Prevention and Management of Childhood and Adolescent Obesity
NR505 Advanced Research Methods: Evidence-based Practice
Chamberlin college of Nursing
Prevention and Management of Childhood and Adolescent Obesity
The phenomenon of interest in this evidence based practice project is obesity in children and adolescents, with focus in the prevention of its occurrence. According tothe Centers for Disease Control and Prevention (CDC),the prevalence of childhood obesity in the United States of America is currently more than three times its prevalence in the 1970’s. About one in five children of school going age (ages 6-19) are obese. With these findings, the CDC recommends the need for multi-disciplinaryresearch aimed at developing effective and efficient behavioral interventions to prevent childhood obesity. Research findings by the National Collaborative on Childhood and Obesity Research (NCCOR) indicate that one out of three children are obese or overweight before their fifth birthday, and seventeen percent of children and adolescents aged between two and nineteen years are obese.
The National Health and Nutrition Examination survey 2009-2010 found that 32% of children between two and nineteen years of age were overweight or obese, and 17% were in the obese range. Indicate in their research findings that the average weight of a child has risen by more than five kilograms in a short span of about three decades, and that about a third of children in the country are overweight or obese. From these research findings, it is evident that there is increase in the prevalence of obesity among children and adolescents and this is therefore a valid concern, not only to the healthcare profession but also to the larger population. There is need therefore, to carry out research on the prevention of childhood and adolescent obesity to reduce the prevalence rates.
A report by states that there is need for further research on interventions to curb childhood and adolescent obesity, other than those implemented in schools or homes. The report recommends need to carry out more research on the role of environmental and policy changes in the reduction of the rates of childhood and adolescent obesity. In addition, this reportstates that there are gaps in literature on aspects including the impact of regulations on availability of food and its impact in the prevention of obesity. It outlines the need for further testing of the value of consumer health informatics products for obesity prevention, and the need to seek evidence on the impact of regional and national policies on childhood obesity prevention, including agriculture policy and on food retailing and distribution regulations. Lastly, the study recommends further research with stratified populations based on age, gender, race or ethnicity and socioeconomic status, to determine how each of these groups respond to a common intervention.
The selected nursing issue is the prevention of childhood and adolescent obesity, with an overall aim of preventing the co-morbidities associated with childhood and adolescent obesity. Childhood and adolescent obesity predisposes children and adolescents to various illnesses including cardiovascular disease, hypertension, dyslipidemias, diabetes mellitus and obstructive sleep apnea.In addition to these, childhood and adolescent obesity along with the associated comorbidities often extends into adulthood.These illnesses place the child or the adolescent in the hands of a nurse whose role is to attend to patient needs.The direct role of a nurse in patient care provides the opportunity for the nurse to support patient recovery or rehabilitation, along with enforcement of interventions aimed at preventing other illnesses and improving the quality of life for the patient.
The rationale for this study is that there is a role for the nurse practitioner in preventing and reducing the rising incidence and prevalence of obesity in children and adolescents through research, due to the impact of obesity on the overall health of a child and their health in adulthood. Evidence from existing research findings described above, indicates the high prevalence of childhood obesity. The nurse practitioner is an immediate caregiver to the patient in a hospital setting, and their role in implementation of preventive measure against childhood and adolescent obesity is of immense value.
The structure of this paper is in various sections to include identification of MSN program specialty track of choice and the impact of the selected nursing issue on advanced practice in the specialty track. A comprehensive discussion on the nursing issue including the identification, description and statistics relevant to the nursing issue follows in the next section. In this section, there is identification of stakeholders affected by the nursing issue, rationale for selecting the identified nursing issue, statement of the Pico question and finally, identification of literature strategy for the research paper. A conclusion of this paper is the final section. This includes a summary of key elements in the paper, the expected outcomes for the project proposal, and a self-reflection of lessons drawn from writing this paper.
Application to selected MSN specialty track
The MSN program specialty track of interest to me is the Pediatric Nurse Practitioner. This places me in a position to deal mainly with children and adolescents between the ages of two and nineteen years. This specialty track will expose and acquaint me with advanced clinical practice in the care of children across practice settings and across the health and illness continuum. The selected nursing issue of prevention of childhood and adolescent obesityhas great impact upon advanced practice in the pediatric nurse specialty track.
