question help

Obesity and Physical Activity in Teenagers

Dana Weisbrot

Chamberlain College of Nursing

NR505: Advanced Research Methods

August 2019

Obesity and Physical Activity

Obesity rates among teenagers in developed nations have moved up dramatically over the past 40 decades. During the same time several secular changes have combined to affect the demand for physical activity on daily basis, and numerous barriers of physical activity are evident. As a result, most teenagers do not meet acceptable public health requirements for physical activity. Accordingly, there is growing need for public health interventions to increase physical activity in teenagers. Successful implementation of such interventions can help in improving fitness and health, and reduce the prevalence of obesity plus overweight in young people. The purpose of this qualitative research is to assess whether overweight and obesity among teenagers be prevented or managed successfully through physical activity programs after six months.

Research Literature Support

Prevalence of Obesity among Adolescents

Adolescent obesity prevalence rates are increasing rapidly across the world. Deren et al. (2018), in a cross-sectional study of data from Ukraine children, found that younger people were more likely to be obese than older population. The researchers collected data from 13,739 Ukraine children aged between 6 and 18.9 years. Body weight measurement was performed using medical scales and participants’ height was measured using stadiometer, and the results were used to compute body mass index. The prevalence rate of obesity plus overweight among participants was 12.1%, 17.6%, as well as 12.6% based on the International Obesity Task Force reference, World Health Organization standard, and the United States Centers for Disease Control and Prevention, respectively. Obesity stood at 2.1%, 4.2%, as well as 3.6%, respectively.

Just as Deren et al, Jacob, Shiji and Savio (2016) found high prevalence of overweight and obesity among Indonesian adolescents. Using a cross sectional study of urban and rural school in Kochi city, the researchers analyzed various secondary data and recorded participants’ weight, height, age, plus sex. Out of 254 girls registered in a rural school, 8.74% were obese and 42.66% were overweight. Obesity and overweight were common among girls aged 12 years old at 6.06% and 12.1%, respectively. Out of the 220 girls registered in urban school, 11.08% and 49.9% were obese and overweight, respectively. Obesity and overweight were high among 13-year-old girls at 5.56% and 14.81%, respectively. Only 1.27% and 29.13% out of the 191 boys registered in rural school were obese and overweight, respectively. Obesity and overweight were mostly common in boys aged 14 years at 1.27% and 5.06%, respectively. More than 21.9% and 55.74% of 272 boys registered in urban school were obese and overweight, respectively. Obesity was high among boys aged 14 years. In as much as the researchers explored the impact of geographical location on obesity, the study did not explain the reasons for the difference in obesity prevalence between rural and urban dwellers.

In the United States, prevalence of obesity among adolescents varies according to race. Skinner, Ravanbakht, Skelton, Perrin and Armstrong (2018) found that White and Asian American teenagers have lower rates of obesity than other races. The study aimed at exploring the prevalence of obesity in United States’ children aged between 2 and 19 years from 1999-2016. The researchers reported a positive linear trend for obesity and overweight among children aged between 2 and 19 years old, most prominently among teenagers. Skinner et al. used the NHANES for years between 1999 and 2016 to calculate the participants’ age and sex specific body mass index. The study adds to other studies on obesity by detailing prevalence of obesity plus severe obesity by age, race, and ethnicity in a countrywide representative data. The study’s main shortcoming is that NHANES are usually repeated cross sections that do not allow the assessment of within-teenage changes over time.

