Background
The prevalence of obesity and overweight among children, and particularly the school-aged one, has emerged to critical global health problem. The current research reveals that the childhood obesity is now over three times as compared to the statistics taken in the recent years across the word (Pangani et al., 2016). For instance, the prevalence of the overweight and obese children has risen to 19.6 percent from 6.5 percent. Many studies have provided the evidence that obese children are at high risk of getting many adverse diseases which result in more health complications. The health concerns that result from obesity have been noted comprise poor psychological outcomes as well as higher chances of having obese adults in the offing. This study is important to the researchers and also the nurses in coming up with the most effective and efficient prevention intervention of childhood obesity.
Problem Statement
The developed and low socioeconomic nations are faced high rates of obesity and overweight among children, which has emerged to be international issue. This problem has resulted to varied concerns among the scholars, whose contribution does not specify to some group, in particular. The population which is greatly affected by obesity involves the children who are in school because of their young and have a little understanding of the importance of the exercise and proper diet. The current studies indicate that overweight and obesity results in further health complications including type-2 diabetes, heart problem, and asthma among other heart-related issues (Bhargava et al., 2016). It is also worth identifying that the children suffering from obesity are at high risk of getting psychological stress because of being bullied by the peers as well as the emotional abuse as a result of their size of the body. In consequence children who have this problem can develop low self-esteem, emotional stress and depression, and living in solitude. Therefore, this proposal seeks to suggest the interventions that can address this issue effectively among the school-going children.
Purpose of the Change Proposal
This proposal seeks to identify the evidence knowledge gap and suggest the key changes to the current prevention policy and practice of childhood obesity to promote the delivery of obesity prevention services to some communities around the world (Bhargava et al., 2016). It will be important to first, examine the prevalence of obesity and overweight among the children resulting from various activities such as lack of physical exercise and poor diet among others. Additionally, there is a need for the determination of the body mass index of such children to help in establishment of the appropriate preventive measures to address the issue.
PICOT
The PICOT question in for this study will be as follows. In the school-aged children with overweight and obesity (P), what approach is effective (I) as compared to others (C) in preventing obesity and overweight and its consequences on the health, wellbeing, and psychosocial development of the children (O) when they are in the hospital (T).
Literature Search Strategy Used
In this proposal, the author selected and retrieved peer reviewed articles performed in within the past five years were utilized in the implementation of the proposed practice change on the basis of the practice that is evidence-based. The literature was developed for 11 articles on the topic of research. The key words that were used for the literature search include the prevalence of obesity and overweight among the school-aged children and the evaluation of obesity effect from fat percentage in male adolescents. The knowledge gaps were identified in the studies concerning the health issue under investigation which were crucial in the development of the work of the researchers. Most of the articles used quantitative research design with a few using both qualitative and quantitative study approach, where interviews and several modes of intervention were used. The main concerns of these articles included the prevalence of obesity, causes, impact of obesity and overweight and preventive measures of obesity among the schooling children.
Evaluation of the Literature
Undoubtedly, the evaluation of the literature indicated that it rests with the nurses to place emphasis on childhood obesity problem and ensure such an issue is approached in an effective and efficient manner. Badawi et al. (2013) examined the prevalence as well as the risk factors for obesity and overweight, where they found out that there is a relatively high obesity and overweight among the children aged between 6 to 12 years. This finding were supported by the study conducted by Pengpid and Peltzer (2015) who investigated obesity and overweight as well as the related factors within the school-aged adolescents. Ripka et al. (2016) presented related finding for the children aged between 12 and 17 years by verifying the effect of the percentage of BF in BMD in male adolescents. Another study performed by Xue et al. (2016) presented evidence of poor trends in the food consumption as the cause of the high rates of childhood obesity. Also, Abdelkarim et al. (2017) pointed out the sedentary lifestyle as well as less activities at home and in school and makes obesity problem more prevalent. Such lifestyles include, playing video games, leisure-time computer use, and TV viewing during their leisure time.
These conditions call for the nurses to come up with prevention interventions such creation of awareness on proper diet and exercise. For instance, Hills et al. (2013) have proposed the regular physical activities as well as the physical exercise at the interventions that make and keep the children active while at school and during their time in hospital. Keane et al. (2017) suggested the physical activities as well as the screening time as critical aspects to consider while addressing the issues of obesity and the risks factors that are subjective this health concern.
