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Weight Management for Overweight/Obese Children: Parents Take Charge (PTC)
Abstract
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
Stakeholders
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.
Problem
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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