Health Care Practitioner Training Assignment (pdf)

Topic: An Exploration of obesity in young Adult and
Nurse Engagement in this Issue.
1

TABLE OF CONTENTS
Topic: An Exploration of obesity in young Adult and Nurse Engagement in this Issue................1
CHAPTER ONE..................................................................................................................................6
1.1 Introduction...............................................................................................................................6
1.2 Research Question...................................................................................................................11
Literature review.................................................................................................................................11
CHAPTER TWO...............................................................................................................................17
2.1 Methodology and Design.........................................................................................................17
2.2. Research inclusion criteria.....................................................................................................17
2.3 Database/Sourcing...................................................................................................................18
2.4 Analysis.....................................................................................................................................19
2.5. Strength, weaknesses and limitations of literature reviews.................................................20
2.6. Ethical considerations.............................................................................................................22
2.7. Justifications of the study.......................................................................................................23
CHAPTER THREE...........................................................................................................................24
3.1 Findings....................................................................................................................................24
3.1.1 Urbanisation......................................................................................................................24
3.1.2 Family environment...........................................................................................................26
3.1.3 Screen times.......................................................................................................................27
3.1.4 Parental weight status........................................................................................................28
3.1.5 Health Care Practitioner Training....................................................................................29
CHAPTER FOUR.............................................................................................................................31
4.1 Discussion.................................................................................................................................31
4.2 Implication for practice...........................................................................................................34
2

6.1 Conclusion................................................................................................................................38
REFERENCE....................................................................................................................................40
3

ABSTRACT
Background:
Worldwide, obesity is the sixth most important risk factor contributing to the overall
burden of disease. In the UK, nearly a third of children aged between 2 to 15 presents as
clinically obese or overweight thus predisposing them to an adulthood plagued with type 2
diabetes, coronary heart diseases, depression, low self-esteem and some form of cancer.
Whilst it is recognised that engagement in physical activities is one of the intervention
approaches that can be employed to promote physical fitness and reduce overweight and
obesity among teenagers in the United Kingdom, the evidence available indicates that
sedentary behaviour influences weight and indeed, does contribute to weight gain in
teenagers.
Aim:
The aim of this study was to uncover the factors influencing the adoption of sedentary
lifestyle among overweight teenagers. Consequently, the study research question was: ‘what
are the factors that influence adoption of a sedentary lifestyle among overweight teenagers?’
Objective
 To explore lifestyle of teenager between age 12- 18.
 To identify impact of obesity among teenager health
 To identify factors influencing adoption of sedentary lifestyle on teenagers.
Method:
4

A research proposal was submitted prior to commencing this study. The study
employed a critical literature review theoretically underpinned by a seven-step model
consisting of three phases - exploration, interpretation and communication.
Findings:
Five key themes were identified as the factors that influence the adoption of a
sedentary lifestyle among overweight teenagers. These factors were urbanisation, family
environment, screen time, parental weight status and health care practitioner training.
Conclusion:
Nurses have a key role to play in addressing overweight and obesity in teenagers.
Accordingly, it is important that nurses are able to have an honest and open conversation with
teenagers and their parents on overweight and sedentary practices. This is likely to be the first
step in empowering teenagers to change sedentary practices.
5

CHAPTER ONE
1.1 Introduction
Whilst obesity was previously not a problem in the developing world, it is now
becoming prevalent and in industrialised countries on the contrary, it is now the most
prevalent form of malnutrition (Peeters and Backholer, 2012). Worldwide, obesity is the sixth
most important risk factor contributing to the overall burden of disease. Indeed, 10% of all
children and 1.1 billion adults are now classified as overweight or obese worldwide (Haslam
and James, 2010). Worldwide, 1 in 4 adults, and 3 in 4 adolescents (aged 11–17 years), do
not currently meet the global recommendations for physical activity set by The World Health
Organisation (WHO, 2018). It is projected that an estimated 38% of the world’s adult
population will be overweight and another 20% will be obese by 2030 (Adela and Frank,
2015). Worldwide, almost three million people die each year as a result of being overweight
or obese (WHO, 2017). Having excess weight triggers a plethora of health conditions such as
cardiovascular diseases, cancers, and type 2 diabetes (WHO, 2018).
According to the WHO (2017), most of the world’s population live in a country where
there are more people overweight compared to individuals who are underweight. Crucially,
this encompasses all high-income and middle-income countries. Moreover, it is generally
acknowledged that obesity is caused by consuming more calories than is burnt off through
physical activity (Berthoud and Klein, 2017; Kohorst et al. 2018). Globally, the prevalence of
obesity has doubled from 1980 to 2014 (Health and Social Care Information Centre, 2016).
Here in the United Kingdom (UK), in 2015, 68% of men and 58% of women were obese
(NHS, 2017). With regards to children, in 1991, only 4.2% of children were classed as being
either overweight or obese. However, by 2015, 26.9% of children were either overweight or
obese (Health and Social Care Information Centre, 2016). Worryingly, it is projected that by
6

2020 in the UK, the number of obese and overweight teenagers will double with an
associated cost to the National Health Service (NHS) of £17.6 billion (Glasper, 2010).
More worrying however, is the exponential rise of obesity in children with nearly a
third of children aged between 2 to 15 presenting clinically as obese or overweight (Health
and Social Care Information Centre, 2015). Associated clinical consequence of obesity
include type 2 diabetes, coronary heart diseases, depression, low self-esteem and some form
of cancers (Foss and Dyrstad, 2011). These associated costs place a significant burden on the
health economy and positions tackling obesity as a government wide priority in the UK
(Selbie, 2018). Indeed, this is evidenced in the UK Government's childhood obesity plan
which is aimed at creating healthier choices and reducing the rates of obesity in the most
deprived sections of our communities (Department of Health, 2016). However, and despite
the UK government’s childhood obesity plan, obesity among adolescents has continued to
increase significantly prompting major concern amongst public health practitioners in light of
the associated medical consequence of progressing into adulthood with obesity (Meyer and
Gulotta, 2012; Berman, Snyder and Frandsen, 2015; Sharman and Nobles, 2016).
Available evidence implicates sedentary lifestyle as an underpinning trigger for
obesity and overweight in adolescents (Kohorst et al. 2018). Sedentary lifestyle is
underpinned by inactivity and is a lifestyle characterised by insufficient amounts of physical
activity on a regular basis (Kim, 2018). This lifestyle is closely aligned with sedentary
activities such as the frequent watching of TV, sitting, reclining, lying down and playing of
video games (Meetoo, 2010). The WHO (2018b) corroborates this indicating that sedentary
behaviour is any waking behaviour such as sitting, lying down or reclining in which an
energy of ≤ 1.5 metabolic equivalents is not expanded. In addition, the emphasis on
intellectual activities at the expense of physical education in the school curriculum has also
7

been implicated as a factor fuelling sedentary lifestyle in adolescents (Meetoo, 2010). More
worryingly, available evidence indicates that sedentary behaviour negatively impacts weight
independent of other factors which could be confounders in the association such as genetics,
diet and physical activity. Corroborating this, a study which prospectively examined sitting
time and mortality in a representative sample of 17,013 Canadians for 12 years indicated that
a higher risk of mortality is associated with being sedentary (Katzmarzyk, Church, Craig and
Bouchard, 2010). Furthermore, this association of sedentary behaviour with adverse health
outcomes was also uncovered in a study examining the association between sedentary
behaviour and obesity among 12-year-old children, while adjusting for confounding variables
(Mitchell et al. 2010). This study indicated that even after controlling for moderate physical
activity defined as any movement of the body that is produced by skeletal muscles which
requires energy expenditure, being sedentary was strongly associated with the likelihood of
children becoming obese and thus progressing into their teenage years with obesity. This is
further supported by the WHO (2018b) which indicates that sedentary practices such as
sitting for long periods of time are associated with abnormal glucose metabolism and hence
could lead to cardio metabolic disease.
Furthermore, research indicates that there is a strong correlation between physical
inactivity and the prevalence of non-contagious chronic illnesses, particularly circulatory
system diseases (Darch, Baillie, and Gillison, 2017). For instance, Lobstein et al (2015)
indicate that cerebrovascular diseases as well as ischemic heart illnesses increase by 25% due
to the adoption of a sedentary lifestyle. This becomes particularly worrying in light of the fact
that 47% of all deaths are caused by circulatory system diseases (Stankov, Olds, and Cargo,
2012). Consequently, the need to promote adoption of programs that will make teenagers
adopt active lifestyles cannot be underestimated. In achieving this, the UK government
8

