Introduction
The chosen subject for a scholarly paper is the prevention of childhood obesity in children of 1 to 10 years of age. This subject was chosen because of the widespread presence of obesity in modern western states, which begins from an early age and follows a person throughout their life, causing significant health, social, and economic complications.
Evidence Research Method
The evidence was researched using a standard literature search methodology. Databases searched included Medlab, CINAHL, Cochrane, and the university library. All evidence would have had to be published in the last 5 years, in the English language, in peer-reviewed sources. Meta-analyses, as well as systematic and integrative reviews, were excluded from the search. Keywords used in the literature search included the following: prevention, intervention, childhood obesity, school-based, family, diet, exercise.
Chosen Theory
The paper will rely on Orem’s theory of self-care deficit to inform the ongoing research. The reason this framework was chosen is because of the specific relationship statements and concepts it utilized, namely the idea of a nurse being instrumental in enabling the patient to perform self-care adequately, and the assertion that a patient would be able to help oneself and their family members if they are properly informed (Alligood, 2017). Both concepts are congruent with an educational type of intervention.
State of the Evidence
The article by Olfert, Famodu, Flanagan, Smith, and Leary (2018) evaluated the effectiveness of the iCook 4-H obesity prevention program, which focused on cooking and physical activity intervention along with follow-up information and newsletters for the test group, for 2 years. The results showed that culinary, physical, and mealtime education has a positive effect on reducing obesity in young patients. The randomized control trial featured 228 dyads with a convenience sample (Olfert et al., 2018). The methodology was approved by the Institutional Review Board (IRB). Inter-rater reliability was indicated to be at >0.80%, constituting a high enough score for the chosen instruments. Based on Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II.
The article by Warnakulasuriya et al. (2018) evaluated the effectiveness of taking metformin in preventing obesity in children. The intervention featured 150 obese children that were selected randomly from Sri-Lankan schools and were given metformin or placebo (Warnakulasuriya et al. 2018).
The intervention was aimed at delivering metformin and forming a disciplined habit of taking it at appropriate times. The article indicated that metformin had a positive anthropometric and metabolic effect on children. BMI was chosen as an instrument of effectiveness evaluation, the validity of which was supported by other studies (Warnakulasuriya et al. 2018). Based on Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II.
The article by Messito, Mendelsohn, Scheinmann, and Gross (2018) on the effect of Starting an Early obesity prevention program on children up to 3 years of age. The program showed to have a positive effect on children and parents alike and empowered the mothers to take a more active role in preventing childhood obesity. The research was approved by the IRB but makes no statements about the reliability or validity of their tools, which makes for a limitation. The number of participants included 566 children (Messito et al., 2018). Based on Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II.
Finally, one source evaluated the impact of Orem’s theory of self-care deficit on patients with type II diabetes, many of whom also suffered from obesity (Borji, Otaghi, & Kazembeigi, 2017). The sample included 80 patients with type 2 diabetes. Orem’s self-care program was performed for 60-90 minutes each week and sought to educate the patients on managing their medications, diet, and various symptoms of the disease. The evidence presented showed improvement in the patients’ quality of life (Borji et al., 2017). The article does not explicitly mention ethical approvals and only implies the validity of their instruments. However, they seem to be in line with other articles of a similar nature. Based on Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II.
Overall, the evidence retrieved was of an appropriate level of quality in terms of hierarchy – randomized control trials present one of the highest standards of evidence to be used in research and offer answers to specific questions of interest. Half of the articles mentioned their explicit approval by the IRB, while the other half did not, which limits the applicability of the methodology for other studies.
Finally, only one of the four studies explicitly stated the reliability of its methods using a Cronbach scale. Another one referenced BMI as an applicable method of evaluating the effectiveness of the intervention and cited articles to support that statement. The rest did not elaborate on the validity of their methods, but since they were similar to other articles, the validity of methods was implied as well.
Application of Theory
Orem’s theory of self-care deficit suggests specific measurable learning objectives, content, and teaching strategies to be utilized in affecting childhood obesity. Namely, the objectives need to reflect the acquiring of knowledge by the patients and their implementation of such (Alligood, 2017). The content could focus on specific techniques, dieting, and the use of medication to reduce obesity. Finally, the measures implemented in an educational intervention must aim at improving the participants’ autonomy past the immediate scope of the intervention.
Conclusions
Educational interventions aimed at proper exercise, dieting, medication, and parental involvement decrease the overall BMI in children. Orem’s theory of self-care deficit helps facilitate and sustain change in participants and families. The reviewed evidence supports these notions. However, there is a gap in evidence related to the validity of instruments used in evaluating the effectiveness of such.
References
Alligood, M. R. (2017). Nursing theorists and their work-e-book. Elsevier Health Sciences.
Borji, M., Otaghi, M., & Kazembeigi, S. (2017). The impact of Orem’s self-care model on the quality of life in patients with type II diabetes. Biomedical and Pharmacology Journal, 10(1), 213-220.
Messito, M. J., Mendelsohn, A., Scheinmann, R., & Gross, R. (2018). Starting early/empezando temprano: Randomized control trial to test the effectiveness of a child obesity prevention program. Journal of Nutrition Education and Behavior, 50(7), S120-S121.
Olfert, M. D., Famodu, O. A., Flanagan, S., Smith, E., Leary, M. P., Hagedorn, R. L. & Franzen-Castle, L. (2018). The effect of iCook 4-H, a childhood obesity prevention program, on blood pressure and quality of life in youth and adults: A randomized control trial. Journal of Childhood Obesity, 3(1), 4.
Warnakulasuriya, L. S., Fernando, M. M., Adikaram, A. V., Thawfeek, A. R., Anurasiri, W. M. L., Silva, R. R.,… & Wickramasinghe, V. P. (2018). Metformin in the management of childhood obesity: A randomized control trial. Childhood Obesity, 14(8), 553-565.
Facchiano, L., & Snyder, CH (2012). Evidence-based practice for the busy nurse practitioner: Part one: Relevance to clinical practice and clinical inquiry process. Journal of the American Academy of Nurse Practitioners, 24(10), 579–586.