The presentation explains the proposal study of obesity prevention among preschool children.

1. OBESITY PREVENTION
AMONG
PRESCHOOL CHILDREN

2. Group Members
Dr Halila
Dr Rayjiv
Dr Munish
Dr Nur Syakirah

3. INTRODUCTION

4.  Obesity prevention in children offers a unique window of
opportunity to establish healthful eating and physical
activity behaviours to maintain a healthful body weight and
avoid the adverse proximal and distal long-term health
consequences of obesity
 Given that obesity is the result of a complex interaction
between biological, behavioural, family-based, and
community environmental factors, intervention at multiple
levels and across multiple settings is critical for both short-
and long-term effectiveness
INTRODUCTION

5. INTRODUCTION
 Based on the periodic National Health and Morbidity Survey
(NHMS), Malaysia still faces the double burden of
malnutrition, with rising rates of childhood obesity as well as
stunting among children
 Malaysian children today are growing up in an obesogenic
environment that leads to sedentary lifestyle and unhealthy
eating habits
 Energy imbalance has resulted from this lifestyle, with more
time being spent on screen-based activities
 Undernutrition among children such as stunting, will lead to
obesity and NCDs in later life

6. Nutritional Status of Children Below 5
Years Old
Source: National Plan of Action for Nutrition of Malaysia III,
2016-2025

7. Prevalence Based on NHMS 2015
(Obesity)
 National prevalence of obesity
among children : 11.9%
 Highest prevalence by age, was
noted among children ages 5-9
years (14.8%) followed by children
aged 10-14 years (14.4%)

8. Source: Nutrition Landscape Information System (NLiS), WHO

9. Percentage of wasting, stunting, underweight, and overweight for
children aged below 5 for Malaysia and the Southeast Asian region
(%)
Source: UNICEF (Urban Child Poverty Report, 2017)

10. JUSTIFICATIONS
 Intervention programmes related to obesity available mostly targeting
on school children and adults
 No programme focussing for preschool children
 The approach in this programme is helping parents of young children
identify factors leading to child overweight and obesity e.g. unhealthy
eating habits, poor nutrition and inactivity
 Hence the focus will be on developing tools and intervention package
empower young parents and preschool teachers for early detection of
obesity among preschool children

11. Justification
 Being an overweight child under 3 years of age, does not
predict future obesity unless at least one parent is also obese
 After the age of 3 years, the likelihood that obesity will
persist into adulthood increases with advancing age of the
child and is higher in children with severe obesity in all age
groups
 After an obese child reaches 6 years of age, the probability
that obesity will persist into adulthood exceeds 50%, and
70%–80% of obese adolescents will remain so as adults
(Segal & Sanchez, 2001).

12. OBJECTIVES

13. OBJECTIVES
 GENERAL
 Develop an assessment tool for
early detection of obesity among
preschool children to be use by
parents and preschool teachers
in registered Nurseries .
 SPECIFIC
 Develop a booklet for teachers which
includes information regarding
nutrition and physical activities
 Assess knowledge regarding obesity
and dietary habits among parents
and teachers by pre and post test
 Reduction of obesity prevalence
among preschool children

14. INDICATORS
 Indicator:
 Reduction in prevalence of obesity
among preschool children by 5 %
 Knowledge assessment :
a. evaluate knowledge on nutrition,
physical activity, obesity-related risks
and healthy lifestyle practices (pre and
post test)
b. at least 80% of parents have knowledge
(pre and post test)

15. GOAL
 Reduction in prevalence of obesity
among preschool children by 5 %
within 1 year
 At least 80% of parents and
preschool teachers have knowledge
on nutrition, physical activity,
obesity-related risks and healthy
lifestyle practices .

16. METHODOLOGY

17. Definition of Obesity for this program
Using WHO Definition for children under 5 years
old:
Overweight is weight for height greater than 2
standard deviation above WHO Child Growth
Standards Median , and
Obesity is weight for height greater than 3
standard deviation above the WHO Child
Growth Standards Median

18. Methods
 Develop booklet to be distributed among teachers and
parents as guideline .
 To organize an Education Programme related to Obesity ,
nutrition and physical activity during Open/ Registration day
with parents and teacher in registered Nursery .
 Using media social (Facebook and Whatsapp) for parents and
teachers as health education channel which include
information regarding nutrition and physical activities .

