Managing Childhood Obesity in the US

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14.04.2022
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Part1: Managing Childhood Obesity in the U.S: An Integrative Review

Abstract

The goal of this integrative review was to identify the most effective interventions that have so far been used to manage childhood obesity in the United States. The aim of the review was to identify the problem and recommend a solution that will enable the country to restore the health of its children. At 16% childhood for obesity and 31% for overweight, the statistics are rather alarming with regard to the health status of children in the US. The review started out with a search for the existing literature on MEDLINE (Web of Science), CINAHL and Proquest. The keywords used in the search included ‘childhood obesity in the US,’ ‘interventions for childhood obesity in the US,’ ‘childhood obesity interventions in the US,’ and ‘managing childhood obesity in the US.’ About 270 articles were found, but after effective screening by independent investigators, only three matched all the inclusion criteria for this study. Since childhood obesity affects too many children, it is about time a definitive solution is obtained. Research shows that the participation of parents improves the chances of success for the intervention. However, more research needs to be conducted in relation to the effect of the specific contexts of the obese child. Race, gender, ethnicity, genetics, socioeconomic status, parental availability, and willingness, as well as parent’s level of education and family setting are only some of the identified areas that must further be investigated.

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Introduction

Childhood obesity refers to a pediatric condition in which a child has a very high body weight that puts his/her health at risk. O’Connor, Evans, Burda, Walsh, Eder and Lozano (2017) regard obesity as ‘a condition that is described by the presence of excess body fat. Conversely, Fulkerson, Friend, Horning, Flattum, Draxten, Neumark-Sztainer, Gurvich, Garwick, Story and Kubik (2017) broach the issue of obesity by clarifying it simply as an outcome of caloric imbalance. Equally, when a child is constantly consuming more calories than the/she can burn, he/she ends up having too much fat deposit in his/her body tissues. The prevalence of obesity within the United States has been on an upward trend for the last twenty years. Dietary changes globally have led to an increase of the obesity rates in the world. For instance, in the US, at least 68% of the adults in the US are obese, with childhood obesity being a significant risk for adulthood obesity. In the past, being a ‘fat kid’ was considered detrimental only psychologically due to bullying, but with time, the health implications of obesity have become better understood (Ling, Robbins, & Wen, 2016). It thus follows that managing childhood obesity would be a primal aspiration of the American health care system. Many studies have since been conducted with the aim of establishing why there are too many obese children and what can be done to stop the trend. The reality, however, is that despite all the effort in writing, the numbers keep escalating to the point that childhood obesity is a fully-fledged pandemic with over 16% of the American children suffering from obesity while another 31% are overweight (Ling, Robbins, & Wen, 2016).

Childhood obesity has dangerous implications to the child and their family members. Some of the main medical co-morbidities associated with childhood obesity include asthma, high blood pressure, diabetes, hyperlipidemia, and dental health issues (Ling, Robbins, & Wen, 2016). Studies show that there is a correlation between childhood obesity and asthma, with some of these studies showing a differential effect between the sexes such that obese boys are more likely to have asthma than their obese female counterparts (Ling, Robbins, & Wen, 2016). The differential effect is, however, not a definite conclusion, with the final deduction being that obese girls have as high a risk for asthma as obese boys. High blood pressure is associated with obesity from the context of metabolic risks. An obese child is consistently at risk for high blood pressure based on the definitive association of a high BMI with the occurrence of high blood pressure for both boys and girls. Conversely, an obese child has a 95% likelihood of suffering high blood pressure, with the statistics indicating that this is twice the likelihood of a child who is not obese (Ling, Robbins, & Wen, 2016). Similarly, obese children have a higher risk for diabetes and hyperlipidemia regardless of their age or sex. It was also noted that the higher the child’s degree of obesity, the more dangerous his/her metabolic risks, thus implying the possibility of worse health outcomes. It might also be important to appreciate that other than the medical effects of childhood obesity, there are quite a number of psychological effects as well. These include ADHD, sleep apnea, and behavioral problems.

