Many children today suffer from obesity and it increase the rate of diseases and fatalities in the children population. This problem is very significant in nursing because nurses can teach parents and children to take care of their health. Nurses can provide information that could prevent and reduce this problem. Childhood Obesity is a global problem that must be stop with the participation of all healthcare professionals.
Background and Significance of the Problem
The obesity rates continue to rise; since the 1980s, obesity’s prevalence among children and adolescents has tripled in the USA (Matson & Fallon, 2012). Different interventions are suggested to address the problem of obesity and include pharmacological treatment, lifestyle changes, education provided to children and their parents to raise awareness of these issues, and combined approaches that include some of these interventions. Dietary and behavioral modifications and physical activity were reported to be imperative for preventing and treating obesity in children (Matson & Fallon, 2012). At the same time, lifestyle interventions are often not enough to decrease obesity rates in children or treat this condition (Matson & Fallon, 2012). The research on the use of the pharmacological treatment in children is relatively limited, but orlistat and metformin are among the most common medication used for obesity treatment. Obesity can lead to different negative outcomes, including physical (e.g., cardiovascular disease) and social (stigmatization, discrimination, low self-esteem, etc.) ones.
As it is yet unclear what interventions exactly can help decrease the adverse outcomes of obesity and prevent it, it is necessary to compare the effectiveness of different interventions for such evaluation. Many interventions use a combined approach to treat obesity, which does not allow researchers to evaluate the effectiveness of separate programs.
Statement of the Problem and Purpose of the Study
Childhood obesity is one of the main problems of our society today and it is our responsibility to do something about it. The purpose of the study is to compare the effectiveness of education of parents about healthy lifestyles with pharmacotherapy for obesity approved for children (e.g., use of orlistat) in reducing negative outcomes of obesity and preventing them.
Literature Review
Researchers have extensively investigated the topic of childhood obesity in order to come up with appropriate solutions to this growing issue and find evidence in support of the proposed intervention. This section will present a literature review of relevant studies on childhood obesity, summarizing different approaches and comparing their effectiveness in the context of improving children’s health through the reduction of obesity rates.
Role of Parents
Kelishadi and Azizi-Soleiman (2014) conducted a systematic review of strategies associated with the reduction of childhood obesity to propose an intervention program that would have a long-term effect on a large group of obese children. The researchers concluded that parents played a critical role in the control and development of children’s behaviours, which pointed to the need of involving them in health-oriented interventions. It was revealed that clinic-based interventions were extremely favourable; varying from lifestyle changes (e.g., increasing physical activities, balanced diet) to behaviouraltherapy, they brought positive results in the reduction of childhood obesity (Kelishadi&Azizi-Soleiman, 2014). The role of parents in such interventions was critical.
Prevention Strategies
A different approach to the one described above was presented by Pandita et al. (2016), who suggested that the effective management of childhood obesity could be accomplished through prevention strategies. Such strategies had to include an array of prevention mechanisms that made children and their parents put an emphasis on healthy lifestyle choices. For example, the researchers proposed the following prevention interventions:
- Controlling target behaviours such as logs of physical activity and dietary choices;
- Monitoring stimuli to reduce environmental factors that add to the unhealthy choices of children and their parents;
- Goal-setting for choosing healthy behaviours over other lifestyle preferences;
- Giving rewards for reaching the target activity and nutrition objectives;
- Providing positive reinforcements for positive lifestyle choices (Pandita et al., 2016).
Based on the information presented above, the effective prevention strategies to reduce the occurrence of childhood obesity are based on positive reinforcements of healthy behaviours and the establishment of strategies that target the achievement of exemplary lifestyles for children and their parents. These suggestions can be used in conjunction with that of Kelishadi and Azizi-Soleiman (2014) for establishing a childhood obesity management and prevention program for dealing with this adverse health problem.
Clinical Interventions
While the previous two approaches focused on the encouragement of positive behaviors and the role of parents in the management of childhood obesity, the need for clinical interventions should also be discussed. Sharifi et al. (2017) explored the cost-effectiveness of clinical childhood obesity interventions. Such interventions have predominantly included the use of electronic health records for the management and change of parents’ and their children’s self-guided behaviors for the purpose of maintaining a healthy BMI. Compared to previously introduced clinical interventions, the use of electronic health records was found to be more cost-efficient for the healthcare system as well as individual families. Importantly, the researchers suggested that such clinical interventions could be used in conjunction with prevention strategies established on a level of population for accelerating work in the reduction of childhood obesity occurrence.
