Obesity in Children: Reduction in Body Mass Index Essay (Literature Review)

Clinical Question

In children with obesity, how does a nutritional diet compared with physical activity affect the rate of reduction in body mass index during childhood?

Literature Review

Obesity among children has become a serious health issue since the number of children who are becoming obese is increasing gradually. Across the world, the trends of childhood obesity are relatively similar due to changes in nutrition and lifestyle patterns. Obesity has become a global phenomenon that affects all people irrespective of their socio-economic standards and demographic factors. According to Raj and Kumar (2010), obesity has become an epidemic and has increased the burden to healthcare systems across the world, because it causes about 2.6 million deaths annually. Moreover, obesity is a predisposing factor to other diseases such as diabetes and cardiovascular diseases. Among children, the trend of obesity has been increasing gradually during the past decade, and projections indicate that the trend is set to increase exponentially if the right interventions are not in place to curb the incidences. Currently, worldwide statistics show that about 22 million children below the age of five years are obese (Raj & Kumar, 2010). In view of this knowledge, healthcare systems have been employing a number of interventions that include change of nutrition and increasing physical exercises.

Nutritional diet is one of the effective interventions in the prevention and management of obesity among children. Through nutrition, children can regulate the intake of calories to suit requirements of their bodies, and thus prevent the accumulation of calories, which subsequently causes obesity. Children who eat a balanced diet do not become obese, unlike children who consume many calories without balancing their diet. Kain et al. (2012) argue that the main reason why obesity figures increased from 7% to 22% amongst Chilean children is due to the increase in energy intake. Food intake makes children gain weight rapidly and become obese. In this view, an increase in the incidences of obesity implies that children’s nutrition has become poor with time. Therefore, to prevent the occurrence of obesity among children, families should improve their nutrition by ensuring that children consume the right amount of calories.

Nutrition diet is also relevant in the management of obesity among obese children. The process of managing obesity entails a reduction of the rate of weight gain, maintenance of weight, and eventually reduction of body mass index. Proper diet plays a critical role in achieving significant changes in body mass index. Usually, nutritional management of obesity should aim at reducing or maintaining weight without compromising the number of calories that the body requires. Special care is necessary when using nutritional diet to manage obesity because it requires gradual initiation and continuous maintenance of healthy eating patterns. Irregular eating patterns and poor nutrition worsen the management of obesity using a nutritional diet. Raj and Kumar (2010) state, “a standard protocol is to recommend a fat intake of 30 to 40 percent kcal in children 1to 3-year-old, with a reduction to 25 to 35 percent in children 4 to 18-year-old” (p.602). Such nutritional intervention is effective because it does not compromise the growth and development of children that normally peak at puberty. Obese children should reduce intake of unhealthy snacks, avoid beverages rich in sugar, reduce salt consumption, and increase intake of fruits and vegetables. Hence, nutritional intervention is important in the management of obesity among children.

Physical activity is another relevant intervention in the prevention and management of obesity among children. Increasing physical activity is an intervention that many schools have adopted in the prevention of obesity in children. Kain et al. (2012) state that development of school-based programs that focus on physical activity are integral in the prevention of obesity among children, since current curriculum does not provide enough training programs for physical exercise. For sustainability of physical activity programs, communities and families should be ready to adopt and apply for these programs at home because the culture of exercising works efficiently if parents participate to reinforce it. In Raj and Kumar’s words, “Community level interventions involve advocacy to increase physical activity at schools and home through the creation of environments, which support physical activity” (2010, p.604). Given that school-based physical activity programs have proved effective in prevention of obesity and improving physical fitness in children, it is advisable to extend these practices to include community and home-based programs.

Physical activity is necessary for the management of obesity among obese children. Fundamentally, physical activity enhances utilization of excess calories in the body, thus reducing weight gain. Since children are active, insufficient physical exercise and the condition of their obese bodies limit their physical activity. Waters et al. (2011) clarify that physical activity improves metabolic activities of the body and promotes the burning of fats that are responsible for obesity. For obese children to attain normal body mass index within the shortest time possible, physical exercise is the appropriate intervention. Through physical exercise, an obese child can burn more calories per day than the total consumed calories. After a certain period, the body would operate on negative calories, which means that the body would utilize the stored energy in the form of fats and glycogen to replenish the deficient energy supply from food. In this manner, the body mass index will reduce gradually, and the obese child will regain the normal weight.

Nursing Implication

The literature review implies that nutritional diet and physical activity are two important interventions in the prevention and management of obesity among children. Hence, when nurses are dealing with children, they should consider ways of improving nutrition and physical activity in the prevention and management of obesity. Nutritional intervention ensures that children eat a healthy diet without excess calories in terms of fats and carbohydrates, which could predispose children to obesity. Moreover, dieticians use nutritional intervention when designing diets for obese children, thus enabling children to reduce the increasing rate of body weight, maintain their weight, and eventually reduce body mass index significantly. Similarly, physical activity stimulates utilization of fats and glycogen by body tissues thus reducing their accumulation in the body to cause obesity. In this view, physical activity is relevant in both prevention and management interventions of obesity. According to Kain et al. (2012), the cause of obesity is the combined effects of decreased physical activity and increased intake of calories. Hence, nurses should develop interventions to increase physical activity and reduce intake of calories among children.

Given that both physical activity and nutritional diet are interventions that help in the prevention and management of obesity in children, nutritional diet plays a primary role in prevention while physical activity is important in the management of obesity. The prevention and management of obesity require different interventions, even though both physical activity and nutrition diet have similar objectives of maintaining or reducing body mass index. For healthy children who are not obese, nutritional intervention with normal exercise is appropriate in preventing obesity. In contrast, for obese children, extensive physical exercise with nutritional diet is essential in the management of their obese conditions. While extensive physical exercise aids in rapid reduction of weight, a nutritional diet has long-term impact on reduction of weight. Hence, nurses should customize their interventions depending on whether they are preventing obesity or managing obesity among children. Given that families influence the aspect of nutrition, schools and communities determine the natural physical activity programs that they formulate. However, Waters et al. (2011) argue that prevention and management of obesity among children require concerted efforts of parents, community, and schools. Hence, nurses should encourage the participation of parents, schools, and communities in the prevention and management of obesity in children.

Change of Practice

The literature review provides significant evidence that requires a change in nursing practice with regard to the prevention and management of obesity among children. From the literature review, it is evident that nutritional diet and physical activities are central in the prevention and management of obesity in children. However, subtle evidence shows that the application of nutritional intervention and physical exercise requires concerted efforts of parents, the community, schools, and nurses. Therefore, it implies that nurses alone cannot afford to prevent and manage obesity in children. Therefore, the practice of nursing should change in tackling the health issue of obesity in children by using several approaches rather than utilizing nursing programs alone.

References

Kain, J., Uauy, R., Concha, F., Leyton, B., Bustos, N., Salazar, G., Lobos, & Vio, F. (2012). School-based obesity preventing Interventions for Chilean children during the past decades: Lessons Learned. Advances in Nutrition, 3 (1), 616S–621S.

Raj, M., & Kumar, K., (2010). Obesity in Children & Adolescents. Indian Journal of Medical Research, 132, 598-607.

Waters, E., de Silva-Sanigorski, A., Hall, B., Brown, T., Campbell, K., Gao, Y., Armstrong, R., Prosser, L, