PICOT Question on Child Obesity Intervention
Childhood obesity is a profound global health concern due to its association with multiple adverse health consequences, including cardiovascular diseases (CVDs), type 2 diabetes, and an increased likelihood of adulthood cancer. According to Lambrinou et al. (2020), obesity prevalence is ever-increasing, with about 170 million children currently grappling with obesity and overweight globally.
In the United States, similar trends persist, rendering obesity a profound health problem of the 21st century. Although obesity and overweight prevail due to the interplay between biological, development, environmental, behavioral, and genetic factors, the presence of multiple modifiable risk factors, including physical inactivity and unhealthy lifestyle choices, provide opportunities for concerted preventative efforts.
In this sense, parents emerge as forefront players in determining children’s susceptibility to obesity. The effectiveness of different preventive interventions for childhood obesity, including parent lifestyle choices and school-based nutrition education programs, is a matter of scientific scrutiny.
Therefore, the purpose of this literature review is to elaborate on scholarly evidence that answers to PICOT question: For children aged between 7 and 14 years (P), does parental lifestyle choice (I) increase obesity instances (O) compared to nutrition education offered in schools (C)?
The current literature supports the tenets of concerted efforts to prevent childhood and adolescent obesity. Although healthcare and educational institutions may implement population-oriented interventions for preventing childhood obesity, parents remain the fundamental determiners of obesity prevalence among children and adolescents.
Parental Lifestyle Choices and Childhood Obesity
In a longitudinal Millennium Cohort Study (MCS), Gray et al. (2018) investigated the dynamic relationship between underlying family lifestyle and childhood obesity during early childhood (Gray et al., 2018, p. 1). The researchers suggested that childhood obesity is consistent with observable behaviors, including breastfeeding, time spent watching television, and physical exercise.
In this sense, children and adolescents have no absolute control over their lifestyles; rather, they rely massively upon the observed parents’ lifestyle cues and habits. The study revealed that family lifestyle could have various beneficial outcomes and disadvantages as well.
From the perspective of the benefits, Gray et al. (2018) revealed that the interrelationships between parental lifestyle choices and childhood obesity can promote preventative behaviors such as physical exercise, healthy diet plans, and regulating the amount of time spent watching television (p .10).
However, over-relying on the role of parents’ lifestyle choices as the primary intervention for preventing childhood obesity is not sustainable due to the underlying social determinants of health (SDOH) that compromise parents’ ability to opt for healthy lifestyles.
For instance, poverty, limited access to healthy foods, parents’ low-level education attainment, and constrained physical exercise opportunities are among the social determinants of health that coerce parents to embrace unhealthy lifestyle choices (Gray et al., 2018). As a result, it is essential to improve parents’ lifestyles by addressing the sources of health disparities to enable them to address childhood obesity and overweight.
Similarly, a population-based cohort study by Naess et al. (2018) investigated the causal relationship between parental lifestyle changes, exemplified by changes in weight and physically active and offspring weight in adolescents.
Also, the study investigated whether parental education level influenced childhood and adolescent weight management. According to Naess et. (2018, p. 7), parents significantly impact their children’s health, although genetic inheritance and social environment issues affect overweight and obesity.
In this sense, the family socialization process can increase exposure to the common obesogenic factors, including unhealthy eating and a sedentary lifestyle. Equally, parents’ engagement in physical exercise and leisure-time behavior can reduce children’s obesity by promoting these preventative measures (Naess et al., 2018).
This study revealed that parental education could be an independent factor in determining childhood obesity since the low-education group seemed more physically active than the high education group. Arguably, such a revelation contradicted the hypothesis that high education attainment correlates with improved adherence to physical activity.
In a qualitative study conducted in a deprived inner area in central Manchester, UK, Goldthorpe et al. (2018) explored parents’ experiences of providing healthy diets for pre-school age children (under 5 years). The study revealed various barriers to the effective implementation of healthy food choices among the participants. These barriers included having children with special needs, children’s demand for preferred food, and using food to promote desired behaviors (Goldthorpe et al., 2018, p. 6).
It is essential to note that the challenges facing parents when providing healthy foods to pre-school children can increase children’s susceptibility to obesity and overweight. For example, providing the preferred food to children to promote desired behaviors may expose them to sugar-rich foods, increasing their vulnerability to obesity.
School-based Nutrition Education Programs and Childhood Obesity
School-based nutrition education remains a profound strategy for reducing the global burden of childhood and adolescent obesity. In a feasibility study, Hawkins et al. (2021) explored the effectiveness of implementing the Healthy Schoolhouse 2.0 health promotion intervention in reducing childhood obesity in Washington, DC. Further, the researchers investigated various variables associated with the program, including teachers’ self-efficacy and students’ nutrition literacy.
According to Hawkins et al. (2021), elementary school teachers can establish and promote healthy eating habits early in life and reduce the future onset of childhood obesity by implementing educational programs that focus on the risk factors, consequences, and preventative behaviors for obesity.
The study revealed that the school setting provides excellent opportunities for advancing child health. In essence, nutrition education programs establish health behaviors that are critical determinants of health across children’s lifespans.
Finally, Hawkins et al. (2021) contended that the Healthy Schoolhouse 2.0 health promotion intervention placed teachers in a leadership role in supporting children’s nutrition, health, and literacy. As a result, it is essential to emphasize these school-based nutrition education initiatives to promote health and prevent the future burden of obesity.
Similarly, other scholarly studies support the feasibility of school-based nutrition education programs in preventing and reducing childhood and adolescent obesity. In a multicenter randomized controlled trial for childhood obesity interventions, Xu et al. (2020) evaluated the effects of comprehensive childhood obesity interventions on dietary diversity among younger children.
