week 3 capstone

Running head: OBESITY AND PICOT STATEMENT

OBESITY AND PICOT STATEMENT 6

Childhood Obesity

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The number of non-communicable diseases is growing steadily in both developing and developed countries. This is a consequence not only of an increase in the life expectancy of the population, but also of malnutrition and a sedentary lifestyle (Foster, et al 2015). Similarly, the prevalence of obesity continues to grow worldwide, the number of overweight and obese people in 2013 reached 2.1 billion. Two major causes of obesity is poor dietary practices and physical inactivity. One of the population groups affected by obesity is children and adolescents. Children represent the special group because they are the future of every nation and healthy children means healthier nation. Since obesity is the main risk factor for the development of type 2 diabetes mellitus (T2DM), understanding the pathogenesis of obesity and the study of methods aimed at reducing body weight are of great importance for the prevention and treatment of T2DM. However, the choice of best intervention for obesity among children is still a problem.

Obese children whose weight reaches or exceeds 20% of the average standard weight calculated by length, have a history of overnutrition, low mobility, or a family history of obesity, are uniformly obese without other abnormal clinical manifestations, can be diagnosed as simple obesity. Body weight over 20%-30% is mild, 30%-50% is moderate, >50% is severe obesity (Herman, 2017).

The vast majority of childhood obesity are simple obesity, also called “physiological obesity”, and a few are pathological obesity or symptomatic obesity. The former cannot find the primary disease, most of which are caused by overeating or underconsumption in children, and a few have family history and are caused by genetic factors (Simmonds, et al 2016). On physical examination, the subcutaneous fat is evenly distributed, the intelligence is normal, and there is no deformity. Pathological obesity can detect the primary disease.

Child obesity also requires differential diagnosis of secondary obesity, such as obesity reproductive impotence syndrome caused by pituitary and hypothalamic lesions, also known as cerebral obesity, which is characterized by short stature, and fat mainly accumulates in the waist and lower abdomen. Sexual growth retardation, which can be accompanied by abnormal fundus and diabetes insipidus; Cushing syndrome (Cushing syndrome) caused by adrenal hyperplasia or tumor, showing short stature, concentric sebum accumulation, full moon face, buffalo back, thin limbs, hirsutism, acne, hypertension, hypokalemia, etc.; at the same time, secondary obesity, often accompanied by clinical manifestations of the primary disease, can be used as a distinction (Herman, 2017).

To diagnose simple obesity clinically, we must first exclude some secondary obesity caused by endocrine, metabolic, genetic, and central nervous system diseases or obesity induced by the use of drugs (Herman, 2017). As a chronic disease, the diagnosis of simple obesity still requires a comprehensive diagnosis from the aspects of medical history, symptoms, signs, and laboratory tests.

The comprehensive intervention of childhood obesity is a combination of schools, families, communities, primary care and other environments, including health education, reasonable diet, physical exercise, and lifestyle improvements (Bryant, et al 2017). Some scholars of the 57 childhood obesity intervention studies conducted systematic review, we found that obese children single intervention is not obvious, but is better integrated intervention. Primary care physicians often advise eating and activity adjusted for the patient, but can not always provide high-intensity behavioral counseling. Moreover, although the front line to play a role in obesity management, but doctors accepted in nutrition consulting and training activities rarely (Farrow, Haycraft & Blissett, 2015). Mere recommendations, including encouraging the use of smartphone apps, have little weight loss effects, which can frustrate both physicians and patients. Therefore, recommending that patients receive high-intensity community intervention is an important method. It is based on the joint intervention of the community, school and family to prevent and control measures such as increasing physical activity time, reducing TV watching time, increasing the intake of fruits and vegetables, enhancing community awareness about the obesity epidemic, and popularizing knowledge about changing bad lifestyles. Eisenmann et al. described the principle, design, and implementation of SWITCH intervention for childhood obesity, but there are few reports on the effect of this method. The study adopted a socio-ecological model.

This inquiry has led to the clinically relevant PICOT question, “In overweight and obese children ages 8-12 years old, how does change intervention (SWITCH) and health education that addresses obesity-related lifestyle behaviors involving nutritional intake, physical activity, and screen time influence these lifestyle behaviors compared to usual care interventions within a period of one year?”

References

Bryant, M., Burton, W., Cundill, B., Farrin, A. J., Nixon, J., Stevens, J., Roberts, K., Foy, R., Rutter, H., Hartley, S., Tubeuf, S., Collinson, M., & Brown, J. (2017). Effectiveness of an implementation optimization intervention aimed at increasing parent engagement in HENRY, a childhood-obesity prevention programme- the Optimising family engagement in HENRY (OFTEN) trial: study protocol for a randomized controlled trial. Trials, 18(40), 1-13. doi: 10.1186/s13063-016-1732-3

Eisenmann JC, Gentile DA, Welk GJ, et al. (2008). SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity. BMC Public Health, 8: 223. DOI: 10.1186/1471-2458-8-223

Farrow, C. V., Haycraft, E., & Blissett, J. M. (2015). Teaching our children when to eat: how parental feeding practices inform the development of emotional eating- a longitudinal experimental design. The American Journal of Clinical Nutrition, 101, 908-913. doi

10.3945/ajcn.114.103713

Foster, B. A., Farragher, J., Parker, P., & Sosa, E. T. (2015). Treatment interventions for early childhood obesity: A systematic review. Academic Pediatrics, 15(4), 353-361. doi:10.1016/j.acap.2015.04.037

Glanz, K., Burke, L. E., & Rimer, B. K. (2015). Health behavior theories. Philosophies and Theories for Advanced Nursing Practice (2nd ed.). Jones & Bartlett Learning: Burlington, MA.

Herman, A. N. (2017). Childhood Obesity: The Primary Care Provider’s Role in Recognition, Diagnosis, and Management (Doctoral dissertation, University of Kansas).

Simmonds, M., Llewellyn, A., Owen, C. G., & Woolacott, N. (2016). Simple tests for the diagnosis of childhood obesity: a systematic review and meta‐analysis. Obesity reviews, 17(12), 1301-1315.