Societal Infant Problems: Childhood Obesity

This project aims to review and identify newer optimal prevention and treatment strategies for childhood obesity among school children in Australia. The focus is on identifying the most effective preventive measures, primary causes, and new interventions for childhood obesity.

Societal Infant Problems: Childhood Obesity
Student name: Sabina kumariNiraula
Student number:
Subject
Coordinator:
University of Wollongong

Objectives
The primary purpose of this project will be reviewing and identifying the newer
optimal prevention and treatment strategies for the childhood obesity among school children
in Australia. Further, in the course, it would provide detailed systematic search so that the
presence of disease among the Australian children could be identified. The PICO question for
this paper would be:
Population Indicator Comparison Outcome of
interest
Time
School children Childhood
obesity
Comparing to the
other population
Preventive
measures,
primary causes,
new interventions
Within 6
months
The question: what is the most effective preventive measure,primary causes, new
interventions for childhood obesity among the school children?
Keywords: childhood obesity, interventions, school children, preventive measures

Background
According to the World Health Organisation (2016), approximately 41 million
children below the age of 5 years were identified as overweight. In the United States alone,
approximately 21-24% of American young adults and children have excessive weight while
another 16-18% are obese. Studies have shown that obesity is prevalent among ethnic
communities. Overweight or obese children are more susceptible to various health and
economic impacts making obesity a serious and complex condition.
The National Health and Nutrition Examination Survey (NHANES) elaborates that
obesity prevalence is becoming rampant in children and young adults of both genders, and in
several racial and ethnic communities’ Older forms of interventions such as individual
responsibility and parental guidance and control are becoming obsolete at best. Due to these
various health and economic concerns, it is therefore critical to examine the causes and risk
factors and at the same time identify the optimal prevention and management approaches
(World Health Organization, 2016).
Childhood obesity is a multifaceted disorder and should be handled at various levels,
from households, individuals, institutions and the society. It is, therefore, necessary to
explore novel and effective measures that involve the integration of communities, the state,
corporations, households as well as individual families to reduce the prevalence. According
to the World Health Organization (WHO), obesity is one of the most critical health
conditions worldwide. The U.S. Surgeon General believes that obesity has become a national
disaster (Skinner, Perrin, & Skelton, 2016). The U.S. Task Force on obesity in children
asserts that obesity is rampantly becoming a national health catastrophe. Previous studies
have shown that if the prevalence of obesity in children if left unchecked, parents will be

outliving their children which leaves little hope for the generations that come after (Skinner,
Perrin, & Skelton, 2016).
A long list of chronic diseases coupled with physical and emotional stress are the
most likely outcomes of the obesity epidemic and while prevention of the outcome of
healthcare process, the intervention should focus more on the prevention aspect than
medication as it would change the thought process and lifestyle of the patient. In
addition, obese children are likely to suffer from lower economic productivity while
their parents incur high healthcare expenses resulting in significant economic costs
reciprocated to individual governments. Older methods of preventing and treating
obesity in children such as individual responsibility and parental control have become
obsolete. That is why it necessary to integrate newer and more feasible solutions by
collaborating communities, with both public and private corporations as well as state
corporations. This will ensure a united vision of enacting policies that encourage and
support healthy and active lifestyles (Harrist&Topham et al. 2016). The World Health
Organization (2016), estimates that 41 million children below the age of 5 years were
either obese or overweight. Obesity was previously considered a condition for high-
income countries, but recent studies are showing that obesity is now on the increase in
low and middle-income countries as well particularly in urban settlements, therefore,
with WHO, and the UNESCO, the sustainable development goal aims to eradicate
childhood obesity by implemented preventive measures and changing the lifestyle of the
affected communities.
As per Kelsey et al. (2014), there are several healthcare complication that arises
due to the presence of obesity and among these type 2 diabetes, heart diseases, stroke,
and osteoarthritis are crucial which affects the quality of life of affected individual.
Further, it was also noted that children affected with obesity are more susceptible to

