Causes, Effects, and Prevention of Childhood Obesity: A Report

This report provides a critical analysis of the causes, effects, and prevention of childhood obesity, focusing on school-aged children in the United Kingdom. It examines the alarming rise in childhood obesity, highlighting key causative factors such as increased consumption of sugary foods, lack of physical activity, and socioeconomic inequalities. The report critically evaluates existing literature, including cohort and qualitative studies, to assess the physiological, social, and economic factors associated with childhood obesity. It emphasizes the importance of considering familial views, socioeconomic disparities, technology usage, and sleep duration in addressing the issue. Furthermore, the report explores the role of nurses in the treatment and prevention of obesity, advocating for changes in clinical practice to ensure equitable access to dietary and exercise education. The report also critiques three specific research papers, analyzing their methodologies, findings, and limitations. It highlights the need for future research to utilize randomized controlled trials and multi-centered trials to reduce errors and bias, and to conduct more follow-up studies to assess the long-term outcomes of various treatment measures. The report concludes by emphasizing the need for comprehensive health promotion strategies and a multidisciplinary approach to effectively combat childhood obesity.

Running head: CAUSES, EFFECTS AND PREVENTION OF OBESITY
CAUSES EFFECTS AND PREVENTION OF OBESITY
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1CAUSES, EFFECTS AND PREVENTION OF OBESITY
Executive Summary
In accordance to present statistics, the prevalence of childhood obesity has reached alarming
levels in the United Kingdom. Considering the present shortcomings in current nursing
intervention practice, the following report aims to critically evaluate the various causes,
effects and treatment pertaining to the prevalence of childhood obesity among school
children. For the assessment of this clinical statement, three papers were critically reviewed,
namely two cohort and one qualitative study, due to their assessment of various
physiological, social and economic factors associated with the incidence of childhood
obesity. Hence, according to the studies reviews, future nursing practice must aim to consider
the role of familial views, socioeconomic inequalities, usage of technology and sleep duration
in the occurrence of childhood obesity. To conclude, considering the lack of high quality
data, future research considering prevalence of childhood obesity must consider usage of
randomized controlled or multi-centred trials for reduction of errors and bias.

2CAUSES, EFFECTS AND PREVENTION OF OBESITY
Table of Contents
Introduction....................................................................................................................4
Identification of Existing Literature: Search Strategy...................................................5
Inclusion Criteria........................................................................................................5
Exclusion Criteria.......................................................................................................6
Critical Examination......................................................................................................6
Turner, Salisbury & Shield (2011).............................................................................6
Goisis, Sacker and Kelly (2015)..............................................................................10
Arora et al., (2012)...................................................................................................15
Contribution of other Research Designs......................................................................18
Conclusion....................................................................................................................18
References....................................................................................................................20
Appendix One – Tables showing results from database searches................................26
Table 1 – Database results from search term ‘Causes, Effects and Prevention of
Childhood Obesity’..............................................................................................................26
Table 2 – Database results from search term ‘Causes, Effects and Prevention of
Obesity among children’......................................................................................................26
Table 3 – Database results from search terms ‘Causes, Effects and Prevention of
Obesity among school age children’....................................................................................26
Appendix Two................................................................................................................0

3CAUSES, EFFECTS AND PREVENTION OF OBESITY
Table 4 – Table showing relevant papers after funnelling and expanding of search
terms.......................................................................................................................................0
Appendix Three..............................................................................................................1
Table 5 – Table showing an overview of the chosen articles....................................1
Appendix Four: CASP Analysis: Qualitative Research (Turner, Salisbury & Shields,
2011)..........................................................................................................................................1
Appendix Five: CASP Analysis: Cohort Study (Goisis, Sacker & Kelley, 2015).........2
Appendix 6: CASP Analysis: Cohort Study (Arora et al., 2012)...................................4

