Childhood Obesity in Ghent, Belgium

Community health care centre (WGC) ‘De Brugse Poort’

By: Grace Hoffman and Vanessa Torres

Personal Objectives Grace: Obesity, both in childhood and adulthood, significantly increases the risk of developing life threatening diseases such as heart disease, stroke, and cancer. By two weeks, I will obtain knowledge on the current status of childhood obesity in children aged 5-12 living in Ghent, Belgium and how preventing this health issue can contribute to increasing the life-expectancy and quality of life of this population as they age.

Vanessa: By the end of my two week international rotation, I will have an increased understanding of the relationship between the Belgian culture and how it affects health outcomes and health-related behaviors with regards to childhood obesity (ages 5-12) and palliative care in Ghent, Belgium.

Background Information ● Belgium is a small country in west Europe. It is located between France, Germany

and The Netherlands. ● The capital city of Belgium is Brussels ● Total population: According to the World Health Organization, the total

population in 2016 was 11.4 million people (WHO, 2016). ● Median Income: The net national income is 37,970 US dollars● Poverty level: 15.3% of Belgian population lives below the poverty line. ● Education level: Nationally, 46% of 25-34 year-olds have attained tertiary

education (OECD, 2018). ● Major sources of employment:

○ Service sectors: Banking, tourism, legal, media ○ Industry sector: textiles, engineering, car assembly, chemicals

Background Information ● Belgium is a parliamentary democracy under a constitutional monarchy. Belgium is a part of the European

Union. ● Ministry/Department of Education: Responsible for development, implementation and evaluation of

policy, encourages knowledge and funds scientific research. ● Ministry of Health: Responsible for protecting and promoting public health.

● A unique cultural health belief in Belgium is the right to euthanasia for physical or mental suffering that is no longer treatable.

● There are notable health disparities among different groups of people in Belgium. Most Belgians report being in good health, but disparities by income group are large.

○ According to the World Health Organization (2017), people in Belgium with higher socio-economic groups have almost 20 additional healthy life years compared to people in lower socio-economic groups.

○ People in lower socio-economic groups are three times more likely to be obese (WHO, 2017). ● Disparities exist in the prevalence of chronic diseases by education level as well, with the prevalence of

chronic respiratory diseases twice as high among people with the lowest level of education, compared with those with the highest level of education (OECD, 2017).

District Health Center of "De Brugse Poort"Community site: Wijkgezondheidscentrum (WGC) Brugse Poort - Literally translated to District Health Center of ‘De Brugse Poort’ Neighborhood

● Total population of Ghent: 260,341 ● Age:

○ 0-14: 16.2% ○ 15-64: 67.%○ 65+: 16.7%

● Gender ratio: 50.2% males, 49.8% females ● Income/poverty level of the population group: Of the Belgian population, 15% lives in poverty. There are 20.8% of households

with children that are at risk for poverty (Statbel, 2017). ● Educational level: Ghent is surrounded by 5 universities, thus a large proportion of the Ghent population comprises of students

attending these Universities. ● Cultural health beliefs and behaviors:

○ In general, the people of Belgium walk significantly more than those living in the U.S. This is largely due to the widespread use of public transportation and lack of cars.

○ Another significant health belief is that of euthanasia. ● Specific health disparities noted:

○ Low education levels and low income ■ Lead to higher smoking rates, excessive alcohol consumption and obesity (European portal for action on health

inequalities, 2010).

Top 5 Health Issues in US1. Ischemic heart disease

2. Alzheimer’s disease

3. Lung cancer

4. Stroke

5. COPD

(IHME, 2017)

Mortality 1. 186 deaths per 100,000

2. 29 deaths per 100,000

3. 47 deaths per 100,000

4. 43 deaths per 100,000

5. 37 deaths per 100,000 (CDC, 2017)

Comorbidities 1. Cerebrovascular disease, heart failure, anxiety,

depression

2. Vascular disease, HTN, diabetes, obesity

3. COPD, heart failure, CAD

4. HTN, depression, cardiac-related diseases

5. Cardiac disease, osteoporosis, psychiatric

disease, diabetes (CDC, 2017)

