Introduction
Childhood obesity is a serious healthcare condition that occurs in well-developed and developing nations around the globe. It is associated with the extended sedentary style of life and work, the availability of fast food and sugary drinks, and the lack of physical exercise throughout the lifespan. In the US, approximately 25% of all kindergarten-aged children are either obese or overweight (Mendez & Santos, 2018). By 6th grade, that percentage increased to 39% (Mendez & Santos, 2018). Children who acquire obesity in early ages are much more likely to carry it throughout their entire lives. At the same time, obesity is associated with various diseases as well as social and economic complications. Obese people are more likely to develop diabetes, lung, and heart diseases. They are also often targets of bullying and social ridicule, resulting in isolation, depression, and a plethora of other psychologically-related illnesses (Mendez & Santos, 2018). Finally, having to treat various obesity-related diseases puts a significant economic pressure on those affected by it. Preventing obesity at an early age is, thus, an important aspect of healthcare to consider. The interest in the subject is motivated by the pressing nature of the issue as well as great potential benefits to the community in case of a successful intervention.
Evidence Research Method
The research will follow a standard literature search methodology, which will include collecting data from peer-reviewed academic resources and systematizing it based on content analysis. The articles would be collected from various databases, such as Medlab, CINAHL, Cochrane, and the university electronic library. For the sake of accuracy and relevance to the current events, all articles would be required to have been published within the last 5 years, in English language, and in peer-reviewed reputable sources. Such measures would help ensure that the information and conclusions derived from it would be relevant to the study area for a while longer, and reflect the reality of the problem more accurately. Using old sources would still be possible to discuss the historical progression of childhood obesity as well as to cite information that is not prone to temporal decay. These would include references to nursing theories, general concepts, and the like. Meta-analyses, systematic, and integrative reviews would be excluded from the search. Keywords used in literature search included the following: prevention, intervention, childhood obesity, school-based, family, diet, exercise.
Chosen Theory
The chosen theory to inform the proposed research is Orem’s theory of self-care deficit. The theory supposes that the patient has a central role in maintaining their own health, and that the purpose of the healthcare systems is to enable them to achieve independence and autonomy (Alligood, 2017). According to it, the purpose of the nurse is to enable the patient to perform self-care adequately (Alligood, 2017). One of the major assumptions of the theory is the desire of the patient to help themselves and other family members, and being able to do so when armed with proper skills and knowledge (Alligood, 2017). The reason why Orem’s theory has been chosen also lies in the fact that managing one’s own weight is a process largely reliant on the patient’s own motivation, knowledge, and actions. Nurses and healthcare services cannot strictly control the dieting and food intact of a patient outside of the hospital setting. Orem’s theory works well with educational interventions that seek to improve awareness and skills at handling healthcare issues (Alligood, 2017).
State of the Evidence
One of the primary reasons for an educational intervention includes an identified gap of knowledge, coupled with proof of the chosen method of study being effective. The article by Olfert, Famodu, Flanagan, Smith, and Leary (2018) evaluated the effectiveness of 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 the Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II. This article proves that a complex intervention with a longitudinal scale and an established follow-up procedure (newsletters) proved effective in reducing the children’s’ obesity. This data is important for the proposed study, as it provides evidence of an effective intervention, which may be copied and applied to other settings.
Medical interventions are often advised as stand-alone or alongside educational interventions. Drugs can assist people with interrupted metabolism patterns and hormonal disfunctions, that cause obesity. 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 the Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II. This information is invaluable to the ongoing research due to the fact that it shows the validity of methods that are less effort-intensive on behalf of the patient. At the same time, drug treatments can go alongside dieting and exercise to significantly improve the overall results.
Empowerment-based programs aimed at children and their families from an early age are getting ground based on the evidence found to support their claims. The article by Messito, Mendelsohn, Scheinmann, and Gross (2018) on the effect on Starting 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 the Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II. Based on these findings, it could be concluded that parents should receive an increased focus in educational interventions due to their ability to define what the child is eating, thus contributing to the formation of healthy feeding habits that would carry on to later stages of life.
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 programme 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 positive improvement on 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 the Fachianno and Snyder’s (2012) hierarchy of evidence, this source is Level II. This evidence suggests that the chosen overarching theory provides results when it comes to educational programs aimed at individuals suffering from obesity.
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 interests. 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 in nature to other articles, the validity of methods was implied as well.
Application of Theory
Orem’s theory of self-care deficit could be applied to the subject in numerous ways. It offers specific measurable learning objectives, content, and teaching strategies that can be utilized to reduce childhood obesity. Some specific objectives in regards to educational interventions include the following (Alligood, 2017):
- The effectiveness of knowledge provided to patients for utilization in self-management practices. Some methods are more effective in reducing BMI than others.
- The effectiveness of teaching methods. Same knowledge can be transferred to individuals using different methods. Understanding which combinations offer the most results is considered important, under Orem’s paradigm of study.
Orem’s theory is also applicable to formulating the content of the educational
intervention. Namely, it supports knowledge and methods that that rely heavily on the patient’s ability to maintain autonomy (Alligood, 2017). Physical education techniques, cooking techniques, the following and application of a specific dieting pattern, and the ability to consume weight-reducing drugs at specific time patterns, without missing a single dose. In regards to child patients, which by default have less autonomy than adults, the theory supports engaging parents to act as supervision and control for their children, ensuring they follow the procedures until they become a habit (Alligood, 2017). The measurable outcome for the results of the intervention is BMI as well as improvements in the overall quality of life, which could be measured using statistical means.
Orem’s theory can be used not only to inform the educational content of an intervention, but also the way in which nurses present it. One of the primary assertions behind the theory is that the nurse is a facilitator of knowledge. Therefore, the educational methods applied to children must be focused on them developing a greater sense of autonomy and a capacity for self-learning. In children that are too young to make decisions about their eating patterns, such approaches could be pointed towards parents. Theory of adult learning would play an important role to complement Orem’s theory of care, as it provides a framework of education, with a focus on a self-motivated, autonomous, and meaningful learning.
Conclusions
Childhood obesity is a significant healthcare problem that has emerged across the world, and is causing significant damage over a long-term scale. Children that are affected with obesity from an early age are more likely to carry them on to the later parts of their lives. Educational interventions aimed at proper exercise, dieting, medication, and parental involvement decrease the overall BMI in children. While stand-alone interventions are possible, it has been shown that conjoined attempts that affect the patient’s knowledge, their practical efficiency, and medication interventions offer the most lasting results. Active engagement of parents and patients over a long-term scale has also proven to be a significant boon to the overarching effort. The role of parents in particular is very important, due to their power over the child and the capacity to enforce discipline. Orem’s theory of self-care deficit helps facilitate and sustain change in participants and families. Some of the variables that correlate with factors of care as identified by Orem include the factual decrees in BMI, the validity of the methods being proposed to control weight, and the capacity of the participants to learn and understand them. 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-ebook. 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.
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.
Mendes, MEM., & Santos, D (2018). Childhood obesity: Problem present, future consequences. Investigação, 17(2), 1-12
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.