4CAUSES, EFFECTS AND PREVENTION OF OBESITY
Introduction
The prevalence of obesity in the United Kingdom is alarmingly high, as claimed by
the Organization for Economic Cooperation and Development (Trembling et al., 2017). There
has been a 92% increase in obesity in the United Kingdom, since the year 1996. The country
holds the highest rank of obesity amongst European countries, with an estimated 27% of the
population being inflicted. Almost half of the children of the nation are overweight, with one
child being obese amongst five (Zilanawala et al., 2015). Increased consumption of sugary
and calorie-dense foods, lack of physical activity along with adherence to sedentary lifestyle
is some of the key causative factors contributing to childhood obesity (Foerste et al., 2016).
However, according to Ratcliffe and Ellison (2015), social and economic inequalities
amongst underprivileged families, stereotypes associated with culturally acceptable physical
features and parental doubts concerning the expertise of public health professionals often act
as barriers for the treatment of childhood obesity. Despite governmental efforts to induce
taxation on sugar-containing foods and promotion of importance of exercise, there still lies a
need to execute further health promotion strategies for the prevention of childhood obesity
(Hawkes et al., 2015). Nurses, as stated by Sivero et al., (2016), lie at the forefront for the
treatment and prevention of obesity amongst children, through the provision of supervised
exercise and dietary intervention strategies, nutritional consultation, involvement of
concerned parents through usage of a family-centred approach and the adoption of a
multidisciplinary team garnering support from various professionals. However, current
nursing practice is still far from considering the inequitable distribution of resources amongst
low income group families, and hence must amend changes related to clinical practice at the
community level, in order to impart effect dietary and exercise education and treatment to
every child, irrespective of income (Blackburn et al., 2015).

5CAUSES, EFFECTS AND PREVENTION OF OBESITY
The following report attempts to critically evaluate existing literature pertaining to the
causes, effects and prevention of obesity among school children. Three articles have been
chosen due to their assessment of a variety of social, physiological and economic factors
pertaining to the prevalence of obesity in children. While the cohort study by Goisis, Sacker
and Kelly (2015) attempts to economically associate the occurrence of obesity and the low
financial status of children’s families, the cohort study by Arora et al., (2012) attempts to
uncover the links between adolescent sleep cycles, physiological complications of obesity
and academic performance. Lastly, the qualitative study by Turner et al., (2011) has been
assessed which focuses on the social views pertaining to the treatment facilities of childhood
obesity, with due emphasis on parental views and opinions.
Identification of Existing Literature: Search Strategy
Databases such as Medline, COCHRANE, BioMed Central, PubMed and CINHL
was assessed with the aid of Boolean operators and key words ‘obesity’, ‘childhood
obesity’, ‘school children’, ‘causes’, ‘prevention’, ‘effects’ ‘treatment’. The search strategy
yielded 730 articles. Articles which dealt with paediatric obesity, obesity in young
adulthood, or the policies and programmes associated with obesity and health promotion
were excluded. Articles referring to countries other than the United Kingdom were excluded.
Researches which discussed concerning the various economical, social and physiological
factors associated with the causes, prevention and treatment of obesity among school children
were included.
Inclusion Criteria
 Studies conducted in the United Kingdom
 Studies assessing childhood obesity
 Research spanning from 2010 to 2017

6CAUSES, EFFECTS AND PREVENTION OF OBESITY
 Studies containing the keywords ‘obesity’, ‘childhood obesity’, ‘school children’,
‘causes’, ‘prevention’, ‘effects’ ‘treatment’
Exclusion Criteria
 Studies conducted in countries apart from the United Kingdom
 Studies assessing paediatric and adult obesity
 Studies dealing with policies and programmes associated with obesity and health
promotion
 Research showing irrelevance to keywords ‘obesity’, ‘childhood obesity’, ‘school
children’, ‘causes’, ‘prevention’, ‘effects’ ‘treatment’
However, upon conductance of the search strategy, it was observed that there was a
dearth of researches utilising multi-centred of high quality or randomized controlled trails,
which are regarded as possessing high levels in evidence based research, as stated by Deaton
and Cartwright (2018). Further, there also seemed to be a lack of sufficient follow up studies,
which could have proved to be beneficial in the evaluation of the long term outcomes of the
various treatment measures undertaken for childhood obesity (Weber et al., 2014).
Critical Examination
Turner, Salisbury & Shield (2011)
 The research by Turner, Salisbury and Shield (2011), aimed at evaluating the
experiences and opinions felt by parents with regards to the provision of primary care
settings directed at the treatment of obesity in school going children of the United
Kingdom. The research included an analysis of the views from 15 parents of children
belonging to the age group of 5 to 10 years, through the usage of interviews in Bristol,
England, at a clinic based in the hospital, providing treatment for childhood obesity.