such concerns and if compared to healthy children, they suffer from the higher risk of
primary healthcare concerns due to obesity (Sahoo et al., 2015). In addition to these,
various types of cancers such as colon, kidney, pancreas, endometrium, thyroid, breast,
ovary, cervix oesophagus, prostate, gall bladder, myeloma, and Hodgkin's lymphoma
have all been closely linked to obesity (Ottaiano& De Divitiis, 2018). Other health risks
related to obesity include high blood pressure and cholesterol, breathing disorders, non-
alcoholic fatty liver disease (NAFLD), and metabolic syndrome. Therefore, preventive
interventions should be implemented in the sections that are affected with mental
healthcare concerns.
A recent study found that obese children are highly susceptible to being isolated and
ostracized from the others and as a result, they may suffer from depression at a young age
(Harrist et al., 2016). The study found that as the level of obesity increased in children, the
worse their emotional and social states became. According to Hales & Carroll (2017),
intervention and prevention efforts should start at an earlier age targeting peer relationships.
Therefore, the primary aim of this process would be to conduct a systematic review and
critical appraisal of the articles obtained so that identification of the preventive and
controlling measures could be identified.
Problem Statement
Obesity in children is a growing risk factor and the cause of most of the chronic
diseases worldwide and besides this it lead to several complex situations due to which crucial
healthcare conditions arises.It also evident that, worldwide, health complicationscommenced
by thechildhood obesity among children are deeply rooted and affects each range of
population due to which, not only their present but future also gets affected. Childhood
obesity is associated with severaltype of health risks in which, gallstones, high blood

pressure, type 2 diabetes, heart diseases, breast cancer prevails among others. Further, there
are the socio-economic issues associated with this disorder that is responsible for the
prevalence of actions such as discrimination, low productivity economic wise and poor
quality of life (Reinehr, 2018).
Contrary to the treatments of other health risk factors, prevention and treatment of
obesity in children are left to individual responsibility of the child and their parents.
Therefore, the pressure in the form of societal stigmatization builds up where parents of
obese children end up fearing the health and social impacts of their children's
obesity(Harrist&Topham, 2016). At the same time, the parents struggle against a much larger
foe which is the media, providing constant exposure to poor-diet foods. Therefore, this paper
aims to critically examine the causes and risk factors of obesity as well as identifying newer
optimal prevention and treatment strategies.
Criteria for considering studies for this review
Types of studies
This paper will consider the systematic reviews that explored novel and effective
measures that involved the integration of communities, the government, private and public
corporations, as well as households to reduce the occurrence of childhood obesity. Childhood
obesity was defined as a medical condition occurring in children with excessive weight or
body fat that might seriously affect their health condition (Skinner, Perrin& Skelton, 2016).
Types of participants
This review will consider research and studies that include any children under the age of 10
years suffering from overweight and obesity disorders.
Types of interventions

This paper will include all novel and effective measures that involved the integration
of communities, the government, private and public corporations, as well as parents to reduce
the occurrence of childhood obesity among school children.
Types of outcomes
The main outcome of this review is to examine and identify the major causes,
prevention measures, and newer intervention methods that involve the integration of
communities, the government, private and public corporations, as well as households to
reduce the prevalence of childhood obesity among school chidlren.
Search Strategy
The search strategy will aim at finding both unpublished and published systematic
reviews. The focus of this search will be done from the following databases:
1. PubMed
2. JSTOR
These two databases has been used for the systematic search process and several
inclusion and exclusion criteria was applied so that 5 accurate and relevant systematic
process or RCT articles could be selected for the assessment process. Besides this, all the five
articles and their reference list has also been searches so that additional resources could be
identified. The inclusion criteria included research articles within 10 years of publication,
English language, presence of RCT and/or systematic review study whereas, exclusion
criteria was associated with different language, publication date before 2010, research
process other than RCT and systematic review. These inclusion and exclusion criteria

