Abstract
UK and Cyprus are two countries in the European region where the problem of obesity is critical. Much of the information regarding the status of these two countries can be derived from scholarly papers and the efforts of such international bodies as the World Health Organisation (WHO). The problem of childhood obesity is global, which means that all countries face similar risks and challenges. Therefore, the focus of this thesis is to examine the effects and interventions, as well as the WHO agenda.
Regarding the effects, the main concern is the emotional and physical implications. The psychological aspects have been extensively studied and only a few attempts have been made on both the emotional and physical aspects. However, it is possible to explain that the external environment and socio-cultural values are the key determinants of the emotional outcomes among overweight children. The argument is that obese children are made to feel bad about their condition, which results in negative emotional responses. The major physical impacts include the abilities and performance of the body, as well as diseases and conditions that affect the physical health of the children.
The WHO agenda for childhood obesity has been expressed through the efforts of the Organisation in helping countries combat the problem. The activities of WHO are regional and global, which means focusing on individual states has been difficult. However, some countries, including the UK and Cyprus, have visibly benefited from the undertakings of WHO. Lastly, the thesis has examined the practice approaches in dealing with overweight children. A key observation has been made that the primary aim of most interventions is to modify behaviors and lifestyles involving physical activity and nutrition. The key conclusion is that the risk factors can be targeted and solutions developed to address the challenge of childhood obesity as the scholarly evidence has illustrated.
Introduction
Background
Childhood obesity is a global health risk, that each country has to address. The key to a healthy population is to make sure that the public health programs are sufficient in addressing major risks. The main challenge with childhood obesity is that its effects are long-term, meaning that they can be felt even when the children transition into adulthood. The argument is that children and adolescents can become obese adults. According to Simmonds et al. (2016), obesity in adults raises the risk of several morbidities and mortality, which include cancer type II diabetes and cardiovascular disease. Therefore, it can be perceived that obesity should be eliminated during childhood and adolescence because allowing it to persist into adulthood causes a critical health crisis for the patients.
The topic of childhood obesity has attracted significant scholarly attention because of the seriousness of the problem. A systematic review by Baidal et al. (2016) suggests that the first 1000 days of a child are the most important because that is the period when obesity and its disparities manifest themselves. Therefore, how parents raise their children for the first two to three years can significantly determine their health. The initial one thousand days since the birth of a child are associated with multiple risks that potentially increase the likelihood of an infant becoming obese. The risks include the mother’s BMI before pregnancy, high weight of infants at birth, tobacco use by mothers, high rate of weight gain and a weak mother-child relationship. The scholarly evidence presents the root causes of the problem, which leave the practitioners and policy-makers with a series of critical decisions and interventions to develop.
In many countries in the European region, including the United Kingdom (UK) and Cyprus, the issue of childhood obesity is considered a critical public health challenge. Therefore, it can be appreciated that these nations are developing multiple practices and interventions to address the dangers of this condition. However, it is more interesting to look at the literature, especially the scholarly work on the prevalence, root causes, interventions, and current preventive practices. In the UK, several studies indicate that lifestyle and the environment are the main factors affecting childhood obesity. According to Wilkie et al. (2016), the lifestyles chosen by individuals tend to significantly contribute to the high numbers of overweight children. The examples of lifestyle behaviors given include sleep, nutrition, hours spent on screens and physical inactivity.
Similarities and differences can be observed across the European region concerning obesity trends. In North Cyprus, obesity and the health problems it causes are similar to other countries along the Mediterranean (Sav & Mousa, 2018). Most importantly, similarities with the UK have been observed, where such lifestyle behavioral aspects as screen time and internet addiction have also been observed to be major contributing factors (Asut et al., 2019). Therefore, it can be argued that there are major similarities in certain aspects of childhood obesity across the world, especially concerning lifestyle behaviors and the environment. Many studies have revealed that modern society is increasingly becoming more sedentary, which means that there lack adequate physical activity to maintain physical health. Among children and adolescents, Asut et al. (2019) explain that internet addiction is associated with sedentary behaviors characterized by excessive and prolonged sitting time. By definition, internet addiction (IA) entails the uncontrolled use of the internet. IA is an illustration of how the current generation exposes itself to health risks.
While to root causes and risk factors of childhood obesity have dominated scholarly literature, it is also important to highlight that there has been an effort to develop feasible solutions. Across Europe, several programs have been established to help fight childhood obesity. Cyprus is a member of a pan-European health program motion labeled ‘Shape Up’, executed between 2007 and 2008 (Pike & Ioannou, 2017). The Zhu et al. (2017) program was intended to create awareness of the need for health promotion and to help the public make healthy decisions regarding their daily lives. The Cypriot case studies in the program highlighted that the schools can be vital aids for health promotion. In other words, Cyprus highlighted the ability of the school communities to create the necessary environment for health. Childhood obesity is a health problem that can be addressed in the country’s schools where all pupils can be subjected to such programs as physical activity.
Rationale
Childhood obesity is an interesting subject for exploration because it affects both developing and developed countries across the world. In Cyprus, the prevalence of obesity is considered to be very high, which means that there is a need to support practice with scholarly evidence regarding all preventive measures. Most importantly, the rationale for this research is that childhood obesity has been labeled a global crisis by the World Health Organisation (WHO). Across the world, this public health problem can persist into adulthood, which makes an urgent national policy matter. Therefore, it is deemed necessary that the full extent of the childhood obesity problem should be acknowledged, which should help in the development of the necessary interventions.
The use of both Cyprus and the UK as case scenarios is intended to help make appropriate comparisons between nations across the European region. In each of these states, this study will present an examination of the detriments of childhood obesity. Additionally, the practice approaches to the health problem are outlined. Additionally, an examination of the WHO agenda for childhood obesity and how each of the two countries implements it will be explored. However, it is important to emphasize that undertaking this dissertation on childhood obesity allows the researcher to acquire the necessary skills and knowledge to design and implement teaching methodologies that can help resolve the problem.
