University of Western Sydney: Epidemiology Assignment 3 Report

This report critically appraises a research study concerning epidemiology, specifically focusing on a study by Golley et al. (2007) that investigated weight management in pre-pubertal children through parental involvement. The analysis delves into the study's design, which involved a randomized controlled trial, and evaluates the effectiveness of parental skills training combined with lifestyle education. The report highlights the study's findings, including the reduction in BMI scores and gender effects, while also addressing potential biases and limitations such as sample size and confounding factors like genetic and environmental influences. The critique assesses the study's validity, generalizability, and the impact of various interventions, emphasizing the need for further research to address identified gaps and biases, such as the lack of sub-group analysis and follow-up sessions. The report also examines the study's strengths, including participant recruitment and the use of standardized protocols.

Running head: EPIDEMIOLOGY
EPIDEMIOLOGY
Name of the Student:
Name of the University:
Author Note:

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Introduction:
Research appraisal incorporates assessing the content and quality of the scholarly
literatures that cover a particular research topic. As stated by Crano et al. (2014), critical
appraisal of a research study involves the process of evaluating a research study in order to
determine the strengths and weaknesses of a study and compare the findings of the study with
other relevant research studies. The advantages of conducting a critical appraisal can be
mentioned as providing a platform to the researcher to be able to compare and contrast a
specific research study with similar research studies in order to evaluate the strengths and
weaknesses of the research parameters such as research design, research method and sample
population. This paper would critique and compare the research study authored by Golley et
al. (2007) and analyse the quality of the research paper.
Response 1:
The research paper authored by Golley et al. (2007) focused on the issue of weight
management in pre-pubertal children. The research can be considered novel as it involved the
intervention that comprised of assisting weight management in pre-pubertal children along
with the direct involvement of the parents. It should be noted in this context that the authors
suggest that parenting-skill based weight-management training can prove to be beneficial for
addressing the issues of pre-adolescent and childhood obesity. The main objective of the
paper is clearly described and it focuses on evaluating the incorporation of parental-strategy
in the weight management of the overweight children. The research design adapted by the
researchers comprised of conducting an assessor-blinded, randomized controlled trail that
included a total of 111 participants (with 64% of the participants being female), overweight
and pre-pubertal children who were aged in between 6 years to 9 years. The included research
participants were randomly assigned to the parenting skills training plus intensive education

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and parental skills training program for a period of 12 months. It should be mentioned in this
context that the height, waist circumference as well as metabolic profile was accessed at an
interval of 6 months and 12 months in order to evaluate the effectiveness of the applied
interventions. The overall results suggested that the group of participants that were subjected
to parenting skills training in combination with intensive lifestyle education reported a
reduction in the BMI z score equivalent to 10% against the group of participants that was
treated with parenting skills training individually or wait-listing as a weight-loss intervention
individually which only reported a 5% reduction in the BMI score. In addition to this, it
should be noted that a reduction in the wait reduction was noticed in the two intervention
groups against the control group. The results also revealed a gender effect which suggests a
greater reduction in the BMI was reported in boys as against girls. Therefore, it can be
mentioned that the research study helped in establishing the findings that parental skills
training in combination with the promotion of a healthy lifestyle approach could help in
effective management of weight among children, specifically in boys. The research topic also
proves to be promising for future researchers to develop effective weight management
interventions for the prevention of obesity in children. In addition to this, it should also be
noted that the researchers have also suggested that future studies could focus on adiposity
reductions among the control groups and incorporate better methods to analyse primary
outcome, secondary outcome as well as gender sub-analysis.
Response 2:
The research participants comprised of 64% participants that were female and most of
them were 8 years and elder and were obese. In addition to this, 72% of the children belonged
to dual-parent families with a total of 98% of the parents who belonged to white ancestry.
The mean standard deviation for the SEIFA index of the relative advantage was 997+/-73
against the South Australian mean of 960. In addition to this, 34% of the parents were

