In the last three decades, the rates of childhood obesity have increased by more than three times. This is according to the American Health Trust (2013), which further reports that 30 states have over 30% of their children above the overweight mark. Weight ranges greater than what is considered healthy for a given height, is what is considered overweight or obese by the Center for Disease Control and Prevention (CDC). These weight ranges are considered to increase the likelihood of some health complications such as Type 2 Diabetes, hypertension, sleep apnea and liver disease. Both the CDC and American Academy of Pediatrics (AAP) recommend the Body Mass Index (BMI) as the screening tool to identify possible weight problems in children.
Overweight and obese children are at a risk of developing serious health complications such as diabetes type 2 and hypertension (CDC, 2015b). Children and adolescents are the ones mostly affected by childhood obesity. Health consequences related to obesity that can be studied include: increased risk for adulthood obesity and corresponding problems and educational plans to prevent childhood obesity risk factors.
Target Population and Setting
The intervention program will consist of Fifth grade students from two different schools. One will be an experimental group while the other one will be a control group. A questionnaire titled “know your body” will test the participant’s baseline knowledge of obesity-related risk factors. BMI, waist circumference, blood pressure, blood glucose and lipid concentration and cholesterol level are the metabolic parameters that will be obtained for each student before and after the intervention to enhance cardiovascular risk factors student’s awareness (May at al., 2010). Researchers will work with science teachers in the school and come up with a program that would address nutrition, physical activity, heart disease and diabetes. The intervention contained four class sessions and lessons for four months and the health questionnaire repeat.
Application to Advanced Practice Role
In today’s world, childhood obesity is an ongoing issue. The risk factors identified such as lack of sufficient physical exercise and poor nutrition are of great significance to understand the etiology of obesity (Fahlman et al., 2008). This study primarily focuses on preventable factors that lead to obesity in a child. In order to end the obesity menace, children must be educated about healthy eating, importance of physical activity and even the obesity facts. Perhaps educational interventions in schools may prevent the obesity problem in children. It will also provide more knowledge on healthy lifestyles among the children which will make them adapt to healthy behavior. This will be of benefit to their families, society and even the economy.
This study is informed by the Health Promotion Model (HPM) by Nola Pender. The focus of HPM is based on the achievement of higher levels of welfare and self-actualization and groups the factors affecting behavior. The changing factors that the model describes are behavioral and situational factors, interpersonal influences, as well as demographic and biological characteristics.
Behavioral factors are those that inform a person’s behavior to current situations in relation to former experiences, while situational factors are their reactions in response to their immediate environment. Interpersonal influences are inclusive of the social support and expectations of relations such as those of family and peers. Biological and demographic tendencies include gender, age, racial and ethnic backgrounds and income; which are necessary towards the self-actualization part of this model.
The modifying factors are reported to indirectly influence health behavior while the cognitive-perceptual determinants are important in informing motivational methods of improving health. The factors include the individual’s view-point on the importance of health and on the profits of healthy practices. This model also insists on the need of understanding how one defines health as this influences how they see their own health and eventually impacts behavior towards their health (Galloway, 2003).
The educational intervention was developed using this model to promote health among middle school students. This can be achieved by increasing their wellbeing levels. It will expound on some of the cognitive-perceptual and modifying factors relevance to obesity during childhood. For instance, certain situational and behavioral determinants were discussed in relation to childhood diets, physical exercise, and risk of obesity factors.
The educational intervention will show the benefits of eating healthy and having enough exercise for the students to understand the need of healthy practices. This intervention will create a positive effect on healthy behavior which will lead to increased self-efficiency and heightened positive behavior for middle-school students.
Review of Literature
A study by Fahlman et.al (2008) tested the efficiency of the MM (Michigan Model) Nutrition Curriculum on nutrition information and eating tendencies among middle school students. The study utilized a pre and post-test quasi-experimental model with a sample size of 783 middle school pupils. The questionnaire developed had 33 questions, looking into the students’ eating patterns and familiarity of nutrition facts. The test was for internal reliability. The intervention was done by teachers trained in the Michigan Model program, and was taught for a month. The post-test was given two weeks after the end of the intervention. The results showed that those middle school students taught the theoretical lesson not only improved their nutrition knowledge, but were also more likely to make healthy modifications in their daily diet.
Childhood obesity impediment methods have been studied by O’Dea and Wilson (2006). Their study supported the idea that the dietary value of breakfast and socio-economic status of children are precise predictors of their body mass index (BMI). Together with age, gender, and height, researchers found out that other factors can also serve as sources of potentially high BMI in children such as nutritional self-efficiency, breakfast contents and socio-economic status (SES) of their parents. Children with low self-efficiency, those who do not eat a nutritious breakfast or no breakfast at all and have a low SES recorded higher BMI compared to their counterparts who had good breakfast and high SES. The sample size of this particular study consisted of 4441 students, all randomly selected from all over Australia.