Research Aims
As explained in the rationale for this dissertation, the focus of the researcher will be on improving skills and knowledge that can be applied to teaching to help prevent and eliminate childhood obesity. The dissertation focuses on three major aspects that comprise the research objectives: physical and emotional effects of childhood obesity, WHO agenda, and practice approaches to childhood obesity. The three aims of the research are summarized in the following statements:
- To explore the physical and emotional effects of childhood obesity;
- To explore the World Health Organisation agenda for childhood obesity, looking in particular at the UK and Cyprus;
- To explore practice approaches to childhood obesity, in particular, those of early years professionals.
Physical and Emotional Effects of Childhood Obesity
The studies of childhood obesity have focused majorly on the health risks of this problem and the causes and interventions. The effects have also received considerable attention, but the physical and emotional impacts have not been adequately studied. A quick search of the current literature reveals that most of the mentions of emotions in childhood obesity have been associated with causative factors. According to Kumar and Kelly (2017), psychological and emotional distress are some of the environmental risk factors of childhood obesity. In this case, obesity is perceived to be the result of maladaptive strategies, including eating as a way to cope or suppress negative emotions. However, Kumar and Kelly (2017) have paid little attention to how obese children emotionally suffer from their condition. Sagar and Gupta (2018) have established that emotions can be considered both a cause and a factor for sustained obesity. Therefore, those studies examining the psychological aspects of childhood obesity also mention such emotions as distress, sadness, hate and anger. Most of these emotions can be seen as the key contributing factors to the psychological outcomes, including low self-esteem, body shape concerns, anxiety and stress.
The emotional effects do not only emanate from within the individuals but are also the result of their experiences with society. The treatment of obese children by society, especially by peers, negatively affects the emotions of the children. Sagar and Gupta (2018) explain that obesity negatively affects the emotional development of children. For example, they are subjected to discrimination, bullying, and social isolation. Bullying is considered to be one of the most critical challenges for overweight children because it comes in many forms. Verbal bullying happens through teasing and name-calling, relational bullying entails the withdrawal of friendship, and physical bullying includes hitting and pushing. Regardless of the form of bullying used, the emotional outcomes are the same, including poor body perceptions and low self-esteem.
An argument can be made that the emotional effects of obesity are external. Many studies have explored emotional regulations and responses to situations. Therefore, emotions are a response to external pressure and those elements that arouse negative emotions among individuals. A study by Anderson and Keim (2016) explains that emotional reactivity in children can be affected by caregivers. Such a finding can be used to support the hypothesis that the emotional outcomes of obesity are affected by society and how it treats obese children. While the emotions can be perceived as the immediate responses, continued exposure to negative emotions lead to psychological outcomes, most of which have been extensively studied. Stress, distress and anxiety are among the few psychological factors affected by negative emotions.
Obese children may stay obese because their emotional reactions and responses facilitate further unhealthy behaviors. According to Sagar and Gupta (2018), psychological and emotional factors can also be maintaining factors, meaning that they result in overweight children remaining overweight. In many cases, unhealthy diets are a major cause of obesity. Therefore, poor emotional regulation for children and adolescents will lead to a scenario where sustained consumption of poor diets keeps children obese. The case of parental or caregiver attachment presented by Anderson and Keim (2016) reveals that negative emotions can be sustained, in which case the major responses include eating sugary foods and salty snacks. An argument can be made that such parental relationships with obese children will worsen the situation. Additionally, when the children are emotionally abused, their reactions could include isolation from society, in which case television, phones and the internet keep them engaged. Such behavioral changes will result in an increasingly sedentary lifestyle, which when coupled with unhealthy diets, make it impossible for individuals to recover from obesity.
The emotional effects of obesity are usually in the form of emotional torture that obese children go through in their daily interactions with other people. According to Panzer (2017), one of the greatest motivations for obese girls to want to change is the teasing and rejection often associated with weight bias. The mental turmoil is often the result of a person lacking a sense of belonging because they do not fit into certain social groups. Obese children will often be negatively perceived and the only way they can become accepted is by losing weight. Such trouble is more prevalent among girls as compared to boys. However, this information is evidence that such emotions as disappointment and distress will result from how obese people are treated. Teasing can be viewed as arousing negative perceptions about oneself, which lead to sadness and other emotions. The main approach to overcome such feelings is through losing weight. Unlike the studies on the health implications, those focusing on the emotional aspect of obesity often imply that the behaviors observed with obese children are either the reason for or the result of obesity.
Depression and anxiety are the main emotional outcomes of obesity as expressed in multiple studies. According to Rankin et al. (2016), there is a positive relationship between depression and childhood obesity. However, this study reveals that depression, poor self-esteem and poor mood states result in weight gain among adolescents. It is important to acknowledge that depression and anxiety are also emotional outcomes of obesity. Many studies have revealed there are higher levels of stress and depression among overweight children as compared to normal ones. Such findings present a diverging conclusion, where one line of thought sees the relationship as evidence of these emotions causing obesity while the other perceives distress and anxiety as the outcomes of obesity. Regardless of the conclusion reached, it is important to highlight that distress and anxiety will be among the most visible emotions among the obese. Further research could be needed to illustrate how these emotions lead to obesity. The need for such research is illustrated by the fact that the most plausible argument for the current findings is that overweight children and adolescents are more likely to suffer anxiety and distress.
An empirical examination of the emotional life of obese children and adolescents has not been extensively performed. However, significant insights into this subject have been presented by Harrist (et al., 2016), who express the various emotional elements that most affect overweight children. First, loneliness is a major result of obesity where, among school-going children, isolation is among the first experiences for an individual. Loneliness and negative affectivity are the results of rejection and teasing. Such evidence has been derived from both self and teacher reports. These findings support the arguments presented earlier that emotional outcomes are externally determined, and that isolation is a major consequence of childhood obesity. Second, children suffering from obesity have been found to display more anxiety than the normal population. The argument by Harrist (et al., 2016) is that children tend to internalize and externalize problems, the result of which leads to higher levels of anxiety. Such findings are also evidenced by self and teacher reports about the children and their emotional and psychological conditions.