Many American parents do not pay attention to their child’s weight issues until the child’s health is significantly affected. Studies indicate that the risks for childhood obesity start even before the child is born. Moreover, there is time to prevent childhood obesity or to control it as much as possible with the goal of keeping the child from reaching extremes that could be detrimental to his/her overall health. This integrative review aims to identify the most effective childhood obesity as applied in the United States. While some progress has been made, there is a need to find effective remedies so that American parents can raise healthy children with manageable weight ranges. The review will examine the existing literature on the childhood obesity management, identify existing knowledge gaps on the subject at hand, and establish recommendations for practice and research with the goal of effectively dealing with the problem of childhood obesity in the United States.

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Methods

This integrative review is based on the method proposed by Holly (2014). As such, the steps used include problem identification, literature review, study appraisal, data analysis, and summarization of results. After the identification of the problem, which in this case is childhood obesity in the US, a comprehensive literature search was conducted across a number of online databases. These databases included MEDLINE (Web of Science), CINAHL and Proquest. The keywords that were used for the search included ‘childhood obesity in the US,’ ‘interventions for childhood obesity in the US,’ ‘childhood obesity interventions in the US,’ and ‘managing childhood obesity in the US.’ More specific criteria used in the search included: (a) studies conducted on children in the US and (b) screening and interventions conducted on children in the US. Studies that focused on the children who were not in the US were excluded, as were any research that focused on adulthood obesity within the US or beyond. Studies that were older than five years were also automatically excluded from the review owing to the dramatic changes in research that can occur within a span of five years. It was agreed that the older articles might not be relevant to the current contexts with regard to the state of knowledge. After identifying the initial studies that will be included in the review, their reference lists were also combed through in search of additional articles that were relevant to the study. Once all the articles were identified, duplicates were found and removed from the list.

The initial search resulted in 270 articles, of which 253 were duplicated and 3 were of no consequential relevance to this review. The remaining 14 articles were then screened through their abstracts and 8 did not meet the inclusion criteria. 6 of these were studies conducted overseas and 2 featured discussions about adulthood obesity alongside childhood obesity. The remaining 6 articles were then assessed in their full texts and only half of them chosen for inclusion in the review. These articles were then organized based on the author(s), year of publication, research question, research design, sample size, findings, strengths, and limitations.

Results

During the review, a major focus was on the interventions that are used to manage childhood obesity in the US. A summary of the aims and objectives as well as the methods used in each one of the articles is provided, along with a critical but brief discussion of the issues addressed in each article, the strengths, the limitations and how the articles compare to one another. The overall summary is provided in Table 1 below.

Table 1: Summary of the Articles on Childhood Obesity Interventions

Author(s)/Year Method Sample Aim Findings
Jiying Ling, Lorraine B Robbins and Fujun Wen (2016) Systematic review of Randomized Control Studies 32 studies met all inclusion criteria To examine the impact of interventions used in the prevention and management of overweight/obesity among children aged 2–5 years and to explore the factors that influence the outcome of these interventions Management interventions are more effective than prevention ones

Management interventions to include parents as the agents of change

Nutrition and physical activity should be used alongside behavioral therapy and interactive hands-on experiences

Jayne A. Fulkerson, Sarah Friend, Melissa Horning, Colleen Flattum, Michelle Draxten, Dianne Neumark-Sztainer, Olga Gurvich, Ann Garwick, Mary Story, Martha Y. Kubik (2017) Randomized Controlled Trial 160 children at the age of 8 -12 years and their parents for a period of 33 months To establish the impact of the

Healthy Home Offerings via the Mealtime

Environment Plus program intervention on the childhood obesity prevention.

The Healthy Home Offerings via the Mealtime

Environment Plus program targets the whole family, thus making it more effective in improving the child’s nutrition-related behaviors. This is a positive indicator of the intervention’s effectiveness in the prevention and management of childhood obesity

Elizabeth A. O’Connor, Corinne V. Evans, Brittany U. Burda, Emily S.Walsh, Michelle Eder, Paula Lozano (2017) Systematic review

 

154 articles, 59 of which were randomized controlled trials which met all inclusion criteria To provide a systematic review of the advantages and disadvantages of screening and treating pediatric and adolescent overweight and obesity

 

The use of medication yields limited the benefits in the case of childhood and adolescent overweight and obesity

