Developing a Health Advocacy Program

Childhood obesity has more than doubled in the past 30 years. These children are at risk for both immediate and long-term effects on their health and well-being. Children who are obese are more likely to be obese as adults (Centers for Disease Control, 2014). An advocacy program that has helped combat childhood obesity is Coordinated Approach to Child Health (CATCH USA, 2013). It has helped schools and after-school centers become healthy environments. Its curriculum is designed to promote health for students and its core elements include physical activity, nutrition, health education, and healthier food choices. The CATCH program has received state, national, and international recognition for being one of the most comprehensive and ambitious approaches to targeting physical education, food services, and classroom curriculum through a coordinated school health program (CATCH USA, 2013).

CATCH began as a university research study and has continuously upgraded their program though evidence-based research. This program was implemented as a clinical trial at four regional sites and succeeded in producing positives and lasting changes in children’s behaviors; decreasing fat consumption and increasing physical activity among children. Today CATCH can be found in 50 states, Canada, and the U.S. Department of Defense Schools around the World (CATCH USA, 2013). CATCH has been successful and effective due to working with the community, partnering with schools, and having large corporations, such as Campbell and Dell, invest millions of dollars into reducing obesity. This program is grounded in evidence-based practices and through years of ongoing research, CATCH has become the gold standard for coordinated school health programs (CATCH USA, 2013). Childhood obesity continues to be a problem that needs to be addressed. CATCH has been influential and successful thus far in improving the health of children. With continuous research and development, CATCH can continue to evolve and improve the lives of children. Let’s Move

Let’s Move is an initiative that was launched in 2010 by First Lady Michelle Obama, to help raise a healthier generation of kids and to combat childhood obesity (Let’s Move, 2010). Over the past three decades, childhood obesity rates have tripled and nearly one in three children is overweight or obese. With this large number of children being affected, many will face future health problems such as diabetes, heart disease, high blood pressure, and asthma. Michelle Obama launched this initiative to help solve the challenge of childhood obesity and help children grow healthier and pursue their dreams (Let’s Move, 2010). The Let’s Move campaign advocates for a decrease in obesity from birth through adulthood. This programs effectiveness comes from putting together a national action plan and focusing on five pillars to be successful. The program gives parents information that teaches them and supports them to ensure a healthy environment. Parents are busier than ever and are given tools and information to instill healthy eating habits in children that will remain a lifetime (Let’s Move, 2010).

Nutrition is taught to school children and they have incorporated more physical activity into their day as it is an essential component to health. Physical activity is encouraged both in school and with families. Families are encouraged to be active each day (Let’s Move, 2010). Between healthy nutrition and physical activity, individuals can be more committed to a healthier life. Another component of the Let’s Move campaign is accessible and affordable health foods. Nutritional information is offered on food products and in restaurants. The MyPlate icon was introduced to help people prioritize food choices and to remind them that half of their plate should be fruits and vegetables (Let’s Move, 2010). Healthy food has been encouraged in rural communities and underserved locations.

The lack of access is one reason why children are not eating the recommended levels of fruits, vegetables, and whole grains. Allowing more access to proper foods and providing nutritional information has been beneficial to the success of this campaign. The collaboration of individuals and the community has made this campaign a success. Multiple groups of people such as the government, schools, health care professionals, faith-based and community-based organizations have united to play a role in reducing childhood obesity (Let’s Move, 2010). Michelle Obama has invested her time, talents, and strengths to help ensure a healthy future for children. The Let’s Move program has empowered people to take responsibility for their actions that impact themselves and those around them. Policy Change

According to the Centers for Disease Control and Prevention, the prevalence of obesity has more than doubled among children ages 2 to 5 (5.0% to 12.4%) and ages 6 to 11 (6.5% to 17.0%). With this increase of a preventable disease, interventions need to be the primary focus in hopes of a change. More prevention efforts need to be done to start a downward trend in reducing excess weight gain as children grown up. Advertising and the media are a prime position to change what food and beverages are advertised and what is linked with it. Virtually all of the more than 1.6 billion dollars that advertisers spend annually is on youth-directed marketing for processed, manufactured foods, such as baked goods, candy, frozen desserts, and breakfast cereals. Less than 1 percent is for healthy foods, such as fresh fruits and vegetables (Spector, 2010). Advertisements link super heroes, toys and games to food products that are deemed as unhealthy choices (Budd & Hayman, 2008).