So far, it has been expressed that the emotional well-being of obese children is negatively affected by the condition. The main theme among the studies examined is that interpersonal and intrapersonal relationships are affected. Such scholars as Small and Aplasca (2016) express that being overweight makes individuals prone to teasing and bullying from other children. According to Harrist (et al., 2016), obese children are less liked by the rest, which explains why they are subjected to emotional and physical torture. The external environment is the key determinant of the emotional well-being of overweight children. An argument can be made that better treatment of obese children could alleviate the negative emotions. A key point to emphasize, however, is that the emotional effects are more visible for older children who are capable of self-perception. An infant who cannot comprehend situations would be hard to subject to emotional torture. Therefore, a key point to emphasize is that young children and adolescents have a higher likelihood of experiencing negative emotional outcomes due to obesity.
Another key theme related to emotions is the role of emotional regulation. While much of the literature discussed above shows emotions as being causes or consequences of emotion, there is also evidence that emotions can also be used to improve the well-being of obese children. The rationale for this position is that if obese children face negative emotions, then emotional regulation can help pursue positive feelings about oneself either to improve child wellbeing or as an intervention for obesity. Such scholars as Kumar and Kelly (2017) highlight that emotional responses to the external environment are major risk factors for obesity. Therefore, emotional regulation can be perceived as a means of improving the well-being of overweight children and improving the health of individuals. An important point to note is that emotional regulation helps reduce such behavioral risk factors as stress eating, which in turn helps avert the problem of childhood obesity. The bottom line is that emotions are a critical subject associated with childhood obesity and can be targeted in the development of interventions and solutions.
Another aspect that has received little scholarly attention is the theme of the physical effects of childhood obesity. As expressed earlier, many studies have discussed the root causes and major interventions for obesity. The health and psychological effects have also been extensively studied. While this part intends to highlight the current literature regarding the emotional and physical effects of obesity, it also presents an opportunity for identifying research gaps and the need for further empirical exploration. However, several deductions can be made regarding the physical effects of obesity. For example, the Mental Health Foundation (2016) in the UK expresses that mental health affects physical health. With such a statement, it is possible to develop an argument that the emotional and mental issues associated with obesity will be likely to reflect in the physical well-being of a child.
The physical health of an individual can be manifested by the physical functioning of the various body parts. Even though there is adequate research exists on how childhood obesity affects physical mechanisms of the body, generalizations and inferences are possible from the evidence on the older populations. A study by Capodaglio et al. (2010) reveals that excess body weight in obese people imposes abnormal mechanics on the movements of the human body. The result of such mechanics includes high incidences of musculoskeletal disorders, which can be deemed to be a key part of physical health. Additionally, obesity restrains movements of other body parts, including the spine and joints.
The muscle strength is also negatively affected, which means obese individuals have reduced capability to hold prolonged fixed postures. In many cases, obesity has been associated with physical disabilities, mainly as a result of the body failing to perform physical functions normally. Therefore, it can be argued that the study by Capodaglio et al. (2010) tends to summarize almost all the physical effects of obesity. Childhood obesity can cause similar effects, which will tend to manifest themselves as the children grow older and bigger.
Physical disability and physical performance are key concepts associated with obesity across all populations. Hsu et al. (2019) present a meta-analysis that explores physical performance among individuals with sarcopenic obesity and finds that a combination of the two extreme conditions of obesity and loss of muscle mass detrimentally affects physical performance. One of the immediate effects of obesity is that it impairs muscle quality and reduces the physical abilities of these body organs. However, it is important to understand that the sarcopenic obesity condition is extreme and that its effects are worse than the conditions of sarcopenic or obesity on their own. Regardless of this observation, the key point taken from Hsu’s et al. (2019) study is that obesity adversely affects the physical functioning of the major body parts. In this case, the physical elements display certain similarities with the emotional ones, especially concerning the fact that they can be both a cause of or result of obesity. Ln other words, physical activity can cause obesity, and being overweight tends to limit the physical activity of an individual.
Physical activity can be deemed to be an indicator of good physical health. Therefore, the concept of physical capacity can be used to illustrate the extent to which obese individuals can perform physical tasks or their bodies can perform physical functions. As mentioned earlier, obesity impairs body parts, including joints and muscles. Research by Tamura et al. (2017) reveals that obesity causes knee problems and such physical health problems as muscle metabolism, systemic circulation, and cardiovascular and pulmonary problems. All these aspects affect the rate at which the body can perform physical tasks. Most importantly, knee-related problems can be common among individuals with chronic obesity, where movements cause excessive strains on both muscles and such joints as the knees. Therefore, physical disability can arise as a result of the failure of the body to perform physical functions.
Obesity has been associated with multiple health conditions, most of which can be categorized under physical health. According to Upadhyay et al. (2017), over 20 medical conditions are caused by obesity, including hypertension, cardiovascular disease, sleep apnoea, cancers, stroke, urogenital issues, gall bladder disease, diabetes mellitus type 2 and dyslipidemia. Therefore, it is acceptable to state that obesity diminishes the overall quality of life because many body parts are unable to function correctly. The comorbidities that arise from obesity have been extensively studied, but cardiovascular disease, diabetes and metabolic syndromes are among the most common. For individuals with a body mass index above 25 kg/m2, the mortality rate increases by approximately 30% (Upadhyay et al., 2017). Vascular, diabetic, renal and hepatic mortalities increase by 40%, 60% and 120%, respectively (Upadhyay et al., 2017). Therefore, the physical health effects are a major concern because of the observation that they increase the mortality rates of individuals. Obesity becomes a major public health concern because of the outcomes associated with physical health problems resulting from excessive body weight.
Obesity and its relationship with physical activity are some of the themes most studied. However, it is important to emphasize that obesity results from physical inactivity and impairs physical activity. Clinical manifestations of obesity include non-alcoholic fatty liver disease, cardiovascular disease and diabetes type 2 (Kim et al., 2017). These health issues prevent the body from functioning normally, which has been outlined in almost all research examined in this section. Therefore, the general conclusion is that obesity negatively affects the physical health of children.
