Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)

Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)
Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)

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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)


This proposal is designed to halt the increasing rate of childhood obesity.  Modifications in nutrition, behavior and physical activity are well documented to produce successful outcomes for obesity with the main change agent being the individual.  Due to the complexities of childhood obesity, an intervention that includes proven elements that prevent obesity and addresses the special factors that affect children is needed. 

Parents Take Charge (PTC) is a multi-component family-based childhood obesity intervention that includes modification in nutrition, behavior and physical activity, but focuses on the parent(s) being the primary change agent for the child, age 10-13 years.  Addressed in this evidenced-based proposal are the assessment of need, an analysis of best evidence, design aspects, implementation, evaluation, integration and maintenance of the practice change in a primary care setting. 

The focus of the intervention is to teach healthy lifestyle behaviors to the child through parental involvement instead of focusing on weight reduction as the primary outcome. 

Weight Management For Overweight/Obese Children:  Parents Take Charge (PTC)

Quality care can be defined as appropriately identifying, evaluating, diagnosing and treating patients.  The term quality in healthcare is correlated to professional knowledge and desired health outcomes (Institute of Medicine, 2012).  It is also defined as being closely associated with patient safety (Mitchell, 2008).  Clinical excellence is the goal of providing quality care.  The process for achieving clinical excellence includes patient-centered care. 

The patient is the focus and includes their concerns regarding their illness, values, beliefs and support network. Making the patient an active participant in their health care results in informed decision-making by the patient.  Autonomy, nonmalfeasance, beneficence, justice and fidelity are ethical principles that are addressed as definitions of providing quality care and achieving excellence in primary care. 

America Nurses Association, American League of Nursing, and Center for Applied and Professional Ethics are organizations that set guidelines for excellence (Stanley, 2011).  Quality and excellence in a clinical site is achieved through appropriate, comprehensive and timely care. 

Examples of methods of providing clinical excellence include providing evidence-based treatment, the timely manner in which patients are seen from when they sign in, the offer of generics versus brand-name medications, patient education, open dialogue with patients and referrals to specialist as needed.  Ethical considerations taken in account are the patient’s autonomy.   The patient is provided information for full understanding of their illness, evaluation, treatment and alternative treatments so that the capability for informed decision-making is established.

Guidelines for the prevention, identification, assessment and management of overweight and obesity in adults and children include how to assess whether people are overweight or obese; what should be done to help people lose weight; how to care for people who are at risk due to their weight and how to help people improve their diets and increase their physical activity (The National Institute for Health and Clinical Excellence NHS, 2012).  

The intention of this paper is to present an evidence-based project (EBP) proposal for childhood obesity.  Included in this paper is assessing the need for change in practice, appropriate theoretical models and frameworks, statement of problem, intervention, goals, systematic review of current research and design.  Assessing the need for change in practice consists of identifying stakeholders, collecting internal data about current practice, comparing external data with internal data, identifying the problem and linking the problem with interventions and outcomes (Larrabee, 2012). 

Step 1:  Assessing the Need for Change in Practice


The first step for the model of evidenced-base change is assessing the need for change in practice.  To facilitate this, identification of stakeholders is needed.  The target population is children, age 10-13 years and their families.  Final decisions to change behaviors lies with the children, but parents have great influences over the young child’s meals, snacks and physical activities. 

Participating parents therefore, will be the change agent, adding them to the list of stakeholders.  Parents make informed decisions regarding the health of their children with the help of a primary healthcare provider (Burns, Dunn, Brady, Starr, & Blosser, 2013).  Primary healthcare providers or nurse practitioners (NPs) are stakeholders that will assist in facilitating and implementing change.

Barriers to Change

Barriers for children’s outcomes include their maturity level; ability to understand or commit to the program and their parents, if they are reluctant to participate.  The primary barrier to change is participation of the parents.  Physical activity and dietary behaviors will need modification in and out of the home.  Without the participation of the parents the goal for long lasting results will not occur. 

Barriers for the parents include health literacy level; language, if the primary language is not English and attitudes towards modifying foods and physical activity.  Another barrier is the participant’s adherences to the nutritional guidelines provided because diet plans do not include the cultural foods that the family consumes. 