Changes need to happen to the current media and advertising to make stiffer regulations on what is shown to children on television, internet, billboards, videos, and audio programming. Currently, there is no policy or law restricting what food content is advertised. Research shows that there is strong evidence that television advertising influences what children 2 to 11 choose to consume and what they pester their parents to buy them to eat (Spector, 2010). I propose a policy change for uniform and regulations in food advertisement. This policy could regulate the quantity and content of what is being advertised. Advertising companies would have to present their ads to a board of nutrition experts who can assess the nutritional value of the food and its targeted audience. By monitoring and decreasing the amount and what content is advertised could potentially reduce and prevent children from childhood obesity. Impacting Legislation

The regulation of advertising food and beverage content is currently not a law but some food companies have pledged to devote half of their advertising to children and promoting “healthier dietary choices”. In 2006, The Council of Better Business Bureaus established the Children’s Food and Beverage Advertising Initiative, or CFBAI. Its goal is to change the ratio of food and beverage advertising messages directed to children. Since then, 17 major U.S. food companies have committed to this type of advertising. These companies represent 80 percent of television food, beverage and restaurant advertising directed to children younger than 12 (Spector, 2010). With these advocacy efforts already under way, it would be beneficial if 100% of advertising companies were required to change what food and beverages are promoted on television to children. To initiate this process, legislators must be made aware of the current statistics and the concern of childhood obesity and how it is impacting our children today and for their future. The law is a powerful tool that can improve public health issues.

To initiate this policy change, a bill would have to be drafted and reviewed by a standing committee for further consideration (Milstead, 2013). A hearing would then need to take place to deem the bill necessary and effective. It would then move to the chamber for voting. In order to convince congress to enact the bill, three necessary pieces need to be used to lobby for a change in advertising to children. A professional lobbyist is needed to represent the group requesting a change and are looked at by lawmakers to present information and support on issues such as childhood obesity. Many professional organizations employ lobbyists to do their bidding. (Milstead, 2013). The CFBAI and the American Nurses Association (ANA) both are groups that would provide support for this proposed bill.

The second group of people is grassroots lobbyists who are constituents who have the power to elect officials through their vote (Milstead, 2013). This group of constituents is valuable in that they can help persuade policymakers of the need for a change in advertising and how it is impacting childhood obesity. The last piece that needs to be in place is the role of money and how it impacts the law. Changing the laws regarding advertising will cost many dollars and will likely need financial backing. National groups such as the CFBAI and ANA could support and back this bill financially. Legislative Obstacles

As with all change that takes place, enacting a law to change food advertising will have some hurdles. Some policy holders claim that restricting marketing and advertising involves limiting the First Amendment of free speech. The Supreme Court has repeatedly ruled that commercial speech must not be misleading. The Court would have to be convinced that advertising unhealthful foods to children is purely informational and that children cannot distinguish between information and persuasive speech (U.S. Institute of Medicine, 2006). Food companies will lobby against changing food advertising as they will agree with the Supreme Court that they have First Amendment rights to what they portray and broadcast. The government will need to be educated in protecting our children and that changing the law would be constitutional. Another obstacle that will be a concern is the financial aspect of enacting this law. Food conglomerates will lobby against this proposal change as they will suffer a financial loss. Advertising companies will lose money if the government puts a ban on what they advertise. Organizations that are dedicated to reducing childhood obesity will be educators and provide financial backing to help make a change. Ethical Dilemmas

As with any new change or mandating a change in actions can cause ethical dilemmas. The advancement of putting a new policy in place can cause challenges. While the rise in childhood obesity in increasing and continuing to climb, food companies argue that they should not be banned from advertising to children. In 2006, the food industry spent more than $900 million in marketing aimed at children younger than 12 years and designed specifically to increase positive attitude and preferences for its products (Harris & Graff, 2011). The food industry often uses popular cartoon characters, sports themes, and toys to entice children. Research consistently demonstrates that until age 8 years, most children do not possess the necessary cognitive skills to understand that advertising is not just another source of information (Harris & Graff, 2011). Food companies dispute that children do not have the cognitive abilities in place to be persuaded by the advertisements they view and that parents have a role in what children eat (Pine & Nash, 2002). The argument is that parents have an obligation to regulate what their children watch on television and what food they purchase for them to eat. Another concern that is debated in banning food advertising for children is that the government should not impede on individual liberty to benefit the general public.

While the responsibility of the government is the protect and promote public health, it is argued that rights such as free speech, due process, and property ownership are being impinged on for food companies (Harris & Graff, 2011). As food companies argue that their rights are being impeded upon, the government needs to step in to develop a fair policy that can change the ongoing crisis of childhood obesity. The ultimate goal of changing the marketing and advertising practice would be to protect our children from harm. The interventions that have been put in place so far have proven to be ineffective; therefore more drastic measures need to be taken to alleviate the epidemic. The objective of regulating food advertisement is to protect American’s children from misleading food marketing in an attempt to reduce childhood obesity. The progress of improving childhood nutrition is difficult to imagine unless a powerful force of food and beverage marketing is attenuated, if not eliminated (Harris, Pomeranz, Lobstein, & Brownell, 2009). While food companies are hesitant to makes a change in what they advertise and promote to children, the solution may come from the government stepping in and mandating a change. Code of Ethics

Childhood obesity is an epidemic that needs to be addressed and resolved. In order to make a change in this ongoing problem we face in the United States, government leaders, nurses, healthcare workers, and educational leaders must collaborate and unite for a change in the future health of our children. Nurse’s makes up the largest group of healthcare professionals in the United States who are respected and can advocate for an ethical and law-abiding policy change. Changing food advertising geared towards children needs to be moral and the American Nurses Association (ANA) Scope of Nursing Practice emphasizes the importance of maintaining integrity and values (American Nurses Association, 2010). The ANA states the importance of “recognizing the healthcare consumer as the authority on her or his own health by honoring their care preferences: (American Nurses Association, 2010).