Physical Activity and Obesity

The rising prevalence of obesity in teenagers is a major concern. Various studies have investigated the significance of physical activity to prevention of obesity in this population. According to Sundar, Londal, Lagerlov, Galving and Helseth (2018) overweight and obese teenagers are less physically active compared to their peers. The researchers explored physical activity experiences among overweight teenagers aged between 13 and 14 years old. Two qualitative post intervention interviews were, with a 9-month interval, were carried out with 21 teenagers, 15 girls plus 6 boys to examine short term and long-term implications. The researchers recruited research participants from 84 participants of the Yong & Active intervention group. Qualitative content analysis was used for data analysis. Research subjects associated physical activity with physical education classes as well as organized sports at schools, and a way for promoting good health plus attractive bodies. Most of the participants were concerned about their health, fitness, and future health. Having fun, socializing with friends, and mastering a physical activity promoted motivation to participate in sports. None of the teenagers highlighted the significance of informal active living in as far as their experiences of physical activity were concerned. The study adds to other research on obese teenagers’ experiences of physical activity. The research participants’ view is a reflection of opinions in society regarding physical activity and its significance for health. The main limitation of the study is that the selected research participants belonged to the Young & Active intervention and were already preoccupied with physical activity.

Whereas physical inactivity may be a major contributor to obesity epidemic, Gray et al. (2018) associate environmental factors with promotion or hindrance of physical activity. To examine the impact of cumulative environmental quality on the physical inactivity-obesity relationship, the researchers conducted a cross sectional study that linked Behavioral Risk Factor Surveillance System data at county level with the Environmental Quality Index across all counties in the United States. The county level association was estimated at 3,137 counties between 2009 age adjusted leisure time physical inactivity and 2010 age adjusted obesity from BRFSS across Environmental Quality Index tertiles using multi linear regression. In overall, the prevalence difference increased from best of 0.341 to worst of 0.645 Environmental Quality Index tertile. Similar trends were reported in men, with prevalence difference increasing from the best of 0.244 to worst of 0.601 quality environments. For women, the researchers reported an increase in prevalence difference from the best of 0.446 to worst of 0.655. Overall, Gray et al. found that poor environmental quality triggers the leisure time physical inactivity- obesity relationship. From the strength perspective, the study proves that any effort aimed at improving obesity through leisure time physical inactivity must consider the relationship between environmental quality and obesity. The primary shortcoming of the study is that BRFSS measures of leisure time physical inactivity and obesity are dependent on self reported data collected from random digit dialing. Specifically, weight is a sensitive issue that can be underreported.

Stankov, Olds and Cargo (2012) identified 35 barriers to physical activity among teenagers in a systematic review of qualitative studies on factors that turn adolescents off physical activities. From a search of articles published from 1950 to 2009 in electronic databases, the researchers identified 15 studies that met inclusion criteria. Bronfenbrenner’s approach to human development helped with the identification and synthesis of hindrances to physical activity. Stankov, Olds and Cargo integrated Miles and Huberman’s cross case analysis with thematic networking to synthesize personal, interpersonal, as well as environmental barriers for teenagers of different socioeconomic status as well as ethnicity, across learning institution setting plus general settings. In total 35 hindrances were identified, out of which 13 happened in physical activity situations in learning institution settings. At least 18 barriers were not associated with specific setting, while 4 barriers were common across the school setting and general contexts. Given that the researchers identified these barriers from studies that addressed issues such as mental health as well as victimization is poignant and illuminates the impact of physical activity and other aspects on their body weight. However, the study on impact of socioeconomic status on obesity was poor.

Vasconcellos et al. (2014), in a qualitative study on the relationship between physical activity and obesity, found direct relationship between physical activity and reduction of fat percentage and waist circumference. Also, physical activity leads to reduction in systolic blood pressure, total cholesterol, insulin levels, low density lipoprotein cholesterol, and significant changes in high density lipoprotein cholesterol, glucose, and diastolic blood pressure. The researchers reviewed analyzed trials examining the effect of physical activity on aerobic capacity, body composition, biochemical markers, endothelial functioning, muscle strength, and hemodynamic variables in obese adolescents. Vasconcellos et al (2014) searched PubMed, Scopus, SPORTDiscus, LILACS, and Web of Sciences for relevant reports on overweight individuals aged between 12 and 17 years. The study suggests that physical intervention may enhance physical fitness plus risk factors for cardiovascular diseases in overweight teenagers. However, the researchers focused on statistical significance of variations within or between groups, which can be affected by sample size plus variability.

