Details:

Running Head: CHILD HOOD OBESITY CAPSTONE 1

Table of Contents 1. Background 3 2. Problem statement 3 3. Purpose of the change proposal 4 5. Literature Review 5 6. Evaluation of the literature 7 7. Nursing Theory Utilized 7 8. Proposed Implementation Plan 8 9. Potential Barriers to Plan Implementation 8 10. References 9

Childhood obesity can be described as a condition in which a child is significantly overweight given his age and height. This condition is usually self-diagnosable as symptoms are always related to excessive weight gained by a child. They include spotting a pot belly, binge eating and sometimes shortness of breath. As reported by statistics from State of Obesity (2018), this condition has affected children between the ages of 2 and 19 years for a long time. At the beginning of the millennium, in the year 2000, the American Heart Association (2018) reported that one third of children and adolescents in the United States are affected by obesity. Going into the first quarter of the millennium, its prevalence has tripled so much so that it is currently regarded as the number one health concerns among parents. This therefore follows that there is need to investigate better intervention measures to help curb this menace. Comment by Melissa Reedy: I am not sure that I agree with these symptoms-I think I would keep this more as cited information vs. your personal opinion

The Latest research indicates that the national childhood obesity rate among children between 2 and 19 years is 18.5% (State of Obesity, 2018). This rate can be attributed to various factors including poor nutritional habits and a lack of physical activity. The availability of “good- tasting” food with high calorie serves to worsen the situation as these foods are not expensive yet their health effects are disastrous. Combining this with a lack of physical activity and inactive behavior results to childhood obesity (Cunningham, Kramer & Narayan, 2014). Of concern is that all these factors are imparted by family characteristics, social culture and other environmental factors. This paper is therefore geared towards addressing these problems through coming up with a PICOT statement to address them.

The purpose of this proposal change is to come up with evidence-based interventions to combat childhood obesity among children aged 12years. The proposed PICOT statement will come up with educational nutritional programs involving proper dieting and physical activity. This would help reduce the impact of Child obesity among children aged 12 years, which often goes beyond health-related issues as it can negatively impact the child’s social status. It is also associated with eating disorders such as Bulimia Nervosa. All these affect the health of the child, its wellbeing and leads to poor performance because of the low quality of life the child is experiencing (Reilly, & Kelly, 2011). The researcher therefore considered all these while coming up with the PICOT statement described in detail in the flowing section. Comment by Melissa Reedy: Your PICOT statement is not coming up with this

4. PICOT

It is evident that obesity and overweight in general have become worldwide epidemics as illustrated by the widespread concerns. For children below the age of 12, obesity has not only resulted to health-related issues such as diabetes and cardiovascular complications, but also forms a basis for ridicule and overall loss of the self-esteem that is vital in development into adulthood (Reilly, & Kelly, 2011). Due to this continued prevalence, there is need for the involved stakeholders such as the government and other policy makers in the healthcare system to have in place research-based interventions that will ensure a drop-in number of children affected. All these can be addressed in a nutrition education program that is suggested by this paper. The following is a PICOT statement intends to find lasting solutions to this problem; Comment by Melissa Reedy: That intends??

P-Obese children under the age of 12 with a BMI index of 30 or more.

I-Educational Nutrition programs involving Proper diet and engaging in physical activity Comment by Melissa Reedy: You have some words throughout that do not need to be capitalized

C- Children who will be involved in the educational program versus those who will not be engaged.

O- Reduction in obesity among children below the age of 12 by increasing knowledge on nutrition education

T- A period not less than 1 year

Due to the serious health and social implications associated with obesity, a lot of efforts have been made to devise ways to prevent it. This systematically reviewed eight studies by comparing their research questions, sample populations and limitations. The following is a summary of what was found; Comment by Melissa Reedy: Don’t forget your search strategy

Each of the eight studies covered childhood obesity as the main study subject, with specific research questions varying across the studies. Bleich, Segal, Wu, Wilson, & Wang (2013) conducted a systematic review of community-based childhood obesity prevention while Tester, Phan, Jared, Tucker, Leung, Gillette, Sweeney, Kirk, Tindall, Olivo-Marston, & Eneli (2018), focused on the characteristics of obese children between 2-5 years. Cunningham, Kramer & Narayan, (2014), differed with the first two since their study involved the identification of obesity prevalence in the United States at the national level. Lee, Scharf & DeBoer, (2018) also conducted a study that was concerned with the causes of childhood obesity and focused on the relationship between food insecurity and obesity and was trying to answer the question of whether food insecurity is an independent risk factor for obesity in the United States. The other study under review was conducted by Fetter, Scherr, Linnell, Dharmar, Schaefer, & Zidenberg-Cherr (2018) and was aimed at determining whether physical activity patterns improved School-Based Nutrition intervention. This differed from the rest in that instead of focusing on the causes of obesity, it was more concerned with the intervention measures at school level. Lydecke, Riley, & Grilo. 2018, conducted another study in which they were trying to answer the question regarding the relationship between parenting, eating behavior and the contribution they made on weight gain. Another study by Marcum, Goldring, McBride, & Persky (2018), questioned the micro-level choices that people make in their daily lives and their effect on their dietary behavior as an intervention to obesity. The last study under review was conducted by Vollmer, (2018) and was aimed at understanding how parents and specifically fathers understand obesity in their preschool aged children. Comment by Melissa Reedy: Use the rule of et. al. here Comment by Melissa Reedy: Again use the rule of et. al. here