promoted selection of recent research articles that promoted recent and relevant research
process. The search table of both the databases has been provided in the appendix section.
Methods of review
Assessment of methodological quality
The studies selected will be evaluated for methodological reliability before including them in
the review using the Assessment of Multiple Systematic Reviews (AMSTAR) (Shea et al.
2017). AMSTAR is an effective and reliable instrument used to assess the methodological
quality of systematic reviews. It consists of 11 precise criteria items to assess systematic
reviews’ methodological quality. In the appendix section, the AMSTAR critical appraisal tool
for the 5 articles chosen has been provided.
Extraction of data
Data that will be retrieved from the papers will include precise details of all the populations,
methods of study, interventions and the results of the studies which are significant to the
objectives of this review. The data extraction table has been provided in the appendix section.
Synthesis of data
The results and findings of this review will be in the form of a narrative and will include facts
and figures as well as tables to assist in the presentation as required.
Design and methods
This section will describe the sample and population, data collection techniques,
sampling methods, instruments used, as well as the analytical process. This proposal will take
a concurrent mixed approach. Mauz & Hoffmann et al., (2018) define the mixed method as a
combination of both qualitative and quantitative methods which can either be multi-phase or
single. The approach may include philosophical assumptions to guide the data collection

procedures to better understand the research questions Younossi et al. (2016). This approach
will be selected because it will help the researcher design interventions and programs the
children’s perceptions by utilizing the instruments from this proposal. However, secondary
sources will play a major role in the entire study.
Conclusion
Obesity in children has become a serious and rampant health risk in the world today
and has negative and long-term effects for the individuals, communities as well as
households. The prevalence rate has dramatically increased over the last few years as
indicated in the literature review and is expected to be on the rise in the future if left
unchecked. Many of the studies to date have focused entirely on the prevention and
intervention of obesity of children under the age of 5. Childhood obesity is linked very
closely with a vast amount of health risks which include, gallstones, high blood pressure, type
2 diabetes, heart diseases, breast cancer, among others. This paper aims to critically examine
the causes and risk factors as well as identifying newer optimal prevention and treatment
strategies.

References
Bhutta, Z. A., Das, J. K., Rizvi, A., Gaffey, M. F., Walker, N., Horton, S., ...& Maternal and
Child Nutrition Study Group. (2013). Evidence-based interventions for improvement
of maternal and child nutrition: what can be done and at what cost?. The
lancet, 382(9890), 452-477.
Cawley, J., &Meyerhoefer, C. (2012). The medical care costs of obesity: An instrumental
variables approach. The Journal of Health Economics, 31(1), 219-230
CDC (2012). Childhood obesity facts the prevalence of childhood obesity in the United
States, 2011-2012.CDC.gov. Retrieved Wednesday, 27, 2019
Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity
among adults and youth: the United States, 2015–2016.
Kelsey, M. M., Zaepfel, A., Bjornstad, P., & Nadeau, K. J. (2014). Age-related consequences
of childhood obesity. Gerontology, 60(3), 222-228.
Kriemler, S., Meyer, U., Martin, E., van Sluijs, E. M., Andersen, L. B., & Martin, B. W.
(2011). Effect of school-based interventions on physical activity and fitness in
children and adolescents: a review of reviews and systematic update. British journal
of sports medicine, 45(11), 923-930.
Mauz, E., Hoffmann, R., Houben, R., Krause, L., Kamtsiuris, P., &Gößwald, A. (2018).
Mode Equivalence of Health Indicators Between Data Collection Modes and Mixed-
Mode Survey Designs in Population-Based Health Interview Surveys for Children and
Adolescents: Methodological Study. Journal of medical Internet research, 20(3).