Martin et al. (2018) posit that school plus community based physical activity programs as part of obesity prevention interventions can enhance executive functioning of children with obesity. The researchers aimed at assessing whether lifestyle interventions in areas of physical activity, behavioral therapy, diet, as well as sedentary behavior could improve school achievement, executive functions and future success of teenagers with obesity. To do so, Martine et al. searched MEDLINE, CENTRAL alongside 15 other databases for data and contacted researchers for unpublished data. For selection criteria, the researchers included randomized as well as quasi randomized controlled trials of behavioral efforts for weight management in children and teenagers with obesity or overweight. The study did not include children with medical conditions that affect weight status, cognitive functioning, plus school achievement. In addition, the study excluded self and parent reported data. Data extraction, assessment, and risk of bias were done through the GRADE approach. This led to inclusion of 18 studies of more than 2380 children and teenagers with obesity or overweight. Out of the 18 studies, 8 delivered physical activity programs, 7 combined physical activity interventions with healthy lifestyle education, and the remainder delivered dietary programs. The study was conducted in 10 different nations, with 2 taking place in preschool setting, 11 at elementary school aged children, 4 studies aimed at teenagers attending secondary schools, and 1 study including primary and secondary school aged children.

Analysis of physical activity interventions showed high quality evidence for enhanced mean cognitive executive functioning compared to standard practice. The intervention showed no statistically significant benefit impact in favor of mathematics, reading, and inhibition control. Analyses of physical activity programs combined with healthy lifestyle education showed no beneficial impact on average achievement across different subjects taught at school, reading achievement, inhibition control, and mathematics achievement. The researchers noted moderate variation in the average achievement across subjects favoring efforts aimed at improving school food programs compared to standard practice in teenagers with obesity, but not in overweight adolescents (Martin et al., 2018). The findings may help health and education specialists in making decisions related to promotion of physical activity plus healthy eating habits in schools. Obesity prevention studies in schools, community, as well as clinical settings should consider examining academic, cognitive, and physical outcomes. The major limitation of the study is that the researchers collected adverse events data from published records and included only a small sample of unpublished data. This affected the study’s ability to identify an intervention effect.

Physical Activity and Community

Studies have shown that built up environment can determine physical activity. Moore, Brinkley, Crawford, Evenson and Brownson (2012) found that children from urban areas are more physically active compared to their rural counterparts. The researchers conducted a study that whose objective was to determine if there are differences for body mass index moderate to vigorous physical activity between rural and urban adolescents. Also, the researchers aimed to determine if perceived plus objective measures of environmental supports for physical activity correlate with body mass index and moderate to vigorous physical activity in middle school urban as well as rural youth. Cross sectional analyses were carried out in 2012 on data gathered between December 2008 and May 2010 for more than 280 middle school teenagers from a rural county and a neighboring urbanized area. Neighborhood spatial variables were measured using a multivariate linear model. The same variable was used to estimate the association between body mass index and moderate to vigorous physical activity.

Mean moderate to vigorous physical activity was significantly lower for rural teenagers than urban youths. The researchers recorded no differences in body mass index or body mass index percentiles between rural and urban teenagers. Significant differences in perceived and objective correlates for body mass index percentile and moderate to vigorous physical activity were identified in multivariate models between urban youth and their rural counterparts (Moore et al., 2012). From the positive perspective, the differences identified for correlates of moderate to vigorous physical activity and body mass index across the different settings indicate that rural areas should be taken into consideration in the identification of targets for intervention. The move would promote moderate to vigorous physical activity and prevent adiposity in teenagers.