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categorized as overweight and 44% were considered obese (Golley et al., 2007). It should be
noted in this case that no significant differences were noted for any child with reference to
family characteristics by the study group. Also, participants that were older than 8 years and
had higher BMI were excluded from the research study. Also, children with waist
circumference 3.54+/-0.64 were excluded from the study (Golley et al., 2007). It has further
been mentioned in the research study that the participants that there was no socioeconomic
disparity between the children that were included in the 12-month intervention program
against the children that were screened but were not included in the research program. The
study comprised of three interventions groups that comprises of control group, a group of
participants who were offered parental-skill training with intensive lifestyle education and a
group of participants with parental skills training but without intensive lifestyle education.
The impact of the implemented interventions can be considered effective as a significant
reduction in the BMI score was noted for all the three groups over 12 months. However, a
striking contrast in the effectiveness of the devised interventions was noticed. The BMI score
decreased double in the group that was led by the intervention of the weight management
program along with lifestyle intervention and the reported effectiveness was reported to be
equivalent to 45% against the group that was only administered the weight management
program and the success rate was reported to be equivalent to 24% (Golley et al., 2007). In
addition to this, the waist circumference also reduced over the period of 12 months in the two
respective intervention groups. Therefore, it can be deduced from the overall results that
weight management intervention assisted with lifestyle education seems to be appropriate for
the prevention of obesity.
However, considering the sample size of the research participants it can be said that
on account of the increased proportion of male research participants, the research results
possess a potential risk of gender biasness. In addition to this, the research design suggests

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that the participants were segregated into the intervention groups on the basis of random
sampling. However, considering the participants allotted to the three groups, it can be said
that sampling method chosen by the researchers offered parameters of biasness. Further, it
should be stated that the results are least likely to be affected by chance variation. As stated
by Babbie (2013), the probability of chance variation while dealing with larger sample size is
less and the errors seem to be uniformly distributed over the sample size such that the errors
appear to above and below the actual mean value and nullify each other resulting in the
expected value to be equivalent to zero. In addition to this, it is crucial to note here that the
results are likely to be affected by confounding factors such as environmental stressors or
genetic factors which has been ignored by the researchers in their research study (Neuman &
Robson, 2014). Also, the researchers have broadly studied the impact of the applied
interventions on the three groups of participants but no sub-group analysis or interaction have
been conducted to establish the relationship between the concerned intervention groups.
Response 3:
It can be mentioned in this context that the researchers in this paper have made use of
a family-focused intervention by using parenting-skills training and lifestyle improvement
factors for the prevention of childhood obesity and ensure effective weight management. In
other words, it can be mentioned that the researchers have made use of parental skills and
awareness in controlling the dietary intake of the children to effectively manage their body
weight. However, the strong influence of gender biases in the overall results question the
validity of the intervention study. Also, the research paper clearly lacks a clear evaluation of
the results in terms of gender sub-analysis as well as primary and secondary outcome
analysis. Also, the research results depict a causal association between the exposure and the
outcome as it can be stated that the intervention group that received a combination of weight
management and lifestyle education were likely to be more motivated for weight loss and

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effective weight management. According to Cumming-Potvin (2013), in order to determine
the validity and reliability of research results while conducting an intervention study, it is
extremely important to expose the control group to a set of interventions that would fetch
results that are aligned to the expected outcome. Also, the research study does not report any
findings based on follow-up sessions that could help in determining the efficiency of the
applied interventions on weight management and obesity control. Follow up sessions and
continuation study up to the adolescent stage would help in determining the effectiveness and
reliability of the devised interventions in the group that was administered a combination of
parental skill improvement weight management training and lifestyle education. Also, the
research results appear to be affected by a number of external factors such as genetic
inheritance, medication side-effects and environmental stressors. The confounding effect of
the external factors on the research results have been ignored by the researchers which makes
the validity of the results in all the three intervention groups uncertain. According to Patten
and Newhart (2017), the validity and credibility of the research study findings in intervention
studies are determined upon the analysis of the interaction between the different intervention
groups and the sub-groups classified under the main intervention groups. Also, the research
study lacks the analysis or discussion on adherence
On the other hand, it can be stated that the research study and the recruitment and
retention strategy used by the researchers to acquire the calculated sample size and ensure
less than 20% attrition in the 12 month program is appropriate and commendable. Also, the
blinded allotment of the participants in the intervention groups and outcome analysis can be
considered appropriate for ignoring the measurement biasness. The researchers used
standards weight management protocols and a single facilitator in order to reduce site bias
which can be deemed appropriate for enhancing the validity of the study. Also, the
consideration of the narrow age range facilitated maintenance of age appropriateness in the

