Nutrition Program and Proposal: Childhood Obesity Intervention

This program proposal outlines a comprehensive nutrition program designed to address childhood obesity through a randomized controlled trial. The program aims to involve both children and parents in educational and behavioral interventions, leveraging the trans-theoretical model of change. The study hypothesizes that a program involving both parents and children will lead to greater weight loss, improved nutritional knowledge, and better compliance compared to a program involving only children. The research design includes two groups: a control group receiving written nutritional guidelines and an experimental group participating in interactive educational sessions with pictorial and written resources. The study will evaluate weight loss, nutritional knowledge (using the MDQI), and program compliance over a three-month period. The sample size is estimated to be 68 participants, and recruitment will occur through weight loss centers, gyms, and diet clinics. The budget includes expenses for a dietician, educational resources, and incentives. Sustainability will be ensured through weekly follow-ups with parents to gather feedback and address any issues. The study references various research papers to support the program's rationale and methodology, with the overall goal of combating the rising rates of childhood obesity.

Running head: NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
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1NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
Introduction
Obesity during childhood has been largely linked to perceptions and behaviors followed
by parents [1]. The following program proposal thus intends to design an educational and
behavioral intervention program involving both children and parents for obesity management.
According to the qualitative, interview-based study conducted by [2] across 21 parents of
children in primary school, participants reported to enroll and involve themselves in a weight
management program for their children, only after engaging in a number of attempts which were
unsuccessful. Additionally, the authors also reported the influence of parent’s misperception
regarding their child’s weight – parents were found to underestimate or misunderstand a change
in the weight of the child as insignificant resulting in delayed enrolment. Thus, these findings
demonstrate the need for healthcare professionals to involve and educate parents of obese
children regarding appropriate dietary and lifestyle interventions. However, the interview based,
qualitative findings are often prone to social desirability [1]. Nevertheless, the cross sectional
study by [3] aimed to assess associations between the weight status of parents and obesity in
children across 23043 children and their parents. It was found that for those children with parents
who are obese, the Odds Ratio for obesity in children were reported to be 3.46 for females
(OR=3.46; 95% CI=3.03-3.94) and 2.79 for males (OR=2.79; 95% CI=2.44-3.20) as compared
to children with parents who were not obese. To expound upon the same, the authors denoted the
association between genetics as well as home environment and childhood obesity since children
are likely to imitate the dietary behaviors of their parents. Additionally, parents often tend to
provide their children with sugar, fat and salt rich processed foods due to their convenience and
lack of awareness resulting in increased risk of childhood obesity. Despite these findings, there is

2NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
limited exploration on the effectiveness of the nutritional and educational interventions involving
both parents and children for obesity treatment [1], [2].
Thus, limited research and the influence of parental behavior on childhood obesity form
the rationale underlying the development of this proposed program. Increased parental awareness
concerning children’s weight and possible implications are the reasons why administering this
behavior is required for this program [4] Additionally, the Centers of Disease Control and
Prevention [4], reports the prevalence of 18.4% of childhood obesity across 6 to 11 year old
children – a number which has tripled in comparison to findings during 1963 to 1965 and 1999
to 2000. Additionally, increased reliance, desirability and convenience towards fast foods are
inevitable. Thus, rising rates of obesity and associated food consumption patterns across this age
group are rationales for developing this program at this point of time and across this population
[6].
Theoretical Foundation
The trans-theoretical model of change will be used since it is based on the principle that
individuals are initially reluctant to change and specific interventions can increase their readiness
[7].
1. Pre-contemplation and Contemplation: Parents and children may be reluctant or
unmotivated due to reliance over current dietary patterns. Along with educational
sessions, group discussions will be used to encourage all parents and children to share
their doubts collectively. This is because peer groups, due to inclusion of participants
with similar objectives, generate greater understanding and participation.

3NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
2. Action and Termination: Nutritional and educational interventions will be implemented
involving both parents and children. After completion, subjective feedback follow ups
will be used for measuring sustainability [7].
Hypothesis and Specific Aims
Proposed Hypothesis: Implementation of a nutritional program involving both obese
children as well as deliverance of educational interventions to parents will contribute to greater
loss in weight, improved nutritional knowledge and compliance as compared to a nutritional
program involving only children.
Specific Aims and Hypotheses
1. To compare differences in weight loss between a nutrition program involving both
parents and children and a nutrition program involving only children by measuring
weight changes before and after the study.
2. To compare differences in nutritional knowledge between a nutrition program involving
both parents and children and a nutrition program involving only children by measuring
changes in nutritional knowledge scores before and after the study.
3. To compare differences in compliance between a nutrition program involving both
parents and children and a nutrition program involving only children by measuring
percentages of participants completing the program before and after the study.
Research Design and Sample Size
A randomized controlled trial will be used where the control group will comprise of
parents and obese children participating in a program where they will only receive written
handouts of nutritionally balanced, weight loss diets to follow. The experimental group will

4NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
comprise of parents and obese children participating in a program where both parents and
children will be involved in an educational, interactive session followed by being provided with
pictorial and written resources for balanced diet which both parents and children can follow.
Both groups will be evaluated for weight loss recorded before and after 3 months of
interventions as well as nutritional knowledge scores using the Mediterranean Diet Quality Index
(MDQI). Both groups will also be evaluated for trial completion [8].
Considering a population of 200 obese children, a confidence level of 95% and assumed
percentage error of 20% of participants who may not give consent to the study, the confidence
interval and sample was estimated to be 9.63 and 68 using the formula n = N*X / (X + N – 1),
where n is the sample size, X is the error percentage and N is the population. The sample size of
68 will then be divided equally between both experimental and control groups [9].
Sampling and Recruitment
Participants will be randomly selected using patient records across weight loss centers,
gyms and diet clinics because of the likelihood of identifying children who have visited due to
obesity in this organizations. Incentives to be used for participation will include telephonic
conversations made to parents where they will be gently persuaded on the details, benefits and
voluntary nature of the study. Financial incentives will not be used due to prevalence of bias. The
following inclusion and exclusion criteria will be considered based on its relevance to the
research hypothesis [10].
Inclusion criteria
1. Children aged 6 to 11 years based on data by [4].

5NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
2. Children admitted with a diagnosis of obesity, or a BMI above 23.9 kg/m2, within the last
3 to 6 weeks.
3. Parents/guardians of such children to proposed hypothesis [10].
Exclusion Criteria
1. Children not belonging to the age group of 6 to 11 years.
2. Children with a body mass index below 23.9 kg/m2 or admitted more than 6 weeks due
prevent increased experience as a confounder [10].
Methods
The primary objective is to compare weight loss and secondary objectives are to compare
nutritional knowledge and compliance between experimental and control groups. The control
group will comprise of parents and obese children participating in a program where they will
only receive written handouts of nutritionally balanced, weight loss diets to follow based on
national dietary recommendations [10]. The experimental group will comprise of parents and
obese children participating in a program where both parents and children will be involved in an
educational, interactive session followed by being provided with pictorial and written resources
for balanced diet which both parents and children can follow. The reason for the same is to
encourage parental involvement and influence in children’s weight loss interventions as well as
increase awareness concerning the effects of overweight and obesity in children. Both groups
will be evaluated for weight loss recorded before and after 3 months of interventions as well as
nutritional knowledge scores using the Mediterranean Diet Quality Index (MDQI). Both groups
will also be evaluated for trial completion [8].

6NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
Evaluation Outcomes
Demographics like weight, height, age, educational level, ethnicity and occupation of
parents and children who are participating will be first collected at baseline. Before and after the
intervention, weights of children for both groups will be collected. Before and after participation,
MDQI or nutritional knowledge scores of parents for both groups will be collected [10].
Table 1: Evaluation Instruments
Outcomes Instruments Statistical Tests
Body weight Measuring scales Descriptive statistics and
students t-test
Nutritional Knowledge MDQI scores – calculates
knowledge scores from 0
(low) to 10 (high) based on
servings of specific food
groups like fruits, vegetables,
olive, whole grains etc. [8].
Descriptive statistics and
students t-test
Compliance Number of participants who
completed the program
Percentage values
Analysis Plan
The data so collected, such as body weight and MDQI scores, will be analyzed using
Excel data sheets and calculated for descriptive statistics like mean and standard deviation.
Differences in values of weight loss and MDQI between the two groups will be calculated using
student’s t-test. Percentages will be used to calculate and compare the number of participants for
each group who have completed the program [11].
Budget and Justification
Local health centers where participants will be recruited will be targeted for funding due
to the greater availability of healthcare resources, instruments and patient influx in these

7NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
organizations. These organizations will also be conducted to recruit dietitians who may be
useful in delivering the educational sessions to parents [11].
Money Resources Details of Spending
$20 Recruiting a dietician
$10 Printing all educational, written resources
$20 Compensation given to health center for
assistance
$10 Arrangements for audio-visuals during
educational sessions and weighing scales
Total: $ 60
Sustainability
To ensure sustainability, parents will be followed up weekly using emails or telephonic
conversations, only with their consent to acquire subjective feedback as well as their current
experiences. This will allow timely identification of any issues in compliance and will allow the
research to motivate participants with their consent [11].

8NUTRITION PROGRAM AND PROPOSAL: CHILDHOOD OBESITY
References
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Latino population: a decade review of literature. Journal of immigrant and minority
health, 2017:19(2), 430-447. doi: https://doi.org/10.1007/s10903-016-0539-3.
2. Davidson, K, Vidgen, H. Why do parents enrol in a childhood obesity management
program?: a qualitative study with parents of overweight and obese children. BMC public
health, 2017:17(1), 159. doi: https://doi.org/10.1186/s12889-017-4085-2.
3. Bahreynian, M, Qorbani, M, Khaniabadi, B. M, Motlagh, M. E, Safari, O, Asayesh, H,
Kelishadi, R. Association between obesity and parental weight status in children and
adolescents. Journal of clinical research in pediatric endocrinology, 2017:9(2), 111. doi:
https://dx.doi.org/10.4274%2Fjcrpe.3790.
4. Berry, D. C, McMurray, R. G, Schwartz, T. A, Hall, E. G, Neal, M. N, Adatorwovor, R.
A cluster randomized controlled trial for child and parent weight management: children
and parents randomized to the intervention group have correlated changes in
adiposity. BMC obesity, 2017:4(1), 39. doi: https://doi.org/10.1186/s40608-017-0175-z.
5. Childhood Obesity Facts | Overweight & Obesity | CDC. Cdc.gov.
https://www.cdc.gov/obesity/data/childhood.html. Published 2020. Accessed April 19,
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Preschoolers With Obesity: A Randomized Controlled Trial. Pediatrics.
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8. Romanos-Nanclares, A, Zazpe, I, Santiago, S, Marín, L., Rico-Campà, A, Martín-Calvo,
N. Influence of parental healthy-eating attitudes and nutritional knowledge on nutritional
adequacy and diet quality among preschoolers: The SENDO
Project. Nutrients, 2018:10(12), 1875. doi: https://dx.doi.org/10.3390%2Fnu10121875.
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researcher, 2016:23(5). doi: 10.7748/nr.23.5.21.s5.
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e11964. doi: http://www.jmir.org/2019/2/e11964/.
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