University of Western Sydney Public Health Report: Weight Management

This report analyzes the effectiveness of a parent-led, family-focused weight management program for prepubertal children, based on the study by Golley et al. The report provides an overview of the selected paper, focusing on the issue of childhood overweight and the effectiveness of parenting skills training as an intervention. It details the study design, which was a randomized controlled trial comparing interventions and a control group. The report evaluates the internal validity, discussing potential biases, confounding factors, and the plausibility of causal associations between exposure and outcome. Furthermore, the report assesses the external validity of the findings, considering their applicability to broader populations and contexts. The study's limitations, such as sample attrition and potential biases, are also acknowledged, providing a comprehensive analysis of the study's strengths and weaknesses. The report emphasizes the importance of a strong and valid association between exposure and outcome, and the need for a large and representative participant population to ensure accurate results.

Running head: PUBLIC HEALTH
PUBLIC HEALTH
Name of the Student
Name of the University
Author note

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Table of Contents
Overview of the paper selected........................................................................................................2
Appraising the internal validity.......................................................................................................4
Casual association in between the exposure and the outcome is plausible or not...........................5
Appraising the external validity of the findings..............................................................................7
References........................................................................................................................................9

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Overview of the paper selected
The selected paper is Golley RK, Magarey AM, Baur LA, Steinbeck KS, Daniels LS.
Twelve-month effectiveness of a parent-led, family-focused weight-management program for
prepubertal children: A Randomized Controlled Trial Paediatrics, 2006;119(3):517-525. The
issue that has been addressed in this paper is childhood overweight. This topic is no doubt a very
important topic as overweight or obesity is not only the problem of the adults but the children are
also effected. If a person do not know the need to control the weight from the early stages of life
and if get obese then it will be difficult for the person to lose weight in the later stages of the life.
In this paper the parenting skills training has been considered as the most effective method to
control the childhood overweight as the parents are the only ones who spend most of the time
with the children (Gortmaker et al., 2015). The objective of this experiment was to evaluate the
effectiveness of the training of the parenting skills as the most important strategy for the
treatment of the overweight of children. The result of the outcome was very effective as the
result was that if the training of the parenting skills and the healthy lifestyle of the family was
combined them the approach becomes very effective in managing the weight of the perpetual
children, especially the boys. The study design was simply a single-blinded randomised
controlled trial. The trial was done for the determination of the effectiveness of two interventions
of child weight management. One of the intervention was the combination of the parenting skills
and maintaining a healthy life style while the other intervention was only training of the
parenting skills. These two interventions were compared with each other and also compared with
the control group. The control group was wait listed for the intervention for the 12 months. The
conduction of the experiment was done at 2 metropolitan teaching hospitals. The sessions of the
interventions were conducted by the same dietician. The parenting skill training programme

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includes providing the parents with proper training for managing the child’s behaviour and
weight and mostly they were taught to maintain the diet of the children and also to maintain the
behaviour activities of the child. Those parents who were under the intervention of training of the
parent and the education of lifestyle were given sessions focussing on the knowledge of life style
and also different skills including the family like practising of the healthy habits of not only the
children but also the adults as the children will learn from the adults with also recommending
about what food would be the best for them to consume, monitoring the snacks, modifying the
recipes, becoming active in a variety of ways, making the people understand about the different
roles and responsibilities about the eating habits, controlling the appetite, self-esteem and
teasing. The population of the experiment were recruited from July 2002 to August 2003 through
the publicity from media and also in the news letters in the schools. The criteria for inclusion of
the children were the children of age in between 6 years to 9 years. The care givers were selected
such that they were able to read English as well as understand English (Perng et al.,2016).
However children having the basal metabolic rate value above 3.5 were excluded from taking
part in the experiment. Part from that other children who were excluded from taking part in the
experiment were those who were obese, who were taking medicines which influence weight gain
or weight loss, children suffering from developmental disabilities or physical disabilities. The
other exclusion criteria was those children whose siblings are already taking part in the
experiment. The findings of the experiment was that all of the groups had shown significant
reduction in the basal metabolic rate after the 12 months of the trial though the reduction number
was double among those children who were kept in the intervention of the combined effects of
training of the patents and maintaining the healthy life style than those children who were under
the intervention of training of the parents. The value of the waist circumference was also