Cyril et al. (2016) postulate that the current studies have some knowledge gap in the perspective of the service providers of the several barriers that affect the effective use of the prevention of childhood obesity. Additionally, Abdelkarim et al. (2017) indicated that there exists a knowledge gap between that have been carried out to examine the physical fitness among the school going children and the relationship between the prevalence of obesity and physical fitness rates. This significance of the literature reviewed from the articles is that it helps researchers in the selection of varying samples, development of distinct research questions, in choosing different research designs, and as well to identify different limitations. Through these disparities, the researchers will be able to provide the knowledge and make positive evolutions or come up with discoveries for the improvement how the modern healthcare field addresses the obesity among children.
Applicable Change
Nurses have been responsible for initiating changes in the behaviors of the students in school and their parents concerning the need to fight the issue overweight and overweight among children. Through this change, it is possible for the nurses to implement the interventions which are effective in minimizing the problem of obesity and other health concerns in the offing.
Proposed Implementation Plan with Outcome Measures
The implementation of the evidence-based practice (EBP) requires nurses to utilize several workshops so as to realize a sustainable change (Melnyk et al. 2012). The time for the implementation plan of this interventional procedure may take duration of six to eight weeks to get the outcomes that will be used in the comparison. Also, 45-60 minutes are recommended for the moderate to vigorous activities every day and the school nurse will be helpful in realizing the set goals by improving such activities. The measurement of the outcome of the interventions is by the reduction in the obesity and overweight as well as change in the behaviors towards childhood obesity.
Potential Barriers to Plan Implementation and How to overcome them
There are various factors that are believed to hinder the success of this project. The first and the most influential in the project is delay in accomplishing the activities. The researchers need to be aware that it is possible for the project to take more time than the scheduled duration because of the resistance of stakeholders involving fast food business people and poor coordination among others. Secondly, the progress of the project may be impeded by insufficient funds need for the creation of awareness programs by the nurses and also the public.
Conclusion
The alarming rates of childhood obesity and overweight among the school-aged children in the developed and low socioeconomic nations have attracted more researchers to investigate the issue. This situation calls for effective interventions so as to reduce issue of overweight and obesity which has been associated with other many health complications. Therefore, nurses play a critical role in the prevention through the application of the appropriate measures to ensure a healthy living.
References
Abdelkarim, O., Ammar, A., Soliman, A. M., & Hökelmann, A. (2017). Prevalence of overweight and obesity associated with the levels of physical fitness among primary school age children in Assiut city. Egyptian Pediatric Association Gazette, 1-6. doi:10.1016/j.epag.2017.02.001
Badawi, N. E., Barakat, A. A., El Sherbini, S. A., & Fawzy, H. M. (2013). Prevalence of overweight and obesity in primary school children in Port Said city. Egyptian Pediatric Association Gazette, 61(1), 31-36. doi:10.1016/j.epag.2013.04.007
Bhargava, M., Kandpal, S. D., Aggarwal, P., & Sati, H. C. (2016). Overweight and Obesity in School Children of a Hill State in North India: Is the Dichotomy Urban-Rural or Socio-Economic? Results from a Cross-Sectional Survey. PLOS ONE, 11(5), e0156283. doi:10.1371/journal.pone.0156283
Cyril, S., Green, J., Nicholson, J. M., Agho, K., & Renzaho, A. M. (2016). Exploring Service Providers’ Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia. PLOS ONE, 11(10), e0162184.
doi:10.1371/journal.pone.0162184
Hills, A.P., Street, S.J., Soan, E.J., Mokhtar, N., & Byrne, N.M. (2013). Physical Activity and Development and Obesity. Current Obesity Reports, 2, 261-266, DOI: 10.1007/s13679-013-0060-0
Keane, E., Kelly, C., Molcho, M., & Nic Gabhainn, S. (2017). Physical activity, screen time and the risk of subjective health complaints in school-aged children. Preventive Medicine, 96, 21-27. doi:10.1016/j.ypmed.2016.12.011
Melnyk, B. M., Fineout-Overholt, E., Gallagher-Ford, L., & Kaplan, L. (2012). The state of evidence-based practice in US nurses: Critical implications for nurse leaders and educators. The Journal of Nursing Management, 42(9), 410-417. doi: 10.1097/NNA.0b013e3182664e0a.
