Introduction
Obesity is a health condition that bothers many people around the world regardless of their gender, age, and ethnicity. When an adult patient is obese, much attention is paid to his or her style of life and health-related decisions that were made. When obesity changes the life of a child, it is necessary to clarify who should take responsibility. The number of obese children grows, proving the need for new approaches and investigations.
Physical education, nutrition environments, school health services, and family (caregiver) engagement are used to prevent and control obesity in pediatric patients. Focusing on these areas can help children and their families to achieve a healthy weight and promote a proper understanding of obesity and its outcomes. In this final project, the analysis of an anti-obesity intervention that includes physical exercises, diet, education, and monitoring sessions will be developed regarding the chosen search strategy, evidence, practices, and outcomes.
The Spirit of Inquiry Ignited
Pediatric obesity is a serious public health concern in the United States. Despite multiple methods used to prevent and control the condition that puts millions of children and adolescents at risk of having poor health and suffering from a decreased quality of life, its prevalence remains high. According to the latest investigations of the Centers for Disease Control and Prevention (2018), approximately 18.5% of American children and adolescents (13.7 million) are defined as obese or overweight. They include13.9% of children aged between two and five years, 20.6% of children aged between six and eleven years, and 20.6% of children aged between 12 and 19 years (Centers for Disease Control and Prevention, 2018).
Children, as well as their parents and other caregivers, pay much attention to the ways of improving their health and avoid dangerous obesity-related complications. The creation of various school-based programs and interventions with healthy diets, physical exercises, and family health nurse education turn out to be good solutions for the population. However, in the majority of cases, these decisions are used separately for specific groups, so the decision to combine the activities is made in some cases.
The PICOT Question Formulated
In obese school-aged children younger than 15 (P), is a school-based exercise program, healthy diet, family health nurse education 3 times a week, and monitoring sessions for children and parents (I) compared with an exercise program in school and healthy diet alone (C) more effective in reducing BMI and decreasing weight (O) at the end of the school year (T)?
Search Strategy Conducted
Several research tools were chosen to develop an effective search strategy and answer the PICOT. CINAHL, PubMed, Cochrane Library, the National Guidelines Clearinghouse, and TRIP Database were the major sources of information in this investigation. They were scanned for such keywords as childhood obesity, exercise intervention for schools, and change in BMI. The guidelines on how to control and prevent depression in children relying on school-based interventions should be chosen. The studies of I and III levels of evidence were found to support the discussion. Various study designs were approved as appropriate for answering and supporting the PICOT, including a randomized control trial, a meta-analysis, a systematic review, and several interventions with specific independent and dependent variables.
Critical Appraisal of the Evidence Performed
Several critical appraisal checklists were used to evaluate the studies, their validity, and practical application. A research worksheet was developed to identify available research tools and search terms. Then, the evidence synthesis table where the population, intervention, comparison, outcomes, and time were analyzed, and an evaluation table was created. Bogart et al. (2016) described the results of a randomized control trial where overweight and obese students from Los Angeles schools participated. The intervention consisted of the promotion of school-wide food environmental changes, posters with physical education, and healthy eating practices to reduce BMI levels.
It was a III level of evidence study with certain positive results to be achieved. The same evidence was defined in the study by Knight, Cole, Dodd, and Oakley (2017), who offered the Eating Good and Moving Like We Should (EGMLWS) nutrition intervention that also included physical sessions and education. Pablos, Nebot, Vañó-Vicent, Ceca, and Elvira (2017) chose the same method of research and introduced practice for students from 5th and 6th grades in Spain in their intentions to reduce BMI levels and improve their health. These investigations supported the PICOT and contributed to the discussion.
There were also several studies with I level of evidence. For example, Mei et al. (2016) described the results of a meta-analysis of randomized controlled trials where primary school children from different countries took a long-term school-based physical activity intervention to reduce their BMI. A systematic review by Verjans-Janssen, van de Kolk, van Kann, Kremers, and Gerards (2018) proved the effectiveness of the school-based intervention with parental involvement, physical activities, and nutrition behavior to reduce weight and control BMI.
In all five studies, the authors prove that the combination of different practices has a positive effect on children’s health and weight control. Children who follow recommendations and participate in school-based activities achieved good results compared to the children who fail to do the same, lack parental involvement, and have a poor level of knowledge about obesity.
Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
To achieve the desired reduction of BMI levels in pediatric patients, a school-based exercise program has to be developed not only for one particular phase but for several practices. Parents may support their children and control their eating and behavioral preferences at home. Still, the information that children obtain in schools or other academic facilities also plays an important role in their understanding of health issues. In this project, the intervention for implementation consists of four main elements – a physical exercise program at school, a healthy diet, education three times per week, and a monitoring session for children and their parents.
Informed consent should be given by parents to prove their (and their children’s) voluntary participation in the study. Regarding the findings by Verjans-Janssen et al. (2018) or Pablos et al. (2017), the number of participants may vary from 100 to 1500. In this case, 100 children aged between five and fifteen years from several local schools will be invited. Pre-test evaluation will include the participants’ answers to simple survey questions about their styles of life and healthy habits and the calculation of their current BMI. Then, the school-based intervention will be implemented, and it will last the next 12 months. Post-test evaluation will include the participants’ answers about health conditions and the calculations of BMI levels.
Outcome Evaluated
One hundred obese and overweight children will participate in the program and express their attitudes towards the offered practices. The peculiar features of this intervention are the location (not at home or a hospital but at school) and parental participation. Children and their parents will answer several questions and share their awareness of the effectiveness of healthy diets, education, and physical exercises.
Evaluations should help clarify whether the school-based program could have a positive impact on participants’ health, particularly BMI reduction in particular. At first, children and parents will introduce their background knowledge about obesity and the necessity to control their weight. Secondly, children will directly participate in a number of activities. Finally, they can calculate their BMI and identify the most effective steps.
Parental involvement is an important factor because parents, as well as children, should be educated by a family health nurse and take specific monitoring sessions. The reduction of BMI to 20-30% is expected within the next 12 months among the children who take exercises, keep to a healthy diet, visit a family health nurse three times per week, and monitor their weight.
Project Dissemination
This project will be evaluated by a teacher and presented in class. Peer feedback on forums is another approach to discuss the intervention and gather opinions. This study will be introduced to the public during a regional conference to be approved for further publication and practical application. The school-based program that includes physical training, education, healthy eating, and monitoring sessions should become standard practice for treating obese children or preventing overweight in school-aged children. Pediatric and family health nurses must use this plan of work to support their patients and avoid obesity-related complications.
Conclusion
In general, pediatric obesity is a common health problem for many nations. Parents try to help their children and follow various recommendations to decrease weight and choose a healthy lifestyle. Schools, in their turn, continue developing new programs and education sessions to improve the level of knowledge about obesity and its risks among children and their families. This project introduces an intervention that consists of school-based physical exercises, diets, education, and monitoring to prove that combined activities are effective in preventing obesity and reducing BMI. Regular training sessions and education contribute to understanding the threats of obesity in childhood.
References
Bogart, L. M., Elliott, M. N., Cowgill, B. O., Klein, D. J., Hawes-Dawson, J., Uyeda, K., & Schuster, M. A. (2016). Two-year BMI outcomes from a school-based intervention for nutrition and exercise: A randomized trial. Pediatrics, 137(5), e20152493. Web.
Centers for Disease Control and Prevention. (2018). Childhood obesity facts. Web.
Knight, K. B., Cole, J. W., Dodd, L. M., & Oakley, C. B. (2017). Effects of a school-based intervention on BMI z-scores and fitness parameters in Mississippi delta children. International Journal of School Health, 4(3), e13793. Web.
Mei, H., Xiong, Y., Xie, S., Guo, S., Li, Y., Guo, B., & Zhang, J. (2016). The impact of long-term school-based physical activity interventions on body mass index of primary school children – A meta-analysis of randomized controlled trials. BMC Public Health, 16(1), 205-217.
Pablos, A., Nebot, V., Vañó-Vicent, V., Ceca, D., & Elvira, L. (2017). Effectiveness of a school-based program focusing on diet and health habits taught through physical exercise. Applied Physiology, Nutrition, and Metabolism, 43(4), 331-337.
Verjans-Janssen, S. R., van de Kolk, I., van Kann, D. H., Kremers, S. P., & Gerards, S. M. (2018). Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children’s BMI and energy balance-related behaviors – A systematic review. PloS One, 13(9), e0204560. Web.