Athabasca University NURS 434 Assignment 2: Epidemiology and Obesity

This assignment is a critical review of a systematic review article focusing on diet, physical activity, and behavioral interventions for treating overweight or obese children aged 6 to 11 years. The review examines the study design, which includes 70 randomized controlled trials (RCTs), assesses the consistency of findings with existing knowledge, and evaluates the validity and reliability of the reported relationships. The assignment also discusses the potential incorporation of the study's findings into community health nursing practice, identifies limitations, and proposes further research questions related to cultural behaviors, geographical areas, lack of education, and the prevalence of mental illnesses contributing to childhood obesity. The report critiques the article's strengths, such as its use of the PICO format and evidence-based practice, while also noting areas for improvement, such as the lack of subgrouping in the outcome discussions and the need for more comprehensive analysis methods.

Running head: ASSIGNMENT 2
ASSIGNMENT 2: APPLICATION OF EPIDEMIOLOGY IN COMMUNITY
HEALTH NURSING
Antony Aby
NURS 434: Community Health Promotion
Instructor Name: Ms Lisa- Anne Barrett
Athabasca University

1ASSIGNMENT 2
Diet, physical activity and behavioural interventions for the treatment of
overweight or obese children from the age of 6 to 11 years.
As per the report of the Public Health Agency of Canada, the rate of obese children is
high, and there were 30 children between 5-17 years that can be considered as overweight or
obese (Bozkurt et al., 2018). The Body Mass Index (BMI) of an obese person is more than
30, where an overweight individual has a BMI range of 25-30. The aim of the paper is to
critically review an article, ‘Diet, physical activity and behavioral interventions for the
treatment of overweight or obese children from the age of 6 to 11 years’ in order to address
the issue of childhood obesity in the current context.
Rationale of the type of study design used
The purpose of the article is to assess the impact of diet, behavioral intervention, and
physical activity for treating wither overweight or obese children between the age of 6 to 11
years old (Mead et al., 2016). It was a systematic review that included study design used in
this particular review was 70 randomized controlled trials (RCTs) that included 8461
participants that include all the variables presented in the aim. From the perspective of
Snyder et al., (2016), it can be stated that the study design used in the research was
appropriate in nature as the observational study will not be able to determine the impact of
the variables on the target population. It specifically focused on understanding the effects of
diet, physical activity, and behavioral intervention upon the treatment process of the
participants. The study was conducted in thirty-one trials that involve reporting of adverse
events as well as a meta-analysis for assessing the impact on treatment and post-
interventional period. Therefore, it included a large number of studies that gave a wide range
of perceptions to testify to the outcome. The use of both qualitative and quantitative studies
has enhanced the context of the particular research enabling the audience to understand the

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different impacts of each of the factors mentioned in the study (Cheng, Fu & de Vreede,
2017). However, the issue was found in the sample size, which was small as compared to the
global statistics of children suffering from obesity-related issues. There was a lack of a
controlled trial in the study that affected the reliability to a large extent.
Finding consistent with the knowledge and information
From the systematic review, it was found that the BMI z score was obtained; however, there
was no distinct outcome derived from the result. The impact of interventional strategies such
as improvement in the quality of life was found to unclear, and no report stated any adverse
events such as death, socioeconomic effect, or morbidity rate in the study. As per the study of
Guyatt (2016), when a research journal is unclear, it offers low-quality evidence that supports
the results. In this particular case, the overall quality of the evidence obtained from the
finding was not consistent in nature as a result; it implies that the evidence was of poor
quality and cannot be taken into considerations because of the study design incorporated. In
addition, it can be stated that the result was inconsistent with the information or knowledge
obtained from other studies because it did not specifically focus on the target population that
is children; therefore, the study was majorly presented on obesity rather than childhood
obesity. The strength found in this particular article is that the evidence is up-to-date as it was
in July 2016. It used a PICO format for establishing a well-built clinical question related to
the objective of the study (Scells et al., 2017). The article stated that evidence-based practice
was employed and helped in proposing a search strategy from MEDLINE, CENTRAL,
CINAHL, PsycINFO, government sites, LILACS, and ICTRP Search portal to access the
studies and reviews. It is important to note that the reported relationship in the article does
make sense from the findings. That is not a supported statement.
Validity and Reliability of Reported relationship

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From the previous section, it was found that the reported relationship made sense because of
multi-component behavior-changing interventions by including factors such as diet,
behavioral changes, and physical activities that were found to be beneficial for obese
children. The relationship of each of the variable were taken into consideration in an
individual manner that help in making sense and understanding the validity of the reported
relationship. As per the opinion of Häkkänen, Ketola and Laatik (2018), change in lifestyle
and dietary components is stated to be one of the best solutions in the management of obesity
or overweight-related issue. However, the outcomes were not discussed by subgrouping the
variables. Even though the evidence was stated to be of low quality; however, it had focused
mainly on the research topic and did not divert from the subject. Therefore, it can be reported
to be a reliable article to be referred to in future studies as well as study can be conducted
based on the findings by taking into accounts the limitations and addressing them to offer
precise, reliable, and valid research on childhood obesity. However, the reported relationship
was comparative weak in nature as the discussion did not included any particular method of
analysis that critically address the relationship and the issue at hand.
Would you incorporate the findings of this study into your community health nursing
practice or recommend this study to others?
Randomized Control Trial is one most popular scientific method that can be included
in practice as a part of evidence based practice; however, the evidence should be of good
quality and thus evaluation can provide good quality reports. The test method applied was
totally based on Body Mass Index selection of the individuals. Moreover, the trial towards
creating an intervention was done by changing the dietary behavior and by introducing the
plan of physical activity. More interventions could have been gathered as a focus, which
include providing rehabilitation as an intervention method, Psychopathology, long term