It can be concluded that interventions targeted at the management of obesity could be applied through the use of different approaches. Additionally, prevention of obesity is another effective tool for not allowing children to make unhealthy lifestyle and diet choices and thus developing obesity altogether.
Research Questions, Hypothesis, and Variables
The research questions of the study are focused on the effectiveness of different interventions and their impact on obesity prevention and reduction of negative outcomes:
- Is education of parents about the importance of a healthy lifestyle more effective in preventing obesity in children than pharmacological treatment?
- Is education of parents more effective in reducing negative outcomes of obesity in children than pharmacological treatment?
As the research focuses on the comparison of two interventions, the research and null hypothesis will be formulated as follows:
H0: The effectiveness of pharmacological treatment is greater in preventing obesity in children and reducing its negative outcomes compared to the education of parents about the importance of a healthy lifestyle.
H1: The effectiveness of education of parents about the importance of a healthy lifestyle is greater in preventing obesity in children and reducing its negative outcomes compared to pharmacological treatment.
PICOT Question
In children suffering from obesity, is the education of parent in healthy lifestyle for the children compared with medication treatment, increase the outcome and prevention of obesity?
Categorical study variables include gender, race, and social status of participants. Quantitative study variables include age, the weight of participants (in kg), body mass index (BMI), weight loss maintenance period (in days or months), education training (hours per week), and medication (mg per day/week). The independent variables are the medication used in research (orlistat) measured in grams (e.g., three intakes per day = 120 mg x 3 = 360 mg per day), education provided to children’s parents measured in hours (e.g., one lesson = one hour; four lessons per week = four hours per week). The dependent variables include children’s weight, BMI, and weight loss maintenance period.
The operationalized variables are necessary as they help control the measurement constant (Grand Canyon University, n.d.). Education of parents is operationally defined as an eight-week intervention that includes 32 learning sessions (32 hours) about healthy lifestyles (importance of exercise, dieting, and avoidance of fast food are included); each session is one hour long, and each week will consist of four sessions. Pharmacological treatment consists of an eight-week intervention with orlistat, the only FDA-approved medication for treating children and adolescents with obesity, which will be taken by participants three times per day. The effectiveness of interventions and obesity preventing is operationally defined as a decrease in weight after the intervention and change in BMI. The reduction of negative outcomes includes weight loss maintenance for a month or more and positive changes in self-esteem.
Theoretical Framework
Overview and Guiding Propositions
The role of nurses in the treatment of childhood obesity can be quite significant since young people sometimes cannot realize the seriousness of this health problem. In this regard, Orlando’s Nursing process theory will be quite an efficient practice of combating obesity at an early age (Orlando’s nursing process theory, 2012). This model is often used in pediatrics and functions on an organizational basis when a problem is identified. All the aspects that can affect its solution (personality, behavior, etc.) are considered in stages, and an optimal method of therapy is determined. According to the theory, behavioral factors are fundamental in many diseases, and the task of nurses, according to the author of the model, is to help those “who suffer or anticipate a sense of helplessness” (Orlando’s nursing process theory, 2012, para. 5). Therefore, this technique is rather relevant.
Application of Theory to Study Focus
When children experience difficulties with being overweight, the fault lies mainly with their surroundings and the lifestyle that they lead. The more frivolous parents are, the more chances that their child’s diet will be disordered. According to the nursing model described, an immediate reaction is one of the useful methods for dealing with the problem (Orlando’s nursing process theory, 2012). Another fundamental aspect of the theory is discipline, and while considering it in the context of the topic of childhood obesity, it will certainly have a positive impact (Orlando’s nursing process theory, 2012). The fact is that children sometimes cannot independently understand why they need to solve the problem of excess weight. The task of parents with the help of a nurse is to stabilize a child’s diet and make them control what and how much they eat. This measure is likely to be significant and effective.
Methodology
Sample/Setting
The sample for the proposed study should be large enough to help fulfil the research aims and estimate the effectiveness of two interventions for the treatment of obesity. The study will target 200 children diagnosed with obesity within the region of Miami. The researcher will limit the participants’ age to fall between 6 and 13 years, excluding significant changes in weight that can be related to pubertal development, BMI including children, with grade 1 and 2 obesity, and the absence of other serious diseases (Chikvaidze, Kristesashvili, &Gegechkori, 2014). The researcher will ensure that the aspects of gender, age, and height are averaged to avoid the existence of extreme statistic that might affect the actual result.
