essay

1. In this assignment, students will pull together the change proposal project
components they have been working on throughout the course to create
a proposal inclusive of sections for each content focus area in the course
At the conclusion of this project, the student will be able to apply evidence-based research
steps and processes required as the foundation to address a clinically oriented problem or
issue in future practice.Students will develop a 1,250-1,500-word paper that includes the
following information as it applies to the problem, issue, suggestion, initiative, or
educational need profiled in the capstone change proposal:1. Background2. Problem
statement3. Purpose of the change proposal4. PICOT5. Literature search strategy
employed6. Evaluation of the literature7. Applicable change or nursing theory utilized8.
Proposed implementation plan with outcome measures9. Identification of potential barriers
to plan implementation, and a discussion of how these could be overcome10. Appendix
section, if tables, graphs, surveys, educational materials, etc. are createdReview the
feedback from your instructor on the Topic 3 assignment, PICOT Statement Paper, and
Topic 6 assignment, Literature Review. Use the feedback to make appropriate revisions to
the portfolio components before submitting.solid academic writing is expected, and in-text
citations and references should be presented using APA documentation guidelines, you are
required to retrieve and assess a minimum of 8 peer-reviewed articles. an abstract is not
required, CITE WEBSITE SOURCE.Running Head: CHILDHOOD OBESITY 2Topic:
Childhood Obesity – PICOT StatementP-I-C-O-T StatementP- Obese children under the age
of 12 with a BMI index of 30 or more.I-Educational Nutrition programs involving Proper
diet and engaging in physical activityC- Children who will be involved in the educational
program versus those who will not be engaged.O- Reduction in obesity among children
below the age of 12 by increasing knowledge on nutrition educationT- A period not less
than 1 yearIntroductionIt is evident that obesity and overweight in general have become
worldwide epidemics as illustrated by the widespread concerns. Moreover, this menace has
been associated with other life-threatening complications such diabetes, cancers,
cardiovascular complications and a wide range of health problems, making it an even
complicated case that needs to be attended to (Reilly, & Kelly, 2011). For children below the
age of 12, obesity has not only resulted to the mentioned health problems, but also forms a
basis for ridicule and overall loss of the self-esteem that is vital in development into
adulthood. Due to this continued prevalence, there is need for the involved stakeholders
such as the government and other policy makers in the healthcare system to have in place

2. research-based interventions that will ensure a drop-in number of children affected. It is
further crucial to understand the implications of obesity go beyond affecting the individual
directly and affect both the individual and the nation through the high cost of treatment. All
these can be addressed in a nutrition education program that is suggested by this paper.
The following is a PICOT statement intends to find lasting solutions to this problem;
Comment by Melissa Reedy: You actually want to include your PICOT statement here as
wellPopulationDespite recording some decline in the prevalence of obesity among children
below the age of 12, the numbers are still too high, and something must be quickly done
before we completely lose control of this problem. Statistics indicate that, 12.7 million
children and adolescents are affected by obesity (Ogden, Carroll, Kit, & Flegal, 2012). The
target population for this research is children below the age of 12.InterventionAll intended
intervention procedures should be based on research evidence and they should primarily
focus on preventing children from being overweight and treating those that are already
affected. The intervention suggested here is having a nutritional education program that
highlights dieting and exercising. Dieting as an intervention requires changing the general
food environment and making available healthy choices. Intense physical activities on the
other hand are meant to eradicate sedentary lifestyles and creating policies that seek to
change the overall socioeconomic environment could impact positively on the health of the
population (O’Reilly, Cook, Spruijt‐Metz, & Black, 2014).ComparisonThrough research-
based evidence, the caregiver is mandated to educate the entire community on the entire
subject matter. This means conducting civil education and ensuring information is readily
available in the community (Summerbell, 2011). For this to work, the evidence provided
must be compared to the practice being opposed. In this case, the practitioner suggests
comparing results from obese children involved in an education nutritional program vs
those not involved in one.OutcomeThe general outcome is to ensure research and evidence
is used to guarantee a society that is working towards healthy living and is characterized by
continued care for the affected and prevention measures (Puhl, & Heuer, 2010). At the end
of the intervention process, there should be little risk of obesity in the United States and an
overhaul of the entire system that has for a long time not dealt with the issue. One of the
leading causes of previous interventions because modifications is targeted at the micro
levels. Whereby targeting children individually, families, or schools make it harder to
achieve positive outcomes or impacts on other influences on weight status that affect the
general environment at the macro levels. Therefore, successful obesity control efforts must
require a more macro-environmental strategy in addition to the micro level behavioral
adjustments.TimeSince obesity is a problem that has affected the community for years, the
intervention process can only last for at least a year before meaningful conclusions can be
drawn. The time it takes to completely have an impact on the problem will also depend on
the number of disciplines that work together to find a lasting solution. Since research
evidence is based on multidisciplinary collaboration, coming up with a fool proof solution to
obesity in children will take a considerable amount of time (Han, Lawlor, & Kimm,
2010).ReferencesBonomi, A. G., & Westerterp, K. R. (2012). Advances in physical activity
monitoring and lifestyle interventions in obesity: a review. International journal of obesity,
36(2), 167.Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2010). Childhood obesity. The Lancet,

