Childhood Obesity Evaluation Research: Well-Child Visits Impact Report

This evaluation research report examines the use of child wellness visits as an intervention to reduce childhood obesity in low-income homes. The study proposes a six-month protocol involving twice-monthly visits to educate parents and children about healthy dietary habits and the importance of physical activity. The report identifies childhood obesity as a significant medical problem with short- and long-term health consequences, disproportionately affecting low-income families. It also considers the social justice implications of childhood obesity, linking it to poverty and marginalization. The research hypothesizes that well-child visits can effectively mitigate childhood obesity by improving health literacy among parents and providing referrals for financial assistance. The methodology includes a quantitative evaluation research design, using questionnaires and BMI measurements to assess outcomes. The report discusses the significance of the study, the literature review, methods, ethical considerations, and expected results, including the limitations and implications for practice. The study aims to provide an in-depth understanding of the societal factors and risk factors associated with childhood obesity, supporting the development of appropriate interventions.

Running head: EVALUATION RESEARCH
EVALUATION RESEARCH
Name of the Student
Name of the university
Author’s note

1EVALUATION RESEARCH
Abstract
The prevalence of childhood obesity had increased in the United Kingdom for more than 100
percent. Overweight in childhood has become a matter of concern in most of the countries and as
per the evidences got due to literary research, the occurrence of childhood obesity has been
found to be largely associated with the socio-economic status. This paper has put forward a
proposal for carrying out well-child visit as effective intervention for reducing the rate of
childhood obesity by educating the parents and the child about the health dietary habits and the
importance of physical activities. It has been proposed to carry out a six month well child visit
protocol twice in a month to have an in-depth understanding of the issue. The paper had also
focused on how childhood obesity is linked with social justice owing to its association with
poverty and marginalization. However, the paper had also described about the probable
implications of this trial on obesity control.

2EVALUATION RESEARCH
Table of Contents
Abstract............................................................................................................................................1
Topic................................................................................................................................................4
Introduction......................................................................................................................................4
Identification of the problem area................................................................................................4
Significance statement.................................................................................................................5
Hypotheses...................................................................................................................................6
References for the introduction.......................................................................................................7
Literature review..............................................................................................................................8
Methods.........................................................................................................................................11
Study sample and research design.............................................................................................11
Instruments................................................................................................................................11
Outcome measures.....................................................................................................................11
Ethical considerations................................................................................................................11
Data analysis..............................................................................................................................12
Conclusion.....................................................................................................................................12
Expected results.........................................................................................................................12
Limitation..................................................................................................................................12
Implications to practice..............................................................................................................13
References......................................................................................................................................14

3EVALUATION RESEARCH
Topic
This evaluation research examines the use of child wellness visits to reduce obesity in children in
low income homes
Introduction
Identification of the problem area
Childhood obesity is a serious medical problem that affects the children and the
adolescents where the body mass index of a child exceeds the normal standard level, as per the
age of the child. In United States, the percentage of children affected due to obesity has tripled in
number since 1970 (CDC, 2018).Globally, obese and overweight children under the age of five
has been estimated to be more than 41 million. Childhood obesity has several short and long
terms effects on the social, physical and the emotional health of an individual. Children with
obesity are more vulnerable to chronic health conditions and diseases like type -2 diabetes and
risk factors for heart disease (CDC, 2018). Children with obesity are often bullied and are teased
more than their peers who are normal weight and hence are teased more than their normal weight
peers. Vos and Welsh, (2010), have highlighted evidences regarding the role of the maternal
body mass index, genetics, environmental factors, dietary habits and other demographic factors
as the predisposing factors of obesity. The dietary habits can again be linked to social, cultural
and the economic aspects of a population.
One of the more concerning fact is that obesity have been found to be increased by 23-
33% for children in low income, low education and higher unemployment households.