Pangani, I. N., Kiplamai, F. K., Kamau, J. W., &Onywera, V. O. (2016). Prevalence of Overweight and Obesity among Primary School Children Aged 8–13 Years in Dar es Salaam City, Tanzania. Advances in Preventive Medicine, 2016, 1-5. doi:10.1155/2016/1345017
Pengpid, S., & Peltzer, K. (2015). Overweight and Obesity and Associated Factors among School-Aged Adolescents in Six Pacific Island Countries in Oceania. International Journal of Environmental Research and Public Health, 12(12), 14505-14518. doi:10.3390/ijerph121114505
Ripka, W. L., Modesto, J. D., Ulbricht, L., & Gewehr, P. M. (2016). Obesity Impact Evaluated from Fat Percentage in Bone Mineral Density of Male Adolescents. PLOS ONE, 11(9), e0163470. doi:10.1371/journal.pone.0163470
Xue, H., Wu, Y., Wang, X., & Wang, Y. (2016). Time Trends in Fast Food Consumption and Its Association with Obesity among Children in China. PLOS ONE, 11(3), e0151141. doi:10.1371/journal.pone.0151141
Appendix
Table 1: Literature Review
| Criteria | Article 1 | Article 2 | Article 3 | Article 4 |
| Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article
| Abdelkarim, O., Ammar, A., Soliman, A. M., & Hökelmann, A. Egyptian Pediatric Association Gazette, http://www.sciencedirect.com/science/article/pii/S111066381630074X | Badawi, N. E., Barakat, A. A., El Sherbini, S. A., & Fawzy, H. M. Egyptian Pediatric Association Gazette http://www.sciencedirect.com/science/article/pii/S1110663813000086 | Cyril, S., Green, J., Nicholson, J. M., Agho, K., & Renzaho, A. M. PLOS ONE http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0162184 | Ripka, W. L., Modesto, J. D., Ulbricht, L., & Gewehr, P. M. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0163470 |
| Article Title and Year Published
| Prevalence of overweight and obesity associated with the levels of physical fitness among primary school age children in Assiut city 2017 | Prevalence of overweight and obesity in primary school children in Port Said city 2013 | Exploring Service Providers’ Perspectives in Improving Childhood Obesity Prevention among CALD Communities in Victoria, Australia. 2016 | Obesity Impact Evaluated from Fat Percentage in Bone Mineral Density of Male Adolescents 2016 |
| Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study
| There is a gap between the studies which have been done to investigate the Physical fitness by typically developed children at primary school age and the relationship between the prevalence of overweight and obesity and the rate of physical fitness /The aim of the present study is to evaluate the prevalence of overweight and obesity associated with the level of physical fitness among primary school children in Assiut city | The mechanism of obesity development is not fully understoodand it is confirmed that obesity occurs when energy intake exceeds energy expenditure. / This study focuses on prevalence and risk factors for obesity in Port Said city covering all socioeconomic classes. | Currently there is a gap in the knowledge of service providers’ perspectives of the various barriers impacting the effective utilization of childhood obesity prevention services by CALD communities in Australia/ this study aimed to address this evidence gap and enable the identification of key changes to the existing childhood obesity prevention policy and practice, in order to improve the delivery of obesity prevention services to CALD communities in Victoria, Australia. | Previous studies which evaluated the relationship between BMD and nutritional status used body mass index (BMI) as a ranking factor, but it is believed that this method tends to generate a different interpretation of that proposed by the analysis of body fat specifically/ The objective of this study was to analyze BMD values in male adolescents (12–17) and to verify the impact of obesity as measured by body fat on the BMD variable through measurements by DEXA. |
| Design (Type of Quantitative, or Type of Qualitative)
| Quantitative study design (cross sectional study) | Quantitative study design (cross sectional study) | Qualitative study using focus group discussions | Quantitative study / Longitudinal study |
| Setting/Sample
| Primary schools in Assiut city | Government schools | City council staff, maternal and child health (MCH) team-leaders, community health center managers and primary school wellbeing officers, | School system in brazil |
| Methods: Intervention/Instruments
| Assessment of the motor abilities of the students like physical fitness and BMI measurements. | Anthropometric measurements and self-administered questionnaire | Heterogeneous focus groups interviews from different groups of the people who are involved in the health provision process at any levels in Australia | Data for this study were obtained for approximately two years (2015–2016) among Caucasian adolescents enrolled in the school system, aged 12 to 17 whose parents gave them permission to participate in the research by signing an informed consent form parents |
| Analysis