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reduced. The study has however some limitations like some portions of the sample were dropped
down with in the 12 months of the trial, some bias were also happened at the site of the
experiment as all of them were handled by the same dietician and the trainers were also not
cooperating properly, limitation also came while delivering the interventions. This research study
is surely going to help a lot on the future for doing further research on this topic.
Appraising the internal validity
The relation in between the exposures and the outcomes of the experiment is explained in
such a way that if the experiment is considered in terms of the broader health outcomes, no such
significant change has been detected. The average values of the indicators of the metabolism
were at the baseline within the range of the references of the children. Regarding the results of
the experiment it can be said that yes the results are clearly depicted in the experiment. The
authors even has given graphical representation of the results so that the readers can understand
the results of the experiment appropriately. Chances are there that the results can differ a lot by
chance variation. If the number of the children for the experiment are either increased or
decreased then no doubt the result will vary a lot. The ratios of the number of overweight
children will change and thus the result will also get changed. Even if the parents were not able
to train properly the children regarding the proper and good habits of eating then also the result
would have varied. Apart from the chance variation, if any bias would occur then also the result
will change. This is because, biases will lead to providing of improper training skills to the
parents and as a result the children will be affected as the parents will not be able to provide
proper education regarding the healthy food habits (Redsell et al., 2016). Apart from all these,
the results of the experiments are likely to be changed by any confounding. Confounding means
that the results can be changed if any third variable is present. In this experiment, the number of

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the children are the variables, so if any extra students are added in the experiment, it is likely to
create a confounding conditions, which has the potential to change the result of the entire
experiment. Each of the subgroups were analysed properly. The whole study included 3
subgroups upon which the whole experiment were dependent. The result was based on the basal
metabolic rate of the participants of every groups or every intervention. The basal metabolic rate
was found by measuring the height and weight of the participants. So if any mistake occurs in the
measurement of the height and weight then the results would get changed. Also if any new
candidate comes in the groups of each intervention then the results would get changed. The
chances of occurrence of bias gets increased with the addition of any new participants. The
measurement of weight also gets changed if the measurement machine do not work properly, so
to avoid any kind of discrepancy new weight machines should be used for every research
purpose. Similarly, the height of each and every participants must be measured properly. If the
basal metabolic rate of the participants come wrong then it would affect the meal planning for
the participants, the parents who are trained for providing the participants with good healthy
habits would not be able to provide the participants with proper foods (Gortmaker et al., 2015).
Casual association in between the exposure and the outcome is plausible or
not
It is very necessary that the association in between the exposure and the outcome must be
strong and valid. If the association in between the exposure and the outcome is casual then the
whole experiment is not going to be a valid one. Measures that are based on the absolute
differences are preferred when the in the outcome the risks associated with the experiment gets

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reduced. Risk assessments is one of the major factors of the any experiment. The association in
between the exposure and the outcome are largely dependent on the internal validity of the
experiment. In this experiment after the analysis of the internal validity it can be conclude that
though the results are accurately described in the experiment, it is seen that large chances of
biases can happen because of the participants. Any kind of discrepancy if occur, the results
would have altered. The experiment is a randomized controlled trial, so huge chances are there or
the creation of any kind of bias. The result of this experiment is mostly dependent on the number
of the participants taking part in the experiment. The addition or deletion of a single participant
would led to the changes in the results. A casual association in between the exposure and the
outcomes is not going to be a feasible one, a strong relation needs to be established between the
exposures and the outcomes (Wilfley et al., 2017). Strong and valid reasons are very necessary to
establish a fact or to establish any experiment. If the exposures of any experiment are not valid,
without having proper rationale and proper reasons then the results of the experiment will also
not be a valid one. It is very necessary to mention the number of participants each experiments.
The population of the participants must be large enough as large number of population always
give accurate results. More the number of the participants more accurate will be the result.
However in this experiment the total number of participants taking part in the experiment are not
mentioned. It would be better if the total number of participants would have mentioned. Also in
the experiment the number of the participants taking part in each of the interventions were not
mentioned. It would have been better if all these were mentioned. These are the reasons for
which the chances of the occurring of bias also increases. It is obvious that if the total number of
the population are not recorded then at any time addition or deletion of any participant may occur
and no one would going to keep notice on this matter and this would surely lead to the