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Facilitators to Change

Facilitators to change include support from their primary care provider or NP that the participants know and trust, educational classes that will be designed to meet their family’s cultural and specific needs and physical activities that can be done as a family that includes utilizing the workout facilities and pool in the local gym.

Internal Data

            Internal data (date retrieved within Porterville Valley PromptCare Medical Center) provides overweight/obesity information that is defined by height, weight, body mass index (BMI), frequency of physical activity and anthropometric measurements of children in rural Tulare County, California. 

External Data

            External data (data retrieved outside of Porterville Valley PromptCare Medical Center) include the following (Ogden, Carroll, Kit & Flegal, 2012; California Center for Research on Women & Families, 2011):

a).  Approximately 31.8 percent of children and adolescents aged 2—19 years are obese in the United States

b).  Approximately 1 in 3 (33.2 percent) of children and adolescents age 6 to 19 years are considered to be overweight or obese in the United States

c).   An estimated 30.5% of children and adolescents aged 10-17 years are presently overweight or obese in California

d).   The total percentage of overweight and obesity from 1999 to 2009 rose from 34.0% to 37.6% for 9-11 year olds in California

e).   For teens ages 12-17 years in California, African American youth had the highest percentage of overweight/obesity (39.9%), followed by Latinos (29.4%), Asian/other (18.0%) and white youth (12.0%)

            Internal data presents an estimated 30% of the children seen in Porterville Valley PromptCare Medical Center are overweight or obese.  When comparing Internal data and External data a change in practice is needed to prevent the incidence of childhood obesity from continuing to grow at an alarming rate.  

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Theoretical Model and Framework

            Since this EBP proposal involves changes in physical activity and dietary behaviors understanding the effects of behavioral and social aspect of the child is necessary.  With this in mind, the Transtheoretical Model will be discussed as an integral element in the design of PTC, an overweight/obese child intervention proposal. 

Transtheoretical Model (TM)

The TM integrates clinical psychology and concepts to support a framework to understand the behavior and motivate behavioral change. The concepts of TM are decisional balance, processes of change, self-efficacy and temptation. The five stages of the transtheoretical model are the following:  precontemplation (not intending to change), contemplation (considering a change), planning or preparation (actively planning change), action (actively engaging in a new behavior) and maintenance (taking steps to sustain change and resist temptation to relapse) (Kadowki, 2012).

Decisional balance occurs in each stage and involves the weighing of advantages and disadvantages towards changing behavior.  The processes of change are the steps that facilitate understanding and behavioral change.  Self-efficacy is essential and will vary depending on the TM stage.  Temptation to revert back to previous stages will exist throughout the model.  Support from the individual’s social network will provide the encouragement to continue within the program’s parameters.


A correlation between obesity and chronic diseases such as cardiovascular disease, diabetes mellitus and hypertension has been documented.  Life expectancy for those who are obese is lower than those that maintain a normal Body Mass Index (BMI) (Centers for Disease Control and Prevention, 2011).  Earlier death rates in adulthood have been linked to excess weight in the younger ages (American Heart Association, 2013). 

The prevalence of obesity has increased three-fold over the past few decades and is reported as a public health problem within the United States (Singh & Kogan, 2010).  The cost of health care for obesity-related diseases (diabetes mellitus, hypertension, cardiovascular disease, etc) has skyrocketed and is predicted to continue to grow. 

In the year 2000 an estimated $117 billion and $61 billion was spent both directly (medical costs) and indirectly (lost work time, disability, premature death and subsequent loss of income, etc) on overweight and obese individuals in the United States (Ward Smith, 2010).  Chronic diseases linked to obesity were once seen mainly in adults, but are now becoming more and more prevalent in children. 

The National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP), Division of Adolescent and School Health (2010) reported “the prevalence of obesity among children aged 6 to 11 years increased from 6.5% in 1980 to 19.6% in 2008…and among adolescents aged 12 to 19 years increased from 5.0% to 18.1%” (NCCDPHP, Division of Adolescent and School Health, 2010).  Health concerns for obese children are a reality that must be addressed since the effects of early obesity will impact their health for the rest of their lives.

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Problem Statement

The problem addressed in this EBP proposal is the growing rate of childhood obesity and the negative effects on the child, parents, family and community.