The nursing issue is among the biggest health concern in the United States of America and the world and it therefore warrants intervention. As a pediatric nurse practitioner, the nursing issue directly affects my specialty track and there is need to be actively involved in reducing the prevalence of childhood and adolescent obesity. This nursing issue will enable me to explore and find out more through research and experience, about childhood and adolescent obesity in terms of possible etiology, prevention, management and prevention of complications. This will improve patient care provided to obese children and adolescents, and enforce preventive measures for those at risk.
Nursing issue and supportive evidence regarding the issue
The selected nursing issue in this paper is the prevention and treatment of childhood and adolescent obesity. Obesity, also known as increased adiposity is the state of increased body weight caused by accumulation of adipose tissue to an extent, which leads to adverse effects on the health of an individual. Obesity results from a complexinterplay of genetically determined body habitus, appetite, nutritional intake or diet, physical activity and energy expenditure. The role of environmental factors such as levels of available food, preferences for types of food and preferences for types of physical activity are significant in the causation of obesity.
Measurement of fat accumulation that leads to obesity is by calculating the body mass index (BMI) and the value obtained determines whether an individual is obese or not. Adults with a BMI of more than or equal to thirty are obese, while those between the range of twenty-five and thirty are overweight. In children, BMI percentiles are used to define obesity and overweight based on age. Children more than two years of age with a BMI percentile of more than or equal to ninety-five are obese while those between eighty-fifth and ninety-fifth percentile are overweight. The need to use a slightly variable measure for overweight and obesity in children is because of changes in body fat levels in childhood, with high adiposity in infancy with a decrease for approximately five and a half years until the period called ‘adiposity rebound’. After this, there is an increase in adiposity until early adulthood.
Childhood and adolescent obesity is a predisposing factor to various illness not only in childhood and in adolescence but also in adulthood. The health risks in an obese child or adolescent involve every organ system in the body. They include obstructive sleep apnea, asthma, diabetes mellitus, hypertension, dyslipidemias, gastroesophageal reflux disease, non-alcoholic fatty liver, gallstones, peripheral vascular disease and cardiovascular disease.These diseases may arise together in the same individual and may carry a worse prognosis.
The children may become obese adults and this may predispose to more health risks. In addition to the health risks, obesity affects the psychology of a child, especially due to the perception of their body image by themselves and by others around them. This affects their self-esteem and may affect their social life due to bullying and teasing by otherchildren. The limitation of physical activity in obese children and adolescents may have more harmful effects on their health and their quality of life.
Findings from various studies in the United States of America and worldwide point towards epidemic levels of childhood and adolescent obesity. The incorporation of obesity in the Healthy People 2020 goals indicates the magnitude of this problem. The World Health Organization describes childhood obesity as one of the most serious public health challenges in the 21st Century. The global rates as per 2015 was at 42 million among children under the age of five years with almost half of all overweight children living in Asia and quarter in Africa.
Findings by the CDC indicate that about one in five children of school going age (ages 6-19) are obese. The National Health and Nutrition Examination survey 2009-2010 found that 32% of children between two and nineteen years of age were overweight or obese, and 17% were in the obese range. The racial prevalence of childhood and adolescent obesity was 24% for non-Hispanic Blacks, 21% for Hispanic, more than 20% of American Indian/ Alaskan children and 14% of Whites. In all these groups, maternal education was protective against childhood and adolescent obesity.
A study by indicates that childhood obesity is a major health problem in the United States. Findings from this study indicate that the prevalence of a BMI at the 95th percentile or higher among children between the ages of 6 and 11 years of age increased from 4.2% in 1963-1965 to 15.3% in 1999-2000 and may have plateaued in the first decade of the 21st century. The National Collaborative on Childhood Obesity Research indicates that the obesity rate has more than doubled since 1980, from 5.0% to 12.4% among children between the ages of 2 and 5 years. In addition, findings indicate that obesity rates have more than tripled from 6.5% to 17% among children between the ages of 6 and 11 years, and has more than tripled from 5.0% to 17.6% in adolescents between the ages of 12 and 19 years.
The issue of childhood and adolescent obesity affects various stakeholders. This includes the immediate caregivers of children and adolescents in this case, their parents or guardians, the people in their home environment such as their families and communities where they live in. This group directly affects the nutrition and lifestyle habits of the child or adolescent. Schools and childcare settings are another group of stakeholders affected by childhood and adolescent obesity. This is because in these settings, there can be modification or control of the nutrition and physical activity of the child or adolescent.