4EVALUATION RESEARCH
Moreover, the low income families are less likely to realize that their child is obese.
Furthermore, the low income families face lots of barriers for improving the health status. They
are more likely to consume unhealthy and cheap food due to the high price of the fresh food.
Lower household income can be strongly correlated to higher prevalence of childhood obesity.
Community based wellness visits and surveys in low income household and health promotion
programs have been found to be effective in mitigating child hood obesity.
This evaluation would examine the effectiveness of the child wellness visits in low income
households to reduce child obesity.
Significance statement
Obesity in UK is a common problem and it is estimated that every four adult and a fifth
of 10 -11 years olds are overweight or obese (BBC news. 2018). According to the Public health
England, nearly half of the kids are overweight in parts of the United Kingdom, with seven out
of the fattest areas in Britain. In September 2018, United Nations has reported that UK is the
third fattest nation in Europe after turkey and Malta (Wang & Lim, 2012). Hence, checking for
obesity in children and health promotion related to obesity control during the well-child visits
can mitigate the problem from the grassroot level.
In contrast to other threats to the health status of the children of the United Kingdom, the
prevention and the treatment of childhood obesity are considered to be useful. Sometimes the
societal stigmatization of the obese children and some environmental factors induce the children
to consume nutritionally poor food (Puhl & Heuer, 2010). Hence the parents of the overweight
children are left in a position to fear the social and the health consequences of the childhood
obesity. Childhood obesity is a social justice issue as it affects the poor and the minorities

5EVALUATION RESEARCH
disproportionately. Hence, poverty and stigmatization are the social justice issue related to
childhood obesity. The intersection of the obesity and poverty should be understood as an
injustice that demands structural changes (Brewis, 2014). Hence, it is important for the social
workers to have clear idea about this social problems. Child wellness visits are a part of
community social services work that involves screening of clinical conditions in children,
immunizing them, checking on their diets (Wang & Lim, 2012). These welfare visits are like a
much needed safety net for the people suffering from socio-economic challenges or for families
or the children in need for advocacy. Hence such evaluation research will provide an in depth
understanding of the societal factors and the risk factors associated to obesity including the
statistical data about the prevalence all around the United Kingdom, such that appropriate
interventions can be taken.
Hypotheses
It is hypothesized that child wellness visits can help to reduce obesity in children in the low
income homes.

6EVALUATION RESEARCH
References for the introduction
BBC news. (2018).Child obesity: Are 22,000 children 'severely obese’? Access date:
11.11.2018. Retrieved from: https://www.bbc.com/news/health-44291492
Brewis, A. A. (2014). Stigma and the perpetuation of obesity. Social Science & Medicine, 118,
152-158. https://doi.org/10.1016/j.socscimed.2014.08.003
CDC., (2018).Childhood Obesity Facts. Retrieved from:
https://www.cdc.gov/healthyschools/obesity/facts.html
Puhl, R. M., & Heuer, C. A. (2010). Obesity stigma: important considerations for public health.
American journal of public health, 100(6), 1019-28.
Vos, M. B., & Welsh, J. (2010). Childhood obesity: update on predisposing factors and
prevention strategies. Current gastroenterology reports, 12(4), 280-287.
Wang, Y., & Lim, H. (2012). The global childhood obesity epidemic and the association between
socio-economic status and childhood obesity.
https://doi.org/10.3109/09540261.2012.688195

7EVALUATION RESEARCH
Literature review
The intervention that has been chosen for bringing about a reduction in the childhood
obesity is to conduct well- child visits in the low income household to keep a check on the
prevalence, the extent of the problem, the social determinants and risk factors associated to
obesity in children.
Childhood obesity prevention approaches should be considered in the well child visit by
the social workers due to its association to the social injustice issues. Childhood obesity has
nearly tripled over the past three decades and has impacted the children belonging to different
racial groups (Vos & Welsh, 2010). Obesity among the African children have been found to be
more when compared to the other races. As per the basic rights of the children, every child is
entitled to grow in non –poor and healthy condition irrespective of the socio-economic status. It
is the duty of the social workers to look after health and the wellbeing of each of the child.
Negative attitudes towards the obese children have increased 66 % over the past three decades.
According to Brewis (2014), society perceives obese persons as innocent persons but as the
architect of their health and often considers laziness and over eating to be the main cause. Some
of these common assumptions lay the foundation of the weight stigma. Hence, the social workers
on a well-child visit, are accountable to eradicate the stigma related to child hood obesity or
change the perception of the parents of the obese children.
Parents play a significant role in preventing childhood obesity. Paradoxically, it has been
found that there are several parents that do not perceive the excess weight of their child as a
health concern. Hence, it is important to educate the parents about childhood obesity (Avis et al.,
2015). It has been found that parents who have a clear perception about the body mass index of