Similarly the ANA’s Code of Ethics addresses the ethical dilemma of autonomy. Banning food advertising brings up the concern of going against the consumers right of autonomy. Currently codes and standards of care are in place to provide autonomy. Provision two of the Guide to the Code of Ethics states, “patient autonomy can be overridden in the service of another, more stringent, ethical principle, to do no harm” (American Nurses Association, 2010). The request for the removal of autonomy in this policy change will cause more harm than good. The ANA’s provides the Code of Ethics as the framework for ethical standards for the nursing profession. Provision 9 discusses the responsibility of the nursing profession to speak collectively in shaping and reshaping the health of our nation, specifically in areas of health policy and legislation (American Nurses Association, 2010). As nurses, the profession needs to be diligent in taking actions to educate and influence legislators.

Nursing continues to gain knowledge and education, and with this knowledge, they can educate and advocate to the public about healthcare issues such as childhood obesity. The epidemic of childhood obesity can be more easily addressed if the public has some education and facts on this ever growing problem. Nurses can “engage family and friends in informed discussion on health policy matters, exercising the right to vote, informing oneself about legislative and ballot issues, and writing to elected representatives on issues related to nursing care can have a significant effect on health policy” (American Nurses Association, 2010). Knowledge can be a powerful tool in shaping policy change and helping improve childhood obesity and the future of our children’s health. Summary

Childhood obesity is an increasing concern that needs to be addressed in order to improve the future health of children. Preventative programs have been initiated to help educate and decrease the evolving concern of childhood obesity. One program has been started to assist schools in facilitating healthier environments. This has been thriving in teaching schools how to offer healthier choices and increase physical activity. Another program has prospered by implementing changes at a national level. It has put multiple interventions in place to reduce obesity and increase physical activity. Currently, there are no federal laws that regulate what is advertised to children in regards to food and beverages. Proposing a policy to regulate food advertisement can help aid in decreasing childhood obesity rates. Educating legislators of this increasing problem that children are facing, a new bill can be assembled. While there are ethical issues that need to be taken into account and addressed, changing food advertisement for children can be influential in the success of decreasing childhood obesity.

References

American Nurses Association. (2010). Guide to the code of ethics for nurses: Interpretation and application. Retrieved from http://ezp.waldenulibrary.org/limited/CodeOfEthicsForNurses.pdfBudd, G. M., & Hayman, L. L. (2008, March/April). Addressing the childhood obesity crisis: A call to action. The American Journal of Maternal/Child Nursing, 33(2), 111-118. Retrieved from http//www.nursingcenter.comCenters for Disease Control. (2014, February 27). Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm Harvard School of Public Health. (2014). Obesity trends. Retrieved from http://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends/ CATCH USA. (2013). Catch coordinated approach to child health. Retrieved from http://catchusa.org/documents/catch brochures/CATCH 2013 Annual pages.pdf Harris, J. L., & Graff, S. (2011). Protecting children from harmful food marketing: Options for local government to make a difference. Preventing Chronic Disease, 8(5), 1-7. Retrieved from http://www.cdc.gov/pcd/issues/2011sep/10 0272.htm. Harris, J.L, Pomeranz, J.L., Lobstein, T., & Brownell, K.D. (2009). A crisis in the marketplace: How food marketing contributes to childhood obesity and what can be done. Annual Review of Public Health, 30(1), 211-225. doi: 10.1146/annurev. Let’s Move. (n.d.). America’s move to raise a healthier generation of kids. Retrieved from http://www.letsmove.gov/learn-facts/epidemic-childhood-obesity Milstead, J. A. (2013). Health policy and politics: A nurse’s guide (Laureate Education, Inc., custom ed.). Sudbury, MA: Jones and Bartlett Publishers. Pine, K., & Nash, A. (2002). Dear santa: The effects of television advertising on young children. International Journal of Behavioral Development, 26(6), 529-539. doi: 10.1080/01650250143000481 Spector, K. (2010, October 01). Healthy-eating advocates seek ways to fight advertising promoting unhealthy
food and drinks to kids. Retrieved from http://www.cleveland.com/healthy-eating/index.ssf/2010/10/healthy-eating_advocates_seek_ways_to_fight_multimedia_food_marketing_to_kids.html U.S Institute of Medicine. (2006). Food marketing to children and youth. Washington, DC: National Academies Press. Retrieved from http://www.nutrinfo.com/biblioteca/libros_digitales/food_marketing.pdf