Similar to the theme of emotional effects, it is important to express that the theoretical and empirical evidence used in this section has been inferred from studies majorly exploring the general populations. However, the fact that these studies can be generalized across individuals of all ages makes it possible to sustain the positions regarding the relationship between obesity and emotional and physical health. Lastly, it is critical to state the need for further research focusing exclusively on childhood obesity. The rationale is that most of the emotional and physical effects are visible in older children, mostly from school-going years too late adolescence stages. The topic of childhood obesity remains an interesting subject with many gaps to fill.
WHO Agenda for Childhood Obesity in UK and Cyprus
WHO agenda for childhood obesity can be described briefly as the plans and programs established by the organization to help handle the obesity crisis. Additionally, the agenda includes all the actions that WHO undertakes, for instance, research and policy development. It is important to acknowledge that the term “WHO agenda” has been defined and used for the purpose of this research, which is to help understand what the international body hopes to achieve in terms or preventing and reducing childhood obesity.
WHO is a major stakeholder in all matters of general public health. All member states to this body subscribe to its recommendations regarding both practice and policy. However, each country may adopt a different approach from the rest in the implementation of the WHO agenda. In the context of childhood obesity, WHO has been at the forefront in efforts to alleviate this problem. After labeling childhood obesity a global crisis, WHO has developed several agendas, plans and initiatives that can be adopted by individual countries and as a collection through regional cooperation. Therefore, the European region is the perfect place to start when exploring the WHO agenda for childhood obesity in both the UK and Cyprus. According to Nittari et al. (2019), the WHO European region has recorded a prevalence rate of 3 out of 10. Additionally, about 60% of overweight children will be obese in their adulthood (Nittari, et al., 2019). Lastly, all European nations have recorded increasing obesity rates among children aged between 5 and 9 years (Nittari, et al., 2019). The statistics justify WHO’s regional plans for the European countries.
In both UK and Cyprus, one of the most visible agendas for WHO is to keep and update the obesity statistics for the region and the individual countries. Such statistics include the prevalence, implications for health and human development, and policies and governance issues surrounding the subject. In a study by Ataey et al. (2020), the relationship between obesity and the human development index in WHO Mediterranean region countries has been presented. The most important aspect of the study is the empirical evidence of the prevalence and projected rates of obesity across the region. Additionally, several plans have been outlined and their implications for the region expressed. Therefore, it can be argued that all efforts by WHO to discuss plans and initiatives are accompanied by critical data to serve as justification and an expression of urgency for the policymakers.
From the multiple initiatives by WHO across the European region, it can be argued that the primary agenda is to find lasting solutions to the challenge of childhood obesity. In UK and Cyprus, similar to all other European countries, a significant portion of their expenditure has been dedicated to fighting obesity and implementing the recommendations by WHO. However, the current prevalence indicates that the problem is yet to be resolved. Despite this anomaly, it is critical to examine some of the initiatives and plans developed by WHO. The Childhood Obesity Surveillance Initiative (COSI) for the European region was developed in 2007 (Nittari, et al., 2019). COSI’s major goals included monitoring the trends of obesity, every three years, among children aged between 6 and 9 years and who were attending primary schools (Nittari, et al., 2019). The monitoring is mainly through taking physical measurements and other aspects related to the health problem. One of the key findings of COSI is that children in the European region tend to overeat and fail to engage in adequate physical activity. The monitoring plan is, therefore, key in informing WHO’s decisions and in updating the obesity statistics throughout Europe.
Monitoring the trends of childhood obesity has been the perfect way to gather and generate statistical reports for the region. In the Eastern Mediterranean region, the outcomes of obesity monitoring have resulted in the assessment of other key demographic factors, including income inequalities, education and human development index (HDI) (Ataey et al., 2020). However, it is important to emphasize that even though these observations are intended for the general public, inferences are still possible for the children in the region. The most important point is that continuous monitoring of childhood obesity makes it possible for WHO to develop and recommend the best policy frameworks.
Another WHO agenda for European countries concerning childhood obesity has been the action on nutrition. In 2016, WHO became part of the proclamation of the United Nations Decade of Action on Nutrition, which was intended to span between 2016 and 2025 (World Health Organisation [WHO], 2016). This initiative aims to foster joint efforts across all stakeholders toward the eradication of hunger and other forms of malnutrition. Overweight and obesity are among the major diet-related health issues addressed in the action on nutrition. The UK is renowned for its progress in nutrition policy, which is manifested by over £3.7 spent on nutrition since 2013 (Worley, 2021). Therefore, it can be argued that the UK follows an independent plan for nutrition and related illnesses. The country has no clear position on the decade of action on nutrition or expressly illustrated its adherence to the agenda. The WHO agenda on childhood obesity in such a country would be hard to examine unless some reports or statements show a connection between the country’s processes and those of WHO.
Similar to the UK, Cyprus has not developed any clear plan in the pursuit of the action on nutrition by WHO. Therefore, it can be argued that several countries lag in implementing WHO’s policy and practice recommendations. Additionally, it can be argued that WHO is responsible for implementing its plans, in which case the Organisation has not presented country-specific agendas. Such an observation supports an earlier presumption that the regional agenda for Europe is the best place to start in exploring what WHO has achieved and is pursuing concerning childhood obesity. Another similarity between the UK and Cyprus is the Cypriot government and other stakeholders in the country have developed and are exploring the possibilities of nutritional treatments. According to Chrysostomou et al. (2020), the Cypriot case study reveals that the nutritional treatment for some illnesses is cost-efficient, which works best for low-income persons. Regarding WHO’s agenda on nutrition, both UK and Cyprus have developed independent programs with no clear expression of adherence to the guidelines given by WHO.
