Kliniese intervensieprogramme

Kliniese intervensieprogramme maak gebruik van ‘n verskeidenheid komponente waaronder fisieke aktiwiteit, dieetaanpassings en gedragsmodifikasie wat aangebied word deur opgeleide medici om kinderobesiteit te behandel. Hierdie tipe intervensieprogram word in noue samewerking met die ouers aangebied (Eneli et al., 2008:130). Die betrokkenheid van ouers in die voorkoming en ook behandeling van obesiteit is van kardinale belang soos uitgelig deur die resultate van Golan en medewerkers (2006:1008) se studie, wat toon dat wanneer slegs die ouer betrek word in die intervensie die bywoningsyfer en die langtermynvoordele groter is as wanneer slegs die obese kind geteiken word. Die ―Kids N Fitness‖ is ‘n multikomponent (voeding-, oefen- en gedragsmodifikasie) familie- gesentreërde buite-pasiënt intervensieprogram om gewigstoename in oorgewig kinders en adolessente (sewe- tot 17-jaar) te verlaag (Dreimane et al., 2007:159). Proefpersone het na afloop van die 12-week program betekenisvolle verlagings in gewigstoename getoon, terwyl verbeteringe in emosionele welstand en gedrag positief met gewigsverlies gekorrelleer het. Nemet et al. (2005:445) het die effek van ‘n dieet-, gedrags-, en fisieke aktiwiteit gekombineerde intervensie op die liggaamsgewig, LMI en fiksheid van obese kinders en adolessente nagevors. Liggaamsgewig sowel as LMI het betekenisvol verlaag en uithouvermoë het betekenisvol verhoog na deelname aan die program vir ‘n tydperk van drie maande. Obese kinders wat volgehou het met die program vir ses maande se LMI het steeds afgeneem en hul uithouvermoë het steeds toegeneem, terwyl die liggaamsgewig en LMI van obese kinders wat die program gestaak het na drie maande, betekenisvol toegeneem en hul uithouvermoë afgeneem het. Die navorsers het ook gevind dat die aantal ure wat die kinders spandeer het aan televisiekyk verminder het na afloop van die program.

Die ―mind, exercise, nutrition and diet (MEND)‖ program is twee keer per week vir ‘n tydperk van drie maande by ‘n sportkompleks in Londen aangebied. Elf obese kinders (sewe- tot 11-jaar) het aan die gedragsmodifikasie, fisieke aktiwiteit en voedingsvoorligting program deelgeneem. LMI, middelomtrek, kardiovaskulêre fiksheid en selfbeeld het betekenisvol verbeter na afloop van die drie maande intervensietydperk. Verder het al die veranderlikes (behalwe LMI) steeds betekenisvol verbeter na ‘n opvolgperiode van drie maande (Sacher et al., 2005:4).

In ‘n ander studie waar obese seuns en meisies (gemiddelde LMI van 33.4kg/m2_{) met ‘n gemiddelde}

(Knöpfli et al., 2008:123). In ‘n kliniese eksperimentele studie deur Weigel en medewerkers (2008:372) op 73 Duitse obese kinders (sewe- tot 15-jaar) het die eksperimentele groep voordele ten opsigte van LMI, vetmassa en sistoliese bloeddruk in vergelyking met die kontrolegroep getoon na blootstelling aan ‘n fisieke aktiwiteit, voedingsvoorligting en hanteringstrategie-intervensie, twee maal per week, vir 12 maande. Die bevindinge van Snethen en medewerkers (2006:54) bevestig dat ‘n kombinasie van dieet, fisieke aktiwiteit en gedragsveranderinge effektief is in die behandeling van oorgewig en obesiteit by kinders. Soortgelyke navorsing (Freiburg Intervention Trial for Obese Children) op Duitse obese kinders met ‘n gemiddelde ouderdom van 10.5-jaar, bevestig ‘n afname in LMI en ‘n toename in fisieke fiksheid na deelname aan ‘n interdissiplinere, buite-pasient program vir ‘n tydperk van agt maande (Korsten-Reck

et al., 2005:358).

Eliakim en medewerkers (2002:451) het die effek van ‘n drie- en ses maand dieet-, gedrags- en oefenintervensie op die liggaamsmassa, LMI en fiksheid van 177 obese kinders (ses- tot 16-jaar) ondersoek. Liggaamsmassa en LMI het betekenisvol verlaag en kardio-respiratoriese uithouvermoë het betekenisvol toegeneem na afloop van die drie maande intervensie. Die navorsers het verder gevind dat obese kinders wat vir ses maande deelgeneem het aan die program hierdie veranderinge gehandhaaf het in teenstelling met obese kinders wat nie aan die ses maande intervensie deelgeneem het nie en wat toenames in liggaamsmassa en LMI en ‘n afname in kardio-respiratoriese uithouvermoë getoon het.