Top 5 Health Issues in Belgium1. Ischemic heart disease

2. Stroke

3. Lung Cancer

4.Alzheimer’s disease

5.COPD and other respiratory diseases

(OECD, 2017)

Mortality 1. 61 deaths per 100,000

2. 38.7 deaths per 100,000 (CDC, 2017)

3. Unable to find statistics

4. Unable to find statistics

5. Unable to find statistics

Comorbidities 1.Cerebrovascular disease, heart failure, anxiety,

depression

2. HTN, depression, cardiac-related diseases

3. COPD, heart failure, CAD

4. Vascular disease, HTN, diabetes, obesity

5. Cardiac disease, osteoporosis, psychiatric disease,

diabetes (CDC, 2017)

Top 5 Health Issues in “De Brugse Poort” Wellness Center, Ghent, Belgium1. Heart disease

2. Stroke

3. Lung Cancer

4. Alzheimer’s

5. Respiratory disease (CDC, 2017)

Mortality 1.Cerebrovascular disease, heart failure, anxiety,

2. HTN, depression,

3.COPD, heart failure, CAD

4.Vascular disease, HTN, diabetes, obesity,

5. Cardiac disease, osteoporosis, psychiatric disease, diabetes

(CDC, 2017)

*Based on the data collected, we are inferring

national statistics regarding incidence and

comorbidities for Belgium are similar to those

seen in Ghent, specifically at the “De Brugse

Poort” Community Center.

0 1000000

Heart disease

Alzheimer's

Stroke

COPD

Lung Cancer

Incidence of health issues

Community Health Care Centre (WGC) 'De Brugse Poort' - At Risk PopulationIn Ghent, Belgium, there are approximately 40,000 children between the ages of 0-14. Through our health promotion plan we hope to reach at least 200-500 of these children between the ages of 5-12. We plan to target both boys and girls.

One of the main goals of the Community health care centre (WGC) ‘De Brugse Poort’ is to provide care for people of all age groups. Thus, this community group (children aged 5-12) might come together because this organization is a usual place of care for neighborhood residents of the community. Also, this organization is centrally located and is within 3 blocks of two elementary schools: Jenaplanschool De feniks and Sint Jan Baptistinstituut. It would be relatively easy for students of these schools to engage in activities at the center and for this organization to implement interventions at one of the schools due to the close proximity.

Health Issue: Childhood obesity According to the World Health Organization, among 8-year-olds living in Belgium, 22.1% of boys and 22.7% of girls were overweight and 8.1% and 6.3% were obese. Among 9-year-olds, 27.4% of boys and 27.1% of girls were overweight and 10.9% and 8.9% for boys and girls respectively, were obese (WHO, 2013).

The CDC states that nearly one out of five school aged children in the United States are considered obese. While the Belgian obesity rates are much lower, obesity is a growing epidemic (Omics International, 2018). Not only this, the Organisation for Economic Co-operation and Development (OECD) reported that obesity rates in Belgium were significantly higher than those in neighboring countries such as the Netherlands and France (OECD, 2017). Healthy people 2020 objectives including Nutrition and Weight Status directly addresses obesity and health promotion related to preventing overweight/obesity in all populations. Furthermore, Good Health and Well-Being is a Sustainable Developmental Goal working to ensure healthy lives at all ages.

Health Promotion to Address Obesity ● Obesity is a growing epidemic in Belgium.

○ Over 25% of 9-year old children in Belgium are considered overweight, and 10% were considered obese (WHO, 2013).

○ Obesity is linked to life-threatening diseases such as heart disease, storke, and cancer (“Obesity”, 2019). ○ Associated with higher mortality, especially for those with comorbidities such as diabetes, heart disease and sleep

apnea (Abdelaal, le Roux, & Docherty, 2017). ○ Many of the patients we interacted with during our clinical suffered from these diseases, and thus required

palliative/end-of-life care.