The lifestyle-based interventions have a higher success rate in both children and adolescents, thus making them the preferred options

Research Aims

Of the three articles reviewed in this paper, two were systematic reviews aimed at examining the impact of interventions that have so far been applied to prevent and manage obesity in children, specifically within the United States. Ling, Robbins, and Wen (2016) looked into the impact of interventions used in preventing and managing childhood overweight/obesity specifically amongst children who were aged between of 2–5 years. Besides, in their study, Ling, Robbins and Wen (2016) reviewed 32 studies evaluating the outcomes of intervention strategies used in the prevention and management of childhood obesity. The articles mainly described the interventions and the outcomes recorded after a given period of time. The sample population for these studies ranged from 33 children and 1663 children (Ling, Robbins & Wen, 2016). After a keen analysis on the impact of the numerous interventions cited by the reviewed researchers, the authors concluded that the interventions used for childhood obesity are more effective in managing than in preventing the condition. Therefore, while prevention is the ideal course of action, more effort has so far been directed towards successful management. The researchers also found that the management interventions have a better chance at succeeding when parents are included as agents of change in the process. All the changes that the child must make in relation to his/her lifestyle must involve the parents in order to succeed. It is also noted in this study that the effective interventions incorporate nutrition and physical activity alongside behavioral therapy and interactive education as well as experiences.

The second study is also a systematic review aimed at examining the harms and benefits of screening and treating obesity and overweight in children and adolescents used 154 articles, 59 of which were randomized controlled trials. The researchers in this study conducted their searches from databases such as MEDLINE, PubMed, PsycINFO, the Cochrane Collaboration Registry of Controlled Trials, and the Education Resources Information Center. They also used the references to the relevant publications identified from the initial sites and related government websites. This research was conducted from January 2016 through to December 2016, allowing the researchers enough time to gather all the data that they needed for a reliable conclusion (Fulkerson et al., 2017). The identified articles were independently reviewed and the useful data extracted only from the trials that were ranked as good or fair. As the researchers generally sought to establish the effect of treatment interventions, they focused on measuring the quality of life, changes in BMI, cardiometabolic outcomes and other health outcomes, as well as the negative effects of the interventions on participants. Furthermore, the researchers were interested in establishing whether there was any effect for screening a child for excess weight. The findings indicated many mean reductions in weight for lifestyle-based interventions, with limited support for the significance of pharmacological interventions.

The third study was a randomized controlled trial with a sample population of 160 children aged between 8 and 12 years. In this case the researchers focused not only on the children but also on the children’s parents as a pivotal part of the child’s support system. The goal was to determine the importance of parental involvement in the process of managing and preventing childhood obesity. The researchers were particularly interested in finding out how effective the Healthy Home Offerings via the Mealtime Environment Plus Program is an intervention. The researchers started by collecting the baseline information for the study for 12 months before implementing the interventions and recording the changes or lack thereof, for another 12 month period (O’Connor et al., 2017). A follow-up was conducted after the post-intervention data collection period, for other 12 months. The parents were subjected to interviews about the home food environment while the children were mainly given dietary recall interviews. Both parents and children were also given psychosocial surveys to complete, followed by a retail gift card after the data collection exercise. The data was then analyzed using multicollinearity diagnostics and the models fit with the help of the likelihood-based estimation method. The specific approach employed the restricted maximum likelihood for the continuous outcomes and the Gauss-Hermite quadrature maximum likelihood for the binary outcomes. The three main measures used in this RCT included the family home’s food environment factors, the parent’s personal and behavioral factors, and the child’s personal and behavioral factors. The obtained data were then compared to show any improvements experienced by the participating families with time. The availability of fruits and vegetables at home improved for a significant majority of the intervention group at post intervention and during follow up; although, there was no significant difference between the control group and the treatment group before the intervention. The parents in the intervention group also exhibited higher levels of self-efficacy in relation to making healthy meals and identifying the right portions during the post-intervention and follow-up phases; although, no significant differences had been recorded prior to the intervention.