7CAUSES, EFFECTS AND PREVENTION OF OBESITY
 The authors clearly stated the aims of their research as evident in their objectives
which were directed at exploration of the experiences and views of the parents with
regards to the treatment of obesity in primary care settings. According to Taveras et
al., (2015), primary treatment principles have been documented to yield beneficial
effects in the treatment of obesity amongst school-aged children. However, according
to Syrad et al., (2015), there has been a dearth of evidence considering the view of
parents with regards to such treatment for their children, which the authors have stated
clearly as their primary research question.
 The purpose of conducting qualitative research is to uncover the deeper explanations
pertaining to individual’s feelings, experiences, opinions and actions as per their
present surroundings (Lewis, 2015). With this regards, usage of a qualitative study by
the authors is an appropriate ethnomethodology since the study focuses on what
parents truly feel concerning the quality of treatment received by their obese children.
 Despite the potential advantages of such a methodology for the purpose of assessing
the claimed research question, the authors however, did not mention the factors of
reasons outlining their selection for such a research procedure. However, considering
the presence of limited information pertaining to the views of parents, the authors
attempted to overcome this prevalent research gap through usage of a qualitative
study.
 The authors clearly mentioned the participant recruitment process which included
parents of school children who were obese, belonging to the waiting list of clinics
providing obesity treatment, recommended by general practitioners dealing with
treatment of obesity and participants of the Mind, Exercise, Nutrition, Do It! Program
initiated by the Childhood Obesity Foundation.

8CAUSES, EFFECTS AND PREVENTION OF OBESITY
 While the authors did not state separately their reasons or appropriateness for
recruiting parents as research subjects, there was however, a mention that the lack of
information pertaining to the parents’ opinion on childhood obesity treatment was the
driving force behind their research statement. The authors however, stated that the
children belonging to primary schools were the key focus of the study, due to
governmental aim of eradicating childhood obesity in the future.
 There was also an absence of discussion considering the details of participant
recruitment or reasons for non-participation by some subjects. Data collected by the
authors were in the form of in-depth interviews. Considering the qualitative nature of
the study which is aimed at assessing the feelings and experiences of participants,
usage of an interview, as stated by Elo et al., (2014), is an appropriate research design
due to the presence of open-ended questions which would provide greater scope for
in-depth expression of opinion as compared to close-ended questions prevalent in
quantitative studies.
 However, the authors provided no justification of the reasons for such data collection
methods and their possible modification during the course of the study. However,
considering the limited subject size and difficulty in recruitment, the authors found it
difficult to assess the presence of data saturation. However, the authors mentioned
that the interviews were conducted at the home of the parents, or through telephonic
conversation, and ranged of durations from 30 minutes to 2 hours.
 The recordings were documented through audio taping and transcribed verbatim.
Qualitative studies, as opined by Morse (2015), often possess major disadvantages in
the presence of researcher bias in interview conductance and subject selection, often
leading to incorrect results. However, the following paper outlines no mention by the
authors considering the presence of possible bias during research question

