In this assignment, students will pull together the change proposal project components they have been working on throughout the course to create a proposal inclusive of sections for each content focus area in the course. At the conclusion of this project, the student will be able to apply evidence-based research steps and processes required as the foundation to address a clinically oriented problem or issue in future practice.
Students will develop a 1,500-1,750 word paper that includes the following information as it applies to the problem(Childhood Obesity), issue, suggestion, initiative, or educational need profiled in the capstone change proposal:
Review the feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to the portfolio components before submitting.
Prepare this assignment according to the guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.
You are required to submit this assignment to Turnitin.
Top of Form
Bottom of Form
Running head: PICOT STATEMENT 1
PICOT STATEMENT 6
PICOT Statement: Childhood Obesity
P- Patients who suffer from obesity (BMI of more than 30)
I- Undertaking nutritional education, diet, and exercise
C- Comparison to not taking nutritional education, diet, and exercise
O- Improved health outcomes in terms of overall weight loss
T – A year’s time limit
PICOT Statement: Patients, who suffer from obesity (BMI of more than 30) undertaking nutritional education, diet and exercise in comparison to not taking nutritional education, diet, and exercise, can have improved health outcomes in terms of overall weight loss in a year’s time limit.
Childhood obesity poses serious health problems in the US as the number of overweight and obese population increases at a rapid pace every year. The effects of this problem have arrested the attention of policymakers, societal members, and government agencies. This has resulted in ranking childhood obesity as a national health concern. The adverse impacts of this disease go beyond the health realms to include economic burden on both personal and national budgets. While there are numerous risk factors and various evidence-based interventions to address this challenge, no single approach is consistently efficacious in curbing the disease. Consequently, it is imperative that efficacious initiatives and policies be developed to address the never-ending problem of childhood obesity. Multidisciplinary approaches are often broad and cut across all dimensions of personal health problems. Instead of placing emphasis solely on biomedical models, health care professionals should also seek to promote behavior change among obesity patients and their family members. A PICOT statement can be utilized as an effective tool to seek interventions of addressing childhood obesity.
In the US, obesity prevalence is highest among children aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased cases of obesity prevalence have been noted among children of all ages, although the differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged families and some racial and ethnic minorities experience the higher median score on obesity than the dominant white population. Higher obesity rates are often recorded among blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al. 2016). For low-income earners, American Indians rank highest at 6.3 percent, followed closely by Hispanics at 5.5 percent.
Evidence-based interventions that seek to reduce childhood obesity incidences in the country should target two major areas: prevention and treatment. High-quality RCT has been proven as one of the most effective preventative intervention, especially in schools (Reilly, 2006). Such interventions involve making changes on the school curriculum by introducing and improving physical education, changing school meal provisions, and reducing the television viewing hours. Schools should also engage in promotional campaigns that encourage walking form home to school (Ickes, McMullen, Haider & Sharma, 2014). This intervention has been successful in most cases involving girls in the sense that the risks of becoming obese are significantly lowered. Treatment interventions should be limited to motivated families and communities, in which the child and parents perceive obesity as a problem. From a theoretical perspective, treatments should be continued for longer periods such as months to years. Diets should be modified, especially with the use of regimen such as traffic light diet. Television viewing habits should also be reduced (Ickes et al. 2014). Furthermore, treatment should be aimed at encouraging families to self-monitor their lifestyle. Finally, more time should be offered for consulting with family members.
Being a member of a multidisciplinary team, the nurse practitioner performs the task of offering standardized care and advocacy support for healthy community environments. In addition, the nurse helps to ensures that there is proper coverage, access to, and incentives for regular obesity prevention, screening, diagnosis and treatment (Vine et al. 2013). There is also need to promote active living and healthy eating at work. Finally, focus should be on promoting healthy living during weight gain. There is also need to expand the role of health care providers, in childhood obesity prevention.
When a nurse is involved as one of the primary members in the multidisciplinary team approach, the child should be guaranteed of better continuity of care. The outcomes of interventions should include reduced obesity risks and curriculum adjustments for sustainable change to make it cost-effective (Ross et al. 2010). The curriculum modifications should be generalizable. One of the leading causes of failure of previous interventions is that they targeted modifications at the micro levels. This means that targeting individual children, families, or schools make it harder to have positive outcomes or impacts on the many other influences on weight status that affect the environment at the macro levels. Obesity control efforts that are successful should require a more macro-environmental strategy in addition to the micro level behavioral adjustments.