Possible Interventions

Intervention of childhood obesity includes early identification and participating in health promotion activities such as eating healthier and becoming more physically active, as early as possible, to reduce the likelihood of chronic diseases and increase the health in those at risk.  Wojcicki and Heyman (2010) stated “studies have shown that early interventions can potentially prevent the development of obesity in school-age children, along with associated health conditions” (Wojcicki & Heyman, 2010, p. 1457). 

Interventions of childhood obesity include promoting a balanced diet and increased frequency of physical activity.  But, with the complexity behind childhood obesity, it requires other interventions as well.  Vos, Wit, Pikl, Kruff and Houdijk (2011) stated their family-based cognitive behavioral multidisciplinary lifestyle treatment “aims to establish long-term weight reduction and stabilization, reduction of obesity related health consequences and improvement of self-image by change of lifestyle and learning cognitive behavioral techniques” (Vos et al., 2011).  

Education and physical activity should be provided to the whole family in order to ensure successful lifestyle change to occur for the child.  It is hoped that by encouraging whole family participation that a lasting positive outcome would result. 

Pender, Murdaugh and Parsons (2011) stated “the significant role the family plays in the development of both health-promotion and health-damaging behaviors, beginning at a very early age is well documented” (p. 243).  Golley, Magarey, Baur, Steinbeck and Daniels (2007) stated “parenting-skills training combined with promoting a health family lifestyle may be an effective approach to weigh management in prepurbertal children, particularly boys” (p. 517).

Critical Outcome Indicators

            Outcome indicators aim to achieve results that matter to the patient (Larrabee, 2012).   Critical outcome indicators include improved BMI, improved laboratory measurements, improved health behavior, improved dietary patterns and increased frequency of physical activity. 

Goals and Purpose

The health goal is to improve outcomes of obese children living in rural Tulare County, California.  Quality goals are to improve access to diagnostics, early treatment and continuity of care with the use of evidence-based practices that include family participation.  Quality measures include the participant’s understanding of the nature of obesity, treatment, the negative impact of obesity on lifestyle and overall health.  These aspects will be measured through documentation of BMI status, weight classification, percent of physical activity and nutritional counseling.

Purpose Statement

            The purpose of the EBP proposal is to promote health and well being in overweight/obese children and their whole family through participation in a nine-week multi-component, family-based community intervention program. 

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Positive Health Behaviors Essay

Positive Health Behaviors
Positive Health Behaviors

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Positive Health Behaviors

One of the most basic instruments of modern public health and preventive medicine is disease screening and positive health behaviors. Screening programs have a long and illustrious history in efforts to prevent infectious disease outbreaks and focus chronic illness therapy. Pregnant women are frequently tested for a complete blood count, blood type, diabetes, syphilis, and other diseases. The approach of disease screening has been demonstrated to save lives, save health-care expenditures, and alleviate suffering.

Breast and cervical cancer screening has been particularly effective in decreasing the disease burden in women (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). Health screenings should be a top priority for everyone to promote good health. some of the most important advantages of health screening Early diagnosis of illnesses can lead to improved treatment and management, lowering the risk of complications and improving the odds of a positive health outcome.

Positive Health Behaviors

Health screening determines if a patient is at risk for, or already has, a disease or condition (Farrington & Mikkelsen, 2020). Furthermore, health screening can aid in the prevention of cardiovascular disease, stroke, and diabetes in those who have a family history of these conditions, as well as offer prompt treatment (Farrington & Mikkelsen, 2020). Age is a key risk factor for a wide range of life-altering illnesses. Early identification and treatment, on the other hand, might provide the body with the strongest resistance against these disorders (Farrington & Mikkelsen, 2020).

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Positive Health Behaviors

Screening, however, can be harmful. When three characteristics of screening programs work in concert, the impact is greater than often recognized. As an example due to the fact that the majority of people who are checked do not have the illness, screening can potentially damage more people than it can help (Farrington & Mikkelsen, 2020). There will always be false positives and negatives since screening tests are not 100 percent sensitive or specific.

Early identification of diseases can lead to overdiagnosis, which is when a person is diagnosed with a condition that will never damage them in their lifetime (Farrington & Mikkelsen, 2020). Also, the ability to reach the desired audience, load on the government, and how everyone involved approaches the problem. Every Woman Counts initiative, which aimed to provide women with preventative health care, proved ineffectual.