recognises that nurses play a significant role in influencing the lifestyle of the public (Turner-
Wilson et al. 2017) and therefore, their role in combating the increasing number of obese
teenagers cannot be overlooked. Indeed, nurses play a key role in promoting lifestyle changes
both in diet and exercise as an approach to obesity management as nurses are more likely to
encounter obese adolescents during visits for other clinical issues as first clinical contacts
(Turner-Wilson et al. 2017).
In addition to physical activities, Lazarou and Kouta (2010) indicate that it is prudent
to ensure the public is enlightened on a healthy diet. Accordingly, nurses possess the
physiological knowledge underpinning obesity and overweight and are consequently well
positioned to devise weight management programs as ideally, weight management programs
entail strategies for reducing caloric intake as well as increasing physical activity
(Bickerstaffe, 2014). In light of this, Rabbitt and Coyne (2012) maintain that nurses play a
significant role in devising programs that aid in managing and reducing body weight whether
through diet regulation or physical activities. Moreover, in line with the public health ethos of
making every contact count (While, 2018), nurses are expected to educate patients and their
family members on contact on the dangers of being overweight and encourage them to
engage in exercise whilst concurrently promoting the health benefits associated with physical
activities.
However, a study (Blake, Malik, Sumaira, Phoenix and Pisano, 2011) investigating
the health behaviours and wellbeing of pre-registration nurses based at an acute NHS
teaching hospital in England indicated that despite undergoing training in health promotion,
and the significant health consequences of negative health behaviour, the health profile of
pre-registration nurses was extremely poor. This study also indicated that pre-registration
nurses who were sedentary were most likely to also indulge in harmful lifestyle behaviours
9

that are detrimental to their health (Blake, Malik, Sumaira, Phoenix and Pisano, 2011). These
findings worryingly allude to the fact that in spite of the significant training on behavioural
change and health promotion which pre-registration nurses receive, knowledge acquired is
not always applied to self in changing personal behaviour and living healthy. Nurses
engaging in health promotion are important to its success as clinicians on the one hand, but
also as professional role models on the other hand.
Indeed, there is a plethora of knowledge on how nurses can be healthy role models
(Kelly et al. 2017). However, this is contradicted by nurses living unhealthy lifestyles which
becomes evident in their poor physical health, and consequently, contradicts the notion of the
healthy role model (Rabbit and Coyne, 2012). Nurses in poor physical health, contradicts the
expectations of patients and limits the extent to which patients engage with behavioural
change advice (Bakhshi et al. 2015). Accordingly, Rabbitt and Coyne (2012) maintain that a
key factor fuelling sedentary lifestyle is poor healthy behaviour among health professionals
as health professionals are more likely to be seen as healthy role models. Indeed, it is clear
from available evidence that several factors, both proximal and distal are associated with
overweight and obesity in adolescents. Whilst this is not in doubt, these factors underpin the
need for a comprehensive strategy to reverse the worldwide obesity pandemic among
adolescents. In addition, nurses are encouraged to ensure they regularly monitor food intake
of adolescents through monitoring of school meals and in settings such as hospitals where
nurses work. Nutrition is an assimilated duty of a nurse and for this reason, nurses are
obligated to ensure that all patients under their care are offered a diet that is nutritious and not
likely to predispose them to overweight or obesity (Sellwood, 2013).
10

1.2 Research Question
It is recognised and acknowledged that engagement in physical activities is one of the
intervention approaches that can be employed to promote physical fitness and reduce
overweight and obesity among teenagers in the United Kingdom and the entire world in
general. As a result, the aim of this study is to explore the factors correlated with physical
inactivity among obese teenagers. This study will also provide recommendations aimed at
reducing overweight and obesity in this group. It is hoped that this critical review of the
literature will contribute to the evidence aimed at mitigating against sedentary lifestyle in
obese teenagers and therefore, promote a healthy lifestyle. Accordingly, the aim of this study
is to uncover the factors influencing the adoption of sedentary lifestyle among overweight
teenagers. Consequently, the study research question is as follows: ‘What are the factors that
influence adoption of a sedentary lifestyle among overweight teenagers?’
Literature review
According to the view of Adela and Frank (2015) adolescence could be defined to as
children who are between ages 13-19 as this is that stage where child is transformed to
adulthood. There are many sort of changes which occur during this stage of development like
that including psychological and physical changes. During this stage they are meant to
discover many things which they find attractive and making choices between many available
choices. At this stage they will also be finding out difficulties in various terms like that of
issue related to self-identity and that of independence as well. Most of the adolescent will be
facing tougher times regarding school, drugs, social life, and attracted towards alcohol,
smoking and sexuality as well.
11

As explored by Beckwith, (2014) it could be stated that there will be many mental
health issues which these adolescent will be confronting most commonly will be that of
anxiety and depression. So it is advised for parents that they are tracking and learning how to
handle the situation when their children are facing the same. It is essential to follow the
balanced approach in way of dealing with situation when children want to become
independent young people. This is the most unique and different type of group which are
having variety of demands and lifestyle patterns as well. It is very much essential to identify
the lifestyle and behavioural pattern within the group of people and subsequently coming up
with issues which are inclusive of special attention. As per the view of Bickerstaffe (2014)
many of the adolescent are having many of the issues related to physical and psychological
development which is been occurring within them. as included within one of the study it was
noted that the female who are felling under the age group of 12-18 will be facing problem
like that of depression and sleep disorder more than that of males of this age.
Their lifestyle will be mostly surrounded by certain regular activities like that of
watching television, listening to music and some of the late night activities as well. There
also included that adolescents were taking about 5 hours sleep for each day while some of
them not doing the same. As per the view of Costa-Font and Mas, (2016) getting attracted
towards things like that of other sex, alcohol, cigarettes and other type of addictions as well.
As per Meyer and Gullotta (2012) it has been said that in present times there is high
rise in obesity among children. This is majorly impacting on their physical and mental health
conditions. Also, it is been found that transfer of genes is not actual reason for overweight.
But rather adoption of sedentary lifestyle by youngsters is also a problem. It has resulted in
rise in number of diseases in them. Alongside it, this is highly influencing the society and
coming generation. It is analysed that children growth stage is impacted as well. The obesity
12

level among them is rising rapidly. In a survey conducted it was found that in 2016, 50
million girls and 74 million boys all around globe are suffering from obesity. This trend has
also raised in Asian continent in past years. It is expected that current trend of obesity is
acceptable and can be prevented if it begins at early stage.
According to Naidoo and Wills, (2016) in present time obesity is major disease
affecting the health of people. Among them, teenagers are facing this problem to a great
extent. This has impacted on social, psychological, etc. behaviour of children. The life of
teenage begins from age 12. Children actual growth and development begins from this age.
Thus, it is necessary for parents to look after teenager needs so that it can be fulfilled.
Furthermore, teenage is an age where many changes in trend in lifestyle occur. It can result in
impact on health either in positive or negative way.
As elucidated by Aguilera, (2016) obesity occurs in children at early age. They are
either transferred by genes or naturally it develops among child. The occurrence of obesity on
child health can impact on its growth and development at later stage. This may lead to rise in
various types of disease such as diabetes, hypertension, sleeping disorder, etc. due to these,
child development is affected in negative way. There is greater risk in health complications
associated with early morbidity. This can affect quality of life leading to long term health
care burden. In view of Ashwell, (2013) current generation of children is having a short life
expectancy than their parents. Besides this, obesity can occur due stigma or reduced
psychological wellbeing. It can further lead to critical consequences through psychological
vulnerability that increases likelihood of over eating and sedentary activity. In a study done
by Beckwith, (2014) it is concluded that teens suffering from obesity are having low self
esteem as compared to others. By comparing themselves with thin and fit people, obese child
does not engage in social life. They may feel weak or lazy by comparing with thin people.
13