Obesity treatment and management should be a process that takes months to years. This is because the focus should not just be on the individual level, but also on the general behavioral patterns of a person’s family, friends, and society at large (Ross et al. 2010). Therefore, interventions should be multidisciplinary and aim at changing the behavior of the patient by promoting long term positive outcomes. Precautions to monitor blood pressure can be done every two weeks or on a monthly basis. Medications such as sibutramine can be utilized for periods of up to one year. However, its use should be discontinued in patients whose weight loss stabilizes at less than five percent of their initial body weight.
Cheung, P. C., Cunningham, S. A., Narayan, K. V., & Kramer, M. R. (2016). Childhood obesity
incidence in the United States: a systematic review. Childhood Obesity, 12(1), 1-11.
Ickes, M. J., McMullen, J., Haider, T., & Sharma, M. (2014). Global school-based childhood
obesity interventions: a review. International journal of environmental research and
public health, 11(9), 8940-8961.
McGrath, S. M. (2017). Childhood Obesity Comorbitities Awareness Hospital-based Education
(Doctoral Dissertation), Walden University, Minneapolis, Washington.
Reilly, J. J. (2006). Obesity in childhood and adolescence: evidence based clinical and public
health perspectives. Postgraduate medical journal, 82(969), 429-437.
Ross, M. M., Kolbash, S., Cohen, G. M., & Skelton, J. A. (2010). Multidisciplinary treatment of
pediatric obesity: nutrition evaluation and management. Nutrition in Clinical
Practice, 25(4), 327-334.
Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the role of primary
care in the prevention and treatment of childhood obesity: a review of clinic-and
community-based recommendations and interventions. Journal of obesity, 2013.
Running head: LITERATURE REVIEW 1
LITERATURE REVIEW 2
Literature Review: Childhood Obesity
Literature Review: Childhood Obesity
The prevalence of childhood obesity in the United States has increased at such a rapid rate that this has been considered a serious healthcare issue. This issue has attracted the attention of policy makers, government agencies, and the community. Due to the extent of the problem, a large number of researchers have investigated a number of factors relating to childhood obesity. One of the factors that have been investigated is the impact of changing the attitudes of the patients towards obesity and lifestyle factors that cause a risk factor. In this study, the main factor being investigated is the impact of education on exercise and diet on patients who have a BMI of more than 30. The following is a summary of a review of the literature used to determine the impact of educating patients on exercise and diet changes.
Comparison of Research Questions
Most of the literature analyzed for this study focuses on the intervention strategies for childhood obesity. Cheung et al. seeks to understand the extent of the childhood obesity in America. The research asks about the incidence of childhood obesity in America in a bid to demonstrate the extent of the problem.
Ickes et al. (2014) research question compares the intervention strategies used in the American schools and international ones. The main aim of this study is to determine the gaps in the intervention used in American schools that has caused the increased childhood obesity. On the other hand, Reilly (2006) research investigates the interventions strategies for childhood obesity in United States schools that have been applied overtime. The research question for this study is to investigate the effectiveness of each of the strategies that have been applied.
McGrath (2017) directly investigates the effectiveness of having an obesity education awareness program for the families of children suffering from childhood obesity. The research asks whether educating patients and family on the importance of maintaining ideal weight and providing awareness on obesity can help reduce the incidence of childhood obesity. Ross et al. (2010) investigates the recommended interventions for childhood obesity. The research question for this study seeks to understand some of the most effective interventions strategies to help reduce obesity among children in the United States.
On the other hand, Vine et al. (2013) seeks to understand the role that primary care providers can play in improving the issue of childhood obesity. The research asks whether primary care providers have the capability to make a positive difference through patient education to help reduce the incidence of childhood obesity. Taveras et al. (2014) compares the effectiveness of various interventions for childhood obesity. The question for this study is whether various interventions applied in primary care have the same impact on the reduction of childhood obesity. Lastly, Janicke et al. (2014) investigates the effectiveness of family lifestyle interventions in the reduction of obesity. The question of this study asks whether changing lifestyle factors such as diet and exercise can help to reduce obesity in children.