Regardless of the reactions and efforts by both the UK and Cyprus, it is important to acknowledge that one of WHO’s main agendas is to address childhood obesity through nutrition. Therefore, WHO recommends that nutritional measures should begin before the birth of a child and proceed throughout early life. Maternal nutrition is a matter of concern because overweight mothers or those who put on excess weight during pregnancy have a higher likelihood of having children who will develop obesity (WHO, 2018). Therefore, WHO’s agenda for the European region is that maternal diet and nutrition should be regulated to protect the children from inheriting obesity and overweight from their mothers. Secondly, WHO recommends higher rates of breastfeeding because it can be a means of eliminating harmful foods for infants. Many studies have examined the importance of breastfeeding and a consensus has been reached that this act boosts the health of children. Lastly, WHO recommends complementary feeding to entire proper nutrition for children. Commercial products can be blamed for the high rates of obesity, especially because the messages in marketing can be misleading.
WHO has always been keen to explore new methods and approaches to childhood obesity, including examining and supporting research efforts. One emergent concept that WHO supports is integrated care, which has been labeled by researchers as a framework for better and more effective delivery of care (WHO, 2019). The framework incorporates physical activity, diet, parenting practices, environmental change and mental health. WHO holds the position that home and school environments can be designed to help address childhood obesity, mainly through creating a convenient environment for the children to grow. Such an environment will comprise the right amounts of physical activity, correct diet, and other aspects that help improve the mental health of the children. The recommendations are embraced by the Organisation despite acknowledging that the concept and framework are relatively novel and would need further research. Therefore, it can be argued that WHO is keen to instill a sense of urgency in the development of solutions.
Integrated care has sparsely been adopted by individual countries in the European region, including the UK and Cyprus. However, there are signs that the approach is being embraced in such countries as the UK. The National Health Service has published a document that describes how integrated health and care for children and young people are put into action in the country (National Health Service [NHS], n.d.). Among the critical components described include encouraging active lifestyles, which means encouraging pupils to walk, jog and run their way to better health. Additionally, integrated health and care in the UK incorporate the improvement of mental health, with the focus being on the school environment. The mental health efforts include increasing awareness and understanding of the teachers’ and students’ mental health and offering resources, tools, leadership, and coping mechanism training. Therefore, the UK has developed its own version of integrated care, which seeks to take full advantage of the benefits offered by the framework. However, the NHS (n.d.) does not make any reference to WHO guidelines, which raises doubts about whether the country implements integrated care as part of the WHO agenda for childhood obesity.
In the case of Cyprus, the country has not developed an integrated system that mirrors that of WHO or that of the UK. However, the Cypriot child healthcare system can be deemed as comprising several mechanisms and approaches that aim to achieve the overall health and wellbeing of the children. According to Efstathiou et al. (2020), Cyprus has acknowledged that child health care challenges include mental health, chronic illnesses and obesity. A national healthcare system was developed in 2017 to help tackle such challenges as quality, financial, effectiveness, efficiency and equity in the country’s healthcare system. In light of the integrated care framework, Cyprus is yet to develop such a mechanism, even though several institutions attempt to integrate several pediatric sub-specialties to help achieve better child health outcomes. Therefore, a country such as Cyprus lacks an ideal health care system to help implement WHO’s agenda and recommendations, including those on integrated care. Additionally, the country has not expressed its efforts and measures in the implementation of WHO’s guidelines regarding childhood obesity.
Another key part of WHO’s agenda for childhood obesity in the European region entails the guiding principles for addressing the issue. Several principles have been developed and recommended to the member states. First, the government and society should uphold children’s right to health. It is a moral responsibility for the member states to ensure that they implement all possible measures to prevent the risk of obesity. Second, government leadership is desired, mainly because childhood obesity is a crisis for individual states. Therefore, government leadership becomes the most effective tool to help the countries overcome the problem, failure to which there will be major social, medical and economic consequences. Third, a whole-of-government approach has been recommended by WHO, which means that all government policies should systematically consider health issues affecting the population, especially children and young people. Fourth, WHO (2015) recommends that childhood obesity should be integrated with the current WHO and other global and regional initiatives for added benefits and longer-term health. In this case, WHO acknowledges that there are other efforts by global and regional bodies, which should also be used and adopted.
Other guidelines include accountability, equity and universal health coverage for treating childhood obesity. Accountability entails both political and financial commitment by governments to appreciate the magnitude of the childhood obesity pandemic. Additionally, accountability takes into account the need for a robust mechanism for monitoring policy development and implementation. Concerning equity, WHO suggests that all states should pursue equitable coverage of interventions, especially for the marginalized and excluded population groups who have a higher risk of both obesity and malnutrition (WHO, 2015). In other words, the government has a responsibility to ensure equitable access to resources, access to healthy foods and safe physical activity for all children. Lastly, universal coverage that includes the treatment of childhood obesity is recommended by WHO. The argument is that each country should perceive childhood obesity as a health crisis, which requires national health policies. Therefore, universal coverage can be seen as the ultimate solution, which makes sure that all patients with obesity can access the required treatment.
In a nutshell, it can be argued that food and nutrition and physical activity are the main components of the WHO agenda for childhood obesity for the European groin, for which the UK and Cyprus are member states. The Organisation states that it supports the member states in addressing the priorities in these components. The main evidence for the childhood obesity agenda for WHO is the European Food and Nutrition Action Plan 2015-2020 and the Physical Activity Strategy for the WHO European Region 2016-2025 (WHO, 2017). These two action plans have been developed to help initiate preventive interventions that target good nutrition and adequate physical exercise to help the children achieve ultimate health. Additionally, the literature provided in the previous section indicates that diet and physical activity are the main aspects associated with obesity. Therefore, the WHO agenda involved helping the member states to devise plans for both nutrition and physical activity as preventive measures.
