Pediatric Obesity and Self-Care Nursing Theory

Introduction

Nowadays, obesity can be listed among extremely common health issues that lead to a variety of risks. The presence of excess body fat in children has to be given special consideration since healthy childhood is a prerequisite to normal physical and psychological maturation. The discussed research project is proposed to comparatively analyze the effectiveness of medication treatment and parent education in managing childhood obesity.

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Background and Significance of the Problem

Unhealthy weight remains one of the most critical problems affecting the health of the underage population in the United States and other countries. As of 2019, more than 18% of U.S. citizens aged 2-19 are obese (Centers for Disease Control and Prevention, 2019). Generalizing on the previously conducted research, one can single out specific risk factors for developing childhood obesity. Thus, this condition is more common in children aged from 6 to 11 and from 12 to 19, racial minorities (especially Hispanics), and those from middle- and low-income families (CDC, 2019). Among the most discussed consequences of the problem are the risks of depressive and anxiety disorders, body image issues, and low self-esteem (Liechty, Saltzman, Musaad, & Team, 2015). Some of the most known medical conditions associated with childhood obesity are type II diabetes, cardiovascular disease, orthopedic disorders, and abnormal cholesterol levels (Gibson et al., 2017). Thus, the problem’s significance is related to multiple factors, including the effects of obesity on children’s physical and psychosocial growth.

Problem Statement and Purpose of Study

Based on the abovementioned facts peculiar to weight abnormalities in children, a problem statement can be formulated. The problem is that the effects of childhood obesity deteriorate the nation’s health, acting as barriers to healthy mental and physical development. The purpose of the research project introduces an attempt to find new ways to resolve the problem. In particular, the study is aimed at assessing the potential of parent education in the treatment of childhood obesity.

Research Questions and Hypotheses

The planned data collection and analysis activities are expected to help answer two research questions. Firstly, is parent education on children’s healthy lifestyle more effective for weight normalization in obese children aged 12-14 compared to pharmacological treatment? Secondly, what are the effects of parent education on obesity rates in children aged 12-14? The following null hypothesis is proposed: the use of parent education on healthy lifestyles is not related to reductions in obese children’s BMI scores. The research hypothesis will be as follows: parent education on healthy lifestyles for children leads to better obesity outcomes in children from 12 to 14 years old compared to pharmaceutical treatment.

Variables with Operational Definitions

The planned study will focus on the relationships between three variables. The first independent variable is medication treatment; it can be operationally defined as the use of prescription medications, for instance, Orlistat, to normalize weight in extremely obese children. The mentioned age range was selected since the FDA does not approve the use of weight loss drugs in children younger than twelve years old (Kaplowitz, 2017). The second independent variable is parent education on healthy lifestyles for children. It is operationalized as the use of evidence-based educational interventions to improve parents’ understanding of children’s nutritional needs and the optimal levels of physical activity. The dependent variable is presented by obesity rates or the percentage of participants with BMI scores that are abnormally high.

Pediatric Obesity: Literature Review

Childhood obesity could be one of the most prominent and pressing issues in modern-day pediatric health issues, affecting minors throughout the US. This complication affects “13.7 million children and adolescents,” creating the prerequisites for a nationwide problem that has implications for both physical and mental health (Centers for Disease Control and Prevention, 2019; Gibson et al., 2017). While there may exist an extensive breadth of literature regarding pediatric obesity’s causes and effects, it is also vital to assess ways of countering it, as well as appraising the more effective treatment approaches. Thus, the following literature review attempts to demonstrate the current level of knowledge on childhood obesity treatments and, additionally, permits contextualizing the proposed research within the existing scientific tendencies.

Analytical Summary and Synthesis

Assessing ways of treating overweight children could allow furthering the currently provided quality of care, as well as providing their guardians with appropriately outlined treatment expectations. Research shows that parent-child involvement as a single familial unit is cost-effective, which allows hypothesizing regarding the potential harbored by adult figures in a child’s life (Altman & Wilfley, 2015). However, Muthuri et al. (2016) argue that the effect of higher education levels relates to childhood obesity inversely. Thus, recognizing the role of parents in obesity treatment remains acute, particularly considering that mother-father involvement significantly betters any undertaken intervention practices (Ward et al., 2017). However, beyond recognizing parents’ importance, it is unclear which variable causes this effect. As an example, the study of Larsen et al. (2015) focuses on the effect of adult-imposed food policing and dietary practices, which, however, allows shedding light only on the manifestation of assumed nutrition-related intelligence. As such, parents’ education levels remain an essential but unaddressed factor that could provide an insight into different treatments’ effectivity.