3. 375(9727), 1737-1748.Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2012).
Prevalence of obesity and trends in body mass index among US children and adolescents,
1999-2010. Jama, 307(5), 483-490.O’Reilly, G. A., Cook, L., Spruijt‐Metz, D., & Black, D. S.
(2014). Mindfulness‐based interventions for obesity‐related eating behaviours: a literature
review. Obesity reviews, 15(6), 453-461.Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma:
important considerations for public health. American journal of public health, 100(6), 1019-
1028.Reilly, J. J., & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood
and adolescence on morbidity and premature mortality in adulthood: systematic review.
International journal of obesity, 35(7), 891.Wang, Y., Wu, Y., Wilson, R. F., Bleich, S., Cheskin,
L., Weston, C., … & Segal, J. (2013). Childhood obesity prevention programs: comparative
effectiveness review and meta-analysis.Waters, E., de Silva‐Sanigorski, A., Burford, B. J.,
Brown, T., Campbell, K. J., Gao, Y., … & Summerbell, C. D. (2011). Interventions for
preventing obesity in children. The Cochrane Library.LITERATURE REVIEW 1LITERATURE
REVIEW 7INSTRUCTOR COMMENT: Your recommendation for further research is
really not present, THIS IS WEEK SIX.Topic: Literature ReviewRunning head: LITERATURE
REVIEW 1Childhood Obesity: Literature ReviewIntroductionObesity has for a long time
been a subject of concern, not only for adults but also for children. Due to the serious health
implications that obesity has, a lot of efforts have been made to devise ways to prevent it.
This includes several studies that are aimed at understanding the prevalence of obesity
across the ages. This review is specifically for eight studies conducted by different
researchers to address the various aspects of childhood obesity for children less than 12
years, from its prevalence, causes and prevention efforts as part of a capstone project aimed
at establishing guidelines to be followed when coming up with intervention
measures.Comparison of research questionsAlthough each of the eight studies covered
childhood obesity as the main study subject, there were specific research questions that
varied across the studies. Bleich, Segal, Wu, Wilson, & Wang (2013) conducted a systematic
review of community-based childhood obesity prevention while Tester, Phan, Jared, Tucker,
Leung, Gillette, Sweeney, Kirk, Tindall, Olivo-Marston, & Eneli (2018), focused on the
characteristics of obese children between 2-5 years. Cunningham, Kramer & Narayan,
(2014), differed with the first two since their study involved the identification of obesity
prevalence in the United States at the national level. Lee, Scharf & DeBoer, (2018) also
conducted a study that was concerned with the causes of childhood obesity and focused on
the relationship between food insecurity and obesity and was trying to answer the question
of whether food insecurity is an independent risk factor for obesity in the United States.The
other study under review was conducted by Fetter, Scherr, Linnell, Dharmar, Schaefer, &
Zidenberg-Cherr (2018) and was aimed at determining whether physical activity patterns
improved School-Based Nutrition intervention. This differed from the rest in that instead of
focusing on the causes of obesity, it was more concerned with the intervention measures at
school level. Lydecke, Riley, & Grilo. 2018, conducted another study in which they were
trying to answer the question regarding the relationship between parenting, eating
behavior and the contribution they made on weight gain. Another study by Marcum,
Goldring, McBride, & Persky (2018), questioned the micro-level choices that people make in
their daily lives and their effect on their dietary behavior as an intervention to obesity. The

4. last study under review was conducted by Vollmer, (2018) and was aimed at understanding
how parents and specifically fathers understand obesity in their preschool aged
children.Comparison of sample populationsSince the different studies addressed different
research questions, the sample populations were also different. One notable aspect of the
sample population in all the studies however, is that the main study subjects were either
child under 12 years or parents. For instance, Tester et al. (2018) investigated 7028
children between 2 and 5 years while Cunningham, Kramer, & Narayan (2014) had 7738
participants who were in kindergarten in the year 1998 and 2007. Vollmer (2018) used 117
fathers with an average age of 35 years while Marcum, Goldring, McBride, & Persky, (2018)
used 221 mothers. Another study that included parents is the one conducted by Lydecke,
Riley, & Grilo (2018) who included a sample of 581 parents.It is important to note that the
selection of the samples was much targeted and involved relatively large samples selected
systematically. The reason behind the large samples was to have representation form as
many regions as possible, given that the focus was the United States and the more the
samples the more the reliability of the findings.Comparison of the limitations of the
studiesEach of the eight studies provided valuable findings that would greatly aid in the
process of formulating policies for intervention measures. However, there were various
limitations of the studies. Generally, since they were all conducted at different times with
different research questions, it would be somehow difficult to generalize all their findings to
arrive at a single conclusion. This therefore means that each study should be looked at
exclusively as they address different questions. Because the studies only focused on obesity
in children less than 12 years, there could be a challenge when formulating intervention
measures. This is partly because the studies somehow overlooked the fact that some cases
of obesity occur even past 12 years. Therefore, coming up with intervention measures for
childhood obesity and focusing only on those below 12 years would leave out a significant
number of children who are obese but fall above 12 years.Studies such as those conducted
by Bleich et al, (2013) were restricted to the quality of studies and the rejection criteria
used. Also, all the other studies were qualitative in nature and therefore meant that their
results were only restricted to what they were told by the participants. For instance, if any
questions were left out during an interview or while answering a questionnaire, then this
would largely affect the outcome of the results.ConclusionThe findings of the studies would
no doubt add a lot of value and insights on ways in which to carry out the capstone project.
By focusing on specific facets of childhood obesity and carrying out systematic studies,
there is a high chance of having a successful project that would probably change the way
intervention measures are always put in place and this could provide an invaluable
guideline within which to combat the problem of childhood obesity and the associated
health implications once and for all. Comment by Melissa Reedy: What recommendations do
you make for further research?ReferencesBleich, S. N., Segal, J., Wu, Y., Wilson, R., & Wang, Y.
(2013). Systematic review of community-based childhood obesity prevention studies.
Pediatrics, 132(1), e201-e210.Cunningham, S. A., Kramer, M. R., & Narayan, K. V. (2014).
Incidence of childhood obesity in the United States. New England Journal of Medicine,
370(5), 403-411.Fetter, D. S., Scherr, R. E., Linnell, J. D., Dharmar, M., Schaefer, S. E., &
Zidenberg-Cherr, S. (2018). Effect of the Shaping Healthy Choices Program, a