One of the main observations regarding the WHO agenda for childhood obesity is that there are few indications of compliance across the countries. Therefore, it can only be presumed that the actions of WHO are used to inform decision-making by individual states. However, the fact that WHO focuses on regions as opposed to individual states could also make it difficult to find literature for each nation, including the UK and Cyprus. Focusing on the region yields greater research material, especially through the reports published by WHO. Using the WHO agenda for childhood obesity for the UK and Cyprus fails to yield adequate information regarding how WHO acts in these countries or how the states implement WHO’s agenda. Therefore, this section can only lead to the presumption that the individual countries have developed their own frameworks for addressing childhood obesity and have subscribed to several treaties and agreements, as well as policy recommendations from WHO. The most important observation, however, is that WHO has been a guiding force in the development of solutions for childhood obesity. Therefore, that the UK and Cyprus are member states means that they comply with WHO’s guidelines.
Practice Approaches to Childhood Obesity
One of the main challenges observed was the fact that there was inadequate literature, especially when narrowing the subject down to the two countries: the UK and Cyprus. Several studies have been conducted, which explore multiple alternatives from both a theoretical and practical perspective. The UK and Cyprus have also developed programs and interventions for childhood obesity, which can be reviewed in terms of their efficacy. Additionally, several efforts from WHO can be explored as implemented by individual countries. The primary focus of this paper is to express what preschool and kindergarten teachers can do to contribute to the reduction of childhood obesity.
From the available literature, it can be concluded that preschool and kindergarten teachers have a critical role to play in the fight against childhood obesity. However, there are two main interventions that be implemented in these institutions, namely proper diet and adequate physical activity. According to Toussaint et al. (2020), playgrounds for toddlers programs (PLAYTOD) have proven an effective intervention when implemented in preschools and targeting children between 2.5 and 4 years old. PLAYTOD programs are simply intended to create spaces for the children to exercise and engage in other physical activities to help keep the children fit. With such an intervention, the preschool and kindergarten teachers can regulate the rigor of the physical activities to suit the needs of the children.
The rationale for physical activity programs for preschools has been supported by multiple scholars who agree that these interventions are among the most effective ways of fighting obesity and its comorbidities (Yuksel et al., 2020). Other studies express that with physical activity programs and interventions, preschools can be reducers of inequality related to the physical activity levels in children between 4 and 6 years (Kippe & Lagestad, 2020). Therefore, it can be concluded that the main practice approaches involve the use of physical activity programs as interventions for childhood obesity in preschools and kindergartens.
The second practice approach that is used by preschool and kindergarten teachers is diet regulation. These interventions are supported by literature, which explains that treating eating disorders and picking the right food for preschool children helps fight childhood obesity. The preschool teachers are, to some extent, responsible for monitoring the type of food offered to children while at school. A study by (Sandvik et al., 2019) suggested that picking the right food contributed to lower obesity levels among children. Such sentiments have been backed by Abd-Elrahman et al. (2021), who state that the quality of dietary intake among preschool children determines their likelihood and prevalence of obesity. This practice approach is less common for preschool teachers as compared to that of physical activity. However, many countries use national policies and programs to guide the actions of preschool teachers in the fight against childhood obesity.
The practice approaches are implemented differently across the various countries, including the UK and Cyprus. Each country has different programs designed for use by preschool teachers and other professionals in the children’s centers. In the UK, a program called Health, Exercise and Nutrition in the Realy Young (HENRY) was developed to support children from the most disadvantaged areas (Burton et al., 2019). The intervention targeted the preschools and other types of child centers where early child care is demanded. The main observation from this program is that it produces positive results, which means that the local authorities in the UK were keen to boost the participation of both the preschool teachers, children, and other professionals involved in the fight against childhood obesity. Another key observation is that the intervention combines the two practice approaches described above: diet and physical activity. It is important to emphasize that these two practice approaches form the basis for all interventions and prevention programs.
Besides engaging the children in physical activities and offering them a proper diet, preschool teachers and other professionals can also teach children about the need for a balanced diet. A study by Anton-Păduraru et al. (2016) expresses the need for nutritional education for preschool teachers and explains that inadequate information regarding nutrition is the main cause of health problems associated with diet. Such a proactive approach can be labeled as awareness creation, which can also be regarded as an intervention for childhood obesity. Healthy eating is a concept that can be learned by children, which means that awareness programs are as effective as those involved with the regulation of diet. The argument is that for preschool teachers, the main objective is to get the children to avoid those types of food associated with obesity.
As a region, Europe has initiated several strategies that can be used in pre-schools and similar settings to address childhood obesity. In both the UK and Cyprus, the Feel4Diabetes study, which is funded by the European Union (EU), has been used to explore multiple strategies and their efficacy. According to Lambrinou et al. (2020), Feel4Diabetes focuses on school-based and family-involved interventions, which seek to manipulate children’s behaviors for positive change. Healthy eating and physical activity have become some of the most common themes across the world. The rationale is that diet and physical activity during early life, both at home and pre-school, are the go-to strategies for any country or healthcare system seeking to improve obesity outcomes. The Feel4Diabetes study is a multicentre undertaking, meaning that it explores interventions across the European region and each country’s efforts in the development and interpretation of childhood obesity interventions. Therefore, it can be argued that the two countries are part of regional cooperation that establishes the right approaches to childhood obesity.
Feel4Diabetes can be described as a community and school-based intervention seeking to promote healthy lifestyles and handle obesity. The program was based on the notion that obesity is the leading cause of diabetes type 2 (Kivelä et al., 2020). As such, Feel4Diabetes was intended to help the European countries identify the risks and develop and implement the relevant strategies. The rationale was that a one-size-fits-all approach would not work because each community faces different challenges. The Feel4Diabetes was designed such that each school or social setting targeted would develop interventions that work best for their unique context. However, it is important to emphasize that the primary these was to improve the diet and physical activity as per the national guidelines for each country. Therefore, the fact that Cyprus and the UK were part of this study implies that the two countries recognize the need for tailored interventions even though the ultimate target is nutrition and physical exercise.
