Childhood obesity is a growing national and worldwide health issue affecting children (Hammersley et al., 2019). Treatment of childhood obesity is challenging. This is attributed to numerous contributing factors, including environment, genetics, eating habits, physical activity, family and cultural customs, and psychological issues (Kennedy et al., 2021). Childhood obesity is also linked to unhealthy parental role modeling and a lack of proper guidance leading to unhealthy eating behaviors (Hammersley et al., 2019). Obese children experience diminished health quality and psychosocial stigma than their age mates with normal body weight (Kennedy et al., 2021). Childhood obesity induces financial and socio-economic burdens on families and society. Families with obese children incur additional expenses to cater for healthier foods and regular clinic visits. Parents or guardians are likely to miss work to take care of their children, while children are also likely to miss school (Bohlin et al., 2017). The purpose of this assignment is to analyze childhood obesity incidence and prevalence, synthesize quantitative and qualitative evidence on the problem by identifying the emerging themes, review evidence translation model, and appraise the quality of the evidence.
Analysis of the Practice Problem
The overall prevalence of childhood obesity has significantly increased worldwide (Bohlin et al., 2017). The rising prevalence is associated with diminished quality of life negative health outcomes, such as psychosocial disorders, psychological and psychiatric issues (Sanyaolu et al., 2019). Obese children are at a higher risk of contracting non-communicable diseases later in life (Sanyaolu et al., 2019). The disease is also associated with comorbidity conditions, such as diabetes, diminished self-esteem, hypertension, depression, sleep apnea, and hyperlipidemia (Kennedy et al., 2021). The association between childhood obesity and reduced quality of life and health outcomes qualifies the disease as a significant practice problem (Hammersley et al., 2019). Childhood obesity incidence is critical in elucidating more about the significance of this particular practice problem (Cheung et al., 2016). The annual incidence of childhood obesity from early childhood to adolescence in the United States has declined with age. The median incidence percentage was 4.0% at ages between 0-1.9, 4.0% for age group 2.0-4.9 years, 3.2% at 5.0-12.9 years, and 1.8% at 13.0-18.0 years (Cheung et al., 2016).
In the past decades, childhood obesity has risen rapidly in the United States and globally. Approximately 23% of the children from developed countries and 13% from developing nations are obese or overweight (Hammersley et al., 2019). The World Health Organization echoed this. The World Health Organization reported that childhood obesity had increased three times since 1975 globally (World Health Organization [WHO], 2021). In 1975, only about 4% of the children aged between 5 and19 were overweight or obese compared to approximately 18% in 2016 (WHO, 2021). The World Health Organization report on childhood obesity further indicated that about 38.2 million children were obese in 2019 (WHO, 2021). The prevalence of this disease is also increasing in both middle-and low-income countries, particularly in urban areas. For example, there has been a 24% increase in childhood prevalence in Africa since 2000. Approximately half of the children diagnosed as obese in 2019 lived across Asia (WHO, 2021). Similarly, childhood obesity prevalence in the United States remains disturbing high. The Centers for Disease Control and Prevention report indicated that between 2017 and 2018 prevalence of childhood obesity was approximately 19.3% (Centers for Disease Control and Prevention [CDC], 2021). The rising prevalence of childhood obesity indicates the need for prevention measures targeted to children before or at the onset of obesity.
Evidence Synthesis
Three major themes emerged from the review of three evidence-based studies. Two of the studies provided quantitative evidence, and the third offered qualitative evidence. The first theme that emerged is family involvement (Bohlin et al., 2017; Hammersley et al., 2019; Kennedy et al., 2021). Physical activity was the second theme that emerged (Hammersley et al., 2019; Kennedy et al., 2021). The other theme was e-healthy/telephone-based programs (Bohlin et al., 2017; Hammersley et al., 2019).