This impacts on their emotional health as well. They start blaming themselves for their
condition. It results in loneliness. The adoption of sedentary lifestyle can lead to depression.
Moreover, by over eating and sitting body parts may not work properly. The bones may feel
more pressure and not able to handle weight of body. Thus, there is deficiency of calcium in
bones. This makes it difficult for teens to walk or do certain activities. Marmot, (2013) said
that obese teens often feel lonely and remain sad most of time. Hence, they do not like to take
part in social activities. In addition to it, teens are more likely to addict with alcohol, drugs,
etc. there are several factors which has contributed in obesity. Genetics plays vital role in it.
Whereas poor diet and sedentary lifestyle are another factor. In today’s era teens consume
more drink and eat junk food but do not exercise as much. Apart from it, advertisement on
TV, newspapers, etc. influence their minds. The second most threat to health of child is risk
of heart attack. The teenager may suffer from heart disease as well. Thus, it develops a
feeling of fear among them affecting their mental condition. Another possible complication is
joint problems such as osteoarthritis. Having extra weight puts pressure on joint of knees and
hips. According to Meetoo, (2010) teen may suffer from sleep apnea and breathing
problems. Due to this, teenager may suffer from night sleeplessness. He or she may not be
able to get proper sleep at night. Along with it, sometime sleep apnea causes difficulty in
breathing that is heavy snoring. It can result to development of asthma.
A teen health depends on type of diet taken by him or her, environment in which they
grow, etc. the increase in weight rises risk of impaired glucose tolerance. It is found that in
overweight teens even in absence of type 2 diabetes, there is high risk of cardiovascular
disease due to hypertension and dyslipidaemia. This is because BMI index is high in them. In
a comparison teen of age 12-18 have risk of 2.5 -7.6 high blood pressure as compared with
10-15 years of age. Furthermore, it is evaluated that obesity can also lead to non alcoholic
14

fatty liver disease. It is estimated to be 38% in them. this disease is associated with insulin
resistance, hypertension, etc. As elucidated by () there are some gynaecologic health risk
associated with it as well. These all impact on growth of teenager in negative way.
furthermore, there are some metabolic syndrome impact as well. Usually, it consists of six
major components.
Factors influencing adoption of sedentary lifestyle on teenagers
According to () teens gets highly attracted towards sedentary lifestyle when they enter
age of 12. It is because proper development mind occurs at that stage. However, there are
some other internal or external factors which forces them to adopt that lifestyle. physical
inactivity is major influence of this thing. In a report of WHO almost, 60% of population is
not involved in any kind of physical activity. They do not care about their health and how to
improve it. in a survey conducted by IPAQ brazil states that prevalence of physical activity in
adult varied between 9-43%. Consequently, in order to get involved in physical activity there
are several factors that can influence such as motivation, time, socio- cultural support, etc. in
social it may include lack of education, finance, etc. in addition to it, in present times teens
are involved more in watching TV, playing video games on smartphone and computers, etc.
Thus, there is lack of involvement in school activities like making assignments, playing
outdoor games, etc. it has also contributed in changing behaviour. Due to this, adolescent
minds are diverted towards adopting sedentary lifestyle. Alongside it, lack of physical
activity reduces mortality and morbidity. It effects on quality of life and creates imbalance.
Therefore, it is found that many teens prefer to engage in indoor activities. They just want
some technological tools to pass their time. As said by () teens get influenced from its
surrounding environment.
15

16

CHAPTER TWO
2.1 Methodology and Design
In order to understand the factors that influence the adaptation of a sedentary lifestyle
among overweight teenagers, a critical literature review was employed in answering the
research question. Through the critical literature review, data was collected from existing
written materials by various sources. A critical literature review is appropriate since through
it, critical thinking skills can be employed to answer and question the theoretical foundations
of various documents that have been published pertaining the research topic. This will ensure
that emergent findings are deconstructed in light of policy, reality of practice and challenges
congruent with promoting health in the context of sedentary lifestyle in overweight teenagers.
This design was of benefit to this study as it enabled a clear picture to emerge on the
knowledge base and state of research on the factors underpinning the sedentary practices of
teenagers in the UK. In this context, critically exploring the literature also enabled an
appraisal of rigour in light of how reviewed literature were designed and conducted. This
ensured that whilst findings were reported, these were reported with reference to the
limitations of the studies informing them. Thus, improving the credibility of this study.
Moreover, the design of a critical literature review was cost efficient as critical literature
reviews as an approach are devoid from the use of primary data which are costly to collect
and prone to time constraint issues such as ethical approval and attrition.
2.2. Research inclusion criteria
17

2.3 Database/Sourcing
The search for the articles that facilitated this critical review of the literature was done
methodically and comprised of a process that included a broad scan of the literature and
detailed appraisal of the literature. The broad scan of the literature entailed identifying the
articles which met the study inclusion criteria and scanning them in the first instance for an
assessment of how they could contribute to the study. Following this, the detailed appraisal
comprised of a comprehensive appraisal of the article. This appraisal was facilitated with the
aid of critical appraisal tools such as Critical Appraisal Skills Program (CASP) framework.
Appraising selected articles using these appraisal tools ensured that in addition to the findings
that were generated by the reviewed articles, the articles were also appraised in light of their
methodological and design associated strengths and weaknesses.
The articles were sourced from a number of scholarly organizations such as; British
Journal of Nursing, Journal of Advanced Nursing, Nursing Time and Nursing Standard and
other peer reviewed journals on physical activity, body weight management and obesity.
Several databases were also searched such as CINAHL, PUBMED and MEDLINE. These
journals and databases were searched as they collate research studies focused on health and
the allied health professions. Accordingly, they were ideal for this critical review as the
review was focused on a topic area under their remit. Search terms were adopted to facilitate
and structure the search conducted. Adopted search terms used truncations which included
‘AND’ ‘OR’ and ‘NOT’. The search terms adopted in this study were ‘teenagers’,
‘adolescence’, ‘obesity’, ‘health promotion’, ‘sedentary’, ‘overweight’, ‘nurses’, and
‘attitudes’. These search terms were used in combination using the aforementioned
truncations as facilitators and to establish the limits of this study.
18

These truncations were used to focus the search on the research topic and to ensure
that articles not related to the topic of interest were excluded. These Boolean operators were
used to combine, broaden and narrow the database search. The Boolean operator ‘AND’ was
used to narrow the search; ‘OR’ was used to broaden the search and ‘NOT’ was used to
exclude unwanted constructs from the search. The use of these Boolean operators ensured
that the databases which were searched in this study were queried for meaningful information
with reference to the study research question which was to explore factors associated with
sedentary practices in overweight teenagers. Importantly, these operators also ensured that
articles were excluded in instances where they were not focused on my research topic. This
ensured that the search conducted in this study remained focused and devoid of off-topic
articles. (see appendix 2)
2.4 Analysis
A seven-step model consisting of three phases - exploration, interpretation and
communication (Onwuegbuzie and Frels, 2016) was used to structure the analysis. The
exploration stage has five steps, exploring beliefs and topics, initiating the search, storing and
organizing information, selecting/deselecting information, expanding the search to include
what the two identify as MODES; media, organization, documents, experts and secondary
data. This phase facilitated the exploration of the research question from different
perspectives and helped inform the background of this study and come to terms with the
remit of the proposed research. The second phase is the interpretation phase, which consists
of the sixth step; analysing and synthesizing information. The final step is the communication
19

