Nursing Article Obesity in Children

N2300 Introduction to Professional and Clinical Concepts in Nursing \ Assignment: Nursing Article Summary Name: Date: Overview The purpose of this homework is to introduce you to APA style, as you will be required to use this format for all of your papers in the College of Nursing and Health Innovation. Please be sure to complete all of the steps as outlined below in order to receive full credit. Rubric Make sure to use the assignment rubric to guide your work. Instructions 1. Locate the name of a recent (<5 years), professional, nursing journal related to the area of nursing you are interested in pursuing. Please refer to the library resources in Canvas to help guide you. Please include a copy of your article with your assignment submission; this can be a .pdf file. 2. Find one sch olarly, peer-reviewed article that interests you and read it; editorial and topical articles will not suffice. 3. Nursing Article Obesity in Children

In the workspace below, type a one page (double spaced) summary of the article you read. In your summary, make sure and use in-text citations, including page numbers if you use a direct quote. Remember, even information that is summarized must be cited to avoid plagiarism. 4. At the end of the summary, type the reference to your article in correct APA style. 5. Simply attach both this template (in Word format) and the article to Canvas when you submit. A word about plagiarism: When you submit homework to an instructor, you are saying, “Unless I have noted otherwise with a citation, this is my own original work; these are my own words and my own original ideas.” Reading the article, understanding it, interpreting it, and creating a summary in your own words is part of the work of learning. Using someone else’s words is like saying “I did this work” when you really didn’t. Use this assignment as an opportunity to work on your skills of reading and summarizing. Workspace: Please begin your assignment below. Follow APA format (double space, no bold font, in-text citations) and make sure and use complete sentences, grammar, and spelling. You do not need a title page or headers but you must include your reference at the end. ©2018 University of Texas at Arlington Page 1 of 2 N2300 Introduction to Professional and Clinical Concepts in Nursing Article Summary: APA Style Reference (at the end of the article): ©2018 University of Texas at Arlington Page 2 of 2 Pediatric Obesity in Primary Practice: A Review of the Literature Jessica Durbin, Mitzi Baguioro, and Donita Jones C hildhood obesity in the United States has more than tripled in the last four decades. Statistics show that 1 in 5 school-aged children (ages 6 to 19) are obese (Centers for Disease Control and Prevention [CDC], 2017). The CDC uses the body mass index (BMI) at greater than or equal to the 95th percentile for children and teens of the same age and sex to define obesity. Research shows that a high BMI in children can be an indicator of high body fat (CDC, 2017). Obesity-related diseases, such as type II diabetes, kidney disease, and hypertension, which are common problems in adults, are now pediatric concerns as well (Fung, 2016). The economic impact on healthcare costs of childhood obesity-related illnesses is estimated at $14 billion per year (National League of Cities [NLC], 2017). Medical expenses from complications and co-morbidities of obesity are foreseen to rise steeply because obese children today might plausibly become obese adults. The obesity epidemic is climbing not only in the United States, but also in other countries (World Health Organization [WHO], 2017). Primary care providers (PCPs) knowledgeable of evidencebased management approaches to prevent obesity can empower parents and caregivers to enhance the physio- Jessica L Durbin, DNP-FNP, BC, is an Assistant Professor, Department of Advanced Practice Nursing School of Nursing, College of Health and Human Services, Indiana State University, Terre Haute, IN. Mitzi Baguioro, MSN, FNP, is affiliated with Indiana State University, Terre Haute, IN; and is a Family Nurse Practitioner, Eastvale, CA. Donita Jones, MSN, FNP, is affiliated with Indiana State University, Terre Haute, IN; and is a Family Nurse Practitioner, Orange Park, FL. 202 Childhood obesity is an epidemic, resulting in physiological and psychological infirmities. Primary care providers (PCPs) can engage in preventing obesity by instilling positive healthy behaviors early in children’s lives. Providing support and evidencebased interventions can enable children to avoid co-morbidities of obesity, such as diabetes, cardiovascular disease, and depression. Relevant literature was retrieved from The Cochrane Library, CINAHL, PubMed, Medline, Sport Discus, and Health Source Nursing Academic Edition from January 2012 through February 2017 by using key words “child obesity,” “physical activity,” “diet,” and “body mass index.” Four studies are reviewed: 1) a randomized control trial on the effects of a 10-week FATmax exercise training of obese 8- to 10-year-old boys, 2) a cross-sectional study on the correlation of physical activities and sedentary behavior to body mass index (BMI) and obesity rates among 6,539 children 9 to 11 years of age, 3) a randomized study on the effects of a walking program on the BMI of children ages 6 to 11 years, and 4) a systematic review on the efficacy of school-based dietary behavior and physical activity in children and adolescents ages 6 to 18 years. Outcomes from all four studies revealed a reduction in obesity when adequate physical activity and balanced meals were incorporated during childhood. Integrating evidence-based findings into practice can foster health and wellness of children, and reduce unnecessary healthcare costs attributed to obesity. logical and psychological health of children at a young age, thereby positively affecting their lives as adults. Nursing Article Obesity in Children

