State of the Science Quality Improvement Paper Part 1

Advanced Research Methods: NUR505NP

November 2019

Childhood Obesity

Child obesity is one of the major health problems that stakeholders in the healthcare industry of the United States are grappling with. The steady increase in the prevalence of child obesity has become a worrying trend because it poses a serious danger not only during childhood but also extending into older age. Apparently, 5% of all the deaths in the world are caused obesity (Boswell, Byrne & Davies, 2019). If the dominance of child obesity continues in this current trajectory, half of the people in the world will be obese or overweight in decades to come (Visscher et al., 2017). Due to the startling statistics recorded with regards to child obesity, there is need for a serious health intervention by different stakeholders to curb the problem. Initially, child obesity was considered as a disease for adults but it is now one of the deadliest with its highest prevalence recorded among children (Watkins & Jones, 2015). The aim of this paper is to come up with a proposed intervention that can address proper screening for childhood obesity.

Problem Discussion

Child obesity is a big problem in the healthcare sector which raises concerns on whether enough is being done to address this ever-increasing problem. Child obesity increases the risk of developing cardiovascular disease, sleep apnea, type II diabetes, hyperlipidemia, hypertension, and the risk of obesity in adulthood (Grossman et al., 2017). It is important to note that childhood obesity has a substantial burden if not well addressed in its initial stages. Research further indicates that children who suffer from obesity are at a higher risk of remaining obese even in their adulthood (Watkins & Jones, 2015). For this reason, it is a concern to all stakeholders in the healthcare that children may end up having a shorter lifespan than their parents. Childhood obesity impacts the government and healthcare system negatively through increased costs in the form of treatment of this condition (Grossman et al., 2017). Childhood obesity also affects parents in that they have to incur costs in an attempt to treat their child to minimize the condition before it escalates into adulthood (Watkins & Jones, 2015). The 2015 research by National Center of Health Statistics revealed that the prevalence of obesity was high among youth with an average of 12.5 million of them being obese (Herbenick, James, Milton & Cannon, 2018). Further research established that 77-92% of the reported youth obesity cases persists into adulthood (Herbenick et al., 2018). Which all means that in the future, there is a likelihood of enormous healthcare costs that will have an impact on the country’s budget.

Due to the effects and the risks of increased occurrence of obesity among children, it is important to reexamine interventions of addressing this health problem. It is essential for parents to take an active role in addressing childhood obesity (Watkins & Jones, 2015). The aim of this proposal is to come up with an evidence-based practice of taking into consideration environmental cues and parental influence when screening for obesity among children.

PICO Question and Literature Search Process

Does including parental and environmental cues when screening for childhood obesity improve outcomes in identifying childhood obesity risk factors when compared to using a BMI screening alone?

P – Problem

Childhood obesity is a big health concern that affects people both in the United States and other places of the world as it continues to increase every single day. In terms of prevalence, obesity is high in children of ages 6 to 11 (Cheung, Cunningham, Narayan & Kramer, 2016). For the last few decades, an increase in cases of childhood obesity has been witnessed in the United States. Children from families that are socioeconomically disadvantaged and ethnic minorities recorded a high number of obese cases (Watkins & Jones, 2015). For example, a survey that was carried out in the Southwest established that blacks recorded 4.5%, Hispanics 2% and whites 0.7% of obesity cases for girls the ages of 13 to 17 years (Cheung et al., 2016). Not to mention that economic status plays a big factor as healthy food tends to be more expensive than many families can afford. The data is an indicator that childhood obesity is a serious issue that should be addressed.

I – Intervention

Screening for childhood obesity should include parental influence and environmental cues. This intervention has proven to yield better results in identification of childhood obesity (Watkins & Jones, 2015). Parents play an important role in influencing the feeding of their children and how they embrace certain eating habits. With good parental choices with regards to nutrition and influence on children to feed only on healthy diets, cases of childhood obesity are minimized. Furthermore, creation of healthy environment by feeding on the right diet by parents reduces cases of obesity. Furthermore, in school environments where healthy diets are encouraged, there can be low prevalence of childhood obesity.

C – Comparison

Screening for childhood obesity currently only involves calculation of children’s BMI. Even though body screening through calculation of BMI helps in identifying childhood obesity, there is need for more to be done especially the environmental factors that contribute to obesity. BMI helps to determine whether the body weight of the child is appropriate for the height (Watkins & Jones, 2015). This is a good intervention in identifying whether the child is obese and needs to check on their diet and even treatment.