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The applicability of different care methods, particularly pharmaceutical treatment, becomes relevant when considering the connotations carried by the knowledgeability of both mothers and fathers regarding health practices. Professionals discourage “the use of any obesity medication unless the patient has failed a formal program of intensive lifestyle modification,” thus, making parents’ low grasp of health-related habits a potentially reliable indicator for prescribing medicine (Kaplowitz, 2017, p. 2). Furthermore, mothers and fathers with a lower health literacy show a decreased propensity to accepting different weight-loss strategies, possibly making pharmaceutical treatment a viable starting point for children’s treatment in sparsely educated families (Liechty, Saltzman, Musaad, & the STRONG Kids Team, 2015). Thus, considering the low results achieved by combined interventions into children’s health, prescribed medicine may become a cost-efficient treatment method in families with lower education levels (Ward et al., 2017). Therefore, recognizing the effect of parental education levels on their children’s sustainable weight loss may help highlight more effective treatment methods per the ramifications of varying factors.

Theoretical Framework

The prevalence of pediatric obesity has resulted in adverse health care conditions and outcomes around the world. As a result, there is a need to address this problem through a combined effort of various strategies. However, it is essential to comprehend the primary risk factors to ensure effective treatment. In this case, diet and lifestyle have been highlighted as the precipitating variables (Skinner et al., 2018). This essay seeks to utilize the self-care nursing theory and how it addresses the issue of obesity in children.

First, the self-care nursing theory was developed by Dorothea Orem with the primary aim of improving patient outcomes (Clarke, Swinburn, & Sacks, 2016). The basic concept behind this theory hinges on the ability of patients to perform acts that promote their health condition. As a result, it is essential for health care professionals to impart the necessary knowledge to patients and the entire populace regarding a certain health condition. This theory can be used to address pediatric obesity since it provides that people are self-reliant and responsible for their care (Clarke et al., 2016). One of the ways to treat obesity is through lifestyle changes. It is advisable to adjust to healthy eating habits to prevent excessive accumulation of fat. For instance, censure controlled intake of calories and increase consumption of dietary fiber. Learning about the self-care theory allows a person to gain an understanding of potential health care problems and how to promote self-care behaviors (Skinner et al., 2018). Since obesity is a serious health complication, people are advised to practice healthy behaviors.

Pediatric Obesity: Methodology

Sample/Setting

The study involves 110 12-14-year-old racially diverse children of both genders who are diagnosed with obesity, as well as their parents. The criteria for inclusion are the following: children should be diagnosed with obesity during the recent two years; they have not taken medication treatment for their obesity problem; only one parent can represent a family. Fifty-five pairs of a parent and a child are assigned to the group receiving pharmacological treatment, and the other fifty-five pairs are assigned to the group receiving parent education.

Sampling Strategy

A non-probability purposive sampling technique has been selected for this project. The reason for choosing this strategy is that families having children with obesity need to be found and attracted to participate in the study intentionally (Campbell & Stanley, 2015). Parents of children with obesity are contacted in healthcare centers, hospitals, and other medical facilities with the help of dieticians and other healthcare providers. These parents are offered more information on the project to decide on their participation.

Research Design

A quasi-experimental research design is selected for this study in order to address its purpose and answer the set research questions. Quasi-experimental designs based on pretest-posttest assessments, similarly to experiments, allow for measuring how a manipulated independent variable can influence a dependent variable. However, in these studies, participants cannot be randomly assigned to groups and conditions (Campbell & Stanley, 2015). The rationale for selecting a quasi-experimental design is that it allows for evaluating the effectiveness of the proposed intervention in situations when the random assignment of participants to conditions is problematic because of their diversity. A pretest-posttest type of this design allows for concluding about the effectiveness of the assigned treatment or intervention.