Data will be collected in two metropolitan hospitals within the Miami city, provided with all equipment for weight and height measurement and overall health assessment. Specifically, the researcher will zero in on two public hospitals in west Miami city to ensure that the elements of cost and convenience are taken care of. In order to make the proposed project viable, a pilot study will be carried out in one of the two hospitals involving 20 respondents to get a true picture of the eventual outcome. The researcher will be keen to pretest the sample for characteristics such as consistency to age, weight, gender, and height variables. During the piloting stage, the researcher will adopt the proposed conceptual framework to pretest the variables of the study for their relevance and interrelationships. This is necessary to ensure that the actual study is comprehensive and within the scope of the research.
Sampling Strategy
The proposed technique that will be used to choose the participants will include simple random sampling. Numbers will be assigned to potential participants who meet the identified criteria. Then, with the help of research randomizer software, 200 participants will be chosen and divided into two equal groups (100 participants each) that will receive two different interventions. The advantages of the sampling strategy include the ease of use and representativeness. The sampling formula that will be applied by the researcher in this study is ideal in modeling a sample space within the acceptable scientific sample size and degree of freedom of 0.05 (Saladana, 2012). The formula presented below was used by the researcher to establish the appropriateness of the sample frame and its relevance to this scientific research. The formula is ideal in measuring the degree of confidence, which should not be below 0.05 for a scientific research. The calculations are presented below.
n=N/ (1+N (e2))
Where:
n = sample size
N= Target population
e= Degree of freedom
n=200/ (1+200*0.052)
n=200/1.075
n= 187.907
Research Design
The research will adopt a quantitative approach to facilitate an in-depth and valuable investigation to boost on the accuracy of the results. According to Saladana (2012), quantitative approach is ideal in exposing and facilitating the understanding of a research phenomenon, which in this case is the effectiveness of different obesity intervention strategies. The research will strive to collect accurate data from the observations made and responses from parents of the respondents (Savin-Baden & Major, 2013). It is planned to conduct an experimental quantitative study based on BMI changes in patients. The researcher will use observation and short questionnaire survey to carry out the study. The observation part will involve actual measurement of the BMI of each participant and recording in a worksheet for each week of the experiment.
The short questionnaire survey will be carried out to establish the educational training that parents receive as part of obesity management (Saladana, 2012). Prior to the research, physical measurements will be taken; after that, both groups of participants will start receiving interventions. Four weeks after the start of the interventions, the BMI of the participants will be measured, and their general state of health and self-esteem will be assessed. Both interventions will take eight weeks long, meaning 8 examinations for each participant. The examinations will then be paired up to establish a potential trend for each intervention strategy. Specifically, the researcher will be keen to observe and record data for each observation to ensure that a consistency graph is achieved. The designs have been selected to the check and verify the results that allow to come out with specific conclusions concerning the impact of interventions.
References
Chikvaidze, N., Kristesashvili, J., &Gegechkori, M. (2014). Peculiarities of sexual development in young women with childhood onset weight problems. Georgian Medical News, 10(235), 11-17.
Grand Canyon University.(n.d.). Variables and operational definitions. Web.
Kelishadi, R., &Azizi-Soleiman, F. (2014).Controlling childhood obesity: A systematic review on strategies and challenges. Journal of Research in Medical Sciences: The Official Journal of Isfahan University of Medical Sciences, 19(10), 993-1008.
Matson, K. L., & Fallon, R. M. (2012).Treatment of obesity in children and adolescents. The Journal of Pediatric Pharmacology and Therapeutics, 17(1), 45-57.
Orlando’s nursing process theory. (2012). Web.
Pandita, A., Sharma, D., Pandita, D., Pawar, S., Tariq, M., &Kaul, A. (2016). Childhood obesity: Prevention is better than cure. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 9, 83-89.
Saladana, J. (2012). The coding manual for quantitative researchers. Thousand Oaks, CA: Sage.
Savin-Baden, M., & Major, C. (2013). Quantitative research: The essential guide theory and practice. London, England: Routledge.
Sharifi, M., Franz, C., Horan, C., Giles, C., Long, M., Ward, Z., Taveras, E. (2017). Cost-effectivenessof a clinicalchildhoodobesityintervention. Pediatrics, 140(5), 1-9.