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Culturally Tailored Intervention to Prevent Obesity Among Dutch-Turkish Primary School Children: An “Wholy”-Approach Intervention

In the IDA elective course "Advanced Applications: Individual Differences, Personality, and Health", students write a grant proposal on a topic to improve health in individuals with chronic diseases by promoting lifestyle change. Congratulations to Viola Siegmeier for winning (one of) the best grant proposal award! 

Background

The rising incidence of obesity represents a significant global healthcare epidemic (1). It does not only represent a risk factor for noncommunicable diseases, but also imposes an economic burden on society. Within high-income countries (e.g., the Netherlands), individuals with obesity incur approximately 30% higher medical expenses compared to those with a normal weight (2). One of the promising strategies for preventing obesity in (young) adulthood is to address childhood obesity and overweight (COO) from the outset (3-5).

Problem

In the Netherlands, ethnic disparities in COO rates have widened since 2007 (6). De Wilde, Verkerk (7) demonstrated that Dutch children exhibited the lowest prevalence of COO (11.4%), while Dutch-Turkish children (the largest ethnic minority in the Netherlands) had the highest prevalence (32.4%). COO can negatively impact children’s lives, including their educational attainment, career prospects, social interactions, and well-being (8, 9). These adverse consequences are amplified among children from ethnic minorities resulting in even greater disadvantages compared to their Dutch counterparts (10).
Current obesity prevention interventions have shown limited to non-existing benefits for ethnic minority children from low-socio economic status (SES) (11, 12). Non-western ethnic minority children in the Netherlands, including those of Turkish background, often have lower SES (13, 14). However, SES alone doesn’t entirely account for COO disparities among Dutch and ethnic minority children. (12, 15). Cultural and environmental factors also appear to be influential (6).

The “Wholy” – Approach Intervention as a Solution

Addressing obesity’s complex nature generally requires a multilevel approach that considers individual, familial, institutional and environmental factors (16). Studies show that – contrary to person-based interventions (e.g., health-educational classes) – school-based interventions addressing a child’s environment, such as providing healthy snacks or water stations, prove significantly more effective in reducing children’s body mass index (BMI) in cases of COO, and in enhancing health-related behaviours, and quality of life (16-21). However, these studies do not target COO prevention in ethnic minorities, neglecting cultural factors. Cultural adaptation to the intervention are suggested to increase its acceptance, as well as its effectiveness in more vulnerable population groups, such as ethnic minorities (18).

Study Design & Timeline

How does it fit into HSRI theme?

Our grant proposal aligns with the HSRI theme of “Adaptive Societies, Organizations, and Workers” by addressing the complex challenge of childhood obesity within ethnic minority populations. As suggested by Bono and Matranga (31), advocating for a healthy lifestyle within the most disadvantaged socioeconomic classes represents a strategic approach to enhance the overall health of the entire population. Through the culturally tailored “Wholy”-Approach Intervention targeted at individual, familial, school, and community level, we strive to
a) promote healthier behaviors among Dutch-Turkish children,
b) reduce social inequalities beginning at the risk of obesogenic behavior in the Netherlands, and
c) enhance the adaptability of schools and communities to address the new challenge of COO in ethnic minority populations, living in the Netherlands.

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