phase where the critical literature review is presented. This is through the critical research
report.
The exploration phase as applied in this study entailed the exploration of the research
topic towards conveying the background to the research question, identifying the databases to
be searched and the search terms to be used, applying the research inclusion criteria and
selecting literature meeting the applied criteria. The interpretation phase entailed synthesising
the information from the articles identified and relating emergent themes to the reality on
ground. This phase facilitated the discussions presented in the section on findings by ensuring
that emergent themes were discussed in light of corroborating applicable research. This phase
also entailed the appraisal of selected articles which ensured that this study was not subject to
information overload as the appraisal facilitated the elimination of irrelevant studies
consequently ensuring that this critical review was focused on the most relevant papers.
Finally, the communication phase entailed the presentation of the findings of the critical
review and allied recommendations oriented towards promoting physical activity in
overweight and obese teenagers who live sedentary lifestyles. This phase also facilitated the
discussion in the section on implication for practice. This was achieved by aligning the
themes that had emerged from the findings of this study to what is already known in terms of
research and applicable policy on the state of affairs in the UK as evident in the background
section on factors influencing the adoption of sedentary practices in overweight teenagers.
2.5. Strength, weaknesses and limitations of literature reviews
The following are the strengths that are associated with the utilization of a critical
literature review as evident in this study:
20

i. The method is inexpensive because it involves reviewing previous studies compared to
conducting a new research study. Indeed, this study adopted the use of only secondary data
accessed from online sources which proved to be cost effective.
ii. The approach is also time advantageous as it can be conducted rapidly compared to
primary research where data collection and the ethical approval process is often lengthy.
iii. The obtained data is more accurate as well as reliable compared to individual research
findings. This is because a critical review of the literature enables a comparison to be made
between similar studies towards arriving at an unbiased conclusion that is more reliable.
iv. Critical literature reviews evidence a trajectory of solutions as it clearly conveys the
trajectory of a problem and associated remedies over time. In this study, this enabled the
scale of the research problem to be brought to light whilst concurrently associating the
problem with solutions that have been historically adopted in mitigation such as the public
health policy – making every contact count.
v. The internet through the databases searched produced a plethora of articles on my research
topic. This ensured that the scope of the analysis adopted was not limited because of
insufficient sample size. Compared to primary research, this is strength of critical literature
reviews as the sample to inform the review is readily available and plentiful.
While it is true that there are some merits associated with the methodology used, there are
some weaknesses as well. The following are the weaknesses present in using critical literature
review to inform knowledge. Importantly, it is acknowledged that these limitations also apply
to this study:
i. The principal disadvantage of the approach is that it is constrained by the materials that are
available for review. Some websites that provide the articles require membership and articles
21

need to be bought in order for one to access them. This is a hindrance as membership can be
time costly and finances can sometimes be a hindrance.
ii. Critical literature review is limited in its ability to justify whether the underpinning
research which determine the facts conveyed in identified articles are credible. This
predisposes critical literature reviews to the danger of reporting findings that may not have
been arrived at robustly.
iii. The direct experience of individuals is often lacking from a critical review of the literature
as findings are informed by secondary data and not the lived reality of individuals in the
circumstance of interest.
2.6. Ethical considerations
The information that was collected from the reviewed publications, journals and
articles were not altered in an attempt to suit the objectives of the researcher. Consequently,
the findings that are recorded in this dissertation are reliable and not biased. In addition, the
search terms used in this study were informed by the need to answer the research question
and were clearly conveyed at the outset of the study. In addition, issues revolving around
informed consent, data protection and confidentiality were not addressed as this study was
not a primary research and consequently did not directly engage with participants towards
collecting or interpreting data. Furthermore, a research proposal was submitted prior to the
conduct of this critical review in order to ensure that the proposed design was robust and the
issue to be investigated was topical and meaningful for practice.
22

2.7. Justifications of the study
In spite of a reduction in food calorie intake in the last thirty years in the UK, the
prevalence of obesity has nonetheless increased with an associated annual health related cost
of approximately 3.3-3.7 billion pounds (Pirgon and Aslan, 2015). It is clear that obesity and
overweight is a significant long-term problem affecting the health outcomes of teenagers.
Being overweight contributes to a plethora of health conditions that include type 2 diabetes,
cardiovascular diseases and several cancers (Dunn, 2015). Worryingly, whilst these health
issues associated with obesity were previously associated with adults, increasingly, these
problems are manifesting in teenagers in the UK and across the world (Adela and Frank,
2015). However, physical activity has been advocated as an intervention against obesity in
teenagers thus positioning physical inactivity among adolescents as an important research
topic in the field of Nursing.
The National Institute for Health and Care Excellence indicates that the United
Kingdom has the highest rate of teenage obesity in Western Europe. Indeed, in England
alone, three out of ten children from the age of two to fifteen are classified as either obese or
overweight (NICE, 2013). Research into how sedentary lifestyle contributes to this is
therefore essential as this could potentially inform measures to promote physical activity in
teenagers who are sedentary and thus reduce the prevalence of overweight and obesity in
teenagers across the health economy. In addition, the lifelong consequence of being obese
underpins the need to ensure that teenagers avoid sedentary practices that predisposes them to
obesity and its accompanying illnesses in the future.
23

CHAPTER THREE
3.1 Findings
This section evidences the results of this critical literature review. This critical review
was aimed at uncovering the factors that influence adoption of a sedentary lifestyle among
overweight teenagers. In uncovering this, indicative search terms were used to search journals
and databases that covered health and allied health issues towards identifying pertinent
literature. Following this, analysis of identified literature was conducted using a seven-step
model consisting of three phases - Exploration, Interpretation and Communication
(Onwuegbuzie and Frels, 2016). The themes uncovered following analysis thus informed the
findings of this study which are discussed below.
3.1.1 Urbanisation
The law of thermodynamics indicates that a decrease in energy output and an increase
in energy input leads to weight gain (Aguilera, 2016). This law clearly explains the pathway
through which an adolescent being sedentary leads to weight gain as by being sedentary,
energy output is minimised and consequently, energy inputted becomes converted ultimately
to fat leading to weight gain (Aguilera, 2016). The evidence uncovered from the critical
review of literature indicates that urban lifestyles make these two conditions easily obtained
by the population living in urban areas (Meeto, 2010; Flegal et al. 2013; Ewing et al. 2014).
Living in urban areas is associated with increased use of labour replacement technologies
such as cars and trains and increased access to high calorie diet (Meetoo, 2010; Flegal et al.
2013). Whilst both factors do not constitute a problem when viewed in isolation, they become
a cause for concern when adolescents who are sedentary are situated within such
environment. This is because such labour replacement technologies limit the extent to which
24

energy is used up and consequently unwittingly contributes to weight gain as energy inputted
is considerable less than the energy expanded.
Indeed, a study investigating the association between time spent traveling in cars and
abdominal obesity in young adults residing in urban areas who do not own a car indicated
that overweight is positively associated with owning a car even after adjusting for physical
activity (Flórez Pregonero et al. 2012). Whilst it is acknowledged that several variables may
confound this association that importantly was not evident in females, the findings
nonetheless highlight the dangers of labour replacement technologies in contributing to
overweight independently of having met clinical recommendations on physical activity.
Whilst the findings of Flórez Pregonero et al. (2012) associated urbanisation with labour
replacement technologies, several other studies have similarly indicated that urbanisation
increasingly predisposes individuals to adopting sedentary lifestyles and consequently
becoming overweight (Rundle et al. 2010).
In addition, the consumption of dense foods that are readily assessable similarly
contributes to overweight in adolescents who are sedentary (Meetoo, 2010). Dense foods are
food that have exceptionally high calories and are energy dense (Ashwell, 2013). In urban
areas, there is a high consumption of such foods due to the marketing practices of large
chains which make such foods attractive to adolescents and cheap to purchase (Harris, 2010;
WHO, 2018b). Moreover, globalisation has also fuelled the availability of such foods in
urban areas as due to trade liberalisation, it is now increasingly easy for large multinationals
that produce such foods to operate in most urban town centres (Harris, 2010). This is
supported by a study which investigated the impact of globalization on caloric intake and
obesity (Costa-Font and Mas, 2016). This study uncovered a significant association between
25

