Childhood Obesity

Summary of Clinical Issue: Childhood Obesity

Childhood obesity is one of the major public health issues whose prevalence is high among young people living in the 21st century. According to the World Health Organization (2021), more than 340 million children and adolescents between the age of 5 and 19 were either obese or overweight by the year 2016. A child is regarded as being obese if his or her body weight is higher than the healthy weight appropriate of his or her height and age (Cheung et al., 2016). Although childhood obesity was once considered to be a problem of high-income countries, its prevalence in low and middle income countries is growing steadily. The condition arises when an energy imbalance occurs between expended and consumed calories.  

Childhood obesity predisposes children to various chronic conditions, including diabetes, cardiovascular diseases, musculoskeletal disorders, asthma, hypertension, and certain cancers (McGrath, 2017; Di Cesare et al., 2019). The condition also leads to psychological health problems such as anxiety, depression, and low-self-esteem (Di Cesare et al., 2019). Childhood obesity as well increases the risk of developing adulthood obesity.  Addressing childhood obesity and the chronic health problems associated with it is often costly. For instance, the United States spends over $ 14 billion in a year on medical costs of the condition (McGrath, 2017). Therefore, it is necessary for nurse practitioners to identify various patterns associated with childhood obesity in order to come up with appropriate interventions that can be used to combat the health problem.

PICOT Question

Among obese children and adolescents (P) is physical activity more effective than (I) health education (C) in promoting weight loss (O) within a period of six months (T)?

Quantitative and Qualitative Articles Supporting the Nursing Practice Problem, and PICOT Question   

Quantitative Articles

Article 1: Tan, S., Chen, C., Sui, M. & Xue, L. (2016). Exercise Training Improved Body Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children With Obesity or Normal Body Mass.  Pediatric Exercise Science, 29 (2): 245-253. https://doi.org/10.1123/pes.2016-0107 

Article 2: Cradock, A. L., Barrett, J. L., Kenney, E. L., Gile, C. M., Ward, Z. J., Long, M. W., Resch, S. C., Pipito, A. A., Wei, E. R. & Gortmakers, S. (2017). Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood. Preventive Medicine, 95: S17–S27. https://doi.org/10.1016/j.ypmed.2016.10.017   

Article 3: Adab, P., Pallan, M. J., Lancashire, E. ., Hemming, K., Frew, e., Barret, T., Bhopal, R., Cade, J. E., Canaway, A., Clarke, J. L., Daley, A., Deeks, J. J., Duda, J. L., Ekelund, U., Gill, P., Griffin, T., McGee, E., Hurleey, K., Marin, J., Parry, J., Passmore, S. & Cheng, K. K. (2018). Effectiveness of a childhood obesity prevention programme delivered through schools, targeting 6 and 7 year olds: cluster randomised controlled trial (WAVES study). BMJ, 360: K211.  10.1136/bmj.k211 