● Many of the schools in Belgium teach about physical health and diet in their health and physical education courses. ○ Organizations such as One Mile a Day project and Start-to-Run speak to children about healthy living and

encourage physical exercise (“Brugse Poort Walks”, 2019). ○ The ‘De Brugse Poort’ community center also implements educational teaching about diet and physical exercise to

its members.

● Vital statistics on the health of children living in Ghent and Belgium overall are a strong indicator of the growing health issue of obesity and helped to lead nurses and others to understand this was a growing health need in the community.

Other factors, environment, modifications ● Factors that might negatively impact children's ability to be successful:

○ Inappropriate health-related behaviors such as poor diet and sedentary lifestyle ○ Decreased motivation, lack of parental support, poor quality of housing and schools, negative family processes, and

poor peer influences. ○ Culture can affect a child’s ability to be successful. For example, some cultural routines include eating certain types of

foods that are unhealthy (National Research Council, 2004). ○ Children and adults with lower socioeconomic statuses may have a higher likelihood of participating in unhealthy

lifestyle behaviors and overall show less adherence to medical regimens (WHO, 2017). ● The environment requires a multi-sectoral approach, because social and environmental factors have a big influence on the

population’s health. ○ These factors include lack of community safety.

■ Most roads did not have a designated bike lane, people did not wear helmets, speed limits were not posted, and cross walks were not clearly marked in some areas. This makes walking/running as physical exercise difficult.

○ A multi-sectoral approach would include partnering with various stakeholders such as the public education system and the WGC ‘De Brugse Poort’.

■ Involve community health education and empowerment, prevention efforts in multiple settings (schools), media partnership, with greater involvement of the society and the public sector.

● Other modifications to promote learning in this population will include providing one-on-one learning for children and families and creating learning material that accommodates their learning needs.

Assumptions and External Factors ● 3 Assumptions

○ Members of the school (teaches, nurses, administration) will be supportive of implementation efforts and volunteer time to help implement certain programs and educational services.

○ One wellness coordinator will be able to successfully carry out projects on own per school. ○ Students will have motivation to participate in activities offered

● External Factors: ○ Social/Cultural - Will these interventions work cross-culturally? And will the community welcome

change? ○ Natural Constraints - Will weather interfere with ability to build new physical infrastructure in

timely manner? ○ Political - Will educational school board support initiatives to improve the health and wellbeing of

students? Will they be willing to consider changes to school lunch menu?

Conclusions/Suggestions Overall, overweight and obesity is becoming an increasing problem in children living in developed countries, namely Belgium. Thus, our community health intervention project focused on formulating a health promotion plan focusing on targeting the health issue of obesity in children aged 5-12.

Throughout our process, we researched current statistics of the country regarding top causes of death. Heart disease and stroke were top causes of death both in the U.S. and Belgium; both of which are ten times more likely to be present in a person who is overweight or obese (“Effects of Obesity”, 2019).

Addressing obesity, through primary, secondary and tertiary interventions can improve the lives of children as well as have an impact on the community as a whole. We believe implementing interventions into areas in which students and children are most influenced can greatly affect the success of said intervention. Thus, our project included implementing activities and education at the primary school level, as well as providing education and information to parents at health fairs so they have the resources to carry out changes at home.

Most significant professional experience Grace: My most significant professional experience involved working and collaborating with those of different cultures. Every healthcare professional (I worked mostly with OTs as seen in this picture) and patient we interacted with were either Dutch, French or German. We had to quickly learn how to adapt to a new culture, communicate without verbal language, and collaborate effectively with interprofessional team members in order to best serve the patient population. These skills are all invaluable to us as nurses.

Vanessa: My most significant professional experience was learning about end-of-life and palliative care. Before this trip, I had trouble accepting that death was part of life and it was very hard for me to think that I would face this issue often as a nurse. I learned that while death is inevitable, we as nurses can make a big impact on someone’s last moments of life. I learned about how the smallest gestures such as a patients favorite meal or a hand massage (as pictured) can mean so much to them. I gained cultural awareness that I will be able to use throughout my career as a professional nurse.

Most significant personal experience

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