| All statistical tests were processed using. SPSS for version 20. All values were expressed as average ± SD. | Coded data were computerized, and analyzed using SPSS (version 11 Inc. Chicago).Normally distributed data were compared using Student’s t-test for 2 groups and ANOVA test for more than 2 groups. On the other hand, non-parametric tests were used for abnormally distributed data; Mann–Whitney test was used to compare two groups and Kruskall–Wallis test for more than 2 groups. Significance level of 0.05 is used. | The data was analyzed for emergent themes based on grounded theory with two researchers AR and SC, following a six-step thematic analysis approach recommended by Braun and Clark | Statistical analysis was made by descriptive presentation of the mean ± standard deviation values. To quantify the intensity and direction of variables association the Bravis-Pearson bivariate correlation test was performed. To test for the equality of mean BMD measurements between nutritional groups (eutrophic, overweight, obese) we used a one-way analysis of variance (ANOVA). For the analysis, the statistical significance value p < 0.05 was adopted and the statistical packages –Statistical Package for Social Sciences (SPSS)–version 17.0 (SPSS Inc. Chicago, IL) were used. |
| Key Findings
| The present study showed a high percent of overweight, obese and thinness subjects among Egyptian children from Assiut. This abnormal increase or decrease in body weight affect negatively the calculated physical fitness levels | This study found a relatively high prevalence of overweight and obesity among 6–12 year-old children in Port Said city. Socioeconomic class, faulty dietary habits, sedentary life style, low level of physical activity, and finally parental BMI showed a strong association with the BMI of students | This study has highlighted the key factors influencing the engagement of CALD groups in obesity preventive services, including low CALD health literacy and co-existing deficiencies in the structure and delivery of obesity prevention services | This study verified the impact of %BF in BMD in male adolescents. The results showed that group stratification according to the %BF highlights the significant loss of BMD for overweight and obesity groups as compared to the eutrophic group in all evaluated segments, with a loss of 9.91% (whole body) and 12.92% (lumbar) |
| Recommendations
| Development of effective programsand strategies to prevent childhood body weight problems. Such programs should be based on multi-sectoral, multidisciplinary, and culturally relevant interventions (i.e., physical activity, dietary, education etc.) and could be implemented in school environment. | Increased awareness about childhood overweight/obesity through publications and symposia for parents is important | Obesity prevention needs to be supported by policy changes from all levels of the government; the Federal government to implement changes to the environmental and food industry ‘upstream’ factors; the State government to coordinate the development of integrated approaches tackling behavioral modification ‘midstream’ factors in educational and community services; and finally the local government to design and implement interventions targeting ‘downstream’ or individual-level factors among high risk groups | It is suggested that overweight and obesity, classified from the %BF are associated with lower BMD among male adolescents. This strengthens the need for health public policies for adolescents in order to prevent and control body fat excess. |
| Explanation of How the Article Supports EBP/Capstone Project
| To understand the relationship between obesity and physical fitness and implementation of the interventions. | Relationship between socioeconomic class and obesity among the children of school age. | To explore the perception among diverse groups of people and to involve the stakeholders and government to implement the interventions | Bone mineral density and impact of obesity in adolescents and school age children |
| Criteria | Article 5 | Article 6 | Article 7 | Article 8 |
| Author, Journal (Peer-Reviewed), and Permalink or Working Link to Access Article
| Keane, E., Kelly, C., Molcho, M., & Nic Gabhainn, S. http://www.sciencedirect.com/science/article/pii/S0091743516304078 | Xue, H., Wu, Y., Wang, X., & Wang, Y http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0151141 | Bhargava, M., Kandpal, S. D., Aggarwal, P., & Sati, H. C. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156283 | Pengpid, S., & Peltzer, K. http://www.mdpi.com/1660-4601/12/11/14505/pdf |
| Article Title and Year Published
| Physical activity, screen time and the risk of subjective health complaints in school-aged children 2017 | Time Trends in Fast Food Consumption and Its Association with Obesity among Children in China 2016
| Overweight and Obesity in School Children of a Hill State in North India: Is the Dichotomy Urban-Rural or Socio-Economic? Results from a Cross-Sectional Survey 2016 | Overweight and Obesity and Associated Factors among School-Aged Adolescents in Six Pacific Island Countries in Oceania 2015 |
| Research Questions (Qualitative)/Hypothesis (Quantitative), and Purposes/Aim of Study
| Recent arguments suggest that physical activity and sedentary behaviorsare separate constructs each having an independent impact on health outcomes and that there is a need to clarify the interplay between them/ This study describes the prevalence of eight subjective health complaints (including headache, stomach-ache, feeling low and irritability) in a large, nationally representative sample of girls and boys aged 10–17 years. This study also examines the separate and independent associations of meeting physical activity and TST recommendations on the risk of reporting health complaints weekly or more frequently | The relationship between Western fast food consumption (FFC) and weight status remains mixed in the existing literature. Some research suggests a positive association while others do not. Moreover, only a few cohort studies have tested the influence of