Causal Model analysis along

with Proposing Interventions

TOPIC:
OVERWEIGHT & OBESITY AMONGST URBAN SCHOOL GOING
CHILDREN

Splitting the Problem !

Target

Phenomena

Obesity
Overweight
Target

Target

Children (School
going)
Adolescent

Arena:

Urban area in Bangladesh

Population

Target Age range:

6-15 years

Why Why & Why?

Why children?

Because, they are the future of the nation and also an early age obesity
makes human more vulnerable to premature death and complicacy.

Why Urban people?

Because they are more prone to be obese according to study result

Why Obesity or Overweight?

This is a chronic problem with unending health problems and Bangladesh

is just started facing the problem hence this has to be made right before it
becomes cancerous as it is in USA

Prevalence of Childhood obesity &

overweight in Bangladesh
Arena

Obese

Overweigh
t

Urban & Rural

Urban
Rural

3.5
5.6
1.2

9.5
10.6
8.6

Age range 6-15 years

Reference: 1. Aronne, L.J., 2002. Classification of obesity and assessment of obesityrelated health
risks. Obesity research, 10(S12), pp.105S-115S

Percent of Population Overweight/obese

57

64

Mother

57

55

13
Dhaka

Chittagong

19

Sylhet

17

Barisal

Children

55
43

22

(WHO)

15

Khulna

10
Rajshahi

35
7
Rangpur

Causal Model of Obesity

Causal

Model.docx

Problems caused by obesity

Health risks now
(CDC)
High

blood pressure and high cholesterol, which are risk factors for
cardiovascular disease (CVD).

glucose

tolerance, insulin resistance and type 2 diabetes.

Breathing
Joint

problems, such as sleep apnea, and asthma.

problems and musculoskeletal discomfort.

Fatty

liver disease, gallstones, and gastro-esophageal reflux (i.e.,

heartburn).

Psychological

stress such as depression, behavioral problems, and

issues in school.

Problems caused by obesity

Health risks later
(CDC)

Children

who are obese are more likely to become

obese adults.
Adult obesity is associated with a number of
serious health conditions including heart disease,
diabetes, metabolic syndrome, and cancer
If children are obese, obesity and disease risk
factors in adulthood are likely to be more severe.

Reducing Weight is
not a piece of CAKE !!

Being
Obsessed with
food will
cause Obesity.

Interventions
1.Family

Based behavioral interventions

2.School and college based interventions
3.Interventions taken at the community or
national stages
4.Hospital based interventions

Criteria for selecting Interventions:

The hierarchy of the interventions proposed are constituted giving preference on their:

Time Frame: Duration from Intervention started until outcome obtained.

Feasibility: Whether the intervention could be plausible on basis of locality

and/or people involved.

Budget: The budget availability of the authority has a proportional effect. A

high cost effectiveness could be explained as the estimated costing will
produce a sustainable result hence would be such productive that the
intervention would be a success.

Sustainability: Even after intervention whether the taken initiatives last

long.

Acceptability: Whether the interventions taken are acceptable to the

receivers.

Lists of Interventions (H-High, M-Medium, LLow)

N Level
of
o. Interventi
on
a Communit
y,
Hospital,
School or
Family
b Communit
y
&
School
c National

d National

e National

National
& School

g School

h Hospital,
School

Intervention

Nutritional
Dissemination
(in
hospital & community)

Interventions
Cost
Time Sustai
addressing the causal effecti bound nabilit
factors
veness
y
Knowledge Lack of awareness, H
M
H
School, low KAP,

Accepta Feasi Total

bility
bility

4H1M

Arrangement of playgrounds and Physical inactivity due

physical exercise center
to lack of space

3H2M

Agricultural
Diversification
(Horticulture,
Homestead
gardening)
Increasing Market availability &
accessibility of fiber rich food,
reducing
processed
food
accessibility
Using Mass media for growing
awareness

Low
availability
of
fiber rich foods year
round
Low availability of low
cost fruits year round