Parental/Family-Involvement
All three studies indicated that childhood obesity programs involving programs effectively alter the trajectory of this health issue (Bohlin et al., 2017; Hammersley et al., 2019; Kennedy et al., 2021). A randomized controlled trial by Hammersley et al. (2019) with a sample of 86 dyads (parents and their children) showed that parent involvement led to a decrease in the frequency of discretionary food intake (estimate -1.36, 95% CI -2.27 to -0.45; P=.004). Parents showed improvement in child feeding pressure to eat practices (-0.30, 95% CI 0.06 to -0.00; P=.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P=.01). Using a sample of 37 children, Bohlin et al. (2017) found that both experimental and control groups had had similar changes in BMI SDS 3.7 years after the first visit to the facility, TC = − 0.42 and UC = −0.52 BMI SDS units (p = 0.6). The findings were consistent with a qualitative study by Kennedy et al. (2021). Kennedy et al. (2021) established that participants perceived parental involvement as the most effective childhood obesity prevention program. The study included a sample of 60 participants (30 parents and 30 children/adolescents). These findings revealed that parental involvement is critical in childhood obesity prevention programs, particularly for programs targeting influencing lifestyle changes
Physical Activity
Two of the reviewed studies indicated that participation in physical activity is a critical element of childhood obesity programs (Hammersley et al., 2019; Kennedy et al., 2021). Hammersley et al. (2019) showed that obesity and overweight intervention involving physical activity compared to the control group positively affects school-aged children’s overall Body Mass Index (BMI). Similarly, parents and children who participated in the study by Kennedy et al. (2021) revealed the significance of the physical activity. Participants indicated that the inclusion of physical in an obesity program would enhance fitness and self-esteem.
Technology-Based Obesity Programs
The two reviewed quantitative studies by Bohlin et al. (2017) and Hammersley et al. (2019) implemented technology-based interventions with children using a randomized controlled trial design. A total of 86 dyads of parents and their children participated in the study by Hammersley et al. (2019). They took part in an internet-led health lifestyle program for 11-weeks and three months of follow-up emails. Participants also received personalized feedback from a dietitian and contributed to a closed Facebook group. The results demonstrated that the e-health childhood obesity program was effective in improving dietary practices. In contrast, Bohlin et al. (2017) implemented a childhood obesity program using telephone-based coaching sessions using a randomized controlled trial design. Participants included a sample of 37 children aged 5–14 years. The intervention had no significant difference with usual physical visits regarding Body Mass Index standard deviations (p = 0.8). Compared to routine physical visits, telephone-based coaching offered greater flexibility (Bohlin et al., 2017).
Discussion of Evidence
The evidence demonstrated that childhood obesity could be prevented and managed using different cost-effective measures (Bohlin et al., 2017; Hammersley et al., 2019; Kennedy et al., 2021). Technology-led interventions, including telephone coaching and internet-based sessions, offered better flexibility than usual care (Bohlin et al., 2017; Hammersley et al., 2019). The findings established that a technology-based obesity prevention program could offer meaningful support to promote dietary practices. The review further suggested that parental or family involvement is fundamental when implementing obesity programs (Bohlin et al., 2017; Hammersley et al., 2019; Kennedy et al., 2021). The evidence supports that the involvement of parents/guardians can help reduce intake of discretionary diet (Hammersley et al., 2019). The reviewed evidence also supports physical activity in obesity programs (Hammersley et al., 2019; Kennedy et al., 2021). The results suggested that increased physical activity could improve self-esteem and fitness in children (Kennedy et al., 2021). These cost-effective interventions have the potential to address childhood obesity and lower ever-increasing prevalence successfully.
Evidence Appraisal to Address the Practice Problem
The level of evidence for the reviewed articles was assessed using Johns Hopkins Nursing evidence-based practice (EPB) tool (see appendix A). The two randomized controlled trials by Bohlin et al. (2017) and Hammersley et al. (2019) had level I evidence. The study by Bohlin et al. (2017) used descriptive statistics and t-test and analysis of variance (ANOVA) to analyze data. Hammersley et al. (2019) utilized linear mixed models to assess variations between experiment and control groups from baseline, three months, and six months. Post hoc analysis of covariance (ANCOVA) analyses was also utilized to determine changes between groups at varying time points. The qualitative study by Kennedy et al. (2021) had level III evidence. The authors used thematic analysis to identify emerging themes.