The Feel4Diabetes study in the UK was conducted in such locations as Newcastle and targeted specific populations, including the Asians living in the UK. The outcomes of the study included changes in weight among the participants (Kivelä et al., 2020). Additionally, the progression of diabetes was also slowed as a result of the interventions. Feel4Diabetes is one of those critical programs across Europe that have provided the necessary evidence to the fact that the regulation of behaviors, diet and lifestyles positively contributed to reduced prevalence of childhood obesity and reduction in such illnesses as diabetes that result from being overweight. The most important point to emphasize is that the study focused on school-going children, in which case the school and home settings were altered to create the right environment for the children. Feel4Diabetes may not be a program implemented by governments, but it presents the countries with case scenarios and evidence to develop the necessary policies for childhood obesity prevention.
Physical activity as an intervention for diabetes has also been manifested in Cyprus, both through research or practice. One of the studies that reflect the situation in Cyprus has been presented by Wyszyńska et al. (2020), who express that low levels of physical activity cause approximately 5.3 million deaths annually. Cyprus recorded one of the lowest percentages for children engaging in over 60 minutes of physical exercise with only 2.0% (Wyszyńska et al., 2020). The highest country in the study by Wyszyńska et al. (2020) was Belgium with 34.1%, which should reflect the fact that Belgium has lower levels of obesity compared to such countries as Cyprus. The most important statistic is that between 95% and 97% of the children and youth across Europe fail to meet the regional physical activity guidelines (Wyszyńska et al., 2020). In Cyprus, it can be argued that the current programs and interventions have targeted improving physical exercise among preschool children in light of the prevalence statistics.
Apart from physical activity, Cyprus is also one of the European countries where diet is a critical risk factor in childhood obesity. According to Argyrides (2019), obesity in Cyprus has resulted from multiple eating disorders, a phenomenon that most affects adolescents. Eating disorders and disordered eating are, therefore, key policy issues and part of the country’s practice approach to childhood obesity. However, the problem in Cyprus is made more complicated by the fact that the media and sociocultural factors play a vital role in the prevalence of these disorders. Therefore, the interventions developed for the country have attempted to make sure that changes in both the media representation and the socio-cultural values are made to address the problem. Examples of interventions, including the Body Image Workbook and the Body, have been recommended for the country majorly because they have been empirically proven. With these programs, the country can reshape how the population feels about their body images and help stimulate corrective action. However, it is important to highlight that the pre-school-going children might not be affected by the media directly, which means a greater emphasis on the practitioners and pre-school teachers should be made.
As one of the countries most affected by childhood obesity can be understood that Cyprus would be bound to implement several interventions. Diet and nutrition are a key part of the country’s efforts, and many studies have explored both the efficacy and the levels of implementation of such interventions. Research presented by Tornaritis et al. (2014) explores the diet intake for children between 6 and 18 years and the relationship between the mothers’ education level and the weight of the children. Additionally, the study examines how education affects adherence to Cyprus’ nutritional recommendations, which indicates that the country has developed deliberate measures to regulate children’s diet. The responsibility of the implementation is largely on the mothers and pre-school teachers, which explains the point of exploring the adherence to the guidance using the mothers’ education as a determining factor.
The main observation of their study was that a majority of the children consumed higher total fats, saturated fatty acids and protein (Tornaritis et al., 2014). Most of the children also failed to achieve the recommended levels of fiber intake, which indicates that the country’s programs are largely not fully implemented. The public can be blamed for the gross neglect of the guidelines but only on the assumption that the country has effectively communicated them. Otherwise, Cyprus can be perceived as a country will good interventions that are not properly implemented. A different research approach may be recommended to clear these doubts, especially because evidence of present interventions is available while the awareness and knowledge of the programs are not examined. However, Tornaritis et al. (2014) highlight that the current diet and nutrition curriculum is inadequate and recommends that it should be modified to make it more effective. Therefore, an initial position can be taken to suggest that Cyprus has feasible practice approaches that are poorly implemented, which should explain the poor outcomes in both diet and obesity statistics.
Most of the interventions developed by researchers and adopted by preschool and kindergarten teachers tend to combine both nutrition and physical exercise. Additionally, it can be argued that the programs devised have been intended to present the necessary evidence that this combination yields the best outcomes. In other words, much of the scholarly work has been intended to illustrate the practice approaches for schools, which are the perfect setting to implement these strategies. Research by Canaway et al. (2019) expresses that increasing the level of physical activity by 30 minutes during a school day produced positive results. Additionally, creating awareness regarding the importance of physical activity and promoting a proper diet was a viable intervention. However, Canaway et al. (2019) hoped to examine the cost-effectiveness of these interventions to help convince the government and other stakeholders of their feasibility. The findings of the cost-effectiveness may not be conclusive enough to offer a final verdict. However, the fact that the UK schools have shown positive progress means that there is some evidence that the diet-physical activity combination is the ultimate answer to the problem of overweight and related comorbidities.
A key observation made in this part is that many of the practice approaches are only illustrated in literature and few can be observed in real-life. For example, it is hard to explain whether the Feel4Diabetes is still practiced among pre-school children. Additionally, physical activity during the earliest stages of life may be impossible, which means that only later stages can be targeted. In both the UK and Cyprus, only general information regarding childhood obesity can be obtained, with a specific focus on pre-schoolers being limited in both the UK and Cyprus.
Countries in the European region, including both the UK and Cyprus, have developed several measures to solve childhood obesity. The insights offered in this part indicate that the interventions focus on the causes of childhood obesity, which are addressed to prevent and reverse overweight. The main idea expressed by both scholars and practitioners is that the changes to nutrition and physical activity change influence obesity outcomes. Additionally, these elements comprise the key risk factors for childhood obesity. Therefore, scholarly and intervention programs have been based on the idea that improving them will lead to better overweight outcomes. In other words, improving child nutrition and encouraging more physical activity will prevent obesity for those not yet suffering from it and help overweight children reduce weight. The evidence of the feasibility of these approaches has largely been theoretical from the studies conducted. However, the UK and Cyprus have also implemented solutions that have been observed to be working. However, the rate of implementation or the seriousness with which the issue is approached is below expectations, despite the two countries acknowledging childhood obesity to be a public health crisis.