globalisation and obesity corroborating the fact that increased urbanisation serves as a factor
increasing the likelihood of individuals to become overweight.
These high-density foods that are consumed by residents of urban areas coupled with
the low levels of energy expanded is a toxic mix which contributes to weight gain and
consequently is identified as a factor contributing to weight gain in teenagers who are
sedentary. Indeed, a study looking at the relationship between urban sprawl and physical
activity, obesity, and morbidity indicated that obesity was more rampant in urban areas than
in rural areas (Ewing et al. 2014). Whilst the study design was limited as it did not allow the
researchers to explore all the potential contributing conditions for the high rates observed, the
study nonetheless contributed to the body of knowledge through its depiction of cross-
sectional data of both rural and urban areas in relation to the impact of urbanisation on
obesity. These findings consequently indicate that teenagers residing in urban settlements are
more likely to be at risk from engaging in sedentary practices compared to teenagers residing
in rural settlements. Consequently, this advocates for the need to offer tailored support aimed
at addressing sedentary practices in teenagers who are urban dwellers.
3.1.2 Family environment
Several studies implicate the family environment as a factor contributing to the
adoption of sedentary lifestyle in teenagers (Gorely et al. 2010; Marsh et al. 2014; Song,
2017). Indeed, a study exploring family circumstance, sedentary behaviour and physical
activity in adolescents living in England indicated that adolescents from single parent
households and adolescents from low socio-economic families were at risk of high sedentary
behaviour. In addition, this study indicated that adolescents living in low socioeconomic
neighbourhoods were at increased risk of reduced participation in sports and exercise (Gorely
et al. 2010). In addition, and with relation to socioeconomic status, a German study which
26

sampled over 8,000 individuals indicated that individuals from households with the lowest
income were more likely to be obese compared to individuals from households with the
highest income (Kuntz and Lampert, 2010).
These findings were corroborated by a sequential mixed methods study exploring the
associations between children’s physical activities, sedentary behaviours and family structure
which indicated that children from single parent households with low income were more
likely to adopt sedentary practices and engage less in physical activity (Quarmby, Dagkas and
Bridge, 2011). The study from Quarmby, Dagkas and Bridge (2011) was limited in terms of
generalisability as only children from comprehensive schools in the midlands of England
were used as participants. Similarly, the study by Gorely et al (2010) was also limited as only
quantitative data was analysed and thus the lived reality of participants from their own
perspective was not conveyed. Nonetheless, both studies indicate that the family environment
contributes to whether or not teenagers adopt sedentary practices. This consequently speaks
to the need for recognition of the difficulties faced by single parents and families in low
socio-economic groups and ensuring tailored support is provided for parents to enable them
disengage their children from sedentary practices which ultimately could contribute to weight
gain and/or obesity in the future.
3.1.3 Screen times
A theme which emerged from this critical review of the factors that influence
adoption of a sedentary lifestyle among overweight teenagers indicated that increased screen
time was a key factor predisposing teenagers to sedentary behaviours which contributed to
their weight gain (Del Carmen Morales-Ruán, et al 2010; Decelis, Jago and Fox, 2014;
Healey et al. 2017). Screen time refers to time spent in front of a television or computer
screen. A study investigating the association between adolescent’s television, computer,
27

videogame, smartphone, tablet use and physical activity indicated that screen time of above 5
hours per day was associated with self-reported obesity and obesity risk factors (Kenney and
Gortmaker, 2016). Similarly, a UK study exploring the independent associations between
multiple lifestyle behaviours (physical activity, sleep, screen time and diet) and overweight
and obesity in UK children indicated that the amount of time spent in front of a screen was an
important lifestyle behaviour associated with overweight/obesity in adolescents (Wilke et al.
2016)
Whilst the study by Kenney and Gortmaker (2016) was an American study and thus
falls outside the remit of this review (to consider UK based study), the findings nonetheless
corroborate those of Wilke et al. (2016) which was a UK based study. Crucially, both studies
suggest a dose response relationship between screen time, being sedentary and consequently
gaining weight. Whilst these findings are not surprising, they nonetheless speak to the need
for reducing screen time as a potentially successful strategy in combating overweight in
teenagers.
3.1.4 Parental weight status
This critical review of the literature indicated that having one or more parents who are
overweight increases the likelihood that a teenager would adopt a sedentary lifestyle (Kable
et al. 2015). Similarly, a study exploring parental and childhood overweight in sedentary and
active adolescents indicated that overweight mothers were most likely to have sedentary
daughters than normal-weight mothers (Pahkala et al. 2010). This finding was also
corroborated by a study investigating how parent and sibling obesity status comparatively
shape a child’s obesity (Pachucki, Lovenheim and Harding, 2014). This study using a
national sample of 10, 244 individuals indicated that in one-child households, it was 2.2 times
more likely (SE=0.5) that the child would be obese if a parent was obese. This finding is
28

significant and strongly speaks to the influence of family socioeconomic status on the
sedentary practices of a child.
Adding another dimension to the above findings, a study exploring factors associated
with nurse provision of healthy lifestyle advice to people who are overweight and obese
indicated that nurses felt teenagers were not receptive to behavioural change advice or
motivated to lose weight when one or both of their parents were overweight (Kable et al.
2015). Furthermore, this study indicated that nurses felt uncomfortable raising weight related
concerns in cases where parents were themselves overweight. These findings importantly
suggest the need for weight management interventions to adopt a whole systems approach. It
is clear that parental weight influences the attitudes of teenagers to adopting sedentary
behaviour and concurrently mitigates against effective health promotion by healthcare
practitioners. In addressing the sedentary practices of teenagers, it is therefore important that
health practitioners recognise this and tailor intervention and advice in a way which is
focused on addressing parental weight and the sedentary practices of their teenage children as
a unit and not in isolation.
3.1.5 Health Care Practitioner Training
Naidoo and Wills (2016) maintain that a barrier facing nurses in successful health
promotion and management of teenage obesity and sedentary behaviour is the lack of
appropriate training. A study exploring whether nurses should be expected to role model
healthy lifestyles to patients indicated that the majority of nurses interviewed had no
thorough grasp of the guidelines which underpin weight management advice. Whilst this
study indicated that nurses faced significant time restraint which hindered their ability to be
role models, it was nonetheless conveyed that nurses themselves did not feel equipped and
well positioned as a consequence of their training to offer weight management advice to
29

teenagers. This is consistent with the findings of Goldie and Brown (2012) which indicated
that substandard clinical training contributes to the limitations associated with tackling
teenage obesity in the UK. This is also corroborated by a qualitative study that explored the
professional and practice-based factors affecting the role legitimacy and adequacy of practice
nurses in managing obese patients in UK general practice (Nolan, Deehan, Wylie, and Jones,
2012). This study indicated that factors that negatively affect the role legitimacy of nurses in
tackling obesity in the UK include limited knowledge and use of guidance and lack of
culturally appropriate materials. Accordingly, these findings speaks to the need for the
provision of clinical training that equips clinical staff with the tools to be able to effectively
promote health and advocate in those spaces were as a consequence of culture or religion,
promoting health and challenging stereotypes on sedentary behaviour in teenagers may be
difficult.
In this qualitative analysis tool is applied. It helped in interpreting effective and high
quality data from various sources. through this, it was number of articles and journals wee
analyse and data and information were gathered This was useful in evaluating results. Beside
this, theoretical and practical knowledge were gained and interpreted to get results. Besides
this, qualitative analysis tool was useful to analyse how obesity is impacting on lifestyle of
youngsters. So, this tool also helped in maintain quality of results. Thus, from articles and
journals facts and figures were collected and evaluated.
30