2H3L

2H2M
1L

Increasing awareness
about consequences of
obesity
School Curriculum enrichment, Increasing awareness
Physical activity mandatory in about consequences of
schools
obesity
Increasing availability of low High
availability
of
calorie food in School
Energy
dense
food
outside
Psychological counselling
Addressing behavioral

problems,
Using

2H1M
2L

2H3M

4M1L

2M3L

Interventions Chosen:
Ran Intervention
k

Criteria
Evaluatio
n

Appropriateness

a.
Nutritional
Knowledge 4H1M
Dissemination (school, hospital &
community)

Appropriate ;
but outcome
might be low and slow.

b. Arrangement of playgrounds and

physical exercise center

3H2M

d. Increasing Market availability

& accessibility of fiber rich food

2H2M1L

It is appropriate for the school

children as they are unwilling to
do exercise, sports are preferred
by them
Needs vivid infrastructures,
Government concern, time
bound is quite long for
Bangladesh

h. Psychological counselling

2M3L

Highly appropriate for those

who failed to have the proper

1. Nutritional Knowledge Dissemination (4H1M)

Wher Who
e to
will
dissem
inate

Traine
r

Target
group

Media

Number of
Sessions

Follow up

Dur Evaluation
ati Criteria
on

Schoo Class
INFS
l
teacher, studen
PT
ts
teacher

School
children,
their
parents

Poster making,
Quiz test,
Puzzle games,
Video show,
Text Books,
Parents
meeting
speech

One in
Every
month; it
will be
continued
with new
children
promote to
class

Every six
month

5
yrs

Com
munit
y

Religiou
s
Leader,
Political
Leader

INFS
studen
ts

Parents &
caregiver
s

Speech

One in
every week

Every 1
month

Hospi
tal

Personal Alread
Physicia y

Obese &
overweig

Through charts, During

brochures &
Patients

Every 1
month

1. FFQ for
household
caregivers,
(the
questionnaire
with several
types of
processed or
high calorie
food
included)
2. Weighing
of the
children in
school

2. Arrangement of playgrounds and physical

exercise center (3H2M)
Where to

Who will
Provide

What to
provide

Target
group

Community

City
Corporatio
n, Local
Communit
y leaders

Playground School
, Roof top
going
or
Children
Basement
open space

School

School
authority

Funding By

Security

Follow
up

Evaluati
on
Criteria

People of
Locality
along with
help of city
corporation

Security of
the place
should be
maintained
by local
police force

School
authority
with the help
of Guardians

School
teachers &
Local police
force

Supervisi Weighing
on after
of school
every 3
children
months,
whether
playgroun
d is used
for other
uses

3.Increasing Market availability & accessibility of fiber rich

food, Reducing accessibility of processed foods 2H2M1L
(A long time, costly but sustainable approach, it is essential for a healthy dietary
habit)
Wh
ere
to

Who will
do

Adviser

Target
group

What will be provided

Follow
up

Evaluatio
n Criteria

Urb
an
Are
a

Governme
nt

Policy
makers,
INFS
Professor
s

Urban
people/
household
of
medium
/low income
group

1. Roads
2. proper vehicles for
transporting fresh foods
in low temperature
without injury,
3. Encouraging farmer to
cultivate fruits/
vegetables
4. giving incentives /
subsidy
5. Ensuring toxicants free
fruits
6. Reducing accessibility of
processed foods via

By
govern
ment
throug
h
market
superv
ision in
every
budget
year

FFQ for
the urban
househol
ds

To children whose condition did not improve

along with intervention
Program

Target group Time to

address

4.Psychologica 1. Children
l Counselling
still obese,
(2M3L)
2. unwilling to
do physical
exercise
3. their
Parents

During
Monitoring
&
Evaluation

Time
Period

Who will do Media

Until the
child gains
normal
condition

School
1. Face-to-face
teacher, INFS
conversations
students,
to child
Physician
2. Parents
meeting at
school

Conclusion:
The

prevalence is yet low to have a nation wide

Intervention, as this is not a public health
program yet.
By assessing institutional and region based
prevalence, intervention should be taken as
soon as possible
As prevention is a far better approach than
cure.

Thank You ! Questions

Please?
A Presentation By Group C.
M.Sc. Batch : 14th
NFS-503; Community Nutrition
Institute of Nutrition & Food Science
University of Dhaka