O – Outcomes

Better identification of obesity risk factors in children will result when screening is done correctly. When a child is screened for obesity by analyzing parental influence and environmental cues, better identification outcomes are guaranteed (Watkins & Jones, 2015). Change of behavior in children through parental influence on nutritional diets helps in reducing childhood obesity (Watkins & Jones, 2015). A good environment where children are encouraged to embrace healthy diet reduces cases of obesity (Cheung et al., 2016). Furthermore, deprivation of unhealthy foods in an environment compels children to embrace healthy eating which results to reduced cases of childhood obesity. Most of the time, unhealthy eating habits are developed in an environment where junk food stirs the appetite among children.

Steps Used in Conducting the Research

Between 2014 and 2019, the researcher conducted a systematic search for literature on various electronic databases which included: EBSCO Host, PubMed, Embase, Researchgate and ScienceDirect, Google Scholar, proquest, Health Collection, Scopus and Medline. The search was guided by PRISMA statement to ensure relevant results are found. The search was also done with the use of subject headings in CINAHL, PsycINFO and Medline. In order to exclude editorials, letters and Meta analyses, limiters were used in the search databases.  The databases contain important peer reviewed journal articles about obesity in children and evidence-based practice that can help in identification of childhood obesity. Furthermore, visual scanning of the reference lists searched in the database was undertaken to determine relevant studies for this particular PICO research. The key search terms used for the research include: screening, childhood obesity, nutrition, environmental cues or surrounding, parents, Nurse Practitioners, and parents. Additionally, alternative search terms such as diet, lifestyle, family nutrition or diet, obesogenic environment, obesity risk, and body mass index (BMI) were also used during the literature review search to identify relevant peer reviewed articles.        The American Academy of Pediatrics (AAP) is a federal organization that is responsible for children’s healthcare. Through various initiatives such as Bright Futures Program, Healthy Child Care America among others, AAP promotes healthy eating among children. AAP provides important information on childhood obesity.

Theoretical Framework

The social cognitive theory and health belief model is the theoretical framework that will be used for the evidence-based intervention practice. According to social cognitive theory, an individual’s perception of norms and social pressure against an action determines how they act towards the condition (Visscher et al., 2017). Similarly, the health belief model which is embedded in social cognitive theory notes that when an individual perceives a condition as a severe risk, there is a likelihood that the person will take an active role in counteracting it (Visscher et al., 2017). The social-cognitive theory model works perfectly in reduction of obesity cases. Obesity is perceived to be a risk factor for individuals to develop chronic conditions such as diabetes, cancer and cardiovascular diseases (Visscher et al., 2017). Research carried out established that the perception of obesity as a cause of other chronic diseases by people, particularly obese children, influenced them to seek help and change their lifestyle (Visscher et al., 2017). Therefore, change of perception is important in addressing childhood obesity.

The social-cognitive theory will play a critical role in the reduction of childhood obesity through inclusion of parental influence and environmental cues in screening. The view that parents create about healthy eating and obesity will go a long way in determining how their children make future choices about nutrition. An awareness of obesity being a deadly disease that can cause many other chronic diseases will make children wan to adjust their eating habits and act in a healthy manner. Furthermore, creating an environment that emphasizes on healthy eating, both at home and in school, will change the insight of children regarding obesity. A healthy environment and behavioral change among children, therefore, will begin with changing their perception about obesity and unhealthy diets.





















Boswell, N., Byrne, R., & Davies, P. S. (2019). Family food environment factors associated with obesity outcomes in early childhood. BMC Obesity, 6(1), 17.

Cheung, P. C., Cunningham, S. A., Narayan, K. V., & Kramer, M. R. (2016). Childhood obesity incidence in the United States: a systematic review. Childhood Obesity, 12(1), 1-11.

Grossman, D. C., Bibbins-Domingo, K., Curry, S. J., Barry, M. J., Davidson, K. W., Doubeni, C. A., … & Landefeld, C. S. (2017). Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Jama, 317(23), 2417-2426.

Herbenick, S. K., James, K., Milton, J., & Cannon, D. (2018). Effects of family nutrition and physical activity screening for obesity risk in school‐age children. Journal for Specialists in Pediatric Nursing, 23(4), e12229.

Visscher, T. L., Lakerveld, J., Olsen, N., Küpers, L., Ramalho, S., Keaver, L., … & Yumuk, V. (2017). Perceived health status: is obesity perceived as a risk factor and disease? Obesity Facts, 10(1), 52-60.

Watkins, F., & Jones, S. (2015). Reducing adult obesity in childhood: Parental influence on the food choices of children. Health Education Journal, 74(4), 473-484.