2.9 Samevatting

Die voorafgaande literatuuroorsig het eerstens ten doel gehad om die voorkoms van oorgewig en obesiteit onder jong kinders in die diverse bevolkingsamestelling van Suid-Afrika toe te lig binne die konteks van wêreldwye tendense, asook om geslag- en rasverskille uit te lig. Na deeglike bestudering van die literatuur is dit duidelik dat die voorkoms van oorgewig en obesiteit by kinders en adolessente toeneem teen ‘n kommerwekkende tempo met gepaardgaande gesondheidsverwante aspekte. Dit blyk verder dat meisies in hierdie ouderdomsgroep meer geneig is tot oorgewig en obesiteit as seuns. Die literatuuroorsig het verder duidelike rasverskille ten opsigte van die voorkoms van oorgewig en obesiteit na vore gebring. Wat die Suid-Afrikaanse situasie betref, blyk dit dat die blanke bevolking die hoogste voorkoms van oorgewig en obsiteit toon, gevolg deur die Indiër-, swart- en kleurling bevolking.

Die literatuuroorsig toon verder dat daar verskeie eksogene- en endogene oorsake is vir die hoë voorkoms van oorgewig en obesiteit by kinders en adolessente, alhoewel eksogene oorsake die grootste bydraende faktor blyk te wees. ‘n Oormatige inname van kalorieë wat nie gepaard gaan met ‘n toename in energieverbruik en ‘n verlaging in sedentêre gedrag nie, word beskou as die hoofoorsaak van die hoë voorkoms van oorgewig en obesiteit by kinders.

‘n Verdere aspek wat in die voorafgaande literatuuroorsig ondersoek is, is die gesondheidsverwante aspekte verbonde aan oorgewig en obesiteit. Oorgewig en obesiteit by kinders en adolessente word geassosieer met verskeie kardiovaskulêre siektestoestande waaronder hipertensie, asook metaboliese afwykings soos Tipe II diabetes mellitis. Daar is verder gevind dat oorgewig en obese kinders ‘n lae selfpersepsie het en dikwels ook aan ‘n swak selfbeeld lei. Daar blyk ‘n stigma aan oorgewig en obese kinders te kleef, wat tot depressie en selfs selfmoord kan lei. ‘n Ander gevolg van oorgewig en obesiteit is dat die kinders se motoriese en fisieke ontwikkeling daaronder ly wat weer verreikende gevolge inhou vir sportdeelname en fisieke aktiwiteit.

Hierdie verbande tussen motoriese en fisieke ontwikkeling en oorgewig en obesiteit is meer breedvoerig bespreek in die literatuuroorsig. Alhoewel literatuur en studies hieroor beperk is, blyk daar kontroversie te bestaan oor oorgewig en obesiteit se effek op sekere motoriese vaardigheidskomponete, waaronder manipulasie-koördinasie aktiwiteite soos die vangvaardigheid. Navorsingsbevindinge, alhoewel skaars, toon dat oorgewig en obesiteit ‘n negatiewe verband toon met motoriese vaardigheidskomponete naamlik liggaamskoördinasie wat balansaktiwiteite insluit, sowel as ratsheid-aktiwiteite. Weinig literatuur kon gevind word om moontlike verbande met fynmotoriese kontrole aktiwiteite te bevestig.

Navorsingsbevindinge bevestig egter dat gesondheidsgerigte fisieke fiksheidkomponente soos spierkrag, spieruithouvermoë, kardio-respiratoriese uithouvermoë en liggaamsamestelling negatiewe verbande toon met die voorkoms van oorgewig en obesiteit by kinders. Soepelheid van die liggaamspiere blyk egter nie beïnvloed te word deur oorgewig en obesiteit nie.

Die literatuuroorsig het laastens gepoog om die omvang en aard van verskillende intervensieprogramme op oorgewig en obesiteit by kinders te bepaal. Dit blyk dat multidissiplinêre intervensies wat ‘n fisieke aktiwiteit-, voeding- en gedragskomponent insluit, die beste resultate lewer vergeleke met studies wat slegs ‘n enkele aspek regstel. Verder kan die gevolgtrekking gemaak word dat skoolgebaseerde intervensieprogramme effektief is in die voorkoming van oorgewig en obesiteit deur die fisieke aktiwiteitsvlakke van kinders te verhoog en om gesonde eetgewoontes te kweek. Die behandeling van reeds gevestigde obesiteit is egter ‘n meer komplekse probleem en vereis meer intensiewe behandeling. Die noodsaaklikheid van ouerbetrokkenheid word egter oor die hele spektrum van obesiteitsintervensieprogramme beklemtoon.

Met hierdie literatuurbevindinge as agtergrond sal die metode en resultate van die studie vervolgens in Hoofstukke 3, 4, 5 en 6 bespreek word.

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