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considered sample size and helped in determining the effectiveness of the considered sample
size (Lobstein et al., 2015). However, the lack of appropriate motivation within the control
group prohibited the generalization of the results. Therefore, overall, it can be said that the
research results are valid but cannot be generalized and at the same time are affected by
research biases.
Response 4:
On closely analysing the research study, it can be mentioned that the research study
findings can be considered appropriate in terms of external validity. The researchers made
use of specific participant selection criteria in order to recruit research participants. The
inclusion criteria broadly comprised of recruiting children that were aged between 6 to 9
years of age and that were overweight as per the International Obesity Task Force definition
and Tanner Stage 1. In addition to this, care providers who could fluently speak and
understand English were included in the research study. The exclusion criteria on the other
hand, comprised of children that had their BMI measurement equivalent to > 3.5. The overall
results revealed a significant reduction of the basal metabolic index in boys than in girls as
opposed to the findings reported that reveal truncal adiposity is higher in girls than in boys as
per the research studies. It should further be mentioned in this context that the weight
management interventions used by the researchers were developed in response to the
literature gap identified by scholarly literature that focused on childhood obesity prevention
interventions. In this context, it should further be stated that research studies reveal that
generally the diet intake of pre-pubertal children are managed majorly by their immediate
care providers. Proper education and awareness in relation to calorie intake and physical
activity so as to lead a healthy life style can help in effective weight management. In this
case, the same has been done by the researchers. Also, research studies show that effective
improvement of parental skills and commencing training and imparting education about risk

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factors that trigger obesity help in the management of weight in children. As stated by
Showell et al. (2013), family centred and family focused weight management intervention
strategies yield successful outcome in terms of obesity prevention among school-children.
However, it is important to note here that on an average basis it has been reported that self-
management obesity prevention strategies yield better success rate in controlling obesity
(Davison et al., 2013, P.1862 ; Seburg et al., 2015,P.158). Also, the major problem with the
devised intervention strategies can be mentioned as lack of data that reveals percentage of
adherence. Therefore, overall it can be mentioned that research results satisfy external
validity and the applied interventions are backed by the evidence base. This suggests that the
applied interventions are effective and can be applied to other relevant populations. Also, the
overall discussion presented by the authors reveal a clear analysis of the research findings but
is condensed and lacks elaborate explanation. A comprehensive and elaborate discussion
based on the research findings would have ensured research clarity and better understanding
among the readers.
Conclusion:
Therefore, to conclude it can be said that the research conducted by Golley et al.
(2007) intended to evaluate the effectiveness of a twelve month parent-focused weight
management program in order to prevent obesity among the pre-pubertal children. The
researchers hypothesised that parent led family focused weight management intervention
program could help in managing weight of pre-pubertal children. The researchers segregated
the participants into three groups with the control group being offered no intervention and the
other two groups were administered parental skills training along with lifestyle education and
individualized parental skill training respectively. The intervention was carried out for a
period of 12 months and overall findings suggested a significant reduction of the BMI among
the boys compared to the girls. The sample size included a total of 111 participants which

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could be considered as a standard sample size for affirming the creditability of the research.
Also, the researchers made use of stringent exclusion criteria in order to recruit the
participants and included overweight children who were aged in between 6 to 9 years and
were considered obese as per the Obesity Task Force definition and Tanner Stage I eligibility
requirement. Also, the recruited participants were overweight and their recorded BMI was
documented to be equal to or greater than 3.5. However, it is important to note in this context
that the research results appear to be influenced by gender biases as the BMI reduction was
more vivid in the boys than in the girls. Further, lack of motivation in the control group
prohibited the generalization of the results. Also, the research suggests that a parent skill
training and life style education awareness were used as interventions for the management of
obesity and body weight in the children but the researchers have not elaborated on the content
of the interventions. At the same time, the research also lacks clarity in terms of presenting a
discussion on the impact of the confounding factors on the research results. However, the
research study findings can be considered reliable as the effectiveness of the applied
intervention strategies are backed by the evidence based research studies.

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