This can correct healthcare disparities, avoid a lifelong state of sickness, and contain healthcare costs. Clinical Significance Childhood obesity is a serious global dilemma that continues to shape children’s health, body image, and self-esteem (Foster, Farragher, Parker, & Sosa, 2015). The WHO (2017) asserts if there are no trends to prevent childhood obesity, the number of obese infants and young children will increase to 70 million by 2025 worldwide. In the United States alone, 13 million children suffer from health and emotional effects of obesity in their everyday life (American Heart Association [AHA], 2017). Between the years 2011-2014, obesity rates in children ages 6 to 11 years significantly increased from 7% to 15.3%, and children ages 12 to 19 escalated from 5% to 15% (Fung, 2016). In the 1972 Bogalusa Heart Study, childhood obesity is tracked into adulthood, predicting increased mortality as the long-term effect of childhood obesity. This further contributes to adults becoming obese and paves the path to serious chronic conditions, such as diabetes, metabolic syndrome, cardiovascular disease, and several types of cancers (Fung, 2016). Children who are obese are not only impacted physically, but also psychologically; they are more subject to bullying and teasing by other children as compared to children of a normal weight. Obese children are more susceptible to social isolation, depression, and lower selfesteem (CDC, 2017). ‘ Nursing Article Obesity in Children

Purpose Health consequences of obesity are too important to ignore. The purpose of this literature review is to provide PCPs, such as advanced practice nurses (APNs), with evidence-based findings to incorporate into their clinical practice. A major goal of advanced practice nursing in primary care is the preven- PEDIATRIC NURSING/July-August 2018/Vol. 44/No. 4 tion of disease and its complications to maintain health and wellness from birth to old age. Identifying and implementing the most effective obesity prevention actions as early as possible in the child’s life can decrease the chance of chronic diseases and mortality. Search Criteria and Results A systematic full-text search was conducted using the key words “child obesity,” “physical activity,” “nutrition,” and “body mass index” for dates beginning January 2012 through February 2017 from the Cochrane Library, CINAHL, PubMed, Medline, Sport Discus, and Health Source Nursing/Academic Edition electronic databases available at the Indiana State University library. The search from the Cochrane Library yielded five results published from March 2013 through November 2016; CINAHL yielded 23 results published January 2013 through November 2016; PubMed yielded 14 results published from 2013 through 2015; Sport Discus yielded 47 results from January 2013 through February 2017; and Health Source Nursing Academic yielded eight results published from 2013 through 2016. These articles presented various obesity interventions, such as diet selection, physical activities, exercise training, parenting style, behavioral modification, physical education, and school curriculum changes. Study settings were home-based, communitybased, school-based, and inpatient settings. Methods included randomized control trials, cross-sectional studies, quasi-experimental, and mixed-design factorial ANOVAs. Relevant articles were selected based on dates of publication; interventions used in the research, particularly on physical activities; exercise; nutrition; and outcome measures specifically on changes in the BMI, the most common method to measure obesity and weight status in children and adolescents. Nursing Article Obesity in Children