9CAUSES, EFFECTS AND PREVENTION OF OBESITY
formulation, recruitment and possible future implications of research. However, the
authors mentioned that they avoided generalisation in their subject selection, through
recruitment of parents who were aware of the obese condition of their child, since
most parents remain oblivious to their child’s health status.
 While the authors mentioned no information pertaining to the acquisition of subject
consent or confidentiality of information, the research has obtained ethical approval
from the Southmead Research Ethics Committee and the Multi-Centre Research
Ethics Committee. For the purpose of explaining the aims of the research, the authors
engaged in the provision of a topic guide to the subjects which clearly stated the
purpose of the study. Considering the rigor of the data collected, the authors presented
no critical examination of the presence of their bias pertaining to the functions of
analysis and selection of data.
 The data was analysed thematically with the usage of a framework approach. The
authors engaged in extensive reading of the transcripts for the purpose of analysing
the views of the parents which could further be studied in the form of themes and
development of a coding tree. The transcripts were coded by three of the authors
through the usage of NVivo, a software tool. Upon analysis through the framework
approach, the authors tabulated the data in the form of specific themes. Information
pertaining to sufficient of data was absent with respect to the limited subject size and
authors’ difficulty in identifying the possibility of data saturation.
 The results of the study were discussed explicitly, related to the original research
questions, as clearly evident in the findings indicating feelings of fear, reluctance and
concern about their child being judged with respect to primary care treatment of
obesity. Along with findings indicative of a parental negative view, the results also

10CAUSES, EFFECTS AND PREVENTION OF OBESITY
indicated a positive view of parents pertaining to the beneficial implications of
primary care treatment for the management of obesity in children.
 The final results of the study, clearly indicated the parental feelings and views
concerned with the provision of primary care obesity treatment in children, as was
associated with the research question. Despite the absence of discussing the credibility
of the results, the results of the study were evaluated by three of the authors who were
involved in the study. Hence, the qualitative study performed by Turner et al., (2011),
paves the way for future positive implications in research through consideration of the
parent’s concern, which was till now largely left out in terms of research as well as
during the provision of treatment by the practitioner’s of the children.
 According to Davis (2016), for future treatment of obesity, the concerned general
practitioners must not only provide quality obesity treatment for the concerned
children, but must also disseminate information pertaining to childhood obesity, and
actively involve parents in the management of additional feelings associated with the
child, such as low confidence and self-esteem. Due to the prevalence of judgment
along with variations in the provision of treatment, parents often prefer additional
secondary treatments in the form of multidisciplinary clinics. Hence, for future
practice, individual clinicians must seek to evaluate a child’s obesity treatment and
follow-up with empathy, devoid of judgment (Reece, Bissell & Copeland, 2016).
Goisis, Sacker and Kelly (2015)
 The research by Goisis, Sacker and Kelly (2015), attempted to establish an association
between the prevalence of childhood obesity and the financial background inhabited
by their families, through the performance of a cohort study. Despite the availability
of sufficient evidence considering the alarming prevalence and negative health
implications of childhood obesity, there has been limited research considering the

11CAUSES, EFFECTS AND PREVENTION OF OBESITY
obesity susceptibility risks associated with economic factors such as low income
group and presence of social inequalities amongst children in the United Kingdom
(Stuart & Panico, 2016).
 Considering the limited information, as stated by Dumuid et al., (2017), indicating the
lengthening of such socioeconomic inequities and the resultant possibilities of such
families being compelled to engage in unhealthy dietary and lifestyle behaviours, the
concerned authors performed a cohort study on children along with measurement of
additional factors such as income of the family and prevalence of inactivity.
 In accordance to the research question stated, the study performed by the authors
addressed a clearly focused on the issue, where children in the United Kingdom
belonging to compromised socioeconomic backgrounds comprised of the researched
population, the prevalence of widening socioeconomic inequity and poor financial
capacity were the risk factors and the association of these with the negative
implications of health, diet and resultant obesity. The classification of economic risk
factors contributing to either increments and decrements in weight were the third and
final outcome considered by the concerned authors.
 The recruitment of the study population by the authors were performed in an
acceptable manner as evident in their selection of subjects who were children, from
the Millennium Cohort Study, which is a nationally acclaimed research in the United
Kingdom. The sample population recruited by the authors was clearly defined as it
involved the selection of 11, 965 children spanning across 19, 244 families belonging
to four nations of the United Kingdom, including regions of diverse ethnic and
economic backgrounds.
 The inclusion of childhood and familial data across various age groups of 9 months, 3,
5, 7 and 11 years, and the additional research conductance of interviews at home, for