Extraneous Variables

Extraneous variables that can potentially influence the results of this research are children’s race and health status. Some races are viewed as having higher rates of pediatric obesity in their communities, and as controlling this variable, racially and ethnically diverse participants are recruited. Furthermore, the health status of children and comorbidities associated with obesity can potentially affect the results of interventions. Therefore, children are selected depending on their generally positive health status and the absence of such comorbidities as diabetes and digestive diseases.

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Instruments

In order to assess the effectiveness of both interventions regarding changes in children’s obesity, it is necessary to use such an instrument as the Lifestyle Behavior Checklist. This measurement allows for assessing parents’ vision of problems associated with children’s behaviors (a Problem scale) and parents’ confidence in overcoming these problems (a Confidence scale). The scale includes items regarding children’s dietary habits and physical activity that are measured with the help of a 7-point Likert scale. This tool is discussed in the literature as highly reliable and valid with Cronbach’s α in 0.85-0.95 (Kim, Park, Park, Lee, & Ham, 2016). Thus, the scales used in the Lifestyle Behavior Checklist are characterized by a high level of internal consistency.

Additionally, the eating behaviors of children should be assessed with the help of the Dietary Self-Efficacy Scale that includes 15 items measured with the help of a 3-point Likert scale. Cronbach’s α related to this scale is 0.84-0.82, which accentuates its high reliability and validity (Sögüt, 2018). In addition, children’s Body Mass Index (BMI) also needs to be measured to conclude on changes in children’s obesity status (Kim et al., 2016). The measurement of BMI is traditionally viewed as an effective approach to assessing possible changes in people’s weight.

Description of the Intervention

Two types of interventions are to be proposed in this project: parent education on a healthy lifestyle for children and pharmacological treatment. Children’s BMI should be measured during the pre-test period of the project (Sögüt, 2018). Parents of children belonging to the first group are expected to receive a 6-week education regarding appropriate diets, physical activity plans, and daily schedules for children. The focus is on educating parents on how to change the life of their children in accordance with the principles of a healthy lifestyle to decrease weight and improve their physical and emotional state. Information on the nutritional value of products, daily dietary plans, and appropriate physical activity and exercise should be provided (Kim et al., 2016; Sögüt, 2018). Parents from the second group should contact healthcare providers and use prescribed medications for their children to contribute to decreasing adolescents’ weight.

Data Collection Procedures

The procedures for collecting data during the post-test period after applying interventions include conducting surveys and measuring BMI for children representing both groups. After six weeks of conducting the study, parents from both groups need to be contacted in order to fill in questionnaires related to the Lifestyle Behavior Checklist. They should also help adolescents in filling in the Dietary Self-Efficacy Scale. This information will be used in the context of independent variables identified for this study (Kim et al., 2016). Children should also be invited by the researcher to measure BMI individually and as the percentage for the group, and this information will be used as a dependent variable in this project.

Analysis of Demographic Variables

Descriptive statistical tests will be performed to describe the basic features of the population based on the demographic variables. In particular, it is important to indicate the number of participants, the mean, median, and range of children’s age and parents’ age, the percentage of males and females, and the percentage of participants living in urban and rural areas. Then, the household wealth quintile should be calculated with differentiation by five categories, from the poorest to the richest. The percentage of parents with higher education should be calculated for each group. Using the chi-square test, the prevalence of childhood obesity by subgroups may be calculated. Subgroups should be created on the basis of gender (males and females), residence area (urban and rural), household wealth level (with five levels), and parents’ education (higher education or secondary).

Analysis of Study Variables

Descriptive statistical tests for analysis of study variables include tests of measures of central tendencies, such as mean, mode, and median. These tests should be performed separately for two groups of interventions, which are medical treatment and parent education. The intervention used for the group with the highest mean value of the rate of childhood obesity may be the least effective one. However, this assumption will be further studied with inferential statistical tests.