The perception of corpulent school children on exercise was looked into by Chang et al. (2009), and identified key driving forces to egg on obese children to participate in regular physical exercise. Purposive sampling was used to make out the 11 obese students, out of 1,714 students in the study. The average BMI for the 11 students, aged between 11 and 13, was 27.2 kg/m2, which is obese for children that age. All students sampled reported that they felt their health was either good or excellent. On analyzing focus group data, six themes were discovered. These, on (p. 172) included;
(a) Positive effects of exercising,
(b) Identification of negative effects associated with not keeping fit,
(c) Discomfort during exercise,
(e) False beliefs concerning exercise, and (f) Excuses for not exercising.
This study was important as it discovered why obese children do not exercise.
Nauta et al. (2009) used a study design that was descriptive and correlated to reveal that school nurses in New Jersey were more informed on childhood obesity, but not many were well skilled in prevention, detection, and management of obesity. As school nurses are the health experts that the children are in contact with mostly, it is needful for all school nurses to be skilled in identifying, preventing, and successfully treating childhood obesity.
Intervention was a lesson put together by the APNs and the middle-school Physical and Health Education teacher at the contributing school. It (the educational intervention) was created with knowledge and activities from Nygard and Hopper’s (1998) Innovative Fitness Connections (IFC) physical fitness program, and from other research sources (CDC, 2015) and (May, et al., 2010). The syllabus has been approved by the National Health Physical Education, Recreation, and Dance council. The school board of the involved school had formerly approved this curriculum as worth for use by middle school students.
More information included in the educational intervention sessions included Montana specifics about childhood obesity as shown by the 2009 Montana Youth Risk Behavior Survey, and repeated obesity facts acquired from reviewing existing studies.
The intervention’s efficiency will be scrutinized by reviewing students’ opinions on the importance of some healthy routines and other obesity risk factors before and after the session. The intervention is anticipated to improve the middle school students’ understanding of obesity risk factors. To determine the strengths and the weaknesses of the intervention, survey results will be broken down into stand-alone factors: obesity consciousness, physical activity, and diet. It is probable that the survey questions will show the usefulness of the intervention through increased awareness on the different aspects that may lead to obesity such as media outlets, peer pressure, and hereditary factors such as genes.
This research will be a survey used to weigh students’ familiarity to obesity before the intervention and after the intervention. The pre-survey will have 24 questions looking into the participants’ knowledge of obesity and awareness of its risk factors such as nutrition, and the need of physical activity. This survey will also investigate the participants’ opinions of the contributing causes of obesity, need of healthy diets, and the importance of, and different facets of physical activity.
It will have precise questions for each of the factors under accession. The post-survey will be a duplication of the pre-survey. The surveys will be created with questions from previous studies and from literature reviewed by the PI under the instruction of Dr. Gallinger, a professional surveyor (Williams et al., 2005).
Centers for Disease Control and Prevention. (2015a). Healthy Weight. Retrieved from https://www.cdc.gov/healthyweight/ on August 29, 2016
Centers for Disease Control and Prevention. (2015b). Childhood Overweight and Obesity. Retrieved from http://www.cdc.gov/obesity/childhood/ on August 29, 2016
Chang, W., Lee, P., Lai, H., Chou, Y. & Chang, L. (2009). Perceptions of exercise in obese school-aged children. Journal of Nursing Research, 17(3), 170-176.
Fahlman, M., Dake, J., Mccaughtry, N., & Martin, J. (2008). A pilot study to examine the effects of a Nutrition Intervention on Nutrition Knowledge, Behaviors, and Efficacy Expectations in Middle School Children. Journal of School Health, 78(4), 216-222.
Galloway, R. (2003). Health promotion: causes, beliefs, and measurements. Clinical Medicine and Research, 1(3), 249-258.
May, W., Suzanne, R., Natalie, S., Anna, M., Launa, C., Caitlin, M., Kelly, F., & Patricia, C. (2010). Exposure to a Comprehensive School Intervention Increases Vegetable Consumption. Journal of Adolescent Health, 74-82.
Nauta, C., Byrne, C. & Wesley, Y. (2009). School nurses and childhood obesity: an investigation of knowledge and practice among school nurses as they relate to childhood obesity. Issues in Comprehensive Pediatric Nursing, 32(1), 16-30.
Nygard, B., & Hopper, B. (1998). Innovative Fitness Connections: Physical Fitness Curriculum. Anchorage, Alaska: Innovative Fitness Connections.
O’Dea, Jennifer and Wilson, Rachel. (2006). Socio-cognitive and nutritional factors associated with body mass index in children and adolescents: possibilities for childhood obesity prevention. Health Education Research, 21(6), 796-805.
Trust for America’s Health. (2013). F as in Fat: How Obesity Threatens America’s Future 2013. Retrieved from http://healthyamericans.org/report/108/ on August 29, 2016
Williams, J., Wake, M., Hesketh, K., Maher, E. and Waters, E. (2005). Health related Quality of life of overweight and obese children. JAMA 293:1, 70-76.
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