Metcalf, B., Henley, W., & Wilkin, T. (2012). Effectiveness of intervention on physical
activity of children: systematic review and meta-analysis of controlled trials with
objectively measured outcomes (EarlyBird 54). Bmj, 345, e5888.
Norman, R. E., Byambaa, M., De, R., Butchart, A., Scott, J., &Vos, T. (2012). The long-term
health consequences of child physical abuse, emotional abuse, and neglect: a
systematic review and meta-analysis. PLoS medicine, 9(11), e1001349.
Ottaiano, A., De Divitiis, C., Capozzi, M., Avallone, A., Pisano, C., Pignata, S., &Tafuto, S.
(2018). Obesity and Cancer: Biological Links and Treatment Implications. Current
cancer drug targets, 18(3), 231-238.
Reinehr, T. (2018). Long-term effects of adolescent obesity: time to act. Nature Reviews
Endocrinology, 14(3), 183.
Roberto, C. A., Swinburn, B., Hawkes, C., Huang, T. T., Costa, S. A., Ashe, M., ...&
Brownell, K. D. (2015). Patchy progress on obesity prevention: emerging examples,
entrenched barriers, and new thinking. The Lancet, 385(9985), 2400-2409.
Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., &Bhadoria, A. S. (2015).
Childhood obesity: causes and consequences. Journal of family medicine and primary
care, 4(2), 187.
Shea, B. J., Reeves, B. C., Wells, G., Thuku, M., Hamel, C., Moran, J., ... & Henry, D. A.
(2017). AMSTAR 2: a critical appraisal tool for systematic reviews that include
randomized or non-randomised studies of healthcare interventions, or both. BMJ, 358,
j4008.
Skinner, A. C., Perrin, E. M., & Skelton, J. A. (2016). Prevalence of obesity and severe
obesity in US children, 1999‐2014. Obesity, 24(5), 1116-1123.

Younossi, Z. M., Blissett, D., Blissett, R., Henry, L., Stepanova, M., Younossi, Y., ...&
Beckerman, R. (2016). The economic and clinical burden of nonalcoholic fatty liver
disease in the United States and Europe. Hepatology, 64(5), 1577-1586.

Appendices
Appendix 1: Gantt chart
Task Formulation
of the project
question
Develop
eligibility
criteria
Literature
search
Screening
research
articles and
assessing
their
quality of
studies
Data
extraction
synthesis and
interpretation
of results
Submission
of research
project
Date
25.03.201
9 to
28.03.201
8
29.03.201
9 to
08.04.201
8
09.04.201
8 to
28.04.201
9
29.04.201
9 to
07.05.201
9
08.05.201
9 to
15.05.201
9
16.05.201
9 to
25.05.201
9
02.06.201
9

Appendix 2: Detailed search strategy for at least one of the databases
1. Childhood obesity
2. ((childhood* or obesity* or prevention*) adj3 (intervention* or mistake* or severe*)).tw.
3. ((severity* or inability*) adj3 (childhood* or obesity or prevention)).tw.
4. ((prevention* or intervention* or childhood obesity*) and reduced*).tw.
5. 1 or 2 or 3 or 4
6. (prevention* or reduction* or intervention*).tw.
7. Preventive measures of childhood obesity/
8. Preventive measures /
9. Intervention monitoring/
10. Proper prevention system/
11. Nutritional treatment and physical activities/
12. ((medication* or medicine* or drug*) adj3 (physical activity* or nutrition* or intervention*
or manag*)).tw.
13. ((prescrib* or prescription*) adj2 (prevention* or intervention*)).tw.
14. 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13
15. 5 and 14

16. meta-analysis.pt.
17. Meta-Analysis as Topic/
18. (Meta analy* or metaanaly*).tw.
19. (systematic* adj2 (review* or overview*)).tw.
20. 16 or 17 or 18 or 19
21. 15 and 20
22. Limit 11 to (meta-analysis or systematic reviews)
23. Limit 12 to (English language and year= "2010 to current")
Total number of articles found after the search strategy: 12 within which 5 was used for
the assessment.

