Obesity has become a global epidemic in the 21st century. In children, this health condition may have lasting implications because one may suffer from different diseases later in life. According to the available research, diabetes type II and coronary heart disease start in childhood, especially in overweight children (Sahoo et al., 2015). However, this problem can be prevented and managed through healthy living and leading active lifestyles. This paper defines obesity and highlights its epidemiology, clinical presentation, complications, and diagnosis.
The basic definition of childhood obesity is having excess body fat (BF) that presents health risks to the involved individuals. However, different definitions have emerged based on disparate contexts. Body mass index (BMI) is one of the parameters used to define this condition. According to Sahoo et al. (2015), when a child or a teenager has a BMI equal or greater than the 95th percentile, he or she is termed obese.
The Spirit of Inquiry Ignited
The prevalence of childhood obesity has been increasing consistently over the years. Agha and Agha (2017) note that from the 1980s to 2015, the number of children with obesity increased by approximately 50 percent. Currently, more than 45 million children around the world are overweight (Agha and Agha, 2017). In the United States, 12 to 19-year olds have a prevalence rate of 20.5 percent, while that of 6 to 11-year olds is at 17.5 percent. In children between 2 and 5 years, the rate stands at 8.9 percent (Agha and Agha, 2017).
Overweight children have a different clinical presentation of the condition. However, the common ones include stretchmark on the abdomen and hips, deposition of fatty tissue in different body areas, and thick and velvety skin in disparate parts, especially around the neck (Sahoo et al., 2015). Others include sleep apnea, gastroesophageal reflux, shortness of breath when active, delayed puberty in boys, early puberty in girls, and eating disorders.
Childhood obesity may have physical and socio-emotional complications. Physical complications include type II diabetes, metabolic syndrome, high cholesterol, hypertension, asthma, sleep disorders, and non-alcoholic fatty liver disease (NAFLD) (Sahoo et al., 2015). In adulthood, obese children are highly likely to suffer from different health complications. Socio-emotionally, the complications of this condition include low self-esteem, depression, and behavior and learning problems (Sahoo et al., 2015). Additionally, such children are likely to be bullied.
Obesity in childhood is diagnosed by the BMI index to determine the percentile ranking. BMI is determined by measuring one’s weight in relation to height. The score obtained is an indication of the amount of body fat that a child or a teenager has at a given time (Agha & Agha, 2017). As mentioned earlier, if the BMI index is equal to or greater than the 95 percentile, a child is considered obese. In this case, one may undergo screening to test for conditions such as diabetes, hypertension, high cholesterol, fatty liver, and menstruation in girls.
The PICOT Question Formulated
PICOT Question: In school-age children (P), does 30 minutes of school-based physical activity (I), compared with no physical activity (C), decrease BMI and childhood obesity risks (O) within a one-year period (T)?
Search Strategy Conducted
CINAHL, Cochrane Library National Guidelines Clearinghouse, PubMed, and TRIP databases were used to find relevant scholarly articles. The following keywords were utilized to find the required information: childhood obesity, obese children, weight status, physical activity in obesity, et cetera. Levels I, IV, and V evidence was obtained.
Critical Appraisal of the Evidence Performed
|Citation||Design||Sample size: Adequate?||Major Variables:
|Study findings: Strengths and weaknesses||Level of evidence||Evidence Synthesis|
|Agha, M., & Agha, R. (2017). The rising prevalence of obesity: Part A: Impact on public health. International Journal of Surgery, 2(7), 1-6.||Literature review. Taxonomy||53 authoritative sources are used. Adequate sample size||IV: age, gender, ethnicity
|S: Allows comparing different populations regarding the prevalence of obesity. Discusses its influences on life expectancy, employment, quality of life, associated diseases, and economic costs.
W: Does not include any original research study.
|Level V||In the UK, the number of obese population increases grammatically, which increases the number of people who have health issues (blindness, cancer, kidney issues, etc.). Childhood obesity leads to increased mortality in this population.|
|Avis, J., Cave, A., Donaldson, S., Ellen, C., Holt, N., Jelinski, S.,…, Ball, G. (2015). Working with parents to prevent childhood obesity: Protocol for a primary care-based e-health study. JMIR Research Protocols, 4(1), e35.||Randomized control trial. Multi-method study. Managed in 3 phases: development, refinement, testing.||200 parents of children of both genders (5-17 years old)
30 healthcare professionals
Adequate sample size
|IV: parents of children
DV: obesity rate
|S: The study focuses on existing health system gaps and provides parents with valuable information.