Table 1

Literature Evaluation for Quantitative Research Articles

Evaluation CriteriaArticle 1Article 2Article 3
How does the article relate to the PICOT question?The article is based on a study that investigated the role of exercise training in promoting physical exercise among 5 year-old obese children. The current article derives from a study that sought to determine the cost-effectiveness of programmatic and policy intervention used to promote physical activity and prevent childhood obesity.This article is based on a study whose aim was to evaluate the effectiveness of family and school based healthy lifestyle programs in preventing obesity among children.
Quantitative, Qualitative (How do you know?)Is a quantitative study since data is analyzed using statistical analyses, and presented using mean and standard deviation The study is quantitative since data is presented using descriptive statistics.This article is quantitative since data was analyzed with the aid of statistical analysis.
Purpose StatementTo investigate effects of exercise training on obese and lean children who are five years old. To evaluate the cost-effectiveness of various national policies and programs in promoting physical activity for prevention of obesity in childhood.To compare the effectiveness of various school and family based lifestyle programs with usual practice in prevention of childhood obesity.  
Research QuestionBased on the effects of obesity on physical fitness and cardiovascular function among 5 year-old childrenDerived from the cost of different interventions and strategies used to foster physical activity among childrenBased on the efficacy of family and school based lifestyle programs for obesity prevention among children
OutcomeExercise training played a significant role in decreasing systolic blood pressure and heart rate responses in obese children.All the six interventions were found to be effective in increasing physical activity levels in children, and reducing obesity.No significant difference was noted between the groups compared in terms of anthropometric, physical activity, dietary, and other measurements.
Setting (Where did the study take place?)Tianjin City, in China.Child care, school, and after school settings in the United States.Primary schools of West Midlands, in the United Kingdom
SampleThe sample comprised 42 obese, and 62 lean children.90,000 youths participating in a health afterschool program, and 3.3 million children reached through active school days policies.1287 pupils from 53 schools.
MethodRandomized controlled trial.Microsimulation model.Cluster randomized controlled trial.
Key findings of the StudyIt was established that moderate intensity exercise training for ten weeks is an effective treatment for both obese and normal children aged 5 years.It was found that adopting appropriate and effective physical exercise interventions leads to prevention of obesity cases among children by increasing physical activity.The study established that use of experiential focused interventions in schools is less likely to have a positive impact in the prevention of childhood obesity. 
Recommendations of the ResearcherThe researcher suggests that future physical activity interventions should be accompanied with dietary records of participants.It is recommended that the interventions explored in the study can inform decision makers on what needs o be prioritized in terms of physical activity promotion and prevention of childhood obesity policies.The researcher recommends that there is need to ensure that proper interventions are adopted across multiple environments and sectors.

Qualitative Articles

Article 1: Bergstrom, H., Sundblom, E., Elinder, L. S., Norman, A. & Nyberg, G. (2020). Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study. The Journal of Primary Prevention, 41: 191–209.

Article 2: Sundar, T. K. B., Londal, K., Lagerlov, P., Galvin, K. & Helseth, S. (2018). Overweight adolescents’ views on physical activity – experiences of participants in an internet-based intervention: a qualitative study. BMC Public Health, 18: 448.10.1186/s12889-018-5324-x

Article 3: Lindsay, A. C., Wallingon, S. F., Lees, F. D. & Boulevard, M. L. (2018). Exploring How the Home Environment Influences Eating and Physical Activity Habits of Low-Income, Latino Children of Predominantly Immigrant Families: A Qualitative Study. Int. J. Environ. Res. Public Health, 15 (978). 10.3390/ijerph15050978

Table 2

Literature Evaluation for Qualitative Research Articles

Evaluation CriteriaArticle 1Article 2Article 3
How does the article relate to the PICOT question?The article examines how parental support programs help to promote physical activity, and other health-related behaviours used to prevent childhood obesity.This article highlights physical activity experiences of overweight adolescents.The current article looks at the role of home environment in promoting physical activity and eating habits among children from low-income communities.
Quantitative, Qualitative (How do you know?)The study is qualitative since data was collected using qualitative methods such as focus group discussions (FGD), and interviews. Data was also analyzed using qualitative content analysis.Is qualitative since he collected data was analyzed using qualitative content analysis.It is qualitative as it used FGDs to collect data.
Purpose StatementTo explore facilitators and barriers to implementation of parental support program for promotion of healthy dietary habits and physical activity in school.To explore the experiences of physical activity among 13-14 year-old overweight adolescents.To explore the beliefs, parenting practices, and parenting styles of low-income Latino parents associated with eating and physical activity behavior of their children.
Research QuestionBased on experiences and views of school principals and nurses concerning parental support programs for promoting physical activity for preventing childhood obesity within a school settingBased on the views of adolescents on physical activity.Based on parents’ perspectives on children’s physical activity and eating behaviors.
OutcomeParental support programs for promotion of physical activity in a school environment helped to address childhood obesity if they are well implemented.Physical activity in the form of sports and physical education helped to promote good health.Parents recognized that physical activity and healthy eating are important for their children.
Setting (Where did the study take place?)School setting in Sweden.Norway.Low-income Latino families, in the United States.
Sample17 informants21 adolescents (15 girls, 6 boys)33 respondents
MethodInductive qualitative designPost-intervention research.Exploratory research n
Key findings of the StudyThe study established that implementation of parental support programs for promoting physical activity among children is influenced by additional funding, political support, external guidance, and integration of the program into the routines of school.It was found that adolescents associate physical activity with physical education and organized sport.The study found that a supportive home environment plays a crucial role in promoting healthy physical activities and eating habits necessary for disease prevention and health promotion among children.
Recommendations of the ResearcherThe researchers recommend that the findings of the study can be used to provide guidance on implementation of health promotions interventions within a school context.This study recommends that further research into what can be done to increase participation in physical activity among children and adolescents is necessary.It is recommended that the study provides useful information on what parents can do in home environments to support their children’s eating habits and physical activities