Appendix 3: Critical appraisal checklist/ tool (AMSTAR tool)
AMSTAR item (Norman
et al.,
2012)
(Kriemler
et al.,
2011)
(Roberto et
al., 2015)
(Bhutta et
al., 2013)
(Metcalf,
Henley &
Wilkin,
2012)
1. Was an a priori design
provided?
Yes Yes Yes Yes Yes
2. Was there duplicate study
selection and data extraction?
Yes No Yes Yes No
3. Was a comprehensive literature
search performed?
Yes Yes Yes Yes Yes
4. Was the status of publication
(that is, grey literature) used as an
inclusion criterion?
Yes Yes Yes Yes Yes
5. Was a list of studies (included
and excluded) provided?
No No No No No
6. Were the characteristics of the
included studies provided?
Yes Yes Yes Yes Yes
7. Was the scientific quality of the
included studies assessed and
documented?
Yes No No Yes No
8. Was the scientific quality of the
included studies used
appropriately in
formulating conclusions?
Yes Yes No No No
9. Were the methods used to
combine the findings of studies
appropriate?
Yes Yes Yes Yes Yes
10. Was the likelihood of
publication bias assessed?
No Yes Yes Yes No
11. Was the conflict of interest
included?
No No No No No
Total Yes Yes Yes Yes No

Appendix 4: Data extraction form
Author Year
Country
Focus
Search
details, range
(database
searched,
articles
included
Quality scoreNumber of studies
Design of included
studies
Intervention/
comparisons
Main
outcomes
measures
Norman RE,
Byambaa M,
De R,
Butchart A,
Scott J, Vos T
2012
the United
Kingdom
to understand
the prevalence
of childhood
obesity among
children
Medline,
EMBASE, and
PsycINFO
124 studies
included
moderate
score (5 to 8)
124 Awareness
about child
malnutrition so
that long term
benefit could be
obtained.
subgroup
analysis as
outcome
measures
Kriemler S,
Meyer U,
Martin E,
2011
the united
kingdom
to understand
Pubmed,
Medline,
Embase,
Psycinfo,
Sportdiscus
and Embase
moderate
score (5 to 8)
20 increase the
physical
activity of the
children
affected with
childhood
obesity
ability to
increase the
outcome

the new
interventions
so that the
fitness level of
children could
be assessed
Zulfi qar A
Bhutta, Jai K
Das, Arjumand
Rizvi,
Michelle F
Gaff ey, Neff
Walker, Susan
Horton, Patrick
Webb, Anna
Lartey, Robert
E Black
2013
34 countries
around the
world
90% of the
global burden
could be
assessed
related to
childhood
obesity
PubMed,
Cochrane
libraries,
electronic
library on
evidence on
nutrition
actions
(eLENA), and
WHO regional
databases
High score (9
to 11)
235 10 direct
nutritional
interventions
Good health
and nutrition of
children around
the world.
Christina A
Roberto, Boyd
Swinburn,
Corinna
Hawkes, Terry
T-K Huang,
Sergio A
Costa, Marice
Ashe, Lindsey
Zwicker, John
H Cawley,
Kelly D
Brownell
governmental
data of the
countries
included
moderate
score (5 to 8)
50 articles and its
data
reasons for the
malnutrition
and childhood
obesity
nutritional
content of
children around
50 countries

2015
Caribbean
population
more than 50
articles were
searched so
that children
and their
nutritional
status that
leads to their
obesity
Brad Metcalf,
William
Henley,
Terence
Wilkin
2012
The United
Kingdom
incorporated a
component
designed to
increase the
physical
activity of
children/adoles
cents and was
at least four
weeks in
duration.
Embase,
Medline,
PsycINFO,
SPORTDiscus
high score (9
to 11)
58 articles Determine
whether, and to
what extent,
physical
activity
interventions
affect the
overall activity
levels of
children.
increased
physical
activity among
involved
children