University Dissertation: Nurse's Role in Childhood Obesity Prevention

This nursing dissertation presents a systematic review of research articles published between 2013 and 2019, investigating the role of nurses in childhood obesity prevention. The study aims to evaluate the effectiveness of nurse-led interventions in reducing obesity risk factors among children. Through a thematic analysis of seven selected articles, the dissertation explores the impact of nurses on children's physical activity, healthy behaviors, and BMI. The findings highlight that nurses are well-positioned to deliver health promotion interventions, but also identify challenges in intervention design and research methodologies. The dissertation concludes with recommendations for enhancing nurses' role in childhood obesity prevention, including improved training, targeted changes in social norms and environment, and the development of resources to encourage physical activity. The research emphasizes the importance of supporting nurses with adequate resources and strategies to ensure parental and child compliance with health advice. The dissertation also includes an introduction, literature review, methodology, results, discussion, and conclusion, providing a comprehensive analysis of the topic.

Running head: NURSING DISSERTATION
Nursing dissertation
Name of the student:
Name of the University:
Author’s note

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Abstract
Background: Childhood obesity is a major health global health concern due to increase in
likelihood of serious illness for obese children. As nurses are actively involved in obesity
prevention program in schools, there is a need to review studies that evaluate
Aim: The aim of this systematic review is to critically examine nurse’s role in childhood obesity
prevention and interpret whether they are rightly positioned to reduce the risk factors of obesity
for children or not.
Method: The systematic review of research papers has been done based on review of CINAHL
and PubMed database. The articles published between 2013 to 2019 have been included in the
review and the data analysis has been using thematic approach.
Results: Based on screening of articles based on inclusion and exclusion criteria, a total of 7
articles were included in the review. Three themes emerged based on evaluation of nurse role in
childhood obesity prevention. This included role of nurse led obesity prevention in influencing
physical activity and healthy behaviours of children, in influencing BMI and Success of Nurse-
led obesity prevention intervention based on resources and availability of adequate support. The
evaluation of the seven research articles gives the insight that nurses are well-positioned to
deliver health promotion intervention for obese children. However, systematic review helped to
examine issues in school nurse led intervention design and weakness in research methodologies
that led to poor or unexpected outcomes for obese children. This systematic gives the implication
that nurses can be successful in preventing obesity if they are supported with right resource and
appropriate strategies are taken to ensure that parents and children comply with the education or
behavioural advice.

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Conclusion: To conclude, the study suggests many recommendations to enhance nurse’s role in
childhood obesity prevention. This involves proper training regarding implementation of
intervention, target changes in social norms and environment and developing resource in schools
and community to encourage physical activity in children.

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Table of Contents
Chapter one......................................................................................................................................4
Chapter two......................................................................................................................................6
Chapter three....................................................................................................................................8
Chapter four...................................................................................................................................19
References:....................................................................................................................................24
Appendix:........................................................................................................................................0

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Chapter one
Introduction:
Obesity is a condition leading to excessive fat accumulation in the body thus increasing
risk of other chronic disease in an individual. Obesity is a major global health burden because the
rate of obesity has tripled since 2015 (World Health Organization 2018). Apart from prevalence
of obesity in adulthood, the prevalence of obesity in childhood is a major concern because
childhood obesity has impact on nearly all organ system and it increases the likelihood of serious
consequences (diabetes, hypertension, psychosocial problem and fatty liver disease) for those
children in adulthood. For example, childhood obesity is associated with an increase in
atherosclerotic process, increased risk of cardiovascular disease and pulmonary disorder (Han,
Lawlor and Kimm 2010). The report by World Health Organization (2018) shows that 41 million
children under age of 5 were overweight or obese in 2016 and 340 million children between the
age group of 5 to 19 years were overweight or obese in 2016 globally. Hence, considering the
prevalence of childhood obesity, taking vital steps to prevent the risk of overweight or obesity is
important.
Obesity occurs as a result of imbalance between energy intake and expenditure. Some of
the risk factors that lead to childhood obesity include dietary intake, physical activity, sedentary
behaviour and influence of parenting styles (Sahoo et al. 2015). Hence, promoting healthy
behaviour in both children and parents are vital to decrease the obesity epidemic. Collins (2018)
supports that nurses are playing a key role in obesity interventions and the future will see more
nurses engaging with children to prevent obesity. As nurses are more in numbers and more
readily accessible compared to other health care professionals, considering the role of nurse in

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addressing the epidemic is necessary. Recently there is an increase in participation of nurse in
childhood obesity prevention initiatives. Rabbitt and Coyne (2012) explain that nurse can engage
in partnership with parents and children by providing nutritional advice and offering strategies to
decrease caloric intake and physical activity. There are many evidences regarding the
participation of nurse in obesity prevention initiative and promoting behavioural change and
giving health behaviour related advice. However, gap in research is that no research has explored
the impact of nurse on preventing childhood obesity based on outcomes, barriers and facilitators
and process employed. Hence, the aim of this systematic review is to critically examine nurse’s
role in childhood obesity prevention and interpret whether they are rightly positioned to reduce
the risk factors of obesity for children or not. The PICO question for the systematic review is as
follows:
What is the role and contribution of nurse in preventing childhood obesity for children at
risk of overweight and obesity issues?
Population (P): Children with obesity
Intervention (Intervention): Role and contribution of nurse
Outcome: Prevention of childhood obesity
Comparator: No comparison
The main purpose of this dissertation report is to examine nurse’s role in prevention of
childhood obesity by systematic review. The focus is to evaluate the effectiveness of nurse in
influencing obesity related to outcome and behaviour of children and evaluating nurse’s
experience in delivering childhood obesity prevention program. The significance of research in

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this area is that it will enable policy makers to understand the potential of nurse in influencing
eating and physical activity related behaviour of children and including more nurses in health
promotion program related to obesity prevention. In the personal areas of nursing practice, this
research will develop understanding regarding the key skills needed by nurse to engage in
obesity prevention initiatives for children. This dissertation will outline the strategy of literature
search in chapter two, present the research and its findings in chapter three. Chapter four will
discuss about the implications of the research findings and recommendations for improvement in
future practice or research. The final chapter five will provide conclusion for the research with a
brief summary on the whole research process.
Chapter two
Search and review strategy:
Introduction:
To find relevant research literatures related to the role of nurse’s in preventing childhood
obesity, systematic review of research papers were done with set of inclusion and exclusion
criteria and going through the process of identification, screening, eligibility and inclusion of
research papers in the study. The main advantage of following systematic review is that it helps
to follow a systematic approach during literature search and summarize the results of high
quality health care studies to inform health care practices and improve patient care (Moher et al.
2015). The dissertation uses thematic approach to report about key findings from the review and
uses specific technique to interpret the quality of the studies. This chapter will give detail
regarding the search process, search terms used and method used to select articles from
databases.

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Search strategy: To find relevant articles related to the topic of investigation, the search for
literatures were done in CINAHL and PubMed database. The main reason behind taking these
databases in systematic review is that both the database published peer review research articles
based on biomedical, health care and nursing research. Hence, searching for papers in this
database increases the likelihood of getting as many high quality research papers. The key terms
that helped to retrieve relevant articles related to the research topics included ‘nursing’, ‘obesity’,
‘children’, ‘teenagers’, ‘adolescents’, ‘weight’ and ‘obesity prevention’. The key search filters
that were used to refine the search process included the source, language and data of
publications. The source selected was peer-reviewed journals only and language selected was
English.. The search was performed in the database for articles published between 2010 to 2019.
Inclusion and Exclusion criteria:
The following inclusion and exclusion criteria helped to retrieve appropriate articles as
per the purpose of investigation:
1. Types of study: As the main purpose of this research is to examine the role of nurse in
childhood obesity, all types of research papers including both primary and secondary
research will be included in the review.
2. Research participant: Only those papers were reviewed were nurses were involved in
health promotion for children or teenagers. The studies reporting about the role of social
workers or other health promotion staffs were excluded.
3. Outcome: The research must report about outcomes in obese children like improvement
in preventive behaviours like increase in physical activity, reduction in weight,
modification in weight and experiences related to change in lifestyle.

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4. Publications: Only peer reviewed journals published between 2010 to 2019 were
included in the review.
5. Language: Apart from English, articles published in other language were excluded
Method of study selection:
After retrieving articles from relevant databases, total of 35 articles were found relevant
to the research topic. The screening of the research papers were initially done by reviewing title
and abstract. On this basis, 10 articles were excluded as they were duplicates or they covered
detail in childhood obesity prevention, but did not discussed about nurse’s role in it. The
remaining 25 articles were screened based on inclusion and exclusion criteria to determine their
eligibility for this research. This was done by reviewing full text of the articles. Based on these
criteria, the final list of articles that were included in the review included 7 research papers.
Data extraction and data analysis:
The data for each article were extracted in a summary table which included article no.,
author, title, research question, research methods, ethical approval and consideration, key
findings, implications/recommendation and comments on strength and weakness of papers. The
quality of the papers was assessed based on assessment of risk of bias, appropriateness of
research design and research rigour. The research findings have been presented using thematic
approach which helps to understand the common patterns found in research data.
Chapter three
Discussion