CHAPTER FOUR
4.1 Discussion
This critical review of the literature on the factors that influence adoption of a
sedentary lifestyle among overweight teenagers uncovered five key themes as key in
influencing the adoption of sedentary behaviour in teenagers. These issues were urbanisation,
family environment, screen time, parental weight status and health care practitioner training.
In relation to urbanisation, the law of thermodynamics underpinned the pathway through
which urbanisation influenced sedentary behaviours in teenagers and consequently led to
weight gain. Importantly, two issues were uncovered to be key. These issues were increased
access to labour replacing technology and cheap and easily accessible high calorie high-
density diet. Whilst both factors do not constitute a problem when viewed in isolation, they
become a cause for concern when teenagers who are sedentary are situated within such
environments.
These high-density foods that are consumed by residents of urban areas coupled with
the low levels of energy expanded is a toxic mix that contributes to weight gain and
consequently is identified as a factor contributing to weight gain in adolescents who are
sedentary. Indeed, a study looking at the relationship between urban sprawl and physical
activity, obesity, and morbidity indicated that obesity was more rampant in urban areas than
in rural areas (Ewing et al. 2014). Whilst the study design was limited as it did not allow the
researchers to explore all the potential contributing conditions for the high rates observed, the
study nonetheless contributed to the body of knowledge through its depiction of cross-
sectional data of both rural and urban areas in relation to the impact of urbanisation on
obesity. This was similarly corroborated by a study which explored the role of urbanisation
31

on childhood obesity (Pirgon, and Aslan, 2015). Accordingly, this theme suggests the need
for intervention strategies targeting the urban environment which is clearly the intent of the
UK Childhood obesity Strategy. Similarly, the World Health Organisation’s global action
plan on physical activity recognised urbanisation as a factor underpinning obesity.
Accordingly, the organisation’s action plan recommended physical activity inducing designs
in the planning of urban spaces as a measure to be adopted in increasing physical activity
(WHO, 2018b). However, this also reinforces the need for nurses during consultations with
teenagers whose lifestyles practices are sedentary to clearly suggest practices which they can
engage in which would mitigate against obesity.
The family environment was also uncovered as an issue contributing to the adoption
of sedentary practices in teenagers. In this context, it was uncovered that teenagers were more
likely to engage in sedentary practices if they came from a single parent household or
households classed as being in a low socioeconomic group. It is not in doubt that there exists
a link between deprivation and obesity (Marmot, 2013) and that single parent households are
more likely to be economically deprived compared to double parent households (Quarmby,
Dagkas and Bridge, 2011). Yet, it was worrying to uncover the link with the sedentary
practices of teenagers. This speaks to the need for financially supporting single parents and
families from low socioeconomic group towards mitigating against the financial cost
associated with teenagers attending physical activity interventions. This also reinforces the
need for enhancing affordable physical activity opportunities in the community where these
individuals reside and for parental involvement in the development of obesity prevention
interventions. Engaging parents in developing these interventions would ensure that cultural
inclinations and economic challenges are communicated and consequently addressed, during
the design phase of these interventions.
32

Another theme that emerged as a factor contributing to sedentary practices in
teenagers was time spent in front of a screen. Interestingly, it was uncovered that a dose
response relationship underpinned the association between screen time and weight gain. This
finding reinforces the need for the promotion of physical activity and a reduction in screen
time. However, it is clear that the constitution of the family influences the time teenagers
spend in front of a screen. This is evident in single parent households where as a consequence
of the cost implications of engaging in sports, parents are more likely to permit increased
screen time. This situation speaks to the need for the provision of extra support to such
families. In addition, whilst it is recognised that nurses may find it challenging to discuss
media habits and screen time with teenagers, this finding nonetheless reinforce the need for
nurses to have this discussions with both sedentary teenagers and their parents during clinical
consultations. It is important that the point is made in these consultations that increased
screen time could have adverse consequence in relation to health outcomes.
In addition, it was also uncovered that parental weight status mitigated against
teenagers being receptive to advice on changing sedentary behaviour. When parents were
overweight, teenagers were less likely to engage with advice on changing sedentary
behaviour, thus reinforcing the need to promote health using a joined-up approach that
recognises the weight of a parent as a factor contributing to the sedentary practices of
teenagers. Finally, it was uncovered that a deficiency in training affected the ability of
healthcare practitioners to promote practices that discourage sedentary practices in teenagers.
This reinforces the need for training aligned with the challenges congruent with promoting
health to teenagers who are sedentary. It is important that such training be underpinned by
cultural competence towards equipping healthcare workers with the tools to also promote
health to sedentary teenagers from marginalised groups.
33

There are different policies and strategies which can be implemented by government.
A global strategy Diet physical activity and health (DPAS) can be executed. In this national
government should develop program and form policies to promote physical health. Changes
must be made in diet plans. Besides this, an integrated strategy exists in which all society as
well as government should make efforts to control risk factor associated with obesity. In this
NCD prevention method must be considered.
Apart from it, government should initiate several other programs in order to solve
problem of obesity. They can increase funds for promoting health. for instance, health
promotion agencies and foundations can be set up. it can be done by rising rate of tax on
tobacco, alcohol, etc. Creating a regular budget. Also, in overseas development programs
including heath promotion activities. There must be some strict monitoring systems
developed. it will be easy to monitor seminars or activities related to heath promotion.
Central government should establish national and state guidelines to support in
implementation of policies. With these it will be easy to initiate different campaigns and
programs. However, there will be proper monitoring of policies which are been followed.
In education sector, children must be taught about what healthy diet and physical
activities in which they should engage. The institutes must make some interventions like
health check ups, counselling, etc. this will be beneficial in bringing change towards healthy
lifestyle.
4.2 Implication for practice
It is important to reiterate here that an increased consumption of energy dense foods,
without an equal increase in physical activity, leads to an increase in weight gain and
consequently obesity. In addition, a reduction in physical activity practices and increased
34

sedentary practices would also lead to an energy imbalance and consequently weight gain
(WHO, 2017). Whilst it is acknowledged that this study had several limitations such as its
limited scope in terms of the databases searched and its non-use of participants to evidence
lived reality on factors promoting sedentary practices in teenagers, the study nonetheless
identified significant themes with implications for nursing practice. Accordingly, the below
recommendations stem from the study findings:
1- The evidence is clear and indicates that increasingly, developments in transport,
urban planning and food marketing influence teenager’s physical activity and
eating habits towards gaining unhealthy weight. It is important therefore that
nurses recognise labour replacing technologies as a factor contributing to
sedentary practices in teenagers. Recognition of this should underpin behavioural
change advice given to sedentary teenagers and their parents towards mitigating
against overweight and obesity. Such advice could take the form of encouraging
teenagers to walk more as opposed to commuting constantly.
2- There is a financial cost associated with attending activities to dissuade teenagers
from sedentary practices. This cost is of particular importance to single parent
households as they are more likely to be economically deprived compared to
double parent households. Accordingly, this speaks to the need for financially
supporting single parents and families from low socioeconomic group towards
mitigating against the financial cost associated with teenagers attending physical
activity interventions.
3- Whilst this study uncovered a dose response relationship between screen time as a
sedentary practice and weight gain, it was clear that moderate amounts of time
(less than 5 hours) spent in front of a screen had no impact on weight gain. It is
35

therefore important that nurses are aware of this and do not construe moderate
screen time as a precursor for weight gain.
4- This study indicates that teenagers from single parent households are more likely
to be permitted to spend more time in front of a screen as a consequence of the
cost of engaging in physical activities such as sports. This situation speaks to the
need for the provision of extra support to such families. Support in form of
sporting gear may be helpful in mitigating against sedentary practices in teenagers
and in addition, such support could concurrently boost their self-esteem.
5- This study indicates that parental weight status mitigates against teenagers being
receptive to advice on changing sedentary behaviour. When parents were
overweight, teenagers were less likely to engage with advice on changing
sedentary behaviour, thus reinforcing the need to promote health using a joined-up
approach that recognises the weight of a parent as a factor contributing to the
sedentary practices of teenagers.
6- Deficiency in training affects the ability of healthcare practitioners to promote
practices that discourage sedentary practices in teenagers. This reinforces the need
for training aligned with the challenges congruent with promoting health to
teenagers who are sedentary. It is important that such training be underpinned by
cultural competence towards equipping healthcare workers with the tools to also
promote health to sedentary teenagers from marginalised groups.
7- Nurses have a key role in promoting lifestyle changes both in diet and in exercise
as an approach to mitigating against sedentary practices in teenagers. Accordingly,
nurses should endeavour to be role models regarding weigh management. In this
context, it is important that nurses endeavour to portray an image that is reflective
of the message being conveyed when promoting health to teenagers on
36

overweight. To teenagers, being overweight as a nurse would be counterintuitive
to the message of weight loss such a nurse is tasked with conveying.
8- It is important that strong leadership and full commitment is shown in all
departments which have a role to play in tackling obesity. With such leadership,
health promotion initiatives on addressing the sedentary practices of teenagers
would be actively disseminated by all members of the organisation.
9- It is important that in designing urban spaces, physical activity inducing designs
be prioritised. Such designs could unwittingly ensure as a consequence of the
practicalities of daily living that individuals residing in such settlements are
engaging in physical activity.
10- It is important to recognise that individual responsibility can only be successful as
a change mechanism in instances where individuals are supported to make healthy
choices (WHO, 2017) Accordingly this speaks for the need to adopt a systems
approach to promoting health in spaces were teenagers are sedentary. This is in
line with the recommendations of the World Health Organisations global action
plan on physical activity 2018-2030. Accordingly, this reinforces the need for a
joined-up approach that recognises the impact of the environment, family and
practices of teenagers.
11- The staff must engage in community based practices. In this they will recognise
health condition of society. It will be easy for them to design program and
planning how to initiate practices.
12- Government should ensure that staff is properly trained and educated. For this a
curriculum must be formed. The continuous training will benefit in making
improving quality of care.
37