5. Multicomponent, School-Based Nutrition Intervention, on Physical Activity Intensity.
Journal of the American College of Nutrition, 1-7.Lee, A. M., Scharf, R. J., & DeBoer, M. D.
(2018). Association between kindergarten and first-grade food insecurity and weight status
in US children. Nutrition, 51, 1-5.Lydecker, J. A., Riley, K. E., & Grilo, C. M. (2018).
Associations of parents’ self, child, and other “fat talk” with child eating behaviors and
weight. International Journal of Eating Disorders, 1-5.Marcum, C. S., Goldring, M. R.,
McBride, C. M., & Persky, S. (2018). Modeling Dynamic Food Choice Processes to Understand
Dietary Intervention Effects. Annals of Behavioral Medicine, 52(3), 252-261.Tester, J. M.,
Phan, T. L. T., Tucker, J. M., Leung, C. W., Gillette, M. L. D., Sweeney, B. R., … & Eneli, I. U.
(2018). Characteristics of Children 2 to 5 Years of Age with Severe Obesity. Pediatrics,
141(3), e20173228.Vollmer, R. L. (2018). An Exploration of How Fathers Attempt to
Prevent Childhood Obesity in Their Families. Journal of nutrition education and behavior,
50(3), 283-288.Running head: CHILDHOOD OBESITY 1CHILDHOOD OBESITY
20Childhood ObesityAfolashade AdeolaGrand Canyon University: NRS
49003/11/2018Table of Contents1.
Background………………………………………………………………………….…….32. Problem
statement…………………………………………………………………………33. Purpose of the change
proposal……………………………………………………………64.
PICOT……………………………………………………………………………………..65. Literature search
strategy employed…………………………………………………..…106. Evaluation of the
literature……………………………………………………………….107. Applicable change or nursing
theory utilized……………………………………………148. Proposed implementation plan with
outcome measures…………………………………159. Identification of potential barriers to plan
implementation: Overcoming barriers………1610.
References………………………………………………………………………………..181. BackgroundThe
increasing rate of obesity among children and adolescents in the last three decades is
posing a major health concern that should be urgently addressed. Despite the latest national
reports in the country that suggest a positive decline in the childhood obesity prevalence
patterns, the country still grapples with about 12 million children suffering from obesity.
Considering the immediate and long-term health impacts of obesity, a lot of resources and
efforts have been spent by government agencies and advocacy groups to address this
epidemic. However, these efforts have only yielded limited or short-term gains. As a result,
the adverse impacts of childhood obesity continue to capture the interests and attention of
public, and policy makers. Childhood obesity not only pose serious health problems, but it
also increases the economic costs for treating children. Therefore, there is need to develop
effective strategies to regulate the worrying increase in the population of overweight and
obese children.2. Problem StatementChildhood obesity is a big health problem that needs a
lot of attention to be solved. The rate of obesity among children is increasing and is likely to
increase further in the future because of the changes in children’s lifestyles. Due to the
development of technology, the nature of children’s recreational activities has changed. In
the past, most children’s recreational activities were outdoor games. However, technology
has caused the development of activities such as video games and films which make
children spend most of their time indoors doing minimal physical activities. An increase in

6. the obesity prevalence rate brings about an increase in the numerous health issues related
to weight. Therefore, the children may continue to have deteriorated health. Therefore, this
problem needs a lot of attention not only by the parents but also the government,
healthcare professionals and the communities. Studying this topic is significant because it
helps to point out the extent of the problem and determine some steps that can be taken to
reduce obesity among children.Childhood ObesityChildhood obesity is a relatively common
condition among the United States’ population. This condition is characterized by excessive
amounts of weight, which affects the health and well-being of children (Kelsey et al., 2014).
As methods to determine the exact amount of body fat percentage are limited, there body
mass index (BMI) is used as the measure to determine whether children are overweight or
obese. The BMI represents the ratio of weight to height. According to the Center for Disease
Control and Prevention (CDC), a person is considered to be obese if their BMI is greater
than or equal to the 95th percentile (Centers for Disease Control and Prevention, 2013).
While obesity is a problem that affects all population demographics, childhood obesity has
some additional effects because of the vulnerability of the affected population.Childhood
Obesity in AmericaObesity is one of the popular health issues that affects children in the U.S.
it is estimated that one in every three children in America is above the recommended
weight. The prevalence of obesity among children in America has tripled during the last
three decades (Cunningham, Kramer & Narayan, 2014). The American Heart Association
rates childhood obesity as the number one health concerns that parents should be worried
about. This problem is rated worse than smoking and alcohol consumption.According to
CDC’s obesity statistics results, the rate of obesity among children increases with age.
Between 2011 and 2014, the rate of childhood obesity among children between 2 and 5
years old decreased significantly. The prevalence of obesity among this age group is
currently 8.9%. Childhood obesity among children from 6 to 11 years old affects 17.5% of
children in America. The older children are at the highest risk with a 20.5% prevalence rate
among the children between 11 and 19 years (Centers for Disease Control and Prevention,
2013).Studies have shown that childhood obesity is more prevalent among the minority
communities. For instance, the prevalence of obesity is higher among the Hispanic and
African-American communities compared to the Caucasian communities (Van Grouw &
Volpe, 2013). The prevalence of childhood obesity is also likely to be higher among the
lower socio-economic groups.Impact of Childhood ObesityObesity has health, social,
emotional, and psychological impacts on the affected children. Obesity has caused the
development of some health concerns in children that were previously just found among
the adults. For instance, health issues such as Type 2 Diabetes, high blood pressure,
cardiovascular diseases, and elevated blood cholesterol are currently very common among
the children’s population (Ogden et al., 2014). These are health issues that were common
among the adult population and almost non-existent among the children.Obesity also has
some negative psychological impacts among the children such a negative body image, low-
self-esteem, anxiety issues, and depression (Reilly & Kelly, 2011). The commonly desirable
body standard in the society is that of a slim person. Therefore, children with excess body
weight tend to go through psychological issues trying to meet the society’s standards of the
acceptable body image.These children may also go through social and emotional distress