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occurrence are of bias as the results will differ a lot due to the inclusion or deletion of any
participants (Nicolucci et al., 2017)
Appraising the external validity of the findings
The external validity of the findings are high as the results that are obtained from the
experiment can easily be applied to other scientific researches. The knowledge of this experiment
can be applied to other contexts of studies. The knowledge that are gained from this experiment
about the obesity and overweight of the children, the need to reduce the weight of the children
are going to help a lot in future. The findings of this experiment can easily be applied to the
sources of the population from which the population were derived. The sources of population of
this particular study are children and the results that are obtained can easily be applied with any
experiments done with the children. The training procedures that were given to the parents of the
children who participated if applied to other children will also have the same result. If the family
members will create good food habits among the children, then no doubt the children will be
benefitted (Llewellyn et al., 2016). The diets that were provided to the children will help children
in reducing a huge amount of weight and also to maintain a healthy weight. Not only among the
children, the results of this experiment, can also be applied to other groups of people. Not only
the children, if the adults and the elders are provided with a healthy diet, then they will also be
benefitted with the new diet. Over weight is not only the problem of the children but has also
become an important issue of all people. If like this experiment other experiments are conducted
keeping populations of other age groups as the participants, efficient results would also come.
The findings of those experiments can be applied to other experiments and in this way, the
results that are obtained from this experiment can help a lot in the scientific research works. The
discussion part of this assignment has clearly discussed about the results that are obtained from

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this experiment (Sonntag, Ali & De Bock, 2016). The discussion part have discussed about the
effectiveness about the parenting training both with and without the changes in the lifestyle of
the children and the also the family members. The die effectiveness of the training of the
parenting skills along with the changes in the lifestyle are clearly described in the discussion
section. The discussion section also dealt with the limitations of the experiment clearly. The
limitations that are shown in this experiment if can be overcome in future then experiments with
much better results can be obtained. The comparison of the results of this experiment with the
previous experiments are also done very efficiently. The limitations of this experiment has to be
overcome in future researches in order to obtain far better results. The potentiality of the
interventions are also clearly described, especially the description of the intervention of the
training of the parents along with maintaining healthy lifestyles.

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References
Gortmaker, S. L., Long, M. W., Resch, S. C., Ward, Z. J., Cradock, A. L., Barrett, J. L., ... &
Moodie, M. L. (2015). Cost effectiveness of childhood obesity interventions: evidence
and methods for CHOICES. American journal of preventive medicine, 49(1), 102-111.
doi.org/10.1186/s12887-015-0443-3
Gortmaker, S. L., Wang, Y. C., Long, M. W., Giles, C. M., Ward, Z. J., Barrett, J. L., ... &
Cradock, A. L. (2015). Three interventions that reduce childhood obesity are projected to
save more than they cost to implement. Health Affairs, 34(11), 1932-1939.
doi.org/10.1377/hlthaff.2015.0631
Llewellyn, A., Simmonds, M., Owen, C. G., & Woolacott, N. (2016). Childhood obesity as a
predictor of morbidity in adulthood: a systematic review and meta‐analysis. Obesity
reviews, 17(1), 56-67. doi.org/10.1111/obr.12316
Nicolucci, A. C., Hume, M. P., Martínez, I., Mayengbam, S., Walter, J., & Reimer, R. A. (2017).
Prebiotics reduce body fat and alter intestinal microbiota in children who are overweight
or with obesity. Gastroenterology, 153(3), 711-722. doi.org/10.1053/j.gastro.2017.05.055
Perng, W., Rifas-Shiman, S. L., Kramer, M. S., Haugaard, L. K., Oken, E., Gillman, M. W., &
Belfort, M. B. (2016). Early weight gain, linear growth, and mid-childhood blood
pressure: a prospective study in project viva. Hypertension, 67(2), 301-308.
doi.org/10.1161/HYPERTENSIONAHA.115.06635
Redsell, S. A., Edmonds, B., Swift, J. A., Siriwardena, A. N., Weng, S., Nathan, D., &
Glazebrook, C. (2016). Systematic review of randomised controlled trials of interventions

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that aim to reduce the risk, either directly or indirectly, of overweight and obesity in
infancy and early childhood. Maternal & child nutrition, 12(1), 24-38.
doi.org/10.1111/mcn.12184
Sonntag, D., Ali, S., & De Bock, F. (2016). Lifetime indirect cost of childhood overweight and
obesity: a decision analytic model. Obesity, 24(1), 200-206. doi.org/10.1002/oby.21323
Wilfley, D. E., Staiano, A. E., Altman, M., Lindros, J., Lima, A., Hassink, S. G., ... & Improving
Access and Systems of Care for Evidence‐Based Childhood Obesity Treatment
Conference Workgroup. (2017). Improving access and systems of care for evidence‐
based childhood obesity treatment: Conference key findings and next
steps. Obesity, 25(1), 16-29. doi.org/10.1002/oby.21712