References

Adab, P., Pallan, M. J., Lancashire, E. ., Hemming, K., Frew, e., Barret, T., Bhopal, R., Cade, J. E., Canaway, A., Clarke, J. L., Daley, A., Deeks, J. J., Duda, J. L., Ekelund, U., Gill, P., Griffin, T., McGee, E., Hurleey, K., Marin, J., Parry, J., Passmore, S. & Cheng, K. K. (2018). Effectiveness of a Childhood Obesity Prevention Programme Delivered through Schools, Targeting 6 and 7 Year Olds: Cluster Randomised Controlled Trial (WAVES study). BMJ, 360: K211.  10.1136/bmj.k211 

Bergstrom, H., Sundblom, E., Elinder, L. S., Norman, A. & Nyberg, G. (2020). Managing Implementation of a Parental Support Programme for Obesity Prevention in the School Context: The Importance of Creating Commitment in an Overburdened Work Situation, a Qualitative Study. The Journal of Primary Prevention, 41: 191–209.

Cheung, P. C., Cunningham, S. A., Narayan, K. V., & Kramer, M. R. (2016). Childhood Obesity Incidence in the United States: A Systematic Review. Childhood Obesity, 12 (1): 1-11.

Cradock, A. L., Barrett, J. L., Kenney, E. L., Gile, C. M., Ward, Z. J., Long, M. W., Resch, S. C., Pipito, A. A., Wei, E. R. & Gortmakers, S. (2017). Using Cost-Effectiveness Analysis to Prioritize Policy and Programmatic Approaches to Physical Activity Promotion and Obesity Prevention in Childhood. Preventive Medicine, 95: S17–S27. https://doi.org/10.1016/j.ypmed.2016.10.017  

Di Cesare, M., Soric, M., Bovet, P., Miranda, J., Bhutta, Z., Stevens, A. S., Laxmaiah, A., Kengne, A. & Bentham, J. (2019). The epidemiological burden of obesity in childhood: a worldwide epidemic requiring urgent action. BMC Med, 17 (212). https://doi.org/10.1186/s12916-019-1449-8

Lindsay, A. C., Wallingon, S. F., Lees, F. D. & Boulevard, M. L. (2018). Exploring How the Home Environment Influences Eating and Physical Activity Habits of Low-Income, Latino Children of Predominantly Immigrant Families: A Qualitative Study. Int. J. Environ. Res. Public Health, 15 (978). 10.3390/ijerph15050978

Linnard-Palmer, L. (2017). Pediatric nursing care: A concept-based approach. Burlington, MA : Jones & Bartlett Learning.

McGrath, S. M. (2017). Childhood Obesity Comorbitities Awareness Hospital-based Education. (Doctoral Dissertation), Walden University, Minneapolis, Washington.

Sundar, T. K. B., Londal, K., Lagerlov, P., Galvin, K. & Helseth, S. (2018). Overweight Adolescents’ Views on Physical Activity – Experiences of Participants in an Internet-Based Intervention: A Qualitative Study. BMC Public Health, 18: 448.10.1186/s12889-018-5324-x

Tan, S., Chen, C., Sui, M. & Xue, L. (2016). Exercise Training Improved Body Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children With Obesity or Normal Body Mass.  Pediatric Exercise Science, 29 (2): 245-253. https://doi.org/10.1123/pes.2016-0107

Wolrld Health Organization (2020). Obesity and overweight. Retrieved from https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight

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