Comparison of Sample Populations
All the researches that have been included in this study were meta-analyses or reviews of literature except Taveras et al. (2015) which included a randomized control trial. This study included a sample of 649 children between 6 and 12 years. The other studies were analyses of other researches that have been done in the past on obesity. Janicke et al. (2014) analysed 20 studies whose sample sizes amount to 1,671 participants. On the other hand, Ross et al. (2010) performed a review of 73 studies. The research does not indicate the number of participants represented by the analyzed studies. McGrath (2017) conducted a literature analysis of 7 articles. There is a variation between the sample sizes of the analyzed articles ranging from 12 participants to 9000 participants. Ickes et al. (2014) conducted a systematic analysis including 12 studies whose samples sizes range between 10 and 20 participants. In general the studies that have been included in this research have generally small sample sizes. Most of the studies are literature reviews with a very low number of studies included in the analysis. None of these studies is longitudinal in nature and the samples are very small. Therefore, there is a high chance that the studies are limited in terms of the choice of methods. The following is an analysis of the limitations of each of the studies.
Comparison of the Limitations of the Studies
The limitations of the studies included in this research are mainly in the choice of methodology, specifically the samples and analysis methods used by the respective researchers. The main limitation of Ickes et al. is that the review of research was done in a narrative format. The study fails to utilize quantitative methods to enhance the accuracy of the results. Qualitative data analysis has a significant risk of inaccuracy. The study by McGrath (2017) is limited by the very small sample size. The review analyses less than 10 studies, which makes the chances of inaccuracy to be very high. Additionally, the author has used only qualitative techniques of data analysis, thus, increasing chances of inaccuracy. On the other hand, Cheung et al. (2016) is limited by the use of convenience data. The studies used in this study were not primarily meant to study the research question of the researcher. Therefore, there is a high chance of inaccuracy in the results collected. Reilly (2006) fails to clearly define the methodology used by the researcher. Therefore, it is hard to ascertain the true strengths and limitations of the study. Ross et al. (2013) is also limited by inconsistencies in the research methodology. The study included research from more than 100 studies but there are some studies that were not specific to the research question. The researchers made the closest connection to determine the results of the study. In general, these studies have a significant chance of inaccuracy and lack of reliability because of the limitations of the methodologies employed by the researchers.
In conclusion, the studies that have been analyzed for this research demonstrate consistent results with regards to the effective intervention strategies for childhood obesity. From the studies it is clear that childhood obesity is an extensive problem in the United States. The best interventions to this problem include changes in the family lifestyle of the families. Lifestyle changes include the increase of physical activity and the change of the diets. Intervention within the primary care setting has also been found to be an effective form of intervention for childhood obesity. The primary care professionals can help parents to reduce the extent of obesity in the American children by implementing education strategies. These studies confirm the hypothesis that education on lifestyles changes to the patients and their families can help to reduce the incidence of childhood obesity in the United States. Therefore, they can be used to confirm the PICOT statement of this study which argues that “Patients, who suffer from obesity (BMI of more than 30) undertaking nutritional education, diet and exercise in comparison to not taking nutritional education, diet, and exercise, can have improved health outcomes in terms of overall weight loss in a year’s time limit”.
Cheung, P. C., Cunningham, S. A., Narayan, K. V., & Kramer, M. R. (2016). Childhood obesity incidence in the United States: a systematic review. Childhood Obesity, 12(1), 1-11.
Ickes, M. J., McMullen, J., Haider, T., & Sharma, M. (2014). Global school-based childhood obesity interventions: a review. International journal of environmental research and public health, 11(9), 8940-8961.
Janicke, D. M., Steele, R. G., Gayes, L. A., Lim, C. S., Clifford, L. M., Schneider, E. M., … & Westen, S. (2014). Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity. Journal of pediatric psychology, 39(8), 809-825.
McGrath, S. M. (2017). Childhood Obesity Comorbitities Awareness Hospital-based Education (Doctoral Dissertation), Walden University, Minneapolis, Washington.
Reilly, J. J. (2006). Obesity in childhood and adolescence: evidence based clinical and public health perspectives. Postgraduate medical journal, 82(969), 429-437.
Ross, M. M., Kolbash, S., Cohen, G. M., & Skelton, J. A. (2010). Multidisciplinary treatment of pediatric obesity: nutrition evaluation and management. Nutrition in Clinical Practice, 25(4), 327-334.
Taveras, E. M., Marshall, R., Kleinman, K. P., Gillman, M. W., Hacker, K., Horan, C. M., … & Simon, S. R. (2015). Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial. JAMA pediatrics, 169(6), 535-542.
Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the role of primary care in the prevention and treatment of childhood obesity: a review of clinic-and community-based recommendations and interventions. Journal of obesity, 2013.
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