FFC on obesity. Very limited longitudinal studies have been conducted to examine the effect of FFC on weight status in children, and no study has been conducted in Chinese children/ This study examined the changes over time in FFC and tested the association between FFC and obesity (including overweight) among children in China using nationwide longitudinal data. We hypothesized that FFC had increased over time in China and FFC increased obesity risk in children. | Mean Body Mass Index (BMI), overweight and obesity are increasing world-wide due to changes in diet and physical inactivity/ the aim of this study isto estimate the prevalence of overweight and obesity in the school-going children (6–17 years age) and to assess the demographic and dietary correlates of overweight and obesity in this age group in context with their urban-rural and socio-economic status. | Childhood overweight and obesity have detrimental health consequences during childhood and adulthood. In order to plan services for the provision of care and to evaluate the impact of policy strategies it is important to monitor the prevalence of obesity/ the aim of this study was to assess overweight and obesity and associated factors in school-going adolescents in six Pacific Island countries in Oceania. |
| Design (Type of Quantitative, or Type of Qualitative)
| Quantitative (cross sectional) | Quantitative Both cross-sectional and longitudinal analyses using longitudinal survey data collected in the 2004 and 2009 China Health and Nutrition Survey (CHNS), which covered nine provinces throughout China | Quantitative Observational cross-sectional survey conducted between June 2013 and May 2014 in Dehradun district of Uttarakhand state in North India | Quantitative Secondary analysis |
| Setting/Sample
| Classrooms within primary (aged approximately 10–12 years) and post primary (aged approximately 12– 18 years) schools were randomly selected and all children within classrooms invited to partake | Household-based open cohort which includes about 4,400 households and 26,000 individuals in the nine provinces | The urban-rural type of the schools in India (both Government and Private schools) | Six Pacific Island countries in Oceania |
| Methods: Intervention/Instruments
| Analysis of children. They were asked about the problems they used to face as an obese person | Urban city, ethnicity, family income and physical activities | Demographic and dietary correlates of overweight and obesity in this age group | BMI Measurement and Overweight Classification, Dietary Behavior and Substance Use and Physical Activity and Sedentary Behavior among school age children |
| Analysis
| Statistical analysis was conducted in Stata 12 IC (StataCorp LP, USA). Prevalence estimates were calculated with 95% confidence intervals. Chi-squared tests were used to test for significant differences in socio-demographic and lifestyle factors (physical activity and TST). All descriptive analysis was stratified by gender. | Analysis was conducted using Stata (Version 11.1, StataCorp) | The data were analyzed using SPSS (IBM SPSS Statistics Version 19) and WHO Anthro Plus Software. Factorial ANOVA was used to test associations at three levels | Data analysis was performed using STATA software version 13.0 (Stata Corporation, College Station, TX, USA) |
| Key Findings
| Subjective somatic and psychological health complaints were common in school-aged children. Poor lifestyle behaviors co-existed in two-thirds of girls and just over half of boys | More Chinese children have consumed Western fast food over time. The increase is dramatic and is more rapid in some groups such as among adolescents (vs. younger children), boys, of non-Han ethnicity, those from low- and medium-income families, and those from rural areas or East China | The present study found a significant prevalence of overweight and obesity in school-going children which co-exists with under nutrition. Affluence was found to be an important factor influencing the problem, irrespective of the urban-rural area. Higher socio-economic status affected many demographic and dietary correlates, irrespective of urban-rural area | High prevalence rates of overweight or obesity were found among school-going adolescents in six Pacific Island countries in Oceania |
| Recommendations
| As physical activity and screen time use are modifiable behaviors, effective population based strategies are urgently needed. Meeting TST recommendations was associated with the risk of health complaints independent of physical activity level in this study. However, associations between physical activity and health complaints were less apparent | FFC (fast food consumption) has been linked with adverse dietary quality and health conditions. Efforts are needed to study the impact of FFC on health outcomes, as well as the methods to promote healthy eating among young people in China. | School curriculum that includes education about diet as modifiable risk factor can address both ends of spectrum of malnutrition. | Increased strategies are needed to prevent and treat overweight and obesity in youth. |
| Explanation of How the Article Supports EBP/Capstone
| To tackle the health complains among children | Fast food and its relationship with obesity in children and how they become obese adults | Socioeconomic status and abundance of the food promotes obesity in the school age children so have to keep an eye on the private urban schools | To assess the factors of obesity among children and how these can be controlled and prevented |
