Childhood obesity is a complex issue within the United States which can lead to immediate health problems as well as future health complications. Childhood obesity is defined by the CDC as children having a BMI at or above the 95th percentile. The body mass index (BMI) is a measurement tool used to determine whether an individual’s height and weight is within normal, overweight or obese and is calculated by dividing the individuals’ weight in kilograms by the square of height in meters. Because boys and girls vary in their body composition as they age, BMI for age is a more appropriate measure. BMI for age uses an age and sex specific percentile for BMI to determine the child’s weight status (CDC). The prevalence of childhood obesity is increasing in the United States. According to CDC, childhood obesity has tripled since 1970 with Hispanics and non-Hispanic blacks having a higher obesity prevalence than non-Hispanic whites and non-Hispanic Asians having the lowest obesity prevalence. The prevalence of obesity in low- and middle-income groups are also higher as compared with the high-income groups. In addition, the CDC has found that there is evidence to illustrate the relationship of increasing level of education of the household head and the decrease in the prevalence of obesity. Certain risk factors, behaviors as well as the environment contributes to childhood obesity. These include consumption of high calorie, low nutrient diets such as sodas, pizzas and fast foods, sedentary lifestyle, and food deserts. Childhood obesity is becoming an epidemic that requires immediate interventions.
The increasing prevalence of childhood obesity has contributed to numerous health related complications. Childhood obesity is related to immediate and future poor health outcomes. Childhood obesity increases the risk of cardiovascular diseases resulting from high blood pressure and high cholesterol levels. According to the CDC, in addition to cardiovascular complications, children who are obese are also at increased risk of developing type II diabetes, asthma and sleep apnea, joint problems and musculoskeletal problems from the increased weight on the joints and bones as well as anxiety, depression and low self-esteem resulting from the stigma of being obese and the experience of bullying. Children who are obese may also develop obesity in adulthood which can increase the severity of risk factors and disease progression.
Conducting this study allows for the examination of the impact of implementation of food programs on reducing childhood obesity. An intervention that is implemented by the government to help address this epidemic is the creation and implementation of the national school lunch program which provides students attending public schools access to free and reduced school meals. Because of the presence of food deserts in communities and the increasing cost of healthy food options in supermarkets, the implementation of free and reduced school meals hopes to provide free and reduced healthy meal options to children who do not have access to cheap, nutritious meals in their communities to help combat the increasing prevalence of obesity in childhood. According to Lill (2016), since the implementation of the school meal programs, more than 30 million students are now receiving free and reduced school meals. Additionally, students spend the majority of their time in school. Most of their diets are consumed in school therefore, school meals play a key role in influencing the students’ eating habits and food choices. According to research conducted by Haynes-Maslow et. al (2015), fifth graders who received free and reduced meals consumed fruits and vegetables “three more times per week” compared to fifth graders who do not participate in the free and reduced school meal program (p. 3).
Utilizing the acronym “PICO,” this evidence-based practice project provides an educational intervention that will translate and apply to the science of nursing to the greater health care field to help reduce the prevalence of childhood obesity. The acronym stands for population (P), interventions (I), comparison of group or intervention (C) and outcomes (O). The population consists of school age children receiving free and reduced school meals. The intervention includes patient education about nutrition and resources such as free and reduced school meals. Comparing children receiving free and reduced meals to children not receiving free and reduced school meals allows for the evaluation of the effectiveness of the program in reducing childhood obesity which would be the expected outcome. Pico allows this project to address the question, “does consuming free and reduced school meals decrease childhood obesity?”
The project provides an educational intervention for parents of school aged children to address healthy food resources for their children to help decrease their children’s BMI, lowering their health risks associated with obesity. Educating parents about the available healthy resources which includes free and reduced school meals brings the parents and their children a step closer towards fighting the epidemic of childhood obesity. Educating the parents and children helps mitigate negative long-term health outcomes. Through education, parents and their children can become aware of healthier food options and healthy food choices. The study will provide an evidence-based strategy to illustrate improved health outcomes from healthy food choices.
A theoretical foundation that guides this study is the family-centered practice which proposes that the involvement of the family plays a vital role in the healthy development of the child. Parents want their child to grow and develop healthy. Because the healthy development of the child is one of the major focus of the parents, their involvement allows for the successful achievement of a healthy lifestyle and diet for the child thereby reducing their child’s risks for obesity and its negative health outcomes.
