The most effective intervention to treat childhood obesity
Table of Contents
Childhood obesity has become a global pandemic with an alarmingly high prevalence rate, short term and long term health implications (Flynn et al., 2004). Onis Blossner and Borghi (2010) reported that 92 million of the children globally were obese, the number that was projected to increase at a rate of 9.1 % percent annually by 2020. As such, mitigation of childhood obesity is a major policy issue since there is evidence linking childhood obesity as a strong predicative of adult obesity. However, it is also worth noting that healthy children can develop obesity as they approach young adulthood, hence the need for early intervention (Collins et al., 2007). The rationale for the study of effective mitigation of childhood obesity is to ensure that vulnerable children are prevented from exposure to the threats of other chronic diseases including hypertension, type II diabetes, carotid-artery atherosclerosis and dyslipidemia. The risk of these health outcomes in adults who were obese of overweight as children reduces significantly and compared to those who were healthy since childhood (Venn et al., 2007). This realization gives rise to the need to prevent and mitigate childhood obesity. While prevention is the most ideal assurance of the future health of the children, effective intervention for the children who are already obese is equally important.
Several methods have been proposed to mitigate childhood obesity including physical activity and diet intake and limiting sedentary behaviors and family involvement among others. This study explores the “physical activity and diet intake” as the most effective intervention for childhood obesity and limiting
sedentary behaviors and family involvement as an alternative approach. This mitigation approach involves a total lifestyle modification in terms of combination of regular exercise and a healthy nutrition regime as essential elements in the management of obesity. There has been multiple systematic reviews that target either the impact of dietary practices in impacting weight loss or the impact of regular exercise on the same. A study published by Collins et al., (2007) shows effectiveness of a childhood obesity intervention approach that involved the dietary component. This systematic review seeks to present evidence of the most effective lifestyle modification regime involving regular physical activity and diet intake to assess their impact on cardio-metabolic risks and weight loss. This study covers the literature published over the period of 10 years; 2006 to 2016.
Evidence Search and Methods
The search strategy was undertaken for purposes of located the most comprehensive set of relevant articles that will provide important information for possible inclusion into this systematic review. An iterative process was chosen as the most effective method of review (Breattle and Grant, 2004). The process involved six stages: clarification of the search questions and aim; identification of the most important elements of the articles search; translation of the concepts used in the identified databases into terms that will be searched to identify relevant documents; extension of the search by identifying a range of alternative terms and synonyms; combination of the concepts to ensure a comprehensive search; and presentation of the results of the review by revisiting the previous five steps.
The search for the relevant articles for this review started with the search of the databases. The databases that had relevant information in this topic were the Medline, Cochrane Reviews, CINAHL, Health source nursing, PsycINFO and Academic Search Premier. Materials were accessed by searching the keywords “children”, “childhood”, “obesity”, “overweight”, “child obesity”, “childhood obesity”, “childhood obesity intervention”, “childhood obesity prevention”, “lifestyle modification and childhood obesity”. The inclusion criteria for the article specified that the article accessed should be from peer reviewed journals including Obesity Reviews, British Journal of Nutrition, International Journal of Obesity, and Psychological Bulletin. The review included only articles published in the last 10 years, from 2006 to 2016. The type of study also had to be experimental, systematic review or meta-analytic. The inclusion criteria started by reviewing the abstracts of the articles to determine their relevance to intervention of childhood obesity.
The preliminary search revealed 15 articles that included the topic of intervention of childhood, the impact of childhood obesity on the future of the children, impact of childhood obesity on economic status of the family, common methods of prevention childhood obesity and the most effective intervention methods for childhood obesity. The methods reviewed in the literature included: physical activity and diet intake; limiting sedentary behaviors and family involvement; reducing television viewing; and increasing physical education in schools. The articles that were not peer-reviewed, not within the 10 – year inclusion range and those that did not have an abstract were excluded from the search, remaining with six articles that were accessed in this systematic review.