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Intervention Outcomes for Childhood Obesity

From the narrative summary technique that was used, Ling, Robbins, and Wen (2016) established a number of facts in relation to childhood obesity interventions and their outcomes. According to these researchers, the management interventions are more effective than the prevention interventions, meaning that in order to deal with childhood obesity in the US at the moment, more effort must be made towards managing the condition. To manage childhood obesity, the applied interventions include home-based, school-based and community-based programs that were all meant to provide the children with all the support that they needed to make the necessary changes in their lifestyles. The management, in this case, succeeded because there was enough rallying around the children with a visible problem. On the other hand, prevention is often handled in isolation, thus making it a more difficult course of action.

Of the successful interventions included in this study, 6 out of 8 involved the parents of the child as a support system, thus making it easier for the child. The parent, in this case, is an agent of change, meant to encourage and support the child through the duration of the intervention. Without the parent’s support, it can be expected that the child will not be able to make any successful lifestyle changes. Children spend time at home, meaning that the home must be conducive to the changes that they are expected to make or the children will not be able to maintain these changes and improve their weight and health outcomes. One intervention that involved the child only in 30 minutes of physical activity daily for 9 months was also successful (Ling, Robbins, & Wen, 2016). The school gave the intervention the structure, discipline, and consistency that are needed to make it a success. The child on their own may not be able to maintain such a high level of discipline required to indulge in exercising for a period of 9 months, but with the encouragement of the school staff, they were able to do so, with impressive results.

In addition, these authors found that nutrition and physical activity should be used alongside behavioral therapy and interactive hands-on experiences for the parents. Furthermore, it is not enough to teach the parents about nutrition and physical activity. They must also be able to provide social support, teach the children about healthy coping skills, learn effective parenting skills that will nurture the children to better health, and generally attain some hands-on experience in the physical activity that the children need. While the children with obesity simply need to learn about nutrition and engage in physical activity, the efforts that their parents make in learning all the necessary skills and abilities make a great difference on the overall impact of the intervention. The researchers also noted that using nutrition or physical activity alone did not bring in a positive outcome, meaning that the two must always be combined for the intervention to work.

Likewise, Fulkerson et al.’s RCT successfully investigated the effectiveness of the Healthy Home Offerings via the Mealtime Environment Plus Program with the conclusion that the support of the family leads to positive weight and behavioral outcomes when managing childhood obesity in the US (2017). The Healthy Home Offerings via Mealtime Environment Plus Program helps to transform the child’s nutrition-related habits through practice within the family setting, thus enabling the child to appreciate the kind of diet that is good for his/her health. Such a child is eventually more willing to eat fruits and vegetables and gradually grow less picky about the meals that they are offered at home. The family, in this case, becomes the trendsetter so that the child redefines the norms with respect to his/her nutrition. Another impressive result in this study was concerning the parents’ improvements in relation to their child’s nutrition. The findings showed that during the follow-up, parents reported higher scores for self-efficacy with regard to meal planning and cooking skills. Parents generally got to become better at feeding their child healthy home-made meals that were packed with the right nutrients in the right measures for the child. This means that the parents must be willing and able to take responsibility for their role in the child’s predicament and thus take the necessary steps to become better. This was the main reason for the positive outcomes associated with the Healthy Home Offerings via the Mealtime Environment Plus Program.

O’Connor et al.’s systematic review concluded that the lifestyle-based weight loss interventions are more effective than the use of medication in childhood and adolescent obesity and overweight (2017). This is mainly due to the fact that there were no positively conclusive findings in favor of the use of medication in the management of childhood and adolescent obesity and overweight. The children who went through the lifestyle-based intervention programs that involved changing their diets and becoming more physically active however displayed many positive results in relation to their weight loss and health outcomes. These children registered improvements in blood pressure compared to the control groups, with limited information regarding their glucose and insulin levels. Thus generally, the study established that while medication may be an option as an intervention for childhood overweight and obesity, the lifestyle-based interventions have a greater success rate for the children. The pharmacological interventions also tend to have adverse side effects in some children while the risks for side effects in the lifestyle-based changes are minimal, if any.