W: Research can be modified. Feasibility parameters and the effectiveness of the intervention will be revealed further.
|Level I (when accomplished)||Online education of parents that lasts for less than an hour can show them how to encourage their children to maintain healthy lifestyles.|
|Hsieh, P.-L., Chen, M.-L., Huang, C.-M., Chen, W.-C., Li, C.-H., & Chang, L.-C. (2014). Physical activity, body mass index, and cardiorespiratory fitness among schoolchildren in Taiwan: A cross-sectional study. International Journal of Environmental Research and Public Health, 11(7), 7275-7285.||Cross-sectional study||1230 male and 1189 female children. Adequate size||IV: Age, gender, fitness, weight.
|S: Reveals the connection between physical activity in students, cardiorespiratory fitness, and obesity.
W: Self-reported data. Appropriate only to similar populations.
|Level IV||Children with obesity have poor cardiorespiratory fitness and are rarely involved in physical activities.|
|Muthuri, S. K., Wachira, L. J. M., Onywera, V. O., & Tremblay, M. S. (2014). Correlates of objectively measured overweight/obesity and physical activity in Kenyan schoolchildren: results from ISCOLE-Kenya. BMC Public Health, 14(1), 436-448.||Cross-sectional study||563 children (adequate sample size)||IV: age, physical activity, neighborhood environment, transportation
DV: body composition
|S: Reveals causes and risk factors of obesity in children
W: No direct measures of physical activity
|Level IV||The intensity of physical activity in children is often not enough. Parental education and socioeconomic status also matter.|
|Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: Causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187–192. doi.10.4103/2249-4863.154628.||Literature review||46 articles that focus on obese children||IV: factors that cause obesity: activity, environmental, socio-cultural, family, psychological.
DV: number of obese children
|S: The study reveals various factors that increase children’s risks of becoming obese. In addition to that, medical, socio-emotional, and academic consequences are identified. The provided information can be used to develop a guideline that should be used to prevent childhood obesity.
W: Even though epidemiological data is discussed, no primary research is developed.
|Level V||Childhood obesity is affected by the environment, lifestyle, and culture. It has adverse influences on kids’ health and well-being.|
Evidence Integrated with Clinical Expertise and Patient Preferences to Implement the Best Practice
In order to successfully translate the gathered evidence, it is essential to plan the intervention. The purpose of the proposed 30-minute school-based physical activity is to assist obese children in reducing their weight and also help healthy students to prevent similar health concerns. The consideration of the identified intervention is critical in terms of schools as students spend much time there, while they tend to be physically passive. Therefore, the creation of engaging physical activity tasks by school nurses seems to be a relevant option to address obesity. One more important purpose of this evidence-based project proposal is the evaluation of the intervention outcomes in the long-term period of one year. Ultimately, the PICOT question stated earlier in this paper should be answered as a result of the study.
For the given project proposal, the following clinical question may be posed: if a 30- minute school-based physical activity effective in reducing body mass index (BMI) and preventing obesity compared to no exercises in children?
In the mentioned PICOT question, a one-year period is mentioned as the timeframe for measuring the intervention. Based on the reviewed research studies, one may claim that the mentioned period is suitable for assessing the level of BMI reduction in children. Since weight is a factor that cannot be decreased rapidly, it is essential to maintain change within a one-year period and encourage school students to participate in physical activities.
Nurses and patients compose the key groups of stakeholders in the proposed evidence-based project. The role of the former is to introduce change, support it, and measure the outcomes. As for the latter, it is expected that school students will also be active in changing their activity patterns and becoming more willing to exercise. In other words, mutual understanding and efforts should be implemented. Among non-direct stakeholders, it is possible to mention init administrators and nursing managers who would coordinate the project.
The complex systems theory was selected for this project due to its potential to integrate several elements and ensure their most effective interaction in achieving the initial goal. In their recent study, Beets, Webster, Saunders, Huberty, and Healthy Afterschool Program Network (2013) elaborate on the idea of organizing the changing environment. Namely, the following elements are identified by the authors: child characteristics, afterschool activities, school nursing leadership, staff management, and external partnerships (Beets et al., 2013). It is of great importance to consider each of the given elements as they work in combination.