7. because of the higher chance of them being bullied by their peers in school. Studies have
shown that children who are obese tend to undergo discrimination even in their home
environment. The bullying, discrimination, and stereotyping may lead them to be
emotionally distressed, which can lead to psychological problems that affect them even
much later in their lives.3. Purpose of the Change ProposalThe primary objective of this
change proposal is to develop more effective interventions of reducing and managing
childhood obesity in the United States. This objective is important especially at a time when
obesity is becoming a very prevalent disorder in the country. Another purpose of this
proposal is to educate and inform the target American audience on ways of addressing
childhood obesity. Finally, the proposal seeks to influence the policy-making process by
providing insights into nationwide strategies of childhood obesity control4. PICOT
StatementP-I–C-O-T StatementP- Patients who suffer from obesity (BMI of more than 30)I-
Undertaking nutritional education, diet, and exerciseC- Comparison to not taking nutritional
education, diet, and exerciseO- Improved health outcomes in terms of overall weight lossT –
A year’s time limitPICOT Statement: Patients, who suffer from obesity (BMI of more than
30) undertaking nutritional education, diet and exercise in comparison to not taking
nutritional education, diet, and exercise, can have improved health outcomes in terms of
overall weight loss in a year’s time limit.PICOT OverviewChildhood obesity poses serious
health problems in the US as the number of overweight and obese population increases at a
rapid pace every year. The effects of this problem have arrested the attention of
policymakers, societal members, and government agencies. This has resulted in ranking
childhood obesity as a national health concern. The adverse impacts of this disease go
beyond the health realms to include economic burden on both personal and national
budgets. While there are numerous risk factors and various evidence-based interventions to
address this challenge, no single approach is consistently efficacious in curbing the disease.
Consequently, it is imperative that efficacious initiatives and policies be developed to
address the never-ending problem of childhood obesity. Multidisciplinary approaches are
often broad and cut across all dimensions of personal health problems. Instead of placing
emphasis solely on biomedical models, health care professionals should also seek to
promote behavior change among obesity patients and their family members. A PICOT
statement can be utilized as an effective tool to seek interventions of addressing childhood
obesity.PICOT StatementPopulationIn the US, obesity prevalence is highest among children
aged from 6 to 11 years (Cheung et al. 2016). The disease has tripled among this age group
from 4.2 percent to 15.3 percent from 1963 to 2012. In the last three decades, increased
cases of obesity prevalence have been noted among children of all ages, although the
differences in obesity prevalence have been recorded in terms of age, race, ethnicity, and
gender (Cheung et al. 2016). In this respect, children from socioeconomically disadvantaged
families and some racial and ethnic minorities experience the higher median score on
obesity than the dominant white population. Higher obesity rates are often recorded among
blacks and Hispanics compared to whites. For instance, a survey on girls in the Southwest
revealed that the yearly cases of obesity stood at 4.5 percent among Blacks, 2 percent
among Hispanics, and 0.7 percent among white girls aged from 13 to 17 years (Cheung et al.
2016). For low-income earners, American Indians rank highest at 6.3 percent, followed

8. closely by Hispanics at 5.5 percent.InterventionEvidence-based interventions that seek to
reduce childhood obesity incidences in the country should target two major areas:
prevention and treatment. High-quality RCT has been proven as one of the most effective
preventative intervention, especially in schools (Reilly, 2006). Such interventions involve
making changes on the school curriculum by introducing and improving physical education,
changing school meal provisions, and reducing the television viewing hours. Schools should
also engage in promotional campaigns that encourage walking form home to school (Ickes,
McMullen, Haider & Sharma, 2014). This intervention has been successful in most cases
involving girls in the sense that the risks of becoming obese are significantly lowered.
Treatment interventions should be limited to motivated families and communities, in which
the child and parents perceive obesity as a problem. From a theoretical perspective,
treatments should be continued for longer periods such as months to years. Diets should be
modified, especially with the use of regimen such as traffic light diet. Television viewing
habits should also be reduced (Ickes et al. 2014). Furthermore, treatment should be aimed
at encouraging families to self-monitor their lifestyle. Finally, more time should be offered
for consulting with family members.ComparisonBeing a member of a multidisciplinary
team, the nurse practitioner performs the task of offering standardized care and advocacy
support for healthy community environments. In addition, the nurse helps to ensures that
there is proper coverage, access to, and incentives for regular obesity prevention, screening,
diagnosis and treatment (Vine et al. 2013). There is also need to promote active living and
healthy eating at work. Finally, focus should be on promoting healthy living during weight
gain. There is also need to expand the role of health care providers, in childhood obesity
prevention.OutcomeWhen a nurse is involved as one of the primary members in the
multidisciplinary team approach, the child should be guaranteed of better continuity of
care. The outcomes of interventions should include reduced obesity risks and curriculum
adjustments for sustainable change to make it cost-effective (Ross et al. 2010). The
curriculum modifications should be generalizable. One of the leading causes of failure of
previous interventions is that they targeted modifications at the micro levels. This means
that targeting individual children, families, or schools make it harder to have positive
outcomes or impacts on the many other influences on weight status that affect the
environment at the macro levels. Obesity control efforts that are successful should require a
more macro-environmental strategy in addition to the micro level behavioral
adjustments.TimeObesity treatment and management should be a process that takes
months to years. This is because the focus should not just be on the individual level, but also
on the general behavioral patterns of a person’s family, friends, and society at large (Ross et
al. 2010). Therefore, interventions should be multidisciplinary and aim at changing the
behavior of the patient by promoting long term positive outcomes. Precautions to monitor
blood pressure can be done every two weeks or on a monthly basis. Medications such as
sibutramine can be utilized for periods of up to one year. However, its use should be
discontinued in patients whose weight loss stabilizes at less than five percent of their initial
body weight.5. Literature search strategy employedThe main search strategy that was
employed for the development of this literature review is the database search method. This
method was utilized to identify the potentially relevant scholarly articles within the