19. Food Supply
Urban Design &
Transportation Systems
Media
Legislation
Framework for Childhood Obesity Prevention
Environmental
Change
Schools
Community
Based
Healthcare System
The
Child
Home
& Family
Developed by:
Gail Woodward-Lopez
U. C. Berkeley Center for Weight and
Health

20. Brief Focused Advice
Step #1: Engage the Patient/Parent
 How do you feel about your child’s weight?
Step #2: Share Information
 Your child’s current weight puts him/her at risk for diabetes, heart disease, asthma…
Step #3: Make a Key Advice Statement
I would strongly encourage you to …
 Get up and play hard at least one hour a day
 Cut back on screen time to < 2 hours a day
 Eat at least 5 helpings of fruits & vegetables every day
 Cut back on soda, sports drinks, juice and sweetened drinks
Step #4: Arrange for Follow-up
 Let’s set up a future appointment to talk about how things are going.
Effective Communications with Families,
Kaiser Permanente © 2004

21. **Gambar Growth Chart

23. Questionnaire pre and post test
For assessment of dietary habits and physical activity
 https://docs.google.com/forms/d/1hee3cKqyw1Xe-VUJP-
CrYWjBOgl3qYrNOqC1zhqA6Es/viewform?chromeless=1&edit_requ
ested=true
For Knowledge
 https://docs.google.com/forms/d/1gLjloKBThXZ-kZ-Ii7H23UT-
9cs7l460NSjbMmBgj-
0/viewform?chromeless=1&edit_requested=true

25. What does a serving size look like for a 1-2
year old on different sized plates?
Small Plate
Medium Plate
Large Plate

26. What does a serving size look like for a 3-5
year old on different sized plates?
Medium Plate
Large Plate

27. Drink Well:
Limit
Sweetened
Beverages
Tips:
Decide what drinks are available in your
home
Offer water or non/low-fat milk instead of
juice or soda
Mix 100% fruit juice
with water and limit to:
4-6 oz. for 1-6 years
8-12 oz. for 7-18 years

29. Tips For Families

30. ABCD Weight Management Program
 The ABCD Weight Management Program was successfully
implemented in two paediatric primary care sites in USA and is
an example of translating evidence into clinical practice
 A- activity goals
 B- behaviour modification
 C- close contact and monitoring
 D- dietary modification

31. AMA Recommended Behaviors for
Obesity Prevention and Treatment
 Breastfeed
 Increase physical activity
 Limit TV and screen time
 Eat more fruits & vegetables
 Eat breakfast daily
 Eat out less often, particularly fast food
 Limit portion sizes
 Limit sugar-sweetened beverages

32. Get Moving:
Aim for at Least 60 Minutes of Physical
Activity a Day
Tips:
 Schedule outdoor time: plan family walks, outings to the park, or
bike rides
 Be active indoors: dance, vacuum, make beds, play balloon
volleyball
 Sign up for activities through the YMCA, Parks and Rec Dept,
schools and community centers
(reference – resource guide)

33. Pull the Plug:
Limit Screen Time to < 2 hrs/day
Tips:
 Remove TV and computers from
children’s bedrooms
 No TV for children under 2 years
 Turn off TV during mealtimes

34. Tips:
 Offer fruits for snacks instead of chips, cookies, and candy
 Choose frozen or canned vegetables if fresh are not
available
 Cut up fruits and vegetables so that they are ready to eat
Eat Smart:
Eat More Fruits & Vegetables

35. Eat Smart:
Eat Breakfast Daily
Tips:
 Stock kitchen with easy to grab breakfast items (fruits,
mini bagels, cheese sticks, yogurt)
 Check if the school has a breakfast program
 Eat breakfast with your child

36. Eat Smart:
Eat Less Fast Food
Tips:
 Order the smallest size food/beverage
 Prepare homemade meals in advance to avoid
the temptation of fast food
 Avoid “extras” like cheese, bacon, and mayo