8EVALUATION RESEARCH
their child are likely to sustain a healthy life style. One of the important way of developing
supportive family- clinician interaction is through a child wellness visit at homes. By child
wellness visit, the pediatricians can begin providing education to the patients regarding shortly
after the birth about the ways to maintain a healthy life style, or developing proper diet chart for
the babies (Avis et al., 2015). Cha and Besse, (2015), conducted a study among the English
speaking parents in the UK, where the odds for the childhood obesity were found to have been
increased with the low health literacy scores of the parents. Health literacy of the parents has also
been associated with obesogenic care behavior on the infants, such as feeding them with more
formula than breast milk (Marks, 2015). A study conducted by the same author had
demonstrated that nutritional knowledge of the parents are variable (Marks, 2015). A health
belief model can be used to understand the barriers to maintain a proper body mass index.
According this belief, health literacy via welfare visits helps to understand or predict the health
related behaviors. Hence, such welfare visits will help to identify predisposing factors of the
childhood obesity. A well- child check allows the health care professionals to keep a track of the
development of the child and make sure they are getting whatever to stay healthy (Tzioumis &
Adair, 2014). They help to identify the evidence based behavioral changes in the diet and the
physical activity for preventing obesity in children. They also counsel families using empathize
provide communication techniques, discuss about the stages of the obesity treatment.
Additionally, a well- child visit an act as a forum for addressing the maternal health needs
affecting the child. Groner et al., (2009) have stated that, anticipatory guidelines, about the
nutrition, health and safety of the child is the main component of a child well care. It has been
found that in most of the household having low education and unemployment, people are more
likely to be ignorant about the standard dietary guidelines. Hence, implementation of the

9EVALUATION RESEARCH
recommended guidelines can produce significant health outcomes when administered at a
population level. A pediatrician taking part in the child wellness visit can suggest the parents
with interventions and can also correct the inaccurate perception of the weight status of their
children. In many cases families having lower levels of health literacy might be unaware of
rights or the grants that might be available for them (Marks, 2015). Such well- child visits can
also provide useful referrals to the families seeking for financial help.

10EVALUATION RESEARCH
Methods
Study sample and research design
The eligible participants will be 20 children aged 2-5 years and who have attended a
well-child care visit at the “X” health community health service clinic within 12 months before
the recruitment and on the visit had a body mass index >85th percentile as per the age. The
wellness visit will be delivered by a pediatrician followed by a researcher.
This study will follow a quantitative evaluation research.
Instruments
A questionnaire related to childhood obesity will be made to fill by the parents prior to
the interventions and the same will also be made to fill after the commencement of the
interventions. The interventions provided focused on parenting style, nutrition and physical
activity. 2 visits each month over a six months period will be considered for providing educating
the parents about childhood obesity. Other interventions included recommendation of dietary
guidelines for each of the children.
Outcome measures
The primary study outcome will be measured by any improvement in the health literacy
as perceived from the filled questionnaire and a significant change in the BMI z score from the
baseline till the post intervention period.
Ethical considerations
Each of the families will be invited by an email and telephonic calls. Before the
conduction of the study each of families will be made to sign a consent form containing all the

11EVALUATION RESEARCH
aims, pros and cons of the study. Before the trial, ethical approval should be taken from the local
ethics committee.
Data analysis
Primary analysis
The change in the BMI score will be noticed to compare the changes over an equivalent time
frame with the help of growth curve models having random intercepts and random slopes.
Secondary analysis
For determining the effect of the interventions on the physical activities, the mean “5-2-1-0”
index from baseline to post-intervention will be measured using a paired t-test.
Conclusion
Expected results
The anticipated outcome is that such interventions will bring about an improvement in
the health literacy among the parents and children. A statistically significant reduction in the
BMI will be noticed.
Limitation
One of the limitation that can be associated with this study is the smaller sample sized
and the age group. Outcome of twenty children cannot be generalized to the entire population.
Furthermore, children above the age of five are more independent and hence their dietary habits
or physical activities might not be dependent upon the parenting skills or the socio-economic
status and can be due to peer influence. Lack of control groups might lead to bias.