Articles considered were cross-sectional studies, systemic reviews, and randomized control trials conducted for 6 months to up to 3 years. Studies that used other outcome measures, such as obesity rates, cholesterol levels, fat mass index, waist circumference, and selfdetermination level, as well as school performance level, were not selected. Evidence-Based Findings Four studies are presented here (see Table 1). A randomized control trial was conducted in China to determine effects of a 10-week FATmax exercise training of obese 8- to 10-year-old boys (Tan, Wang, & Cao, 2016). A total of 26 obese and 26 lean boys were classified randomly into two intervention groups and two control groups. Intervention groups participated in 10 weeks, 5 days per week of supervised FATmax training. The control groups were asked to continue their regular physical activity during the trial. FATmax training consisted of a 10-minute warm-up period followed by a 40-minute physical activity, such as playing ball, walking, jogging, and running, then a 10-minute cool-down period of muscle stretches and walking slowly; no diet changes were initiated for any participants. The study revealed that FATmax training decreased body mass (-1.0 kg, p<0.05) and BMI (-1.2 kg/m2, p<0.01) of the trained obese boys. Findings suggested that FATmax exercise training intensity is an effective treatment for childhood obesity, and that overweight or obese boys exercise training should be initiated to treat and counteract the condition rather than restricting energy intake. The exception is children who are morbidly obese because growing children require sufficient nutrients to thrive. Nursing Article Obesity in Children

Tan and colleagues (2016) postulated that negative energy balance generated from physical activeness is crucial to reduce obesity. Katzmarzyk and colleagues (2015) conducted a systemic review called “The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE)” in 12 countries, including Australia, Brazil, Canada, Finland, China, Colombia, India, Portugal, Kenya, South Africa, United Kingdom, and the United States. The study determined the correlation of vigorous and moderate-to-vigorous physical activities, and sedentary behaviors on BMI and obesity rates among 6,539 participating children from 9 to 11 years of age. Vigorous physical activities (VPA), moderate-to-vigorous physical activities (MVPA), and sedentary behavior of participants were monitored 24 hours per day for 7 days by having children wear an accelerometer around their waists 24 hours per day except in water activities. An accelerometer is a device that monitors time and assesses the PEDIATRIC NURSING/July-August 2018/Vol. 44/No. 4 intensity of a movement or physical activity and sedentary activity (Keadle, Shiroma, Freedson, & Lee, 2014). This trial ran from September 2011 through December 2013. BMI and BMI z-scores were determined by using age- and sexspecific reference data from the WHO. The 3-year study displayed a significant decrease in trends of BMI and obesity rates in boys and girls who engaged in MVPA for 45 to 71 minutes per day and VPA for 13 to 23 minutes per day. Girls with lower MVPA had average BMI zscores of 0.1, while those with higher MVPA had lower BMI z-scores of 0.09. Boys with lower MVPA had BMI zscores of 1.2, and those with higher MVPA had lower BMI z-scores of 0.3. Results showed that engaging in at least 55 minutes per day of MVPA lowers obesity (Katzmarzyk et al., 2015). Zuraikat and Dugan (2015) conducted a randomized study that examined a walking program among school-aged children 6 to 11 years old (kindergarten through 4th grade) using current BMI. The study included 5,158 students from three different schools in a rural area of western Pennsylvania. The aim was to determine how predominant the classification of being overweight or obese was among school-age children, and then to evaluate an intervention. Students were directed to walk around the perimeter of the playground area during recess with a target goal of 5 to 10 miles over the course of the semester. BMI was measured preand post-walking intervention program. Results showed a decrease in students’ BMI. The percentage of BMI in the three schools was as follows IN school #1, students’ BMI decreased by 7%, while in school #2, BMI decreased by 1%. For school #3, BMI increased by 3.4%. Overall, results show a decrease in BMI of at least 1.5% by increasing physical activity (Zuraikat & Dugan, 2015).

This study offered no explanation as to why BMI increased in school #3, other than that since participation was voluntary and not tracked officially, students in school #3 did not participate as fully or self-report as much as students in schools #1 and #2 (Zuraikat & Dugan, 2015). Verstraeten and colleagues (2012) conducted a systematic review on the efficacy of school programs involving both nutrition changes and physical activity for obesity prevention in children and adolescents from ages 6 to 18 years. This was accomplished by reducing daily intake of sweetened carbonated drinks, fast food, fried 203 Source Tan, Wang, & Cao (2016) Katzmarzyk et al. (2015) Zuraikat & Dugan (2015) Table 1. Literature Summary Table Sample/Study Description Purpose Results A randomized control interventional study of a 10-week FATmax exercise training (10-minute warm-up, 40-minute physical activities, 10-minute cool down) of 46 boys, 8 to 10 years old. Twenty-six obese and 26 lean boys were randomly segregated into the intervention and control groups. Intervention groups participated in a 10-week, 5 days/week supervised FATmax training. Control groups were asked to continue their regular physical activity habit during the trial; no diet control for all subjects. Anthropometric measurements were measured before and after intervention. To determine results of 10 weeks of exercise FATmax training on BMI, composition, cardiovascular fitness, and functional capacity. Body mass decreased (-1.0 kg, p<0.05), BMI decreased (-1.2 kg/m2, p<0.01) of the trained obese boys. Study proved that FATmax training is effective to treat childhood obesity. Nursing Article Obesity in Children