In looking at the enrollees in the Nebraska Every Woman Matters program who were getting checked for breast and cervical cancer, it was discovered that there was a link between socio-demographic factors and obtaining cancer screening. As a result, getting cancer screening services is hampered by people’s social position, income, and knowledge.

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Because the advantages and risks of screening are diverse in nature and are assessed and valued differently, it’s impossible to compare them. Valuing benefits and harm is affected by such things as the economic capability of individuals. That is why organizations such as Every Woman Matters (EWM) which is a state-run federally funded program were formed to reduce financial and public awareness barriers to preventative breast and cervical cancer screening by improving public knowledge of the danger and making screening more affordable for low-income women (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

A clinical breast examination, mammography, and Papanicolaou smear test are provided at a reduced or free cost to eligible women. Practices can use the EWM program’s services to help them implement the program. With the aim to reduce the number and impact of risks as well as improving their service delivery in hospitals and clinics, the EWM program conducted an analysis using the GAPS method (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

They included office employees at each phase of the GAPS model to improve preventive care and alter office operations: goal-setting, analyzing existing routines, planning routine modification, and giving support for these improvements (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). The findings of the analysis showed that the main reasons why program was not effective in meeting its preset goals include lack of enthusiasm from some physicians and staff, lack of leadership skills of individuals who are in charge of the facilities and also organizational problems hence some internal instability (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

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Despite the obstacles that prevented large improvements in screening in some of the practices, we feel the GAPS model’s ideas are valid and propose it as a realistic structure for bringing desired change to a complex organizational system like a clinical practice (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005). In addition, additional process factors like as leadership, cohesion, resources, and shared vision were emphasized in our research (Backer, Gesk, McIlvain, Dodendorf, & Minier, 2005).

Positive Health Behaviors

There are a good number of successful advocacy programs for early cancer screening and evaluate the characteristics that are deemed effective and are given credit for the work they do. A good example is the American Cancer Society who promote a healthy lifestyle to help prevent cancer for all people. By supporting cancer advocacy in nations with growing cancer societies, the ACS has taken a leadership position in global cancer advocacy (ACS, n.d.).

The centerpiece of the ACS global effort is training international cancer control leaders through the American Cancer Society University (ACSU) in all aspects of running a community-based cancer control organization or program (ACS, n.d.). The ACSU program begins with a week-long course, which is held a few times each year in different parts of the world, followed by support of participants in home countries (ACS, n.d.).

This society donates millions of dollars annually to cancer clinics and hospitals, all of which is utilized in cancer research, cancer prevention, cancer screening and many other services (ACS, n.d.). Another such organization is The International Union Against Cancer, also known as UICC, which is the most prominent and inclusive international body dedicated to cancer control. It is a membership organization with a small administrative head office, with controlling committees made up of volunteers (Mortara, 2011).

The World Cancer Congress, conducted every two years in a large city, most recently in Washington, DC in 2006, is the most conspicuous UICC activity (Mortara, 2011). Thousands of people from all walks of life attend these conferences, the vast majority of whom are from high-income nations, but with a growing focus on establishing efficient cancer management in those countries (Mortara, 2011).

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Positive Health Behaviors

Those involved in the health care system, nurses, physicians, patients, and others play increasingly interdependent roles. Problems arise every day that do not have easy or singular solutions. Leaders who merely give directions and expect them to be followed will not succeed in this environment.

What is needed is a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. To accomplish the objective of a reformed health-care system, strong leadership will be necessary. Strong leadership is critical if the vision of a transformed health care system is to be realized.

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Backer, E. L., Gesk, J. A., McIlvain, H. E., Dodendorf, D. M., & Minier, W. C. (2005). Improving Female Preventive Health Care Delivery Through Practice Change: An Every Woman Matters Study. The Journal of the American Board of Family Medicine.

Farrington, J., & Mikkelsen, B. (2020). Screening programmes: a short guide. Copenhagen: World Health Organization.

Mortara, I. (2011, July 18). The International Union Against Cancer. From touch oncology: https://touchoncology.com/immunotherapy/journal-articles/the-international-union-against-cancer/

ACS. (n.d.). Facts About the American Cancer Society. From American Cancer Society: https://www.cancer.org/about-us/who-we-are/fact-sheet.html

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