37. Eat Smart:
Limit Portion Size
Tips:
 Serve food on smaller plates
(Note that a child’s stomach is the size of his/her
fist)
 Keep serving dishes off the table
 Split an entrée or take half home when eating out

38. Impact of Increasing Portion
Sizes in Children
•Doubling an age - appropriate portion of
entrée   25% entrée &  15% total energy
intakes
•Children consumed 25% less of an entrée
when allowed to serve themselves vs. being
served a large portion
• (Stomach  size of child’s fist)
Fisher et al, AJCN, 2003
**P<.01

39. REDUCE Programme
 Parents play an important role in preventing childhood obesity as they can
influence their children’s intake and energy expenditure.
 One of the approaches to prevent childhood obesity is to target parents as they are
capable of creating an environment to foster children’s healthy eating and physical
activity .
 REDUCE (REorganise Diet, Unnecessary sCreen time and Exercise) programme :
a. assess family-based intervention using social media related to childhood obesity in
Malaysia.
b. tests the effectiveness of social media in the management of childhood obesity.
c. funded by University Putra Malaysia, project’s code GP-IPS/2013/9398400

40. Components of REDUCE (REorganise Diet, Unnecessary
sCreen time and Exercise) programme
 WEEK 1 - Unit 1: Introduction
- Unit 2 : Sugar sweetened beverages (SSB)
 WEEK 2 - Unit 3 :Fruits and vegetables (FV)
- Unit 4 :Unhealthy snacks/junk food
 WEEK 3 - Unit 5 : Physical activity
- Unit 6 : Screen time
 WEEK 4 - Unit 7 :Risky situations and review of performance
- Unit 8 : Further role and action

41. Summary of training and booster
sessions of REDUCE programe
Week Phase Session Unit
1 Training Face-to- face training Unit 1 and 2
2 Facebook Unit 3 and 4
3 Facebook Unit 5 and 6
4 Face-to- face training Unit 7 and 8
5-16 Booster WhatsApp All units

42. Childhood obesityPark Nicollet.pdf
Paediatric Obesity Tool Kit
Comprehensive questionnaire on food and
physical activity questionnaire
FOOD
1.What are your 5 favourite food?
2. How many fruits and
vegetables do you eat a day?
(check 1 answer)
o None
o 1-2 a day
o 3-4 a day
o 5-6 a day
7. If yes, what kind of
of milk?
o Fat-free
o Low fat
o 2% milk
o Whole milk
8. Do you skip meals?
o Yes/No
3. Do you have a favourite fruit or
vegetable you eat more than 3-4
times a week?
o Yes /No
4. If yes, what fruit and
vegetable?
5. List all fruits and vegetables
you enjoy eating
6. Do you drink milk?
o Yes/No
10. How often do you
drink soda or juice?
o None
o 1 time a month or
less
o 1 time a week
o 2-3 times a week
o 4-6 times a week
o everyday

43. The recommendations in the Live 5-2-1-0 message are evidence-based, originating
from the Childhood Obesity: Assessment, Prevention and Treatment Expert Committee,*
and endorsed by the Canadian Paediatric Society.
The message is widely used, with many successful children’s health programs across
North America using the 5-2-1-0 guideline

44. WORKING
TEAM

45. OPERATIONAL DEVELOPMENT
1- Human Resources Planning
The health team provider for this program are:
 Pediatricians
 Family Medicine Specialists
 Medical Officers
 Nutritionist/ Dietitians
 Counselor
 Nurses
 Health Educator
 Klinik Kesihatan

46. OPERATIONAL DEVELOPMENT
2- Training to the Obesity Prevention Among Preschool Children
 The team must be trained using the Obesity Prevention Among
Preschool Children module with the toolkit provided. The team are
required to give talks on the given topics and conduct activities that
have been listed in the module. TARGET group to be trained are
preschool teachers who will be assessing the preschool children from
time to time .
3- Target Population
 All children aged 2-6 years old attending registered preschool
education in Malaysia