Sample Characteristics

The first study featured primary research that targeted children between 2 and 5 years. The second study, on the other hand, targeted children between 8 and 12 years, while the last study was more interested in children and adolescents aged between 2 and 18 years (Ling, Robbins, & Wen, 2016). Regarding the exact percentage of demographics in the studies, it can be appreciated that there was only one primary research. Therefore, the demographic data could only be obtained for that one study. The following study included a sample population that was 95% female, 3% – Hispanic-Americans, 77% white, 15% Afro-Americans and 8% multiracial, American Indian or Asian. For the systematic reviews, there was no sufficient differential data to warrant a report on the demographics featured in the researches that were reviewed.

Strengths and Limitations

The systematic reviews were limited in the scope of their data. For example, neither research teams were able to report on the number of children in the control groups who were independently seeking interventions for their condition. It is possible that some of the control group data was flawed due to personal interventions by the obese and overweight children, especially for the systematic review involving the adolescents. Another limitation that can be noted is with respect to the RCT. The participants self-selected themselves for the study, meaning that they are not entirely representative of the general population. Almost all of these participants ate at home with their families at least five times a week, and their parents were well educated. This indicates an inability to apply the same conclusions on the population where the family ate together less than 5 times a week and the parents were not well educated. The greatest strength of this review is that the independent investigators in the systematic reviews were very strict in their screening, thus ensuring that only the most relevant, most valid and most reliable researches were picked for inclusion. The RCT also used a standard measurement instrument for the quality of foods that are served during family meals for the participating families, thus making it easier to have a generally accurate measurement across the board.

Discussion

The results of this review are in favor of lifestyle-based interventions for managing obesity in children within the US. There are, however, a number of important considerations that will make the interventions more successful. First, any interventions used in childhood obesity management must be lifestyle-based (Ling, Robbins, & Wen, 2016). Besides, instead of prescribing pharmacological interventions that may or may not eventually harm the child, it is more effective and generally responsible to prescribe the necessary lifestyle changes that have been proven to enable weight loss and improved health outcomes in obese and overweight children. In this case, lifestyle changes are more consistent and thus more reliable than the use of medication, especially owing to the high risk of regaining lost weight. Comparatively, the only way to sustainably improve the child’s health is to help him/her change his/her lifestyle rather than putting him/her on medication for the rest of his/her life.

A second point to note refers to the need for holistic interventions that cover all aspects of the child as related to his/her health and weight. The interventions that only focused on nutrition were noted to have failed in showing any weight loss outcomes, as were interventions that focused only on physical activity. This means that unless the intervention incorporates both physical activity and nutrition, the child is not likely to experience any positive results in the management of obesity. Physical activity and nutrition must go hand in hand. In the reviewed studies, it was established that the interventions in which both parents and schools were involved in physical activity and nutrition were more successful. The complete cooperation among the parents, the school and the community is the best way to support the child and enable him/her not only to lose the excess weight but also to stay healthy and physically active for the rest of his/her life. The right intervention must enable changes within the home, the community and the school in order to accommodate the weight loss needs of the child. A 30-minute physical activity period every day for the duration of 9 months at school, coupled with a supply of healthy meals with enough fruit and vegetable at home. Similarly, the serving of water and 100% fresh fruit juices in small portions only during community gatherings ensures that the child is well supported as they manage his/her condition (O’Connor et al., 2017).

Parents play a critical role in the childhood obesity management. In the reviewed studies, it was noted that the active involvement of parents in the childhood obesity management always had better outcomes. The parents, in this case, are not just limited to providing healthy foods for the child. They have an obligation to inspire and motivate the child through their intervention so that he/she can be healthy and happy as he/she grows into adulthood. While physical activity is mostly attained at school and within the community through active sports, parents are encouraged to be hands-on with regard to indulgence in physical activity so that they can understand, appreciate and even offer to engage the child in these physical activities. The studies that monitored the progress of the parents with interventions also indicated that as the parents got better with nutrition, coping skills, and behavioral therapy for their child, the child also got better in managing his/her condition more effectively. The role of the parents in this case thus becomes more pivotal concerning the weight and health outcomes of the child.