To discover if there is a significant difference between the impacts of the two types of interventions on childhood obesity, a simple t-test should be performed. Before running this test, it is important to ensure that test data has a normal distribution and its variances are homogeneous. Otherwise, the results generated by this statistical method may be unreliable. The Shapiro-Wilk test is the general test to determine if the data has a normal distribution, and the Bartlett test shows if the variances of a variable are homogeneous (Moore, Notz, & Fligner, 2015). These two tests should be run for the dependent variable, which is the obesity rate of a child. Results obtained from a simple t-test will show if obesity rates of children differ between the two groups, based on the calculated p-value. The recommended level of significance for the t-test is 0.05. If the p-value is lower than 0.05, the independent variable for which the mean value of the rate of a child’s obesity is the lowest will be the most effective intervention.

Another inferential statistical test that may be used to determine which type of intervention has the most positive impact on the dependent variable is a one-way ANOVA. There will be only one independent variable named Treatment with two levels, the first one is medical treatment, and the second one is parent education. Based on the p-value, conclusions will be made if the mean values of the dependent variable significantly differ. If the p-value is lower than 0.05, there is a significant difference between the values of the dependent variable for the two groups, so the null hypothesis should be rejected. If the p-value is greater than 0.05, differences between the values of the dependent variable for the two groups are not statistically significant, so the null hypothesis should be accepted.

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The above-mentioned statistical methods may be performed using any statistical software, including SPSS, SAS, RStudio, or even MS Excel. It is recommended that results obtained be appropriately visualized by building boxplots to show differences between the impacts of two types of interventions on the dependent variable (Franklin, 2015). The given model may be enhanced by adding more independent variables, such as the age of a parent and the gender of a child.

Ethical Considerations

The basic principles of ethical research include how the research will benefit the scientific society and humanity in general, fair selection of research participants, and respect for the personality and rights of the human subject. Protecting the rights of human subjects in research is vital because no harm should be inflicted on participating parties. Various philosophical underpinnings may be used to approach human rights protection in scientific studies (Ketefian, 2015). Because participants are not divided into two groups in a randomized manner, it is crucial to adequately inform the ones who will be receiving the pharmacological intervention and obtain their consent. This type of intervention will be conducted under the careful observation of doctors and will immediately be stopped should unexpected outcomes occur in the form of adverse psychological or physical side effects. Written consent will also be obtained from the rest of the participants. Rights concerning privacy will be protected by securely storing personal data, and published results will not contain any personal information, such as names.

Limitations of the Study

Limitations have a significant impact on how the results are interpreted and, sometimes, even how the research is designed and conducted. For instance, various ethical boundaries may exclude the usage of some methodologies and instruments. They are generally viewed as a defect or a deficiency of the study. Limitations, however, not only explain to the reader the shape of the study results but also give authors an opportunity to learn in which direction they should go in terms of future research (Greener, 2018). There are two limitations that are important to mention and consider when interpreting the study results. The first one is the fact the research is limited by geographical boundaries: participants reside in one area and are not spread out despite the racial and gender diversity. This constraint limits the generalizability of the results but calls for similar research to be conducted in other geographical areas of the country. The second limitation is that only one pharmacological product is going to be tested out on the participants, but that may not give the most precise picture because other products may have different effects. Because the market of such medicaments is too broad, it is very challenging to review the impact of each one of them.

Implications for Nursing Practice

Nursing deals with a wide range of health problems and patients directly and is a significant element of the contemporary health care delivery system. While obesity problems may not have a straight connection to nursing practice, the results of the research may directly impact the future of nursing. Should the hypothesis of the study, which states that education on obesity might be better than pharmacological intervention, be proved, nurses will receive an additional line to their list of responsibilities. Because nurses are the first ones to deal with patients, they may become responsible for giving required information on obesity to parents, who in turn will educate their children. Educational interventions may take the form of one-to-one meetings between parents and nurses or, more effectively, of local community events for raising awareness and providing support and information. Nursing education may also be impacted because required training on providing support and knowledge on obesity will have to be included in educational programs at universities and colleges for prospective nurses.