Description of Recommended Intervention
Physical activity has been asserted as the most effective form of managing childhood obesity. Recent studies indicate that the most adjustable aspect of energy expenditure is physical activity, which is a representation of 20-40% of the total energy expended (Dietz et al., 2015). The World Health Organization (WHO) Physical Activity Guidelines suggest that physical activity should be carried out by an individual frequently, and this and this will enhance expedition of the total energy. Physical activity is vital since it reduced the sedentary lifestyle among the children, which implies that physical activity will reduce sedentary behaviour among the children. The physical activity include activities such as moderate-intense physical activity such as walking for about 15-20 minutes, brisk walking, and leaving the children to play in the open field for some times. Additionally, the children can have aerobic sessions during the week as part of physical activity. Dietary intervention is also suggested as an effective way of managing obesity since majority of the children with obesity might have significant nutritional deficiencies such as vitamin D and Iron. The dietary programs are aimed to alter macronutrients that are present in children. Thus, the dietary program will include ensuring that the children take diets that are low in carbohydrates, low fat, diets that have higher levels of unsaturated fats, and low-glycaemic diets. Therefore, a combination of physical activity and dietary intervention is a very effective way of managing childhood obesity.
Evidence and Rational for Physical Activity and Diet Intake
Physical activity and dietary intake has been documented by numerous literature as the most effective form to address childhood obesity. There is empirical evidence that 20-40% of the total energy expended through physical activities (Dietz et al., 2015). Other studies indicate that regular physical activity in childhood and adolescence improves strength and endurance, which is fundamental in building up healthy bones and muscles that will help to control weight, reduce anxiety and stress, enhance self-esteem, and improve blood pressure and cholesterol levels (Brown & Summerbell, 2008). Additionally, two extra hours of Physical Education (PE) per week in school are reported to improve BMI of obese children significantly (Brown, & Summerbell, 2008). Physical activity has also been found to reduce blood pressure as well as improve lipid profile and decrease abdominal fat (Dietz et al., 2015). Some systematic reviews concluded that weight regain following weigh loss can be reduced by physical activity (Bray & Wadden, 2014). Sporting activities are part of physical exercises and children should be sensitized to engage in sporting activities in school and other platforms since this will help burning calories and fats.
Dietary intervention as a technique to manage obesity in children can be undertaken in schools. Evidence that examined the outcome on weight loss and obesity comorbidities indicate that some diets have a great impact on weight loss (Nieman, 2010). Dietary intervention has been documented in numerous studies as one of the main approach of obesity management, an aspect that requires a complete change of lifestyle. Therefore, compliance can be very difficult for the patient, which is why some studies have indicated that the choice of diet should be able to address the patient’s preference and ease of compliance (Dietz et al., 2015).
Childhood obesity is as a result of behavioral and environmental factors, which are mainly physical inactivity and consumption of foods that have high levels of cholesterol and calories. Parenting is therefore linked to a large extend to childhood obesity, and therefore it is important for the parents to be involved managing childhood obesity by making sure that their children eat proper diets and they are involved in physical activities. Therefore, there should be familial aggregation of physical activity and eating habits. Parenting styles is very effective since some studies have indicated that they are the main agent of change that have a very significant effect on the weight loss of their children (Golan, Kaufman & Shahar, 2006). The parents have a great impact in modification of their children’s behavior such as ensuring that they don’t eat unhealthy diets, they engage in physical activities, and limiting sedentary behaviors such as long hours of watching television. (McLean et al., 2006) indicated that effective form of prevention and management of obesity should comprise of behavioral modification, and this can be very helpful if there is family involvement in food intake and physical activities.