It is clearly understood and appreciated that there is a genetic component to childhood obesity, along with cultural or ethnic risk factors as well. Yet, throughout the review, it was noted that there was a gaping hole in the differential statistics as related to the demographic groups that were included in the numerous studies. In order to be certain about the specifics of an intervention that would work for all obese children in the US, it is important to consider the impact of their cultural background, socioeconomic status and the education level of their parents (O’Connor et al., 2017). The social contexts of the child may also have a significant impact on his/her response to interventions. Consequently, research must also be conducted to determine the impact of coming from a single parent home, a violent home and a home where parents abuse drugs and alcohol. The parents who are always at work or traveling and are thus unable to prepare and share meals with their children or even to take them out for physical activity also fall under the category of the parents who are likely to prevent their child from testing well after an intervention. All these are aspects that affect parenting skills and thus influence the ability of the parents to provide the required support for the child during and after the intervention. The realities, in this case, is that the child needs all the support that he or she can have, but if the parents are unable to provide this support for one reason or another, it is unlikely that the intervention may work.

Conclusion

Substantial work has been done on the subject of managing childhood obesity in the US, but more needs to be done with a specific interest in the type of families that these children come from. The current findings indicate that the obese children who have the support of their parents and teachers through the intervention process are likely to record positive outcomes at the end of the intervention. However, the reality is that not all children in the US come from a family of loving, available, capable and supporting parents as described in the reviewed articles. It must also be appreciated that the ethnic and genetic aspects of the participants in the studies were not considered. It is important to establish whether the said interventions that work for a white child will be just as effective for an African-American, American-Indian or Hispanic-American child. In addition, it will be good to establish whether there are any implications if the child’s family has a significant population of obese people. Another critical consideration is the fact that nutrition is an impediment to the management of childhood obesity for the families from the poor neighborhoods where nutritious foods are expensive and thus substituted with frozen pizza and canned soups among other things. Consequently, it is advisable to establish whether the intervention mechanisms in place work for the children whose families are poor and as such have limited access to fresh foods. The only way to ascertain that these interventions are the most effective is to establish if they work for all children or whether there are modifications that must be made to the intervention based on the race, gender, ethnicity, genetics and socioeconomic status of the child and the availability of the parent.

Part 2

Quality Improvement Plan

Using the PDCA method of quality improvement, the first step involves planning the improvement based on one’s appreciation and investigation of the problem at hand. In this case, the problem is the prevalence of obesity amongst the children of the United States. As of 2014, over 16% of the children are obese and 31% are overweight (Karp & Gesell, 2015). In order to effectively manage childhood obesity, it is important to look beyond the general contexts of the obese children and focus on their individual situations as representative of the American children. It was established in the integrative review above that the interventions were only likely to be successful if they involved parents. The conclusion, in this case, was that the interventions must involve the child’s parents if they are to succeed. That way, in order to improve the quality of the interventions that are used to manage childhood obesity, a plan must be devised to ensure the participation and support of the child’s parents. It is important to consider in this case that while not all American children have or live with their parents; the term “parent” is used loosely to include the child’s guardians.

Problem Identification

According to the three reviewed articles, the problem with childhood obesity management interventions in the US is the absence of the parents in an active capacity. All the interventions that featured active participation and support of the parents recorded great weight loss and health outcomes based on the level of lifestyle change support the children were able to obtain from their parents. Therefore, without the parents, the intervention will not be effective. The challenge, however, is that parents are not always available or willing to participate in the interventions unless they have to. The plan, in this case, is to make it mandatory for these parents to avail themselves. Most participants in interventions for childhood obesity are recruited in the health care centers, schools and community centers where the children’s parents can also be easily accessed. Comparatively, the best approach is to seek out the parents as a prerequisite for enrollment in any intervention program. The interventions will not necessarily exclude the children whose parents do not actively participate. Instead, policies will be created to ensure that it becomes mandatory for the parents of obese children to participate in their interventions for the management of childhood obesity (Pulgar?n, 2013). The justification for such a policy is that childhood obesity is an important burden to public health care, and without effective interventions, this burden is carried throughout the child’s lifetime as it turns into adulthood obesity and a lifetime of lifestyle diseases and dependence on medication. Thus, the best way to prevent this cycle is to ensure that the parents play their role in managing the condition effectively as early as possible.