47. OPERATIONAL DEVELOPMENT
4- Equipment
 Below is the listed equipment that needed during Obesity Prevention Among
Preschool Children program.
 Health Promotion
 Child Health Record Book
 Factsheet
 Physical Examination
 Weighing scale
 Height scale
 Growth chart
 Social Media (Facebook/Whatsapp)

48. ORGANIZATIONAL COMMITTEES
Steering Committee
 The steering committee formed at the organization to conduct the Obesity
Prevention Among Preschool Children Program.
 President/ Chairperson
 Committee members
 The committee members are chosen according to their capabilities in
handling the type of listed activities at the various level:
Health education and consultations
Health promotion
Health screening

49. STEERING
COMMITTEE
National (MOH)
Steering Committee
National Level
Program Committee
State Steering
Committee
State Level Program
Committee
District Level
Committee

50. National Level Organization Committee
ADVISOR
TECHNICAL
COMMITTEE
ORGANIZATION DOCUMENTATION TRAINING IMPLEMENTATION EVALUATION

51. State Level Organization Committee
ADVISOR
State Health
Director
CHAIRPERSON
Senior Principal
Assistant
Director
Maternal and
Child Health
DEPUTY
CHAIRPERSON
Senior Assistant
Director
Maternal and
Child Health
SECRETARY
Senior
Assistant
Medical Officer
COMMITTEE
MEMBERS
District Health
Officer
Promotion
Health Unit
Nutritional
Unit/ Dietitian
Nurses
Preschool
teachers
Parents

52. District Level
Committee
CHAIRPERSON
District
Health Officer
TECHNICAL
COMMITTEE
CHAIRPERSON
District MCH
Officer
SECRETARY Matron
COMMITTEE
MEMBERS
Family Medicine
Specialist
Medical Officer In
Charge
Matrons/Sisters

53. GANNT CHART AND
BUDGETTING

54. ACTIVITY
YEAR 2019
1 2 3 4 5 6 7 8 9 10 11 12
Workshop to develop counselling kit
Harmonization session of counselling kit
Training for health staffs and teachers for pilot project of
counselling kit and initiation of the
Pilot project
Meeting on findings from the pilot project
1st National Training on counselling kit for the health care
staffs and teachers
2nd National Training on counselling kit for the health care
staffs and teachers
Baseline Data Collection and Pre-test
Data Collection (BMI Charting) and Impact Evaluation
Post-test and Outcome Evaluation
Complete Evaluation and Conclusion

55. GANTT
CHART**

59. EVALUATION

60. EVALUATIONS
Process Evaluation Impact Evaluation Outcome Evaluation
1. Evaluate the activities of
programme being carried
out
2. Assess the participation or
involvement of target
population In terms of
early detection of
childhood obesity and
their commitment in the
programmes
1. Measure BMI after 3
month
2. Assessment of knowledge
of parents and preschool
teacher (pre test)
3. Establishment of healthy
eating habits and
involvement with regular
physical/ outdoors
activities (feedbacks
through Facebook and
Whatsapp)
4. Rate of referral to Health
facilty
1. Measure BMI 6 monthly
2. Reduction in prevalence of
childhood obesity
3. Awareness among
community regarding the
adverse health
consequences of obesity
4. Assessment of knowledge
of parents and preschool
teacher (post test)

61. THINGS TO THINK ABOUT
 Childhood obesity cases in Malaysia’s
health clinics
 Education for health staff in detecting
obesity
Knowledge of pre-school teachers and
parents in detecting obesity

62. PLAN OF ACTION
ITEM AGENCY INVOLVE OBJECTIVE SUGGESTION DATE
Setting up community
meeting
MOH
MOE
JKM
Setting up Community January
Follow up meeting MOH MOE JKM Discussion of activities January
Inter-agencies meeting MOH
MOE
JKM
Discussion regarding on
going activities , materials
and delegation of task
February
Planning courses MOH Planning ,discussion and
preparation
February
Information Gathering ALL AGENCIES Planning ,discussion and
preparation
End February /March
Implementation MOH, MOE Execution of plan March
Evaluation MOH Data analysis and feedback December