Introduction
Obesity is fast becoming one of the moist challenging public health problems being faced by the United States at ore sent with prevalence rates tripling in the last thirty years. Obesity is being related to a wide range of chronic health challenges including diabetes, hypertension, heart disease, joint and musculoskeletal problems, asthma, sleep apnea as well as certain cancers (Hollar et al, 2010). Obesity is also linked to psychological aspects such as low self esteem as well as depression. Studies have found that women who are obese are also far less likely to attend college, live in poverty and are not likely to get married (Yin et al, 2012).
Obese children on the other hand are moiré likely to suffer from higher levels of bullying as well as a decline in their school performance. Obesity is one of the most socially stigmatizing conditions where the perception is that the child or the caregiver should have done better to ensure that the condition was prevented(Brotman et al, 2012). Increasingly obese children are being diagnosed with type 2 diabetes which before was only affecting adults who were obese. Experts are increasingly arguing that the lifetime risk of type 2 diabetes for children is 30% for boys and over 40% for girls. Obese children often grow up to be obese adults in the future and have a distinct burden on the country’s health care system with an estimated cost of over US $ 100 billion in either direct or direct costs(Robinson et al, 2013).
Prevalence/Statistics
According to recent studies, children and youth in the United States spend between 6 and 8 hours a day being sedentary with reports suggesting that this decrease in physical activities often occurs between early to late adolescence. It is this period that is often critical for development as well as growth of the child. Wright et al (2013) found that in the United States, the percentage of children who are obese and are aged between 5 to 14 years has more than doubled over the last three decades rising from 15% to 30%. Of particular concern was the fact that disproportionate rates of childhood obesity continue to be reported among ethnic minority groups especially those from the Black/African American, Hispanic, girls and those coming from low socio economic status.
For instance between 15% and 25% of children attending Head Start preschools which are early childhood education programs that are funded by the United States government are obese(O’Connor et al, 2011). In Orange County, Latino or Hispanic children had an obesity rate of 13.9% for children up to four years old and 22.9% for children aged between five to eleven year olds. It has been estimated that over 46% of American school children are at risk for type 2 diabetes and being diagnosed with cardiovascular disease even before they reach adulthood (Bryars et al, 2012).
Obesity has been considered as an especially difficult challenge in children from low economic families since they often have to deal with food insecurity. Most especially, students who find that they are unable to get sufficient food might also score lower in math and often experience social as well as psychological difficulties(O’Connor et al, 2011). It has been argued that successfully addressing the public health challenge of childhood obesity will require collaboration from multiple level and agencies that are directed towards the numerous factors that impact on the management of weight (O’Connor et al, 2011).
Schools have been targeted as key in the reduction of obesity among children since children attend school 5 days a week and many of these schools are located in communities of different socio economic as well as racial group (Bryars et al, 2012). In this regard, the school environment presents a wide array of opportunities to teach children concerning critical health as well as nutrition practices. It has been argued that the impact of schools on the positive health of children is especially strong in low income communities since the school is where the children find the large proportion of their daily nutrition requirements (Yin et al, 2012).
In an analysis carried out by Wright et al (2013), the study found that children and youth over have little control over the physical activity options as well as food choices available to them especially in the context of low socio economic communities. Schools therefore found that schools serve as the most appropriate venue to enable students with the chance to engage in physical activity on a daily process and to teach them the importance of taking part in regular physical activity as this helps in the building of skills that help to support active lifestyles. Most importantly, schools provide access to school nurses who can provide services such as screening, counseling as well as a continuous process of care.
As opposed to clinical programs, programs initiated in school can be delivered at little cost to the families and can reach children from low income families more effectively; children who might not otherwise have access to treatment (Yin et al, 2012). It has also been argued that while child care providers as well as preschool teachers might be eager to provide a healthy learning experience for the children, one of their greatest impediments (Hollar et al, 2010).
Out of the ten studies reviewed, all were intervention studies; 6 were quasi experimental, three were non-experimental and one was RCT. The studies were carried out over a period of two years, one year, 6 weeks, 6 months while another study was done over a period of 12, 24 and 36 months. Hollar et al (2010) found in their quasi-experimental controlled pilot study that the Healthier Options for Public Schoolchildren included a number of components that could be replicated including modified dietary offerings, nutrition/lifestyle educational curricula as well as aspects of physical activity and projects dealing with wellness. According to their study, there was a marked improvement in the BMI, blood pressure as well as academic scores of children coming from low income Hispanic and White communities in the intervention study. Their conclusion was therefore that holistic obesity prevention interventions can be key in improving outcomes of health as well as academic performance in populations that have been identified as high risk.
Hollar et al (2010) on the other hand sought to examine the impacts of a school based obesity prevention intervention that included components of diet, curricula as well as physical activity on the body mass index as well as academic performance of school children from low income families. In carrying out their quasi-experimental design, they found that obese school children involved in the intervention study were more likely to score higher scores in reading over the two years that the study was carried out. In this regard, Hollar et al (2010) agreed that school based interventions could be key tools in enabling the improvement of both health as well as academic performance among children from low income populations.
