DC through advising relevant authorities
to create a farmer’s management network.

September 3, 2014 –
September 10, 2014

4 Create a statewide childhood obesity prevention
social marketing campaign that will provide families
in Washington DC tools and information for
preventing childhood obesity.

September 11, 2014 –
September 16, 2014

5 Launch a healthy living challenge to the children of
Washington DC that would incorporate obesity
prevention social marketing campaign.

September 18, 2014 –
September 28, 2014

6 Recommend to policy makers in Washington DC to
improve physical activity as well as nutrition policies
within child care settings in Washington, DC.

October 2, 2014 – October 7,
2014

7 Provide resource opportunities and education for
primary care providers and other healthcare
practitioners to promote prevention of childhood

October 10, 2014 – October
17, 2014

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
obesity.
8 Promote healthier environments in pre-school and
school settings

October 18, 2014 – October
23, 2014

9 Recommend policy makers to reduce advertising and
marketing to children

October 24, 2014 – October
25, 2014

Appendix 3: budget for this project showing the financial resources required

Budget Item Cost ($)
1 Recruiting 6 personnel who will help in the implementation each costing $
2,105 per month for 12 months

$75,780.00

2 Hiring conference room to train parents on ways to prevent obesity in their
children costing $877 per month for 12 months

$10,524.00

3 Materials such as flyers, brochures, magazines and handouts which contain $905.00

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
text that encourage parents in Washington DC to ensure physical activity
and healthy eating for their children
4 Running campaigns and promotional activities on radio and television in
Washington, DC that encourage parents to ensure physical activity and
healthy eating for their children

$33,418.00

5 Total cost of project $120,627.00

Appendix 4: Timeline

Communication idea Timeline
1 Communicate with partners in Washington, DC about
increasing meal reimbursement in order to support the
provision of high-quality and much healthier foods in
Washington DC schools

August 15, 2014 to October
22, 2014

2 Begin and expand promotional and marketing programs
to encourage parents in Washington DC to get their
children physically active.

October 23, 2014 – December
30, 2014

3 Encourage the increase of healthy and fresh foods in
Washington, DC by supporting farmers markets in
Washington DC through advising relevant authorities to
create a farmer’s management network.

December 3, 2014 – February
10, 2015

4 Create a statewide childhood obesity prevention social
marketing campaign that will provide families in
Washington DC tools and information for preventing
childhood obesity.

February 11, 2015 – April 16,
2015

5 Launch a healthy living challenge to the children of
Washington DC that would incorporate obesity
prevention social marketing campaign.

April 18, 2015 – May 28,
2015

6 Recommend to policy makers in Washington DC to
improve physical activity as well as nutrition policies

May 6, 2015 – June 20, 2015

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HEALTH PROMOTION PROPOSAL, PART 1 & 2 (OBESITY IN WASHINGTON DC)
within child care settings in Washington, DC.
7 Promote healthier environments in pre-school and school
settings

June 18, 2015 – July 23, 2015

8 Recommend policy makers to reduce advertising and
marketing to children

July 24, 2015 – August 25,
2015

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