Sedentary lifestyle, which refers to a lifestyle that is characterized with no physical activity has been suggested to be a risk factor that is associated with childhood obesity. Limiting sedentary behavior have been asserted as one of effective forms of reducing childhood obesity. Some of the common sedentary behaviors include desk work, television watching and sitting all day either at home or at school doing nothing. Sedentary behavior is a lifestyle that ought to be modified and this requires behavioral change strategies. Sedentary behavior have been asserted as one of the reasons that contribute to the child’s weight gain and in obese in the long-run. Some programs that have been initiated to reduce obesity comprise of reduction of sedentary behaviors and this include activities such as Physical Exercise (PE) in schools (DeMattia, Lemont & Meurer, 2006). Therefore, sedentary behavior is leads to physical inactivity, and this is why physical activity is asserted as the most effective way of reducing sedentary behavior. Moreover, sedentary behavior has been linked to physical inactivity and unhealthy eating, and a reduction of sedentary behavior can be very fundamental in managing weight loss and obesity management among children (Golan, Kaufman & Shahar, 2006).
Physical activity and dietary intervention have been asserted as very important mechanisms of management of obesity children. Physical activity and dietary intervention can be very challenging since they require a complete lifestyle modification, which can make compliance difficult. Therefore, Cognitive Behavioral Therapy (CBT) can be very important since they provide strategies for overcoming barriers to compliance with dietary intervention and/or physical activity, especially due to the fact that these two are very important form of obesity treatment. CBT are approaches that are aimed to help a patients; insights and understanding of thoughts beliefs regarding weight regulation, obesity and its consequences.
Other than physical activity and diet intake and limiting sedentary behaviors and family involvement, Doak et al, (2006) shows the successful adoption of other mitigation measures including reducing television viewing; and increasing physical education in schools. According to the authors, there is no one intervention practice that can work to prevent and intervene in childhood obesity, recommending adoption of a broad scale of preventive measures that combines regular exercise, diet and education or a regular exercise, diet and reduction in the number of hours children spend watching television. Doak et al, (2006) systematic review contrasted different studies to show that a combination of different intervention measures was effective in mitigating childhood obesity. Thy featured a study conducted by McMurray to determine the effectiveness of three types of intervention. The study showed that showed that only an exercise intervention was the most effective. However, Vandongen et al. found that success in using school nutrition programs plus fitness.
Empirical evidence shows that care givers shape the eating behaviors of the children, thereby contributing to childhood obesity, intervention practices should not only be focused on dietary measures as targeting parents. Parents are considered role models at homes in terms of lifestyles including eating right, exercising regularly and the length of time spend watching television. As such, the role of parents in prevention of childhood obesity is central as they determine how the home environment contributes to the children’s health outcomes. Doak et al, (2006) explore the role of the parent in influencing the home environment that contributes to childhood obesity in terms of food selection, feeding cues, meal structure and general parenting styles. Parents can plays a major role in shaping their children’s eating behavior, regular exercising, reduction of the time spent watching television and training in best lifestyle practices.
Conclusion and Implications
With over 92 obese children globally and a target increase of 9.1% annually by 2020, childhood obesity is a menace to the future globally health and is therefore a crisis that needs to be handled urgently. The body of research reviewed in this study suggests that physical activity and diet intake are the most effective intervention practice for childhood obesity. Diet and nutrition measures help not only to reduce weight in children, but also to improve their cardio-metabolic outcomes, resulting in favorable health outcomes that have a long term impact. The findings of the study are consistent with the overall suggestion noted in the reviewed studies that regular exercise with a diet component helps prevent children from developing obesity in the ping run. As such, the recommended intervention is not only for intervention, but also for prevention of obesity in children who are more vulnerable.
The findings of this study have major research and academic implication. Policy for intervention of obesity should focus on school-based practices to ensure that the children benefit from a holistic approach to prevention and mitigation of childhood obesity through education classes and regular exercise. Future research is required to draw more insights, not only on the long term effectiveness of obesity intervention methods, intensity and optimal length, but also in the determination of the magnitude of weight loss that is required to ascertain clinically significant health outcomes.