Yin et al (2012) argue that research on the active prevention of obesity among young children who are at risk of obesity is hard to find and therefore sought to examine the effectiveness of a prevention intervention that was culturally tailored. This particular intervention sought to actively promote healthy weight gain as well as gross motor development in preschool going children who came from low income families. In their study, they used a predominant number of children from the Mexican American community. They found that more positive results were found in children who took part in an intervention program that actively combined school and home based components.
Children involved in this particular intervention showed a higher increase in outdoor physical activity and were more encouraged to consume healthy food. They therefore came to the conclusion that there was a distinct promise in the creation of a healthy environment for preschool children since it would have a positive impact on both the weight as well as the development of gross motor skills for children who are at risk of obesity.
For Bryars et al (2012) their purpose, just as Yin (2010) was to find out whether a home and center based intervention would be helpful in enabling early childhood students to experience any type of significant changes in their body mass indexes as well as behaviors related to obesity and the identification of foods that are healthy as well as engagement in physical activities. The end of the study, their preliminary findings were that their program under study, Healthy for Life/PE4ME might be effective in actively reducing on the trend of childhood obesity among preschool children.
All the studies analyzed found that programs that aimed at reaching children and their parents in an effort to encourage them to adopt lifestyle behaviors that were healthy worked better if they combined efforts from both the homes of the children and their time at school. For instance, O’Connor et al(2013) found that Helping HAND which was an obesity intervention aimed at reaching five to eight year old children in primary care clinics had the potential to be effective. This was attributed to the fact that the program had low levels of attrition, positive levels of attendance and improvements that were clinically relevant to child as well as parent behaviors.
In acknowledging that childhood obesity is a core public health issue not only within the United States, the studies sought to show that daily physical activities can be increased for both male as well as female students and can also help to actively decrease the body mass indexes of children who are at risk of obesity. It was further argued that morbidity levels attached to minority populations would be significantly reduced if early measures for intervention were put in place.
Gaps in the Literature
Childhood obesity is a highly prevalent aspect in the United States growing to such an extent that it has come to be referred to as a global epidemic. The analysis carried out above has shown that the large majority of studies regarding obesity in children from low income families are carried out in schools. Moreover, the large majority of school based interventions can be critical in enabling the prevention of obesity especially those that are lined to a home intervention measure that seeks to target both the diet of the child as well as the levels of physical activity that he is involved in.
Even thought there is a significant amount of evidence for interventions that are school based, it is difficult to conclude that settings put in place in other settings could be helpful in effectively dealing with childhood obesity. In this regard, there are distinct gaps with regard to the effectiveness of interventions that have been put in place in other settings aside from either school or home especially with regard to changes in the environment and policy. While the above studies did provide an overview of the effectiveness of putting in place interventions on food as well as nutrition policies at school on the changes on children’s diet as well as school food environments, there are still a wide array of gaps in the literature in some regard.
The studies have not examined the impact that regulations have on the availability of food and the impact that this has on prevention of obesity. None of the studies reviewed used social marketing as a way in which to deliver messages on aspects of nutrition, physical activity as well as health. This particular aspect might be integrated into other components of intervention as a way to create an atmosphere that is favourable to healthy as well as active lifestyle and other related behavioral changes. In addition, there is need to examine the value of consumer health information’s on products as a way in which to reduce childhood prevention.
There is also a distinct lack of evidence on the impact of either regional or national policies with regard to childhood obesity prevention including policies on agriculture as well as regulations concerning either retailing of food or distribution. In addition, future research should focus more on stratified analysis of subgroups such as gender, age, and race and socio economic status. This will be key in enabling a greater understanding of the way in which different groups might respond to a similar intervention. This in turn might be key in tailoring future interventions and subsequently to ensure that benefits are maximized.
There were a number of methodological limitations of the studies that were reviewed which might be taken as a way to suggest that future research might benefit from improving on these methods. A number of the studies I reviewed reported process evaluation which would be key in providing useful insight regarding the reason why some of these studies might actively detect desirable impacts of the intervention.
Childhood Obesity and the Role of the Nurse
For nursing it is especially critical as it articulated the core role that is played by them considering how one study argued that nurses provide critical counseling and guidelines on what constitutes healthy eating. Within the school setting, there are numerous opportunities available to provide education on aspects such as nutrition as well as exercise. As a Family Nurse Practitioner, analysis of the articles has been key in articulating the role I will play in enabling children to lead more healthy lives and ensuring that their parents have a clear understanding of the role that their own behaviors play into the food choices of their children.
Conclusion
Analysis of the studies brought to the fore the importance of putting in place effective interventions for reducing childhood obesity especially in children coming from low socio economic families. Most importantly, it outlined the importance that integrating home and school based interventions can be helpful in ensuring the decline of childhood obesity rates in children from low income families.
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