The study involved various themes, including nutrition education intervention (NE), physical activity interventions (PA), and a contingency approach involving NE and PA. The study revealed that physical activity (PA) interventions were effective in promoting immediate weight management approaches for the participants.
However, nutrition education improved participants’ knowledge of healthy foods, creating opportunities for long-term awareness of causal and contributing factors to obesity (Xu et al., 2018, p. 11). Therefore, implementing a contingency plan consisting of physical activity and nutrition education can provide opportunities for immediate and long-term benefits.
Finally, Jacob et al. (2021) conducted a systematic review of literature and meta-analysis of school-based interventions to investigate the effectiveness of health education interventions delivered in school in preventing obesity and overweight. To achieve their objective, the researchers selected scholarly journals from reputable databases, including MEDLINE, CINAHL, and Psych INFO.
After a comprehensive review of 39 publications, the researchers revealed that school-based health education programs could potentially reduce learners’ Body Mass Index (BMI) and reduce obesity by providing easy channels for accessing at-risk peer groups (Jacob et al., 2021, p. 17).
Also, to study exposed the potential possibility of complementing school-based nutrition education programs with other preventative interventions such as physical education and healthy food programs in schools. However, researchers called for stakeholder collaboration when implementing these approaches to ensure their effectiveness in reducing childhood and adolescent obesity.
Conclusion and Recommendations
Undoubtedly, the selected six scholarly publications provide contentions that support the PICO question. In essence, it is possible to identify the discrepancies between parental lifestyle choices and school-based nutrition education programs in preventing and reducing childhood and adolescent obesity.
Although parents are essential determiners of children’s health, they face multiple challenges in embracing healthy lifestyles. For example, the prevailing disparities and inequalities in access to healthy foods, poverty, low income, and health illiteracy force parents to embrace unhealthy lifestyles.
Equally, issues surrounding the practice of providing healthy foods to pre-school children, including using preferred food to promote desired behaviors, can increase susceptibility to obesogenic factors such as sugar-rich foods. Therefore, it is essential to implement additional interventions to ensure effective obesity management opportunities.
School-based nutrition education programs emerge as a profound strategy for improving the at-risk population’s awareness and knowledge of preventative mechanisms for obesity. In this sense, educating children and adolescents on healthy food choices and self-management approaches can prevent the onset of obesity.
Despite the potential of reducing and preventing obesity by educating children and adolescents, the current literature suggests the importance of stakeholders’ collaboration in implementing multifactorial plans consisting of nutrition education programs and other approaches like physical activity and school-based food programs.
Further, more comprehensive research targeting the complex interrelationship between positive parental lifestyle choices is necessary for providing generalizable contentions regarding the role of parents in improving offspring’s health and well-being.
Goldthorpe, J., Ali, N., & Calam, R. (2018). Providing healthy diets for young children: The experience of parents in a UK inner city. International Journal of Qualitative Studies on Health and Well-Being, 13(1), 1–14. https://doi.org/10.1080/17482631.2018.1490623
Gray, L. A., Hernandez Alava, M., Kelly, M. P., & Campbell, M. J. (2018). Family lifestyle dynamics and childhood obesity: Evidence from the millennium cohort study. BMC Public Health, 18(1). https://doi.org/10.1186/s12889-018-5398-5
Hawkins, M., Belson, S. I., McClave, R., Kohls, L., Little, S., & Snelling, A. (2021). Healthy schoolhouse 2.0 health promotion intervention to reduce childhood obesity in Washington, DC: A feasibility study. Nutrients, 13(9), 2935. https://doi.org/10.3390/nu13092935
Jacob, C. M., Hardy-Johnson, P. L., Inskip, H. M., Morris, T., Parsons, C. M., Barrett, M., Hanson, M., Woods-Townsend, K., & Baird, J. (2021). A systematic review and meta-analysis of school-based interventions with health education to reduce body mass index in adolescents aged 10 to 19 years. International Journal of Behavioral Nutrition and Physical Activity, 18(1). https://doi.org/10.1186/s12966-020-01065-9
Lambrinou, C.-P., Androutsos, O., Karaglani, E., Cardon, G., Huys, N., Wikström, K., Kivelä, J., Ko, W., Karuranga, E., Tsochev, K., Iotova, V., Dimova, R., De Miguel-Etayo, P., M. González-Gil, E., Tamás, H., Jancsó, Z., Liatis, S., Makrilakis, K., & Manios, Y. (2020). Effective strategies for childhood obesity prevention via school-based, family-involved interventions: A critical review for the development of the Feel4Diabetes-study school-based component. BMC Endocrine Disorders, 20(52), 1–20. https://doi.org/10.1186/s12902-020-0526-5
Naess, M., Sund, E. R., Holmen, T. L., & Kvaløy, K. (2018). Implications of parental lifestyle changes and education level on adolescent offspring weight: A population-based cohort study – the HUNT study, Norway. BMJ Open, 8(8), 1–9. https://doi.org/10.1136/bmjopen-2018-023406
Xu, H., Ecker, O., Zhang, Q., Du, S., Liu, A., Li, Y., Hu, X., Li, T., Guo, H., Li, Y., Xu, G., Liu, W., Ma, J., Sun, J., Chen, K., & Ma, G. (2020). The effect of a comprehensive intervention for childhood obesity on dietary diversity among younger children: Evidence from a school-based randomized controlled trial in China. PLOS ONE, 15(7), e0235951. https://doi.org/10.1371/journal.pone.0235951