The proposed study may be regarded as experimental since the intervention implies the introduction of the intervention and further observation. In terms of the specified theoretical framework, an experimental design seems to be a relevant option. Physical activity will be an independent variable, while the dependent variable will be composed of children’s health outcomes. Such methods as surveys and interviews will be applied to collect the necessary data. It is anticipated to collect both qualitative and quantitative data; therefore, a mixed-method analysis will be utilized (LoBiondo-Wood & Haber, 2017). SPSS or ANOVA tools may be considered for the statistical analysis of the obtained information.
All sensitive information regarding children will be properly protected. Each of them will be assigned an ID to secure their names (LoBiondo-Wood & Haber, 2017). Parents of children will receive informed consent forms before their children participate in the experiment. Caregivers and nurses will be explained that this study is confidential, and it is prohibited to disseminate any data related to the project. In addition, protection measures will be complemented by encryption and storage of the collected information on the external device.
50 school-age children with obesity and those at risk of its development will be chosen for the study. Among the selection criteria, there will be age and increased BMI. The school setting will be used for providing physical activity and controlling the course of the project. Such a setting seems to be the most appropriate since children have the opportunity to exercise together with their classmates, thus being more involved. The procedures will involve the presentation of benefits of physical activity for children, preparation of interesting physical activity exercises, and subsequent monitoring. The last stage of the study implies that children will be asked to share their perceptions and attitudes regarding the intervention. At the same time, medical data will be analyzed to determine either positive or negative changes. One can suggest that BMI should be measured every three months as a control means.
Written plans and tables should be prepared with detailed procedures and expected outcomes. Nurses will present these tables to children to assist them in understanding how physical activity will be introduced. Also, such an instrument will provide the opportunity to pay attention to any suggestions expressed by children. For example, it may turn out that they would like to play volleyball instead of basketball that was offered by a nurse. Some changes may be considered to make the intervention more specific to the needs of the target population.
The outcome of Practice Change Evaluated
The main metrics that will be evaluated are a change in children’s BMI levels as well as the risk in those who were at higher risk of this disease. At the same time, students’ willingness to take part in the offered physical activity will be assessed based on interviews with them. The initial and ultimate stages of the intervention implementation will be compared. The achievement of the reduced weight will be regarded as a success. It is important to note that physical activities will be designed adequately since overstrain may be dangerous to children.
The evidence-based project results will be disseminated to nurses of the unit. Namely, nursing managers will receive written reports, and the direct participants of the study will discuss the outcomes in collaboration during the meeting. Parents of children will receive the results via email, and they will be free to ask any questions. Other schools may also request the results of the project to use it in their own settings in addressing obesity among school-age children.
In conclusion, the presented proposal focuses on planning the study regarding the role of physical activity in school in reducing obesity and preventing its development. The literature review revealed that this health concern is rather critical and should be addressed urgently. The mixed-method design and the complex systems theory were proposed as the framework for the study. It is expected that the implementation of a 30-minute physical activity in schools will reduce BMI in students in the period of one year.
Agha, M., & Agha, R. (2017). The rising prevalence of obesity: Part A: Impact on public health. International Journal of Surgery, 2(7), 1-6.
Avis, J., Cave, A., Donaldson, S., Ellendt, C., Holt, N., Jelinski, S.,… , Ball, G. (2015). Working with parents to prevent childhood obesity: Protocol for a primary care-based e-health study. JMIR Research Protocols, 4(1), 35-46.
Beets, M. W., Webster, C., Saunders, R., Huberty, J. L., & Healthy Afterschool Program Network. (2013). Translating policies into practice: A framework to prevent childhood obesity in afterschool programs. Health Promotion Practice, 14(2), 228-237.
Hsieh, P.-L., Chen, M.-L., Huang, C.-M., Chen, W.-C., Li, C.-H., & Chang, L.-C. (2014). Physical activity, body mass index, and cardiorespiratory fitness among school children in Taiwan: A cross-sectional study. International Journal of Environmental Research and Public Health, 11(7), 7275-7285.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing research-e-book: Methods and critical appraisal for evidence-based practice (9th ed.). St. Louis, MO: Elsevier Health Sciences.
Muthuri, S. K., Wachira, L. J. M., Onywera, V. O., & Tremblay, M. S. (2014). Correlates of objectively measured overweight/obesity and physical activity in Kenyan school children: Results from ISCOLE-Kenya. BMC Public Health, 14(1), 436-448.
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: Causes and consequences. Journal of Family Medicine and Primary Care, 4(2), 187-192.