Research and Literature Review
Golan and Crow (2014) conducted a long-term qualitative study assessing the effectiveness of family-based health center interventions. Participants of the study were randomly split into two groups, children-only and parent-only group. Both groups participated in 30 1-hour information sessions conducted by nurses and clinical dietitians over the course of a year. The information sessions for the parents-only group included teachings on nutrition education, proper eating behaviors, and patterns, coping with resistance, activity modifications, problem-solving, and parenting models. The child-only group were education on physical activity, self-monitoring, nutrition education. Problem-solving, eating modifications, and stimulus control. Individual sessions were provided if the participants encountered difficulties adhering to diet or needed further education. Data was collected over the course of seven years. At one, two, and seven years following the conclusion of the education sessions the children’s height and weight were recorded and assessed. At the conclusion of the study, 35% of the children in the parents‐only group reached a non-obese weight, whereas in the child‐only group, only 14%.
The aim of a study conducted by Liu, Zhang, & Li (2012), was to assess the correlation of sleep duration and childhood obesity and how nurses play a vital role in assessing sleep patterns. A systematic literature search was conducted. The authors used two databases that include a large number of peer-review articles. The authors focused on two disciplines: nursing and medicine and searched for the key phrase “sleep duration and childhood obesity” Twenty-five studies were chosen for review. Data was collected through surveys that included sleep questionnaires and sleep logs. Obesity was determined by using the standardized BMI calculation and percentile ranking established by the Center for Disease Control and Prevention. As a result, all studies indicated an association between sleep duration and childhood obesity. The study also suggests that literature evidence supports the need for sleep duration to be considered as a modifiable risk factor for childhood obesity.
A qualitative design with focus group interviews was used to assess the perceptions and challenges school nurses face when implementing guidelines to manage overweight and obese adolescences (Helseth et al, 2017). Twenty-one nurses were interviewed, and data were analyzed by qualitative content analysis. The consensus indicated that school nurses did not feel adequately prepared to implement school health guidelines. School nurses mentioned multiple barriers including training and support, professional collaboration, referral options, available resources, sensitivity of weight-related issues, and skepticism of BMI starting point for intervention.
In 2018 the American Academy of Pediatrics published a study analyzing the prevalence of childhood obesity amongst minorities based on behavioral risk factors and socioeconomic status compared to their Caucasian peers. The study used a longitudinal approach reviewing data from a large sample size (10,700 children ages 9 months old to kindergarten entry). Racial/ethnic groups were categorized as: Asian, African American, Hispanic, American Indian, and White (the reference group). Behavioral risk factors assessed were vegetable consumption, fruit consumption, and television viewing. The results showed that socioeconomic status played a larger role in BMI disparities than behavioral risk factors. Furthermore, the results identified a widening racial/ethnic difference in children’s BMI compared to Caucasian children. The study suggests that public health nurses can develop resources and encourage behavior that can create a healthy environment to help close the gap between racial and ethnic groups and children with low socioeconomic status.
Limitations in Childhood Obesity Studies
Limitations are found in all research studies. A common limitation found amongst childhood obesity studies, including (Helseth et al, Golan and Crow), is that the studies do not look at males and females separately. More research needs to be conducted to analyze the gender disparities. Gender can largely impact obesity as males tend to have higher BMI scores during early childhood and females during adolescence. Another limitation observed in the studies was the lack of validity that is associated with longitudinal studies. Studies that occur over the course of many years make it hard to see the full outcome. In Golan and Crow (2014), fifty of the sixty participants could not be reached. It is important for longitudinal studies to maintain communication in order to accurately retain outcomes.
Information provided by parents through surveys and questionnaires also act as a limitation. Especially, the behavioral risk factors were reported by parents and could have been subjected to misreporting or error. This could have contributed biased estimates which would result in an inaccurate assessment of risk factor contribution. Also, a major limiting factor in all of the studies was the disregard for birth weight. Children with low or high birth weights usually present a different growth trajectory than normal birth weight children.
Childhood obesity is a very sensitive topic, however, in order to fight the epidemic, nurses should take a caring approach when sharing concerns. It is important for nurses to be committed to creating and promoting a healthy environment for children and their families in order to combat childhood obesity. Nurses should not only target the children but their parents as well. Parent’s influence over their children’s environment can improve their children’s adherence to a healthy lifestyle. Although biological risk factors are difficult to combat, nurses can educate parents on common environmental factors including healthy eating, physical activity, and sleep duration. When assessing the need for education, nurses should develop intervention through assessment tools such as access to fresh fruits and vegetables, availability of unhealthy foods in relation to schools, and proximity of opportunities for organized physical activity. Also, nurses should consider the disparities amongst certain racial and ethnic populations. Nurses can act as role models for parents and children by resembling the lifestyle they are encouraging for their patients and their families. If parents and nurses do not have a positive outlook or the ability to lead by example, it is likely children and adolescents will adopt similar feelings as well. Nurses have the ability to be a pivotal factor in curbing the childhood obesity epidemic and promoting a favorable lifestyle amongst our society’s youth.