Medical care providers and faith-based institutions have a direct role in identification of obese children and adolescents, at risk populations and are in a position to develop and implement interventions. Government agencies and the media can influence the formation of policies and regulations to control the factors that contribute to increased rates of childhood and adolescent obesity. Food and beverage industries and entertainment industries have a direct role in influencing the nutritional content of their products and in influencing the eating habits and lifestyles of children and adolescents. Therefore, they have a direct role in the prevention of childhood and adolescent obesity.
The rationale for selecting the nursing issue of prevention and treatment of childhood and adolescent obesity is that, there is a high prevalence of obesity based on research findings, and as evidenced above, medical care settings impact childhood and adolescent obesity. The role of a nurse in patient care involves the provision for patient needs. In my specialty track of choice as a pediatric nurse practitioner, I am likely to encounter children from a very early age when their parents bring them to hospital for other illnesses and I am therefore in a position to enforce prevention strategies to ensure that children do not become obese. This comes in during assessment of children for growth and development. Parents and caregivers are more likely to take advice from a medical professional; this may help in preventing, controlling and treatment of childhood and adolescent obesity.
The Pico question for this research is: In obese or overweight adolescents (P), is exercise and diet (I) more effective in reducing weight (O) compared to using exercise alone (C) in treatment?
The literature search strategy that I intend to use in the development of a research paper includes searches in online databases such as CINAHL, ProQuest Nursing& Allied Health, PubMed, Medline, Ovoid Nursing Journals,JSTOR, Google Scholar, and National Center for Biotechnology Information (ncbi). I will look for peer reviewed journal articles on childhood and adolescent obesity from various journals sourced at the Chamberlin College of Nursing library and others sourced online. The terms I intend to usein exploring the databases include childhood obesity, adolescent obesity, prevention of obesity, management of childhood and adolescent obesity, obesity in the United States.The information found scrutinized to determine authenticity, relevance and value in the intended research.
From the paper, it is evident that there is a rising prevalence of childhood and adolescent obesity and there is a recommendation for the need for more research on prevention and management. Prevention and management of childhood obesity is a nursing issue that is relevant to the nurse, and especially the pediatric nurse practitioner. Childhood and adolescent obesity affects not only the child or adolescent but also their families, communities, medical professionals, government agencies, food and entertainment industries and therefore requires the combined effort of these stakeholders to prevent and manage.
The expected outcomes for this project proposal is to come up with sufficient evidence on the high prevalence of obesity among children and adolescents, to determine the impact of diet and exercise on management of childhood and adolescent obesity. Other expected outcomes include to identify the gaps in literature concerning prevention and management of childhood and adolescent obesity, and to come up with nursing-inclined strategies and interventions to improve the management and prevention of childhood and adolescent obesity.
Writing this paper has been of great value in several aspects. I have learnt a lot on the prevalence of childhood and adolescent obesity, the etiology, the role of the nurse practitioner in prevention and management of childhood and adolescent obesity, and the need for collective responsibility in the eradication of what has become a menace in the 21st century.
Centers for Disease Control and Prevention. (2017). Childhood Obesity Facts. Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion.
Cunningham, S. A., Kramer, M. R., & Narayan, K. V. (2014). Incidence of Childhood Obesity in the United States. New England Journal of Medicine, 403-411.
Kliegman, R. M., Schor, N. F., St Geme III, J. M., & Behrman, R. E. (2016). Nelson Textbook of Pediatrics. Philadelphia: Elsevier.
Lobstein, T., Jackson-Leach, R., Moodie, M. L., Hall, K. D., Gortmaker, S. L., Swinburn, B. A., . . . Mc Pherson, K. (2015). Childhood and adolescent obesity: Part of a bigger picture. The Lancet, 2510-2520.
National Collaborative on Childhood Obesity Research. (2008). Childhood Obesity in the United States. NCCOR.
Wu, Y., Lau, B. D., Bleich, S., Cheskin, L., Boult, C., Segal, J. B., & Wang, Y. (2013). Identification of Future Research Needs From Comparative Effeciveness Review No. 115. John Hopkins University Evidence-based Practice Center. Agency for Healthcare Research and Quality(US).
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