The sample populations addressed by each study were also different. One notable aspect of the sample population in all the studies however, is that the main study subjects were either children under 12 years or their parents. For instance, Tester et al. (2018) investigated 7028 children between 2 and 5 years while Cunningham, Kramer, & Narayan (2014) had 7738 participants who were in kindergarten in the year 1998 and 2007. Vollmer (2018) used 117 fathers with an average age of 35 years while Marcum, Goldring, McBride, & Persky, (2018) used 221 mothers. Another study that included parents is the one conducted by Lydecke, Riley, & Grilo (2018) who included a sample of 581 parents.

Finally, each of the eight studies provided valuable findings that would greatly aid in the process of formulating policies for intervention measures. However, there were various limitations of the studies. Generally, since they were all conducted at different times with different research questions, it would be somehow difficult to generalize all their findings to arrive at a single conclusion. This therefore means that each study needs to be looked at exclusively as they address different questions.

The findings of the studies would no doubt add a lot of value and insights on ways in which to carry out the capstone project. By focusing on specific facets of childhood obesity and carrying out systematic studies, there is a high chance of having a successful project that would probably change the way intervention measures are always put in place and this could provide an invaluable guideline within which to combat the problem of childhood obesity and the associated health implications once and for all. However, further studies should be conducted on the impact of obesity among adolescents by taking their accounts as well as that of their caretakers. This is valuable for purposes of comparison.

There is no doubt that many genetic, physiological, and behavioral factors play a role in the etiology of obesity. As such, behavioral change theory was utilized to help explain how behavior management can be an intervention through teaching better nutritional habits and enraging physical activities (Michie, Van Stralen & West, 2011) Comment by Melissa Reedy: This is very brief you want to thoroughly discuss the theory, its components and how you will incorporate it into your project

The proposed implementation plan will involve several stakeholders including employees, owners, clients and suppliers while external stakeholders may include donors, the community and the government. They are all vital to the project implementation as far as the goals and objectives, interests, expectations, involvement and the influence on the project success is concerned. The project will have factors that affect obesity as the independent variables i.e. physical activities and nutritional education. The dependent variable on the other hand can be a factor that describes obesity, e.g. BMI. These are what will be measured to determine the outcome of the project before and after implementing the interventions. Comment by Melissa Reedy: This should be a very comprehensive step by step plan of how you are going to implement your change proposal

Implementing this project will see several changes in the health care sector. This will be met by several barriers including human resistance to change and a lack of proper nursing leadership. Human resistance will be overcome by cultivating a culture that embraces the use of evidence-based practices to solve childhood obesity issues. Proper nursing leadership on the other hand will be solved by providing better training in schools.

Cunningham, S. A., Kramer, M. R., & Narayan, K. V. (2014). Incidence of childhood obesity in the United States. New England Journal of Medicine, 370(5), 403-411.

Cunningham, S. A., Kramer, M. R., & Narayan, K. V. (2014). Incidence of childhood obesity in the United States. New England Journal of Medicine, 370(5), 403-411.

Lee, A. M., Scharf, R. J., & DeBoer, M. D. (2018). Association between kindergarten and first-grade food insecurity and weight status in US children. Nutrition, 51, 1-5.

Lydecker, J. A., Riley, K. E., & Grilo, C. M. (2018). Associations of parents' self, child, and other “fat talk” with child eating behaviors and weight. International Journal of Eating Disorders, 1-5.

Marcum, C. S., Goldring, M. R., McBride, C. M., & Persky, S. (2018). Modeling Dynamic Food Choice Processes to Understand Dietary Intervention Effects. Annals of Behavioral Medicine, 52(3), 252-261.

Michie, S., Van Stralen, M. M., & West, R. (2011). The behavior change wheel: a new method for characterizing and designing behavior change interventions. Implementation science, 6(1), 42.

Reilly, J. J., & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood and adolescence on morbidity and premature mortality in adulthood: systematic review. International journal of obesity, 35(7), 891.

Tester, J. M., Phan, T. L. T., Tucker, J. M., Leung, C. W., Gillette, M. L. D., Sweeney, B. R., ... & Eneli, I. U. (2018). Characteristics of Children 2 to 5 Years of Age with Severe Obesity. Pediatrics, 141(3), e20173228.