Conclusion and Recommendations
Conclusion
The attention of this thesis is on the global public health crisis of childhood obesity. The thesis has used only two countries as case scenarios. However, it is important to understand that all states across the world are faced with the test of creating adequate solutions to the predicament. The major concern and motivation behind the need to find working solutions are that childhood obesity can persist into adulthood, where major comorbidities and mortality are experienced. The literature explored reveals that the major illnesses associated with obesity include type II diabetes, cardiovascular disease, various types of cancers, and muscle and joint problems. With the potential for death being significant, countries will need to have feasible interventions for childhood obesity.
The purpose of the thesis was threefold, meaning that it addresses three major aspects: emotional and physical effects, the WHO agenda and the practice approach. The thesis has examined the emotional and physical effects of childhood obesity. The literature explored reveals that there are huge research gaps left by previous studies. However, inferences were possible, in which case several implications could be established. Regarding the emotional impacts, the key observation was that the perception and treatment of overweight children affect their self-perception, self-esteem, and other behavioral responses. Such emotions as sadness, anxiety and loneliness have been associated with this form of treatment. Additionally, it is these emotional outcomes that cause more serious psychological issues, including stress and depression. Another observation is that such experiences are environmental, which means that the external setting in which the children grow exposes them to these risk factors. Most importantly, the behavioral responses to these emotions can make the problem worse, with the problem of eating disorders and disordered eating being among the major results. Such eating behaviors not only increase the possibility of becoming obese but also make it difficult for the interventions to produce positive results.
Emotional outcomes affect physical health, a correlation that has been supported by the literature. However, the most important observation is that childhood obesity negates the physical functioning of the body where several organs fail to work normally. Theoretically, the excessive weight makes it impossible for the body to function normally with the major results being higher cases of such issues as musculoskeletal disorders. Muscles, joints and the spine have been established as the organs most affected by obesity. Additionally, physical activity and performance are adversely affected by excess body weight, which should be the key indicator of physical disability.
Another interesting these in this thesis was the WHO agenda for childhood obesity. The argument given is that the Organisation is a leading actor in the race to solve the problem of childhood obesity. One key observation made in this thesis is the fact that WHO has regional and global plans as opposed to specific countries. Therefore, it was difficult to examine the institution’s efforts in either the UK or Cyprus. Inferences were also made and backed by the notion that both Cyprus and the UK are member states of the UK. Most importantly, some of the interventions and programs recommended by WHO has been adopted by these countries. For example, integrated care in the UK has mirrored WHO’s framework. Cyprus has deployed the nutrient profile provided by WHO to make policy decisions, including the marketing of child foods in the country. The main agenda for WHO is to continually monitor the trends and update childhood obesity statistics in the European region and to help the countries in their efforts to develop and implement the necessary interventions.
The third focus of the thesis was the practice approaches for solving childhood obesity, in which care the attention has been turned to both the UK and Cyprus as case scenarios. Interventions to overweight have been extensively explored, meaning that there is adequate evidence regarding the subject. The key idea in developing interventions is that the risk factors are addressed and modified as both curative and preventive approaches. In other words, nutrition and physical activity for obese children are used to reduce overweight on one hand. In pre-school and at home, teachers and mothers have a role to play in ensuring adequate diet and physical activity for the children in their early life. On the other hand, the same approaches are used for both children and pregnant mothers to prevent childhood obesity. Therefore, it is important to acknowledge that the main solution to childhood obesity is through behavioral modification to include good eating habits and regular physical exercise.
Another key observation regarding practice approaches is that the early life of the child can be targeted and interventions developed to prevent childhood obesity from occurring. The argument given is that there are developmental factors that pose high risks of overweight, especially the health status of the mother. Antennal and postpartum strategies can help keep the children healthy if properly implemented. With this understanding, practitioners can fully appreciate the causes, consequences, and solutions to the global problem of childhood obesity. The general conclusion reached is that both the UK ad Cyprus will need better initiatives to address the issue of childhood obesity. The fact that the trends show a worsening situation means that the current practices are inadequate. Additionally, the application of the WHO guidelines is not clear, despite the Organisation being a key supporting institution to countries’ efforts in fighting childhood obesity.
Recommendations
The global crisis of childhood obesity needs more heightened efforts than the current ones. This is because the insights offered by WHO present evidence of the fact that there is a growing prevalence across the European region. Therefore, several recommendations can be made, both for practice and research. The main idea is that the current interventions have been shown to work in theory while in practice huge gaps emerge. The recommendations will be tough on both the UK and Cyprus to improve the fight against childhood obesity.
First, both the UK and Cyprus will need to conduct several feasibility studies targeting the individual interventions. The focus should be on both diet and physical activity, as well as other such initiatives as early childhood and developmental influences. The argument is that the budget for childhood obesity is big while the results are not promising. Therefore, a key question emerges concerning whether the current interventions are economically feasible. Further scholarly exploration on the subject would also be needed, which could be used to inform government decisions.
The second recommendation is that both research and practice should place more emphasis on early childhood and developmental influences. Scholarly evidence has been given to illustrate that antenatal and postpartum strategies can be effective in reducing childhood obesity. Focusing on pregnant women and new mothers will mean implementing approaches that seek to modify lifestyles and behaviors to reduce exposure to the risk of overweight infants.
Lastly, communication and awareness of the practice approaches to address childhood obesity would be needed for both Cyprus and the UK. The thesis has revealed that in Cyprus, many women are unaware of the strategies and the country’s efforts have thus been proven inadequate. The key determining factors for the success of the intervention programs is the parents and their willingness to embrace the strategies. The argument is that the children cannot be expected to implement them because they do not make most of the decisions. Additionally, the parents are responsible for the environment in which the children grow. Therefore, teaching the parents about the dangers of childhood obesity and preventing them with the mechanisms to address the issue should work perfectly. Most importantly, the school and community settings are equally important, and the governments should create awareness and communicate with the relevant stakeholders to help them embrace the intervention programs.
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