Just as Moore et al. (2012), Ganter, Nader and John (2015) found that rural elementary aged learners do not meet the minimum moderate to vigorous physical activity recommendations of 60 minutes per day during school hours. The researchers aimed at evaluating the relationship between physical activity at school and body mass index among rural elementary aged learners in Oregon. Heights, weight, and physical activity were measured for more than 1760 children aged 5-12 years enrolled in 6 rural Oregon elementary schools in 2013. Physical activity at school was measured over 4 days using the Walk4Life pedometers. Learners with at least 3 valid monitoring days were included in analyses. The researchers calculated means for wear time, total physical activity, and moderate to vigorous physical activity. Body mass index were computed and regression models were used to examine the link between physical activity and body mass index scores, by adjusting for sex, grade, plus wear time. Overweight and obesity prevalence was the same for boys and girls, with the number of boys standing at 782 and that for girls at 700. More moderate to vigorous physical activity was linked with lower body mass index, independent of wear time, grade and sex. Based on the findings of the study, initiatives geared at promoting physical activity for obesity prevention among rural youths should aim at increasing opportunities for moderate to vigorous physical activity.

Research Approach and Design

A qualitative research approach, specifically a phenomenological research design will be employed for the present study. Phenomenological research design is an inquiry coming from both the philosophy and psychology in which a researcher describes lived experiences of persons about a phenomenon as demonstrated by study participants (Munhall, 2012). The research participants’ description will culminate in essence of lived experiences for several people who have experienced the relationship between physical activity and obesity. The benefits of physical activity are lived experiences, people have been engaging in physical activities throughout history. The purpose of this study is to assess whether overweight and obesity among teenagers be prevented or managed successfully through physical activity programs after six months. Phenomenological design has been chosen because it is a blend of art and science (Munhall, 2012). The process of developing a research proposal, finding eligible participants, adhering to ethical research requirements and staying true to the purpose of a study is a rigor of scientific method. Interpreting participants’ lived experiences requires a researcher to observe beyond given words. One of the primary strengths of phenomenological design according to Munhall (2012), is that it aims to find the universal nature of experiences and offer a deeper understanding. However, research participants must have the ability to articulate their feelings plus thought about an experience under study. They may have difficulties expressing themselves due to language barrier, age, and embarrassment.

Sampling

A total of 200 research participants from local high schools will be employed for the study using non probability sampling technique, especially purposive sampling approach. For inclusion into the study, the boys and girls must be aged between 12 and 19 years and be either physically active or physically inactivity. The study will not include persons with health conditions known to affect a person’s body weight. Etikan, Musa and Alkassim (2016) define purposive sampling technique as a non probability sampling approach in which a researcher uses his or her judgment to investigate an event. In essence, purposive sampling technique relies on a researcher’s judgment on matters relating to selection of units to be studied. The primary goal of purpose sampling is that a researcher focuses on certain attributes of a population under study to answer research questions. One of the key advantages of purposive sampling is that a researcher can employ a wide range of sampling approaches such as homogeneous sampling, critical case sampling, and expert sampling for a qualitative research design. On the flip side, purposive sampling is prone to researcher bias because it is anchored on a researcher’s judgment.

Various approaches will be used to protect participants’ rights including confidentiality, anonymity, informed concept, as well as protection from harm. Participants will be provided with information relating to: a statement that participation in the study is voluntary, purpose of the study, foreseeable risks to participants, procedures involved, and benefit of the study to the society before providing their informed concept. Participants will also be protected from events and activities that may lead to physical and mental distress. This implies that participants will not be subjected to embarrassment and any offending or frightening activities, events, and statements. With regards to confidentiality and anonymity, data gathered from participants will be kept anonymous unless a participant provides his or her full consent. Also, the research report will not contain any names.

Proposed Implementation with a Change Model

A project would be applied to promote physical activity among teenagers. The intent is to learn from the project about what work as well as how to work through obstacles toward obesity reduction among teenagers. The project will follow the Plan, Do, Study, and Act change model with different activities taking place at different phases. Reed and Card (2016) posit that Plan-Do-Study-Act model focuses on change, translation of ideas plus intentions into actions. Hence, Plan-Do-Study-Act cycle is central to program implementation.

Plan Phase

Formation of team members will take place at the plan stage. The team will comprise of school principals, subject experts, improvement methodology experts, and front-line staffs. The school principals will increase physical activity among learners in one grade. The project team will identify the project’s aim, which is to identify improvement objectives in quantitative measurable and time specific terms with the context of the study under population.