Objectives of the Plan

The objective, in this case, is to ensure that all children receive a fair chance at a successful intervention by making it mandatory for their parents to actively participate in this intervention. Having noted that the interventions are only likely to be effective if the parents participate in them, it can be stipulated that parents are the hindrance to having healthy children with normal weight ranges in the US (Tchernof, 2007). The plan must thus focus on ensuring that parents stop failing their children and the nation as a whole, seeing how childhood obesity affects the public health sector. With the high rates of childhood obesity, the nation unnecessarily spends more on health care for prolonged periods of time as the children grow into the obese adults who are dependent on medication and at a high risk for a wide range of chronic illnesses.

Expected Outcomes

Screening for overweight and obesity has been proven to have no negative impacts on the child. Similarly, there is no reason for schools and hospitals/clinics not to screen children for obesity and overweight. Once a child is confirmed to be obese, the child’s parents will have to be called in and informed of their obligation to participate in the child’s intervention program. The expected outcome is that there will be increased parent participation in the interventions for the management of childhood obesity, thus resulting in the higher success rates. The higher success rates will then result in more healthy children within the US, and consequently fewer obese adults. The overall outcome is less spending on public health as the nation gets to save all the money that it would have spent on the obese children who turn into obese adults with a dependence on medication.

Implementation

Creating a new policy or changing an old one needs a collaborative approach and advocacy from the perspective of the health care sector. Firstly, the policy must be written along with all the pieces of evidence that justify its implementation. In this case, all the required pieces of evidence are in the reviewed articles. The fact that the participation of a parent is the most definitive factor in the success of an intervention makes it mandatory for the parent to participate (Pulgar?n, 2013). However, without the legal backing, it is virtually impossible to compel parents to participate in the interventions that will make their children healthier. This is the justification for a new policy.

Once the policy is drafted, the health care professionals have to work towards getting support for the policy. Support, in this case, must be obtained from the influential echelons of the society, including the professional association and the political class. In some cases, it is easier to start with the electorate so as to inspire the political class to support the cause. Peaceful demonstrations, public debates, social marketing campaigns and social media conversations are all effective in passing the message across the society. Once the policy has the attention of the influential parties, it becomes a matter of urgency and can thus be presented to the relevant authorities for consideration.

Evaluation

Once the parents start actively participating in the interventions for their obese children, more data will have to be collected to establish that there is a significant improvement in the performance of these interventions. In the reviewed studies, it was noted that interventions that did not involve parental participation had the lower rates of positive outcomes, if any. With mandatory parent participation, the evaluation will be interested in how the parents influence the outcomes of the interventions. The expectation is that the parents will enable and encourage positive weight loss outcomes. Every child whose parents participate in the intervention should be able to record an improvement in his/her weight loss and health outcomes over time provided the intervention combines both nutrition and physical activity. That is the baseline for evaluation, with negative results for the child whose parents actively participate in the intervention being considered a problem for the quality management plan.

Monitoring for Sustainability

For childhood obesity interventions, sustainability is mainly about the child losing the excess weight and being able to keep it off all the way into his/her adult years. To accomplish this, the child’s parents must be able to keep supporting him/her even after they are done with the intervention. To monitor the sustainability of this plan, there will be follow-ups for the child who participates in the interventions. In the same way, in a short span of time, a follow-up will be conducted to see how these child is progressing and if his/her parents are still offering him/her the support that he/she needs in order to stay healthy. It is important to note in this case that while the policies cannot make it mandatory for the parents to remain supportive all through the child’s life, it is expected that they will, after seeing how much their support can be effective in helping their child become healthier.

Conclusion

Childhood obesity is a serious problem in the US today. Ideally, the government should do everything to ensure that obesity no longer threatens the lives of American children. The reality, however, is that not enough has been done so far, especially considering that one of the greatest impediments to progress on this subject is the willingness and ability of the parents to participate in the child’s intervention program. For the American children to be healthy again, the government has to make it mandatory for the parents of obese children and adolescents to participate in the intervention programs so that they can effectively support their children and enable them to attain better weight loss and health outcomes both post intervention and during follow-up. Without the parent’s support, the child lacks the behavioral structure, moral support, discipline and self-regulative control to enable him/her not only to eat well but also to have a good health in the long term. Active participation of the parents is the only way that America will win the fight against childhood obesity and in the process triumph over adulthood obesity as well.

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