13- The nurses should get involved in physical practices so that they can engage
teenagers. Through this, care services can be provided to youngsters suffering
from obesity. Moreover, policies formed must be followed by them in delivering
home care services.
38

CHAPTER SIX
6.1 Conclusion
It is generally acknowledged that obesity is caused by consuming more calories than
is burnt off through physical activity and it is clear that teenagers are becoming overweight in
the UK very early, and staying obese for longer, with those from low income households
more likely to be overweight compared to teenagers from higher income households. In
addition, available evidence indicates that overweight adversely affects self-esteem and
predisposes teenagers to mental health issues. Obesity is a growing epidemic amongst
teenagers that needs to be resolved. Obese teenagers are more likely to grow up to become
obese adults and present with a host of health-related complications such as type 2 diabetes,
cardiovascular diseases and various forms of cancers. It is clear that if obesity as an epidemic
is not tackled now, the United Kingdom will see a number of health complications that may
overburden the healthcare system. Indeed, obesity in the UK, costs the health economy
approximately 3.3-3.7 billion pounds annually (Pirgon and Aslan, 2015). This is significant,
and if not tackled, obesity could consequently cripple the UK National Health Service.
Background evidence indicates that in teenagers, sedentary practices underpinned by
inactivity and characterised by insufficient amounts of physical activity on a regular basis
contributes to predisposing them to obesity. This is alarming and this issue needs to be
resolved. Whilst it is acknowledged that here in the UK, there is an increased drive to
mitigate against the sedentary practices of teenagers through promoting physical activity
which is clearly evident in the UK government’s childhood obesity plan, however, several
issues nonetheless underpin the factors that predispose teenagers to engage in sedentary
practices in the UK. These issues include urbanisation, family environment, screen time,
parental weight status and health care practitioner training. A critical exploration of these
39

factors indicates that changing the practices underpinning sedentary behaviour in teenagers
requires a joined up and system wide approach which recognises, deprivation, socioeconomic
status and nurse training as issues which must be addressed in mitigating against the
sedentary practices of teenagers.
Finally, it is clear that obesity is a complex, multifactorial disease, with various
associated factors one of which is behavioural as evidenced in the sedentary practices of
teenagers. In tackling this however, nurses have a key role to play. Accordingly, it is
important that nurses are able to have a honest and open conversation with teenagers and
their parents on overweight and sedentary practices. This is likely to be the first step in
empowering teenagers to change sedentary practices. Indeed, this is in line with the ethos of
the nursing profession which advocates that nurses should give advice and assistance through
education and knowledge of best practice to promote healthier life style.
40

REFERENCE
Adela, H. and Frank, I. (2015) The epidemiology of obesity: a big picture.
Pharmacoeconomics 33(7): pp. 673–689.
Aguilera, J. M. (2016) Edible structures: The basic science of what we eat. 1st ed. CRC
Press.
Ashwell, M. (2013) An examination of the relationship between breakfast, weight and
shape. British Journal of Nursing 19(18): pp.1155-1159.
Bakhshi, S., Sun, F., Murrells, T. and While, A. (2015) Nurses' health behaviours and
physical activity-related health-promotion practices. British Journal of Community
Nursing 20(6): pp.289-296.
Beckwith, S. (2014) The relationship between diabetes and atherosclerosis. British Journal
of Cardiac Nursing 9(5): pp.237-242.
Berman, A., Snyder, S. and Frandsen, G. (2015) Kozier & Erb’s fundamentals of nursing.
Harlow: Pearson Education Limited.
Berthoud, H. and Klein, S. (2017) Advances in obesity: causes, consequences, and therapy.
Gastroenterology, 152(7): pp. 1635-1637.
Bickerstaffe G. (2014) Advising on lifestyle can improve nurse’s health. Nursing Times
110(51): pp. 17–19.
Blake, H., Malik, S., Mo, P. K. H., and Pisano, C. (2011) ‘Do as I say, but not as I do’: Are
next generation nurses role models for health? Perspectives in Public Health
131(5): pp. 231-239.
41

Costa-Font, J., and Mas, N. (2016). ‘Globesity’? the effects of globalization on obesity and
caloric intake. Food Policy 64(3): pp.121-132.
Darch, J., Baillie, L. and Gillison, F. (2017) Nurses as role models in health promotion: a
concept analysis. British Journal of Nursing 26(17): pp. 982-988.
Decelis, A., Jago, R., and Fox, K. R. (2014) Physical activity, screen time and obesity status
in a nationally representative sample of maltese youth with international
comparisons. BMC Public Health 14(1): pp. 664-664.
Del Carmen Morales-Ruán, M., Hernández-Prado, B., Gómez-Acosta, L. M., Shamah-Levy,
T., and Cuevas-Nasu, L. (2010) Obesity, overweight, screen time and physical
activity in mexican adolescents. Salud Publica De Mexico 51(4): pp. 613-620.
Department of Health (2016) Childhood obesity: a plan for action. London. (Online)
Availableat:https://assets.publishing.service.gov.uk/government/uploads/system/
uploads/attachment_data/file/546588/Childhood_obesity_2016__2__acc.pdf .
(Accessed 12 August 2018)
Dunn, D. (2015) Addressing the problem of obesity. Journal of Advance Nursing 102(2):
pp.111-115
Ellis, P. (2016). Evidence-based practice in nursing (3rd ed.). London: SAGE/Learning
Matters.
Ewing, R., Meakins, G., Hamidi, S. and Nelson, A. C. (2014) The relationship between
urban sprawl and physical activity, obesity, and morbidity–update and refinement.
Health and Place (26): pp. 118-126.
42

Flegal, K. M., Kit, B. K., Orpana, H., and Graubard, B. I. (2013) Association of all-cause
mortality with overweight and obesity using standard body mass index categories: a
systematic review and meta-analysis. Jama 309(1): pp. 71-82.
Flórez Pregonero, A., Gómez, L. F., Parra, D. C., Cohen, D. D., Arango Paternina, C. M.,
and Lobelo, F. (2012) Time spent traveling in motor vehicles and its association with
overweight and abdominal obesity in colombian adults who do not own a car.
Preventive Medicine 54(6): pp. 402-404.
Foss, B., and Dyrstad, S. M. (2011). Stress in obesity: Cause or consequence? Medical
Hypotheses 77(1), pp. 7-10
Glasper, A. (2010) The fat of the land: obesity prevention over obesity treatment. British
Journal of Nursing 19(4): pp. 212-213.
Goldie, C. and Brown, J. (2012) Managing obesity in primary care. Nursing times 108(1-2):
pp.14-6.
Gorely, T., Atkin, A. J., Biddle, S. J. H., & Marshall, S. J. (2010). Family circumstance,
sedentary behaviour and physical activity in adolescents living in england: Project
STIL. International Journal of Behavioral Nutrition and Physical Activity, 6(1),
pp. 33-33.
Harris, J. L., Pomeranz, J. L., Lobstein, T., and Brownell, K. D. (2010) A crisis in the
marketplace: How food marketing contributes to childhood obesity and what can be
done. Annual Review of Public Health 30(1): pp. 211-225.
Haslam, D. W. and James, W. P. T. (2010) obesity. Lancet 366(9492): pp. 1197-1209.
43

Health and Social Care Information Centre (2015) Health Survey for England 2014.
(Online). Available at: https://www.gov.uk/government/statistics/health-survey-for-
england-2014. Accessed 3 August 2018
Health and Social Care Information Centre (HSCIC) (2016) Statistics on Obesity, Physical
Activity and Diet. England: HSCIC
Healy, S., Haegele, J. A., Grenier, M., and Garcia, J. M. (2017) Physical activity, screen-
time behavior, and obesity among 13-year olds in ireland with and without autism
spectrum disorder. Journal of Autism and Developmental Disorders 47(1): pp. 49-
57.
http://apps.who.int/iris/bitstream/handle/10665/272722/9789241514187-eng.pdf
Kable, A., James, C., Snodgrass, S., Plotnikoff, R., Guest, M., Ashby, S., Oldmeadow, C.
and Collins, C. (2015) Nurse provision of healthy lifestyle advice to people who are
overweight and obese. Nursing and Health Science 17(4): pp.451–459
Katzmarzyk, P. T. I., Church, T. S. and Bouchard, C. (2010) Sitting time and mortality from
all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc 41(5): pp. 998-
1005.
Kelly, M., Wills, J., Jester, R. and Speller, V. (2017) Should nurses be role models for
healthy lifestyles? Results from a modified Delphi study. Journal of Advanced
Nursing 73(3): pp.665-678.
Kenney, Erica L. and Gortmaker, S. L. (2016). United states adolescents' television,
computer, videogame, smartphone, and tablet use: Associations with sugary drinks,
sleep, physical activity, and obesity. Journal of Pediatrics 182: pp. 144-149.
44

Kim, S. Y. (2018) Sedentary lifestyle and cardiovascular health. Korean Journal of Family
Medicine, 39(1): p.1
Kohorst, M. A., Warad, D. M., Nageswara Rao, A. A. and Rodriguez, V. (2018). Obesity,
sedentary lifestyle, and video games: The new thrombophilia cocktail in adolescents.
Pediatric Blood & Cancer 65(7): pp.1-5.
Kuntz, B. and Lampert, T. (2010) Socioeconomic factors and obesity. Deutsches Arzteblatt
International 107(30): pp.517.
Lazarou, C. and Kouta, C. (2010) The role of nurses in the prevention and management of
obesity. British Journal of Nursing 19(10): pp. 641-647.
Lobstein T., Jackson-Leach R., Hall, K.D., Moodie M.L., Gortmaker, S.L., Swinburn, B.A.,
James, W.P., Wang, Y. and McPherson, K. (2015) Child and adolescent obesity: part
of a bigger picture. The Lancet 385: pp.2510-2520.
Mareno, N. (2014) Parental Perception of Healthy eating and Physical activity: results from
a preliminary photovoice study. Journal of Clinical Nursing 24(9-10): pp. 1440-
1443.
Marmot, M. (2013) Fair Society, Healthy Lives. Marmot Review. Oxford university press:
London.
Marsh, S., Foley, L. S., Wilks, D. C. and Maddison, R. (2014). Family-based interventions
for reducing sedentary time in youth: A systematic review of randomized controlled
trials: Family-based sedentary time interventions. Obesity Reviews, 15(2): pp.117-
133.
45

Meetoo, D. (2010) The imperative of human obesity: an ethical reflection. British Journal
of Nursing 21(12): pp. 563-568.
Meyer and Gullotta (2012) Physical activity across the lifespan: prevention and
treatment for health and well-being. New York Springer
Mitchell, J. A., Mattocks, C., Ness, A. R., Leary, S. D., Pate, R. R., Dowda, M. and
Riddoch, C. (2010) Sedentary behavior and obesity in a large cohort of children.
Obesity 17(8): pp. 1596-1602.
Naidoo, J. and Wills, J. (2016) Foundations for Health Promotion. 4th Ed. London:
Elsevier
National Health Service (NHS) (2017) Statistics on Obesity, Physical Activity and Diet.
England: NHS Digital.
National Institute for Health and Clinical Excellence (NICE) (2013) Weight management:
lifestyle services for overweight or obese children and young people. London:
National Institute for Health and Clinical Excellence.
Nolan, C., Deehan, A., Wylie, A. and Jones, R. (2012). Practice nurses and obesity:
Professional and practice-based factors affecting role adequacy and role legitimacy.
Primary Health Care Research and Development, 13(4), 1-11
Onwuegbuzie, A. J. and Frels, R. (2016). 7 steps to a comprehensive literature review: A
multimodal & cultural approach. London: SAGE
Pachucki, M. C., Lovenheim, M. F. and Harding, M. (2014) Within-family obesity
associations. American Journal of Preventive Medicine 47(4): pp. 382-391.
46

Pahkala, K., Heinonen, O. J., Lagström, H., Hakala, P., Sillanmäki, L., Kaitosaari, T. and
Simell, O. (2010) Parental and childhood overweight in sedentary and active
adolescents. Scandinavian Journal of Medicine & Science in Sports 20(1): pp. 74-
82.
Peeters, A. and Backholer, K. (2012) Is the health burden associated with obesity changing?
Am Journal of Epidemiol 176: pp. 840–5.
Pirgon, Ö. and Aslan, N. (2015). The role of urbanization in childhood obesity. Journal of
Clinical Research in Pediatric Endocrinology 7(3): pp.163-167.
Quarmby, T., Dagkas, S., and Bridge, M. (2011) Associations between children's physical
activities, sedentary behaviours and family structure: A sequential mixed methods
approach. Health Education Research 26(1): pp. 63-76.
Rabbitt, A. and Coyne, I. (2012) Childhood obesity: nurses’ role in addressing the epidemic.
British Journal of Nursing, 21(12): pp. 731-735.
Rundle, A., Roux, A. V. D., Freeman, L. M., Miller, D., Neckerman, K. M. and Weiss, C. C.
(2010) The urban built environment and obesity in New York city: A multilevel
analysis. American Journal of Health Promotion 21(4): pp. 326-334.
Schroeder, K., Travers, J. and Smaldone, A. (2016) Are School Nurses an Overlooked
Resource in Reducing Childhood Obesity? A Systematic Review and Meta-Analysis.
The Journal of School Health 86(5): pp. 309 -321.
Selbie, D. (2018). Reducing childhood obesity in the UK. The Lancet 391(10115): pp. 26.
Sellwood, L. (2013) Public health and obesity: the role of the district nurse. British Journal
of Community Nursing 18(1): pp. 26-33.
47

Sharman, K. and Nobles, J. D. (2016). Using a stepped-care approach to help severely obese
children and young people. Primary Health Care, 26(7): pp. 32-38.
Song, M., Dieckmann, N. F., Stoyles, S., Kim, Y. and Lumeng, J. C. (2017) Associations
between mother's and children's moderate-to-vigorous physical activity and
sedentary time in the family context. Preventive Medicine Reports 8: pp.197-203.
Stankov, I., Olds, T., and Cargo, M. (2012) Overweight and obese adolescents: what turns
them off physical activity? International Journal of Behavioral Nutrition and
Physical Activity 9(1): pp. 53.
Turner-Wilson, A. L., Mills, A. M., & Rees, K. (2017). Can nurses rise to the public health
challenge? how a novel solution in nurse education can address this contemporary
question. Nurse Education Today, 57: pp. 65-67
While, A. (2018) Does every contact count? British Journal of Community Nursing
23(5): pp. 258-258.
WHO (2017) 10 facts on obesity. (Online) Available at:
http://www.who.int/features/factfiles/obesity/en/ (Accessed 2 August 2018)
WHO (2018) Global health observatory data. (Online) Available at:
http://www.who.int/gho/ncd/risk_factors/obesity_text/en/ (Accessed 2 August 2018)
WHO (2018b) Global action plan on physical activity: more active people for a
healthier world (online) http://www.who.int/gho/ncd/risk_factors/obesity_text/en/
(Accessed 15 August 2018)
Wilkie, H. J., Standage, M., Gillison, F. B., Cumming, S. P. and Katzmarzyk, P. T. (2016)
Multiple lifestyle behaviours and overweight and obesity among children aged 9-11
48