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monitoring and surgical interventions can also take as a trial for application towards the
remedy to obesity.
Study towards the child obesity prevention can also be stated by categorization, based
on the type of required prevention: primordial prevention, primary prevention and secondary
prevention. Also traffic line diet system can be used as an intervention towards the reduction
towards the childhood obesity. The diet plan holds food based on green yellow and red;
where Green signifies that food are good to go and can be eaten by anyone whereas Yellow
highlights as a factor for caution that means the food is having moderately high calorie and
the Red indicates a consumable with high calorie (Pandita et al., 2016).
This article ‘Diet, physical activity and behavioral interventions for the treatment of
overweight or obese children from the age of 6 to 11 years’ mentioned diet plan as an
intervention but did not mentioned any method that can be used for mitigating the issue at
hand. However, above stated facts can be taking into consideration and incorporated in
nursing practice to formulate action plan.
Further research question(s) to develop in relation to the study and our observations
The research has been conducted based on the Body Mass Index. Further research that
can be conducted are based on the cultural behaviour contributing to childhood obesity, based
on geographical area contributing to childhood obesity, lack of education and lack of
healthcare education contributing to childhood obesity and lastly the prevalence of mental
illness such as eating disorder and depression contributing towards childhood obesity.
Along with these factors another study can be drawn which may include the bias due to
obesity and discrimination due to obesity. These factors can arise study on the structures how
obesity can push a group of individual much prone to bias situations and discrimination in
their community. The article stated that evidence-based practice was employed and helped in

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proposing a search strategy from MEDLINE, CENTRAL, CINAHL, PsycINFO, government
sites, LILACS, and ICTRP Search portal to access the studies and reviews. However,
application of GOOGLE SCHOLAR and SAGEPUB could have contributed more to the
knowledge.
Henceforth it can be concluded that, the study design used in this particular research
was 70 randomized controlled trials (RCTs) that included 8461 participants that include all
the variables presented in the aim. The Body Mass Index (BMI) of an obese person is more
than 30, where an overweight individual has a BMI range of 25-30. It included a large
number of studies that gave a wide range of perceptions to testify to the outcome. The study
shows that depending on the factor is not enough to determine obesity. It can be stated that
this is a strength of the article that is backed with the findings to develop a strong
relationship. However, the outcomes were not discussed by subgrouping the variables.
Moreover, much more article review could have added to the part of study.
Randomized Control Technique is one most popular said method that can be included
in practice as a part of evidence based practice; however, the evidence should be of good
quality and thus evaluation can provide good quality reports. Rather than the said technique,
other evidence-based practice can be stated for a better knowledge and further studies.

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References
Alexander, P. E., Brito, J. P., Neumann, I., Gionfriddo, M. R., Bero, L., Djulbegovic, B., ... &
Guyatt, G. H. (2016). World Health Organization strong recommendations based on
low-quality evidence (study quality) are frequent and often inconsistent with GRADE
guidance. Journal of clinical epidemiology, 72, 98-106.doi:
10.1016/j.jclinepi.2014.10.011
Bozkurt, H., Özer, S., Şahin, S., & Sönmezgöz, E. (2018). Internet use patterns and Internet
addiction in children and adolescents with obesity. Pediatric obesity, 13(5), 301-
306.doi: 10.1111/ijpo.12216
Cheng, X., Fu, S., & de Vreede, G. J. (2017). Understanding trust influencing factors in
social media communication: A qualitative study. International Journal of
Information Management, 37(2), 25-35. Doi: 10.1016/j.ijinfomgt.2016.11.009
Häkkänen, P., Ketola, E., & Laatikainen, T. (2018). Screening and treatment of obesity in
school health care–the gap between clinical guidelines and reality. Scandinavian
journal of caring sciences, 32(4), 1332-1341. Doi: 10.1111/scs.12578
Mead, E., Brown, T., Rees, K., Azevedo, L. B., Whittaker, V., Jones, D., ... & Beardsmore, E.
(2017). Diet, physical activity and behavioural interventions for the treatment of
overweight or obese children from the age of 6 to 11 years. Cochrane Database of
Systematic Reviews, (6). Doi: 10.1002/14651858.CD012651
Scells, H., Zuccon, G., Koopman, B., Deacon, A., Azzopardi, L., & Geva, S. (2017,
November). Integrating the framing of clinical questions via PICO into the retrieval of
medical literature for systematic reviews. In Proceedings of the 2017 ACM on
Conference on Information and Knowledge Management (pp. 2291-2294). Doi:
10.1145/3132847.3133080

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Snyder, G. M., Young, H., Varman, M., Milstone, A. M., Harris, A. D., & Munoz-Price, S.
(2016). Research methods in healthcare epidemiology and antimicrobial stewardship
—Observational studies. infection control & hospital epidemiology, 37(10), 1141-
1146. Doi:10.1017/ice.2016.118
Pandita, A., Sharma, D., Pandita, D., Pawar, S., Tariq, M., & Kaul, A. (2016). Childhood
obesity: prevention is better than cure. Diabetes, metabolic syndrome and obesity :
targets and therapy, 9, 83–89. doi:10.2147/DMSO.S90783