A cross-sectional and multinational study that measured the intensity of physical activities of 6,539 children 9 to 11 years old in 12 countries as either MVPA or VPA, and sedentary activities by wearing an accelerometer around the waist 24 hours/day for 7 days, and after effects to the BMI and obesity rates. To determine the correlation of VPA and MVPA, to sedentary behavior on BMI and obesity rate among children. A randomized study of 5,158 students from three different schools in Pennsylvania to evaluate the effect of nutrition changes and physical activities on the BMI of school-aged children. Students were asked to walk around the playground during recess with a goal of walking 5 to 10 miles each semester. BMI was measured pre- and post-walking intervention program. To prove how a walking intervention is beneficial in decreasing the BMI of school-aged children. Significant decrease in trend for BMI z-scores while increasing MVPA and VPA (p<0.001), but the trend across sedentary behavior was not significant. Verstraeten et Performed systematic reviews from peer-reviewed controlled al. (2012) studies from Cochrane Library, MEDLINE, WEB of Science, Center of Reviews, Dissemination databases, and EMBASE on nutrition and physical activity measures. To review evidence on how effective school based interventions (diet and physical activity) can reduce obesity in children and adolescents ages 6-18 years old. School 1: BMI decreased by 7%; School 2: BMI decreased by 1%; School 3: BMI increased by 3.4%. Results show a decrease of 1.5% proved physical activity helps improve children’s BMI. 7,218 references, 22 studies were used. School-based nutrition changes and physical activities successfully decreased BMI. Result size ranged from -0.48 to 1.61. Nursing Article Obesity in Children

Effect size ranged from -0.70 to 0.0. The authors noted that despite the small effect size, the public health effect at a large population level can be substantial if implemented in large groups of children and when sustained over long periods of time, which would negate the small effect size. Notes: BMI = body mass index, VPA = vigorous physical activities, MVPA = moderate-to-vigorous physical activities. 204 PEDIATRIC NURSING/July-August 2018/Vol. 44/No. 4 foods, soda beverages, and snacks high in fat, sugar, and salt, coupled with adding physical exercises of 50 to 315 minutes per week integrated in the physical education program. After gathering all data and synthesizing 7,218 references, 22 studies were used. These data revealed interventions conveyed a favorable effect on food, physical, and activity modifications (effect size ranged from -0.48 to 1.61), attested by a decrease in BMI (effect size ranged from -0.70 to 0.0) (Verstraeten et al., 2012). Limitations A limitation of the four studies is the use of BMI to measure obesity. BMI measures excess body weight indirectly but does not measure excess body fat; however, it has been used to approximately judge body fatness. The relationship of BMI and body fat can be influenced by age, sex, ethnicity, muscle mass, fat, or fat-free mass. BMI does not provide any indication of the distribution of fat among individuals because it cannot distinguish between excess fat, muscle, or bone mass. BMI does not reflect these changes and influences that can affect accuracy of measurement. Implications and Recommendations In Clinical Practice Correcting childhood obesity at a very early stage in the child’s life promotes positive health behaviors in the child by instilling healthy lifestyle choices that will improve overall health and prevent health complications in adolescent and adult years. Nursing Article Obesity in Children

Prevention must start at conception because maternal weight gain influences neonatal weight gain (Fung, 2016). Adverse effects of obesity on children’s health trickles to adulthood, with diseases such as coronary heart disease, cardiovascular disease, diabetes, hypertension, inflammation, cancer, and depression. There is a need to place emphasis on the role of PCPs in clinical practice to abate this disease. One implication of this synthesized literature review from existing studies in clinical practice is the screening and diagnosing of obesity and other comorbid conditions by cli … Nursing Article Obesity in Children