Conclusion

In summary, the planned study is expected to offer new perspectives on the role that parents’ knowledge and resulting behaviors play in abnormal weight gain in children. Moreover, it can help to make conclusions on circumstances in which pharmaceutical treatment is the preferable option. Finally, if the research hypothesis is confirmed, it will be possible to formulate new practical recommendations peculiar to obesity treatment and prevention. While numerous studies tackle the effect of parental involvement on children’s weight-loss management, their education levels remain an unaddressed factor. Confirming or refuting the link between these two determinants could allow deciding on productive treatment pathways for different types of families, for example, pharmaceutical treatment for children with parents who maintain low education levels. The existing body of literature supports this query, highlighting the existence of a weak point in education-focused research within pediatric obesity analyses. Therefore, investigating the effect of parents’ education levels may be essential to formulating practical recommendations for childhood obesity treatments, considering the already existing implications of parental influences on children. In summary, pediatric obesity is a health condition that needs to be addressed to prevent worsening of the associated symptoms. Furthermore, parents need to get involved in addressing this issue to promote healthy eating habits and lifestyles. To this end, the self-care theory will facilitate knowledge acquisition and dissemination.

References

Altman, M., & Wilfley, D. E. (2015). Evidence update on the treatment of overweight and obesity in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 44(4), 521-537. Web.

Campbell, D. T., & Stanley, J. C. (2015). Experimental and quasi-experimental designs for research. New York, NY: Ravenio Books.

Centers for Disease Control and Prevention. (2019). Childhood obesity facts. Web.

Clarke, B., Swinburn, B., & Sacks, G. (2016). The application of theories of the policy process to obesity prevention: a systematic review and meta-synthesis. BMC Public Health, 16(1), 1084.

Franklin, J. (2015). The science of conjecture: Evidence and probability before Pascal. Baltimore, MD: Johns Hopkins University Press.

Gibson, L. Y., Allen, K. L., Davis, E., Blair, E., Zubrick, S. R., & Byrne, S. M. (2017). The psychosocial burden of childhood overweight and obesity: Evidence for persisting difficulties in boys and girls. European Journal of Pediatrics, 176(7), 925-933.

Greener, S. (2018). Research limitations: the need for honesty and common sense. Interactive Learning Environments, 26(5), 567-568.

Kaplowitz, P. (2017). Is there a role for metformin in the treatment of childhood obesity? Pediatrics, 140(1), e20171205.

Ketefian, S. (2015). Ethical considerations in research. Focus on vulnerable groups. Investigación y Educación en Enfermería, 33(1), 164-172.

Kim, H. S., Park, J., Park, K. Y., Lee, M. N., & Ham, O. K. (2016). Parent involvement intervention in developing weight management skills for both parents and overweight/obese children. Asian Nursing Research, 10(1), 11-17.

Larsen, J. K., Hermans, R. C., Sleddens, E. F., Engels, R. C., Fisher, J. O., & Kremers, S. P. (2015). How parental dietary behavior and food parenting practices affect children’s dietary behavior. Interacting sources of influence? Appetite, 89, 246-257. Web.

Liechty, J. M., Saltzman, J. A., Musaad, S. M., & Team, T. S. K. (2015). Health literacy and parent attitudes about weight control for children. Appetite, 91, 200-208.

Moore, D. S., Notz, W. I., & Fligner, M. A. (2015). The basic practice of statistics (7th ed.). New York, NY: W. H. Freeman & Company.

Muthuri, S. K., Onywera, V. O., Tremblay, M. S., Broyles, S. T., Chaput, J. P., Fogelholm, M.,… ISCOLE Research Group. (2016). Relationships between parental education and overweight with childhood overweight and physical activity in 9-11 year old children: Results from a 12-country study. PloS One, 11(8), 1-14. Web.

Skinner, A. C., Ravanbakht, S. N., Skelton, J. A., Perrin, E. M., & Armstrong, S. C. (2018). Prevalence of obesity and severe obesity in US children, 1999–2016. Pediatrics, 141(3), e20173459.

Sögüt, S. C. (2018). Determining the differences in nutrition knowledge, dietary behaviors, physical activity and self-efficacy behaviors based on obesity status among adolescents. Journal of Human Sciences, 15(2), 747-754.

Ward, D. S., Welker, E., Choate, A., Henderson, K. E., Lott, M., Tovar, A.,… Sallis, J. F. (2017). Strength of obesity prevention interventions in early care and education settings: A systematic review. Preventive Medicine, 95, 37-52. Web.

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