9. childhood obesity literature. Examples of these databases included the Cochrane and
Medline databases. Search terminologies related to childhood obesity were used to identify
relevant scholarly works. Thereafter, an article review was undertaken to examine the
degree of relevance of each article to the research topic.6. Evaluation of the LiteratureThe
prevalence of childhood obesity in the United States has increased at such a rapid rate that
this has been considered a serious healthcare issue. This issue has attracted the attention of
policy makers, government agencies, and the community. Due to the extent of the problem,
a large number of researchers have investigated a number of factors relating to childhood
obesity. One of the factors that have been investigated is the impact of changing the
attitudes of the patients towards obesity and lifestyle factors that cause a risk factor. In this
study, the main factor being investigated is the impact of education on exercise and diet on
patients who have a BMI of more than 30. The following is a summary of a review of the
literature used to determine the impact of educating patients on exercise and diet
changes.Comparison of Research QuestionsMost of the literature analyzed for this study
focuses on the intervention strategies for childhood obesity. Cheung et al. seeks to
understand the extent of the childhood obesity in America. The research asks about the
incidence of childhood obesity in America in a bid to demonstrate the extent of the
problem.Ickes et al. (2014) research question compares the intervention strategies used in
the American schools and international ones. The main aim of this study is to determine the
gaps in the intervention used in American schools that has caused the increased childhood
obesity. On the other hand, Reilly (2006) research investigates the interventions strategies
for childhood obesity in United States schools that have been applied overtime. The
research question for this study is to investigate the effectiveness of each of the strategies
that have been applied.McGrath (2017) directly investigates the effectiveness of having an
obesity education awareness program for the families of children suffering from childhood
obesity. The research asks whether educating patients and family on the importance of
maintaining ideal weight and providing awareness on obesity can help reduce the incidence
of childhood obesity. Ross et al. (2010) investigates the recommended interventions for
childhood obesity. The research question for this study seeks to understand some of the
most effective interventions strategies to help reduce obesity among children in the United
States.On the other hand, Vine et al. (2013) seeks to understand the role that primary care
providers can play in improving the issue of childhood obesity. The research asks whether
primary care providers have the capability to make a positive difference through patient
education to help reduce the incidence of childhood obesity. Taveras et al. (2014) compares
the effectiveness of various interventions for childhood obesity. The question for this study
is whether various interventions applied in primary care have the same impact on the
reduction of childhood obesity. Lastly, Janicke et al. (2014) investigates the effectiveness of
family lifestyle interventions in the reduction of obesity. The question of this study asks
whether changing lifestyle factors such as diet and exercise can help to reduce obesity in
children.Comparison of Sample PopulationsAll the researches that have been included in
this study were meta-analyses or reviews of literature except Taveras et al. (2015) which
included a randomized control trial. This study included a sample of 649 children between 6
and 12 years. The other studies were analyses of other researches that have been done in

10. the past on obesity. Janicke et al. (2014) analysed 20 studies whose sample sizes amount to
1,671 participants. On the other hand, Ross et al. (2010) performed a review of 73 studies.
The research does not indicate the number of participants represented by the analyzed
studies. McGrath (2017) conducted a literature analysis of 7 articles. There is a variation
between the sample sizes of the analyzed articles ranging from 12 participants to 9000
participants. Ickes et al. (2014) conducted a systematic analysis including 12 studies whose
samples sizes range between 10 and 20 participants. In general the studies that have been
included in this research have generally small sample sizes. Most of the studies are
literature reviews with a very low number of studies included in the analysis. None of these
studies is longitudinal in nature and the samples are very small. Therefore, there is a high
chance that the studies are limited in terms of the choice of methods. The following is an
analysis of the limitations of each of the studies.Comparison of the Limitations of the
StudiesThe limitations of the studies included in this research are mainly in the choice of
methodology, specifically the samples and analysis methods used by the respective
researchers. The main limitation of Ickes et al. is that the review of research was done in a
narrative format. The study fails to utilize quantitative methods to enhance the accuracy of
the results. Qualitative data analysis has a significant risk of inaccuracy. The study by
McGrath (2017) is limited by the very small sample size. The review analyses less than 10
studies, which makes the chances of inaccuracy to be very high. Additionally, the author has
used only qualitative techniques of data analysis, thus, increasing chances of inaccuracy. On
the other hand, Cheung et al. (2016) is limited by the use of convenience data. The studies
used in this study were not primarily meant to study the research question of the
researcher. Therefore, there is a high chance of inaccuracy in the results collected. Reilly
(2006) fails to clearly define the methodology used by the researcher. Therefore, it is hard
to ascertain the true strengths and limitations of the study. Ross et al. (2013) is also limited
by inconsistencies in the research methodology. The study included research from more
than 100 studies but there are some studies that were not specific to the research question.
The researchers made the closest connection to determine the results of the study. In
general, these studies have a significant chance of inaccuracy and lack of reliability because
of the limitations of the methodologies employed by the researchers.The studies that have
been analyzed for this research demonstrate consistent results with regards to the effective
intervention strategies for childhood obesity. From the studies it is clear that childhood
obesity is an extensive problem in the United States. The best interventions to this problem
include changes in the family lifestyle of the families. Lifestyle changes include the increase
of physical activity and the change of the diets. Intervention within the primary care setting
has also been found to be an effective form of intervention for childhood obesity. The
primary care professionals can help parents to reduce the extent of obesity in the American
children by implementing education strategies. These studies confirm the hypothesis that
education on lifestyles changes to the patients and their families can help to reduce the
incidence of childhood obesity in the United States. Therefore, they can be used to confirm
the PICOT statement of this study which argues that “Patients, who suffer from obesity (BMI
of more than 30) undertaking nutritional education, diet and exercise in comparison to not
taking nutritional education, diet, and exercise, can have improved health outcomes in

11. terms of overall weight loss in a year’s time limit”.7. Applicable Change/Nursing Theory
UtilizedTwo theories that can help to explain and develop interventions related to
childhood obesity include the health belief model and the theory of planned behavior. The
theory of planned behavior helps to clarify many of the issues that are related to negative
behavioral patterns (Sothern, Gordon & Von Almen, 2016). The theory postulates that the
environmental attributes are fully mediated by perceived behavioral control. This
framework moderates the relationship of intention to behavior from perceived behavioral
control. In case perceived behavioral control is high, then the intention will convert to
behavior. On the contrary, if the perceived behavioral control is low, then it is less likely that
the intention will convert to behavior.Unlike the theory of planned behavior, the health
belief model is based on the idea that people are motivated to change when the perceived
severity and susceptibility is high. In this respect, people are most likely to embark on
recommended positive behavior such as proper dietary practices if they feel that the
possibility of getting childhood obesity is high, and that childhood obesity is so severe
(Sothern, Gordon & Von Almen, 2016). In such a situation, they will be motivated to embark
on behavioral change, a situation referred to as ‘readiness to act’.The theory that makes
more sense in implementing EBP project for childhood obesity is the theory of planned
behavior. The health belief model was originally designed with concern for public health
issues (Sothern, Gordon & Von Almen, 2016). This model has not been received well in the
pediatric community since children and adolescents basically perceive themselves as
immortal and may not use rationalism. The theory of planned behavior can inform message
strategies that seek to address parental issues over infant and toddler feeding practices.
This is because toddlers’ appetites may fluctuate from day to day depending on many
factors such as their activity levels, whether or not they are in a growth spurt. Therefore,
parents can regulate their dietary behaviors.8. Proposed Implementation Plan with
Measurable OutcomesThe solution to childhood obesity is the implementation of initiatives
to prevent unhealthy weight gain and to manage the weight for children who already have
excess weight. There needs to be education initiatives that will encourage parents to
promote a healthy lifestyle for their children. Children need to have healthy diets and
engage in physical activity as often as possible. A healthy lifestyle can be promoted both in
the school and the home environment. At school there should be rules and regulations that
promote healthy lifestyles such as compulsory participation in sports and regulated sale of
unhealthy food options (Hanks, Just & Wansink, 2013). At home, the parents should be able
to control the types of foods and food portions that their children have. They should also
promote participation in physical activity to promote metabolism and avoid gaining of
unhealthy weight.In the medical setting, there is not much that can be done to improve the
issue of childhood obesity. There are no medications currently approved for use in
childhood obesity in America. In fact, the American Association of Pediatrics discourages
use of medication to control children’s weight. However, healthcare professionals can
participate in education of parents to promote healthier lifestyles (Bleich et al., 2013).9.
Identification of Potential Barriers to Planned ImplementationPotential BarriersEfforts that
seek to prevent and respond to childhood obesity problem must take into account potential
barriers and limitations for them to be successful. For instance, there are numerous

12. potential barriers that hamper adolescents from accessing these programs and services
(Smith et al. 2014). Adolescents can be difficult to recruit to healthy lifestyle initiatives for
different reasons. For some, the fear of humiliation or bullying makes it harder to seek help.
For others, the promotion of a healthy lifestyle is not enticing if they are overly concerned
about their weight. In most situations, adolescents do not want to admit that they are
overweight.Another potential barrier is the challenge experienced in the retention of
program participants. This is especially true for families who find it hard to remain engaged
with the program (Smith et al. 2014). For most families, this requires a commitment in
terms of time engagement. Another program-specific factor of start and finish times can be
viewed as a barrier that makes it tougher for families to remain engaged in the long-run.
Some participants are conflicted in their view for the most appropriate start time, since
others seek to include children and adolescents immediately after schooling hours or days
(Smith et al. 2014). For some parents, if these programs cannot be implemented full time,
they have to be addressed during working part time hours.Overcoming the BarriersThere is
need to focus on making the programs more enjoyable and rewarding for both children and
adolescents. This would improve the possibility that their families would remain in such
programs (Smith et al. 2014). It is also important to get parents involved since they are the
ones who are in control of the food and can regulate their children’s use of video games and
television. Program staff members are also key enablers for maintaining families’ levels of
engagement in the programs (Smith et al. 2014). Therefore, there is need to establish a good
relationship between facilities and participants as one of the most crucial parts of the
program.For adolescents who are hesitant to join activities geared towards reducing or
preventing childhood obesity, there is need for a wide-reaching and personalized
communication campaign to reach adolescents and parents (Smith et al. 2014). Emphasis
should be placed on the message. Face-to-face selling goes a long way in promoting
behavior change communication. In particular, use of communication channels such as
brochures, newsletters, and email communication can work effectively (Smith et al. 2014).
Finally, participants should receive a generalized feedback regarding the entire program
and has been achieved.ReferencesBleich, S. N., Segal, J., Wu, Y., Wilson, R., & Wang, Y. (2013).
Systematic review of community-based childhood obesity prevention studies. Pediatrics,
132(1), e201-e210.Centers for Disease Control and Prevention (CDC. (2013). Vital signs:
obesity among low-income, preschool-aged children–United States, 2008-2011. MMWR.
Morbidity and mortality weekly report, 62(31), 629Cheung, P. C., Cunningham, S. A.,
Narayan, K. V., & Kramer, M. R. (2016). Childhood obesityincidence in the United States: a
systematic review. Childhood Obesity, 12(1), 1-11.Cunningham, S. A., Kramer, M. R., &
Narayan, K. V. (2014). Incidence of childhood obesity in the United States. New England
Journal of Medicine, 370(5), 403-411..Hanks, A. S., Just, D. R., & Wansink, B. (2013). Smarter
lunchrooms can address new school lunchroom guidelines and childhood obesity. The
Journal of pediatrics, 162(4), 867-869.Ickes, M. J., McMullen, J., Haider, T., & Sharma, M.
(2014). Global school-based childhoodobesity interventions: a review. International journal
of environmental research andpublic health, 11(9), 8940-8961.Janicke, D. M., Steele, R. G.,
Gayes, L. A., Lim, C. S., Clifford, L. M., Schneider, E. M., … & Westen, S. (2014). Systematic
review and meta-analysis of comprehensive behavioral family lifestyle interventions

13. addressing pediatric obesity. Journal of pediatric psychology, 39(8), 809-825.Kelsey, M. M.,
Zaepfel, A., Bjornstad, P., & Nadeau, K. J. (2014). Age-related consequences of childhood
obesity. Gerontology, 60(3), 222-228.McGrath, S. M. (2017). Childhood Obesity
Comorbitities Awareness Hospital-based Education(Doctoral Dissertation), Walden
University, Minneapolis, Washington.Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M.
(2014). Prevalence of childhood and adult obesity in the United States, 2011-2012. Jama,
311(8), 806-814.Reilly, J. J., & Kelly, J. (2011). Long-term impact of overweight and obesity
in childhood and adolescence on morbidity and premature mortality in adulthood:
systematic review. International journal of obesity, 35(7), 891-898.Reilly, J. J. (2006).
Obesity in childhood and adolescence: evidence based clinical and publichealth
perspectives. Postgraduate medical journal, 82(969), 429-437.Ross, M. M., Kolbash, S.,
Cohen, G. M., & Skelton, J. A. (2010). Multidisciplinary treatment ofpediatric obesity:
nutrition evaluation and management. Nutrition in ClinicalPractice, 25(4), 327-334.Smith,
K. L., Straker, L. M., McManus, A., & Fenner, A. A. (2014). Barriers and enablers for
participation in healthy lifestyle programs by adolescents who are overweight: a qualitative
study of the opinions of adolescents, their parents and community stakeholders. BMC
pediatrics, 14(1), 53.Sothern, M. S., Gordon, S. T., & Von Almen, T. K. (Eds.). (2016).
Handbook of PediatricObesity: Clinical Management. New York: CRC Press.Taveras, E. M.,
Marshall, R., Kleinman, K. P., Gillman, M. W., Hacker, K., Horan, C. M., … & Simon, S. R. (2015).
Comparative effectiveness of childhood obesity interventions in pediatric primary care: a
cluster-randomized clinical trial. JAMA pediatrics, 169(6), 535-542.Van Grouw, J. M., &
Volpe, S. L. (2013). Childhood obesity in America. Current Opinion in Endocrinology,
Diabetes and Obesity, 20(5), 396-400.Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C.
(2013). Expanding the role of primarycare in the prevention and treatment of childhood
obesity: a review of clinic-andcommunity-based recommendations and interventions.
Journal of obesity, 2013.CHILD HOOD OBESITY CAPSTONE 9Topic; Child Hood Obesity
CapstoneRunning Head: CHILD HOOD OBESITY CAPSTONE 1Table of Contents 1.
Background 3 2. Problem statement 3 3. Purpose of the change proposal 4 5.
Literature Review 5 6. Evaluation of the literature 7 7. Nursing Theory Utilized
7 8. Proposed Implementation Plan 8 9. Potential Barriers to Plan
Implementation 8 10. References 91. Background Comment by Melissa
Reedy: These don’t need to be numberedChildhood obesity can be described as a condition
in which a child is significantly overweight given his age and height. This condition is
usually self-diagnosable as symptoms are always related to excessive weight gained by a
child. They include spotting a pot belly, binge eating and sometimes shortness of breath. As
reported by statistics from State of Obesity (2018), this condition has affected children
between the ages of 2 and 19 years for a long time. At the beginning of the millennium, in
the year 2000, the American Heart Association (2018) reported that one third of children
and adolescents in the United States are affected by obesity. Going into the first quarter of
the millennium, its prevalence has tripled so much so that it is currently regarded as the
number one health concerns among parents. This therefore follows that there is need to
investigate better intervention measures to help curb this menace. Comment by Melissa
Reedy: I am not sure that I agree with these symptoms-I think I would keep this more as

14. cited information vs. your personal opinion2. Problem statementThe Latest research
indicates that the national childhood obesity rate among children between 2 and 19 years is
18.5% (State of Obesity, 2018). This rate can be attributed to various factors including poor
nutritional habits and a lack of physical activity. The availability of “good- tasting” food with
high calorie serves to worsen the situation as these foods are not expensive yet their health
effects are disastrous. Combining this with a lack of physical activity and inactive behavior
results to childhood obesity (Cunningham, Kramer & Narayan, 2014). Of concern is that all
these factors are imparted by family characteristics, social culture and other environmental
factors. This paper is therefore geared towards addressing these problems through coming
up with a PICOT statement to address them.3. Purpose of the change proposalThe purpose
of this proposal change is to come up with evidence-based interventions to combat
childhood obesity among children aged 12years. The proposed PICOT statement will come
up with educational nutritional programs involving proper dieting and physical activity.
This would help reduce the impact of Child obesity among children aged 12 years, which
often goes beyond health-related issues as it can negatively impact the child’s social status.
It is also associated with eating disorders such as Bulimia Nervosa. All these affect the
health of the child, its wellbeing and leads to poor performance because of the low quality of
life the child is experiencing (Reilly, & Kelly, 2011). The researcher therefore considered all
these while coming up with the PICOT statement described in detail in the flowing section.
Comment by Melissa Reedy: Your PICOT statement is not coming up with this4. PICOTIt is
evident that obesity and overweight in general have become worldwide epidemics as
illustrated by the widespread concerns. For children below the age of 12, obesity has not
only resulted to health-related issues such as diabetes and cardiovascular complications,
but also forms a basis for ridicule and overall loss of the self-esteem that is vital in
development into adulthood (Reilly, & Kelly, 2011). Due to this continued prevalence, there
is need for the involved stakeholders such as the government and other policy makers in
the healthcare system to have in place research-based interventions that will ensure a drop-
in number of children affected. All these can be addressed in a nutrition education program
that is suggested by this paper. The following is a PICOT statement intends to find lasting
solutions to this problem; Comment by Melissa Reedy: That intends??P-Obese children
under the age of 12 with a BMI index of 30 or more.I-Educational Nutrition programs
involving Proper diet and engaging in physical activity Comment by Melissa Reedy:
You have some words throughout that do not need to be capitalizedC- Children who will be
involved in the educational program versus those who will not be engaged.O- Reduction in
obesity among children below the age of 12 by increasing knowledge on nutrition
educationT- A period not less than 1 year5. Literature ReviewDue to the serious health and
social implications associated with obesity, a lot of efforts have been made to devise ways to
prevent it. This systematically reviewed eight studies by comparing their research
questions, sample populations and limitations. The following is a summary of what was
found; Comment by Melissa Reedy: Don’t forget your search strategyEach of the eight
studies covered childhood obesity as the main study subject, with specific research
questions varying across the studies. Bleich, Segal, Wu, Wilson, & Wang (2013) conducted a
systematic review of community-based childhood obesity prevention while Tester, Phan,

15. Jared, Tucker, Leung, Gillette, Sweeney, Kirk, Tindall, Olivo-Marston, & Eneli (2018), focused
on the characteristics of obese children between 2-5 years. Cunningham, Kramer &
Narayan, (2014), differed with the first two since their study involved the identification of
obesity prevalence in the United States at the national level. Lee, Scharf & DeBoer, (2018)
also conducted a study that was concerned with the causes of childhood obesity and
focused on the relationship between food insecurity and obesity and was trying to answer
the question of whether food insecurity is an independent risk factor for obesity in the
United States. The other study under review was conducted by Fetter, Scherr, Linnell,
Dharmar, Schaefer, & Zidenberg-Cherr (2018) and was aimed at determining whether
physical activity patterns improved School-Based Nutrition intervention. This differed from
the rest in that instead of focusing on the causes of obesity, it was more concerned with the
intervention measures at school level. Lydecke, Riley, & Grilo. 2018, conducted another
study in which they were trying to answer the question regarding the relationship between
parenting, eating behavior and the contribution they made on weight gain. Another study by
Marcum, Goldring, McBride, & Persky (2018), questioned the micro-level choices that
people make in their daily lives and their effect on their dietary behavior as an intervention
to obesity. The last study under review was conducted by Vollmer, (2018) and was aimed at
understanding how parents and specifically fathers understand obesity in their preschool
aged children. Comment by Melissa Reedy: Use the rule of et. al. here Comment by Melissa
Reedy: Again use the rule of et. al. hereThe sample populations addressed by each study
were also different. One notable aspect of the sample population in all the studies however,
is that the main study subjects were either children under 12 years or their parents. For
instance, Tester et al. (2018) investigated 7028 children between 2 and 5 years while
Cunningham, Kramer, & Narayan (2014) had 7738 participants who were in kindergarten
in the year 1998 and 2007. Vollmer (2018) used 117 fathers with an average age of 35 years
while Marcum, Goldring, McBride, & Persky, (2018) used 221 mothers. Another study that
included parents is the one conducted by Lydecke, Riley, & Grilo (2018) who included a
sample of 581 parents.Finally, each of the eight studies provided valuable findings that
would greatly aid in the process of formulating policies for intervention measures.
However, there were various limitations of the studies. Generally, since they were all
conducted at different times with different research questions, it would be somehow
difficult to generalize all their findings to arrive at a single conclusion. This therefore means
that each study needs to be looked at exclusively as they address different questions.6.
Evaluation of the literatureThe findings of the studies would no doubt add a lot of value and
insights on ways in which to carry out the capstone project. By focusing on specific facets of
childhood obesity and carrying out systematic studies, there is a high chance of having a
successful project that would probably change the way intervention measures are always
put in place and this could provide an invaluable guideline within which to combat the
problem of childhood obesity and the associated health implications once and for all.
However, further studies should be conducted on the impact of obesity among adolescents
by taking their accounts as well as that of their caretakers. This is valuable for purposes of
comparison.7. Nursing Theory UtilizedThere is no doubt that many genetic, physiological,
and behavioral factors play a role in the etiology of obesity. As such, behavioral change

16. theory was utilized to help explain how behavior management can be an intervention
through teaching better nutritional habits and enraging physical activities (Michie, Van
Stralen & West, 2011) Comment by Melissa Reedy: This is very brief you want to
thoroughly discuss the theory, its components and how you will incorporate it into your
project8. Proposed Implementation PlanThe proposed implementation plan will involve
several stakeholders including employees, owners, clients and suppliers while external
stakeholders may include donors, the community and the government. They are all vital to
the project implementation as far as the goals and objectives, interests, expectations,
involvement and the influence on the project success is concerned. The project will have
factors that affect obesity as the independent variables i.e. physical activities and nutritional
education. The dependent variable on the other hand can be a factor that describes obesity,
e.g. BMI. These are what will be measured to determine the outcome of the project before
and after implementing the interventions. Comment by Melissa Reedy: This should be a
very comprehensive step by step plan of how you are going to implement your change
proposal9. Potential Barriers to Plan ImplementationImplementing this project will see
several changes in the health care sector. This will be met by several barriers including
human resistance to change and a lack of proper nursing leadership. Human resistance will
be overcome by cultivating a culture that embraces the use of evidence-based practices to
solve childhood obesity issues. Proper nursing leadership on the other hand will be solved
by providing better training in schools.10. ReferencesBleich, S. N., Segal, J., Wu, Y., Wilson, R.,
& Wang, Y. (2013). Systematic review of community-based childhood obesity prevention
studies. Pediatrics, 132(1), e201-e210.Cunningham, S. A., Kramer, M. R., & Narayan, K. V.
(2014). Incidence of childhood obesity in the United States. New England Journal of
Medicine, 370(5), 403-411.Cunningham, S. A., Kramer, M. R., & Narayan, K. V. (2014).
Incidence of childhood obesity in the United States. New England Journal of Medicine,
370(5), 403-411.Fetter, D. S., Scherr, R. E., Linnell, J. D., Dharmar, M., Schaefer, S. E., &
Zidenberg-Cherr, S. (2018). Effect of the Shaping Healthy Choices Program, a
Multicomponent, School-Based Nutrition Intervention, on Physical Activity Intensity.
Journal of the American College of Nutrition, 1-7.Lee, A. M., Scharf, R. J., & DeBoer, M. D.
(2018). Association between kindergarten and first-grade food insecurity and weight status
in US children. Nutrition, 51, 1-5.Lydecker, J. A., Riley, K. E., & Grilo, C. M. (2018).
Associations of parents’ self, child, and other “fat talk” with child eating behaviors and
weight. International Journal of Eating Disorders, 1-5.Marcum, C. S., Goldring, M. R.,
McBride, C. M., & Persky, S. (2018). Modeling Dynamic Food Choice Processes to Understand
Dietary Intervention Effects. Annals of Behavioral Medicine, 52(3), 252-261.Michie, S., Van
Stralen, M. M., & West, R. (2011). The behavior change wheel: a new method for
characterizing and designing behavior change interventions. Implementation science, 6(1),
42.Reilly, J. J., & Kelly, J. (2011). Long-term impact of overweight and obesity in childhood
and adolescence on morbidity and premature mortality in adulthood: systematic review.
International journal of obesity, 35(7), 891.Tester, J. M., Phan, T. L. T., Tucker, J. M., Leung, C.
W., Gillette, M. L. D., Sweeney, B. R., … & Eneli, I. U. (2018). Characteristics of Children 2 to 5
Years of Age with Severe Obesity. Pediatrics, 141(3), e20173228.The State of Obesity
(2018). The State of Childhood Obesity. Retrieved April 23, 2018 from

17. https://stateofobesity.org/childhood-obesity-trends/Vollmer, R. L. (2018). An Exploration
of How Fathers Attempt to Prevent Childhood Obesity in Their Families. Journal of nutrition
education and behavior, 50(3), 283-288.