The quality of the study by Bohlin et al. 2017 and Hammersley et al. (2019) was rated as good quality. Both studies contained consistent findings and a sufficient sample size of the experimental design. These studies also had fairly definitive conclusions guided by the results. The study by Kennedy et al. (2021) also had a good quality rating. The sample sized was adequate for a qualitative design. Kennedy et al. (2021) provided reasonably consistent recommendations founded on available literature.
As mentioned above, the obtained evidence is considered appropriate to address childhood obesity. All three studies highlighted issues, aims, and systematic data collection procedures. Studies Bohlin et al. 2017 and Hammersley et al. (2019) were internally valid based on design and control. This helped address potential bias. In the two studies, participants were randomly assigned to experimental and control groups, addressing selection bias. Kennedy et al. (2021) independently reviewed and compared themes, promoting the reliability of their results.
Evidence Translation Model
The knowledge to action (KTA) model is among the most adopted translation frameworks in healthcare settings when implementing evidence-based practice (Spooner et al., 2018). The framework encompasses two but related components: knowledge creation and the action cycle. Each component entails various phases which overlap and could be iterative. The knowledge-creation cycle encompasses three steps and distills knowledge from its basic form. This facilitates the collection of synthesized, appraised, and user-friendly products centered on users’ needs (Xu et al., 2020). The action cycle involves the process of translating knowledge into practice and has seven components. The components include identifying the problem, adapting knowledge, assessing barriers, implementing, monitoring, evaluating, and sustaining (Xu et al., 2020).
Engagement of stakeholders and tailoring knowledge to their needs is critical. The knowledge to action framework is deployed to facilitate the utilization of available research knowledge by different stakeholders, including policymakers, patients, and practitioners (Moore et al., 2020). A plan to determine key stakeholders is developed to allow evidence translation into practice. The mode acknowledges the importance of engaging different stakeholders at varying phases of knowledge translation (Moore et al., 2020). For example, stakeholders are integrated when identifying barriers or facilitators that influence the success of knowledge translation in an organization. Stakeholders are also involved in the action cycle during problem identification and knowledge selection (Spooner et al., 2018). This forms the link between knowledge creation and action cycle components of the framework. The model holds the premise that the involvement of stakeholders in the generation of research ideas increases the applicability and translation of evidence into practice. For example, stakeholders are integrated into the model to help tailor the knowledge to local contexts, facilitating effective translation of knowledge into practice (Spooner et al., 2018).
Conclusion
Childhood obesity remains a major public health concern worldwide. The disease is linked to reduced quality of life and socioeconomic and financial burden. Although childhood obesity is declining, its prevalence is still high. Previous literature suggests that telephone-based programs, parental involvement, and physical activity are cost-effective strategies that healthcare providers could implement to address childhood obesity. The knowledge to action could be adopted to facilitate translation of the best evidence when implementing evidence-based childhood obesity programs. Stakeholders are engaged in problem identification and different stages of translating evidence into practice.
References
Bohlin, A., Hagman, E., Klaesson, S., & Danielsson, P. (2017). Childhood obesity treatment: Telephone coaching is as good as usual care in maintaining weight loss: A randomized controlled trial. Clinical Obesity, 7(4), 199-205. https://doi.org/10.1111/cob.12194
Centers for Disease Control and Prevention. (2021). Childhood obesity facts: Prevalence of childhood obesity in the United States. https://www.cdc.gov/obesity/data/childhood.html
Cheung, P. C., Cunningham, S. A., Narayan, K. V., & Kramer, M. R. (2016). Childhood obesity incidence in the United States: a systematic review. Childhood Obesity, 12(1), 1-11. https://dx.doi.org/10.1089%2Fchi.2015.0055
Hammersley, M. L., Okely, A. D., Batterham, M. J., & Jones, R. A. (2019). An internet-based childhood obesity prevention program (Time2bHealthy) for parents of preschool-aged children: Randomized controlled trial. Journal of Medical Internet Research, 21(2), 11964-11984. https://www.jmir.org/2019/2/e11964/
Kennedy, B. M., Davison, G., Fowler, L. A., Rodriguez-Guzman, E., Collins, M. L., Baker, A., Cook, S., Lindros, J., Wilfley, D. E., Zebrick, A. J., & Staiano, A. E. (2021). Perceptions of a pragmatic family-centered approach to childhood obesity treatment. Ochsner Journal, 21(1), 30-40. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993422/
Moore, J. L., Virva, R., Henderson, C., Lenca, L., Butzer, J. F., Lovell, L., Roth, E., Graham, I. D., & Hornby, T. G. (2020). Applying the Knowledge-to-Action Framework to implement gait and balance assessments in inpatient stroke rehabilitation. Archives of Physical Medicine and Rehabilitation,1-16. https://doi.org/10.1016/j.apmr.2020.10.133
Sanyaolu, A., Okorie, C., Qi, X., Locke, J., & Rehman, S. (2019). Childhood and adolescent obesity in the United States: A public health concern. Global Pediatric Health, 6, 1-11. https://doi.org/10.1177%2F2333794X19891305
Spooner, A. J., Aitken, L. M., & Chaboyer, W. (2018). Implementation of an evidence‐based practice nursing handover tool in intensive care using the Knowledge‐to‐Action framework. Worldviews on Evidence-Based Nursing, 15(2), 88-96. https://doi.org/10.1111/wvn.12276
World Health Organization. (2021). Obesity and overweight. https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight
Xu, Y., Li, S., Zhao, P., & Zhao, J. (2020). Using the knowledge-to-action framework with joint arthroplasty patients to improve the quality of care transition: a quasi-experimental study. Journal of Orthopaedic Surgery and Research, 15(1), 1-5. https://dx.doi.org/10.1186%2Fs13018-020-1561-7
Appendix A
Johns Hopkins Summary Tool
Article Number | Author and Date | Evidence Type | Sample, Sample Size, Setting | Findings That Help Answer the EBP Question | Observable Measures | Limitations | Evidence Level, Quality |
1. | Hammersley et al., 2019 | RCT | Sample: Parents and children Sample size: A total of 86 dyads of parents and their children. Setting: Australian and New Zealand | Parent-focused eHealth childhood obesity prevention program may offer needed support to promote dietary-related practices. Parent involvement led to a decrease in the frequency of discretionary food intake (estimate -1.36, 95% CI -2.27 to -0.45; P=.004). | – BMI- Dietary intake- Physical activity- Sleep habits | Due to the small number of participants in the overweight and obese ranges, the authors did not manage to conduct a sub-analysis of these participants. Since multiple outcomes were assessed, there is a risk that there was a type 1 error | Level I |
2. | Bohlin et al., 2017 | RCT | Sample: Children Sample size: 37 Setting: Södertälje outpatientclinic, Sweden | Telephone coaching had similar impact on BMI changes as usual care, including physical visits, TC = − 0.42 and UC = −0.52 BMI SDS units (P = 0.6 between groups). Experimental and control groups had had similar changes in BMI SDS 3.7 years after the first visit to the facility, TC = − 0.42 and UC = −0.52 BMI SDS units (p = 0.6). Telephone coaching offered greater flexibility in the treatment of pediatric obesity | – BMI – Treatment time – Parental weight status | The study groups were small. | Level I |
3. | Kennedy et al., 2021 | Qualitative research | Sample: parents and children Sample size: A sample of 60 participants (30 parents and 30 children/adolescents) Setting: Louisiana | – Parents indicated that healthy eating education, involvement of parents, and influential program leaders as the most critical when implementing family-based WMP for childhood obesity. Children/adolescents felt that education on healthy eating and exercise would significantly help manage obesity when included in a family-based WMP. | N/A | The composition and representativeness of participants may limit the generalizability of the results. | Level III |