Do Phase

Project team will have to identify interventions, activities, plus changes that are likely to positively affect measures and that will lead to desired outcome

Study Phase

Members will assess if changes led to improvement among study participants.

Act Phase

At this stage members will test the intervention in real setting, making necessary modifications, and running the entire PDSA Cycle again. After initial testing and observation of the outcome, the change would be applied on a large scale. The project team may have to test the intervention severally under different circumstances and settings to identify the conditions under which the program works best.

Overcoming Barriers to Project Implementation

In order to overcome barriers to the proposed program it is important that project members understand the challenges that individuals at high risk of gaining weight perceive in trying to shed off some weight. Hence, it is important to deal with the perceived barriers to physical activities including lack of time as well as lack of motivation.

Fostering an Environment that Supports Physical Activity

Physical literacy is the way forward to building an environment that believes in the significance of physical activity for a person’s healthy development. Having physical literacy is a shared responsibility between family, communities, and school. It is an essential aspect of the process due to the fact that it provides a platform from which children acquire knowledge concerning healthy behaviors and build motor skills required for physical activity.

References

Dereń, K., Nyankovskyy, S., Nyankovska, O., Łuszczki, E., Wyszyńska, J., Sobolewski, M., & Mazur, A. (2018). The prevalence of underweight, overweight and obesity in children and adolescents from Ukraine. Scientific Reports, 8(1), 3625-3632.

Etikan, I., Musa, S. A., & Alkassim, R. S. (2016). Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1-4.

Gray, C. L., Messer, L. C., Rappazzo, K. M., Jagai, J. S., Grabich, S. C., & Lobdell, D. T. (2018). The association between physical inactivity and obesity is modified by five domains of environmental quality in US adults: A cross-sectional study. PloS one, 13(8), 1-14.

Gunter, K. B., Nader, P. A., & John, D. H. (2015). Physical activity levels and obesity status of Oregon Rural Elementary School children. Preventive Medicine Reports, 2, 478-482.

Jacob, J. K., Jacob, S. K., & George, S. B. (2016). Prevalence of overweight and obesity in adolescent children: A Cross-sectional study. International Journal of Scientific Study, 4(6), 50-54.

Martin, A., Booth, J. N., Laird, Y., Sproule, J., Reilly, J. J., & Saunders, D. H. (2018). Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight. Cochrane Database of Systematic Reviews, (3), 1-138. DOI: 10.1002/14651858.CD009728.pub4.

Moore, J. B., Brinkley, J., Crawford, T. W., Evenson, K. R., & Brownson, R. C. (2013). Association of the built environment with physical activity and adiposity in rural and urban youth. Preventive Medicine, 56(2), 145-148.

Munhall, P. (2012). Nursing research. (5th ed.). Sudbury, MA: Jones & Bartlett Learning.

Reed, J. E., & Card, A. J. (2016). The problem with plan-do-study-act cycles. BMJ Quality & Safety, 25(3), 147-152.

Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics, 141(3), 1-11.

Stankov, I., Olds, T., & Cargo, M. (2012). Overweight and obese adolescents: what turns them off physical activity?. International Journal of Behavioral Nutrition and Physical Activity, 9(53), 1-15

Sundar, T. K. B., Løndal, K., Lagerløv, P., Glavin, 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), 1-10.

Vasconcellos, F., Seabra, A., Katzmarzyk, P. T., Kraemer-Aguiar, L. G., Bouskela, E., & Farinatti, P. (2014). Physical activity in overweight and obese adolescents: systematic review of the effects on physical fitness components and cardiovascular risk factors. Sports Medicine, 44(8), 1139-1152.

OBESITY AND PHYSICAL ACTIVITY

Running head: OBESITY AND PHYSICAL ACTIVITY IN TEENAGERS

TYPE SHORT TITLE IN ALL CAPS

TYPE SHORT TITLE IN ALL CAPS