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Introduction: This section provides a discussion regarding the results obtained from the
systematic review of selected studies and provides thematic presentation of study findings based
on their contribution in understanding the role of nurse in obesity prevention. The advantage of
thematic analysis for this study is that it offers discussion of groups of studies under single theme
based on similarity of outcomes and favours collective evaluation of evidence in relation to the
theme identified. Based on review of research papers, three themes has been identified which has
been discussed in detail in this section.
Results and discussion:
Seven research articles were found relevant to the research question and based on
analysis of common patterns in research finding, the result for the systematic review has been
grouped into three themes. The discussion of the research papers under each theme are as
follows:
Theme 1: Role of nurse led obesity prevention in influencing physical activity and healthy
behaviours of children
There were two papers (Tucker and Lanningham-Foster 2015; Pbert et al. (2013) which
reported about increase in healthy behaviour like physical activity and health diet for children
with obesity by participation in nurse-led school based child obesity prevention program.
Tucker and Lanningham-Foster (2015) investigated about school nurse role in
preventing obesity using a pre and post research designs with comparison between two groups
and control group. The intervention that was implemented by nurses included a Let’s Go 5-2-1-0
health message program delivered to fourth and fifth graders. The education was given on
physical activity levels and health behaviour change among school children. The evaluation of

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outcome measures related to physical activity, healthy habits and BMI percentile revealed that
physical activity level of children increased significantly. This is evidenced by increase in
number of steps taken by children from baseline to end of year. Nurse led education was also
found to be associated with increase in healthy habits like consumption of fruits and vegetables
among children. Although BMI related data was collected, however data related to BMI is not
important because it was a universal intervention which included normal weight children too.
The significance of this research is that it has used an evidence based childhood obesity
prevention program whose effectiveness has been widely evaluated in research ‘Let’s Go 5-2-1-
0’. Rogers et al. (2013) gives the evidence that Let’s Go 5-2-1-0 is an effective community based
intervention that offers consistent message to positively influence behaviours that lead to
childhood obesity. Hence, the study gives the implication that by using evidence based health
coaching, the school nurse plays an important role in reducing negative health behaviour and
preventing obesity in children.
Another research paper that gave positive outcome related to the role of nurse in
delivering obesity intervention to children includes the paper by Pbert et al. (2013) which
evaluated the efficacy of school nurse-led intervention on diet, activity and BMI among
overweight and obese children. With the use of pair matched cluster-randomized controlled trial,
6 high schools were randomized to either nurse delivered counselling intervention or nurse
contact with information. The advantage of a counselling intervention is that it can help to
achieve significant effect if the target group is at high risk of gaining weight (Mustila et al.,
2018). In the study by Pbert et al. (2013), the target group included adolescents in grade 9 to 11
with BMI of greater than 85th percentile. During the counselling sessions for the intervention
group, the nurse use 5-3-2-1-0 approach and social cognitive theory to promote changes in self-

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management behaviour of adolescents. The strength of the intervention used by nurse is that it
included patient centered approach and supports that interventions were delivered as per the
needs of children. To ensure success of the intervention, the school nurse were also trained
regarding didactic presentation of topic related to problem of obesity and role play exercise to
promote behavioural change. Wilfley, Kass and Kolko (2011) justified that providers are able to
incorporate key recommendations related to healthy behaviour especially following training. The
strength of this research paper is that it has used a robust research design and considered all
factors that could enhance the research outcome. For example, high rate of follow up, nurse
training and content of the session was considered.
In contrast to the research by Tucker and Lanningham-Foster (2015) which did not
considered nurses skill in delivering obesity related education to children, the significance of the
study by Pbert et al. (2013) is that it has considered training needs of nurse and enhanced the
possibility of successful outcomes post the intervention. The review of the study findings
revealed that treatment fidelity was high and students were comfortable with the counselling
intervention given by nurse. As the participation rate is high, this is also associated with an
increase in positive changes related self-reported obsogenic behaviours in children. For
examples, students restricted eating at fast food restaurants and drinking soda per week.
However, little effect was seen on screen time and time spend in moderate physical activity. This
outcome is consistent with past research as Wu et al. (2016) shows that methodological
limitations reduces the impact of counselling on screen time reduction and BMI. In the context of
Pbert et al. (2013), verbal message might have limited student’s capability to strategizes ways to
increase physical activity and reduce time spent in physical activity. The study gives the
implication to develop more intensive school nurse intervention targeting childhood obesity.