There are several concepts that surround the theory of family-centered practice. Transparency is important in developing and establishing a trusting relationship with the family which contributes to the success of the study. Clear and explicit information about methods and procedures used in the study for example, provides a sense of researcher accountability and openness assisting in the active participation of the family in the research study. Collaboration plays an important role in addressing childhood obesity because the parents, the children, school administration and staff and the health care professionals have to work together to implement these programs to ensure its success.
On studying the impact of free and reduced meals on childhood obesity, Johnson et. al (2016), conducted a study to evaluate the nutritional quality of foods that are chosen by students as they participate in the study. In assessing the nutritional quality of the food the students chose, the researchers calculated the monthly mean adequacy ratio which included calcium, vitamins A and C, iron, fiber and proteins and the energy density of the selected food. After the program, the study found that there was a “significant improvement in the nutritional quality of foods chosen by the students, as measured by increased mean adequacy ratio from a mean of 58.7 prior to policy implementation to 75.6 after policy implementation and decreased energy density from a mean of 1.65 to 1.44” (Johnson et. al, 2016). Taber et. al (2013) also conducted a study to determine the effect of the national school lunch program on the weight status of the students. The study compared students receiving different school lunches and outcomes were obtained from the students’ BMI index percentile and obesity status. They found that in states that exceeded USDA standards, “the difference in obesity prevalence between students who obtained free/reduced-price lunches and students who did not obtain school lunches was 12.3 percentage points smaller compared with states that did not exceed USDA standards” (Taber et. al, 2013). Free and reduced school meals positively impact the food choices chosen by the students which equally impacts their weight and their BMI.
Participants will compose of a purposive sample of forty-five to fifty elementary and middle school students from Montebello Elementary/Middle School. The sample will include students between the ages of seven through thirteen with a BMI at or above the 95th percentile who are attending a public school. Most reduced and free school meal programs are implemented in public elementary and middle schools. Targeting students with BMI at or above the 95th percentile will compare their progress as they participate in the study. Exclusion criteria will include homeschooled children, students with religious diet restrictions, students attending private schools and students with food allergies.
Following a longitudinal study design, the parents and children will be observed for a whole year to determine food choices in school and outside of the school. The study will illustrate whether healthy school meals reflect food choices after school and during the summer in the absence of free and reduced meals. The study will begin with describing and defining childhood obesity which will include information about its prevalence, risks factors, contributing behaviors and health complications. A seven-question survey will be given prior to the study to assess the family and child’s understanding of healthy food choices and resources as well as methods of reducing childhood obesity. The questions will address whether the child is involved in a free and reduced school meal program, family and child’s satisfaction of the food choices offered in the school, compliance with healthy eating guidelines such as MyPlate, importance of a healthy diet in the child’s immediate and future health and assessing the family and the child’s perception of obesity. Data will be collected through personal family recorded videos to observe their day to day encounters as they become educated in the management of obesity as well as written food journals to record daily food intake. Free classes will also be offered to further educate the family and the child about healthy food options, reading nutritional labels and several other methods of addressing obesity. A survey similar to the survey given in the beginning of the program will be given at the end of the study to assess the family and child’s progress and renewed understanding in managing obesity.
The participants will be provided complete explanation of the study prior to the beginning of the study. They will be asked to sign an informed consent form to acknowledge their understanding and voluntary participation in the study. Confidentiality of the participants will be maintained. Each study involves certain risks. Participants will be informed of the minimal risks associated with the study. Data will be collected through the surveys, family video recordings and written food journals and will be analyzed based on the overall effect of the program on the child and the families’ food choices. One important question that will be answered and analyzed is the overall effect of free and reduced school meals on food choices made by the family and the child. Another question that will be addressed will be whether the family and the child has learned about healthy food choices including reading nutrition labels, watching caloric intake and preparing healthy meals. Another question is whether the participants will be able to adhere to healthy eating and choosing healthier food options outside of school especially in the summer. Analyzing these questions and the responses from the study will allow for the review of the study to determine its limitations and its possible application for nursing practice as well as possible revisions for conducting future study to obtain better data and address the limitations within this study. Limitations that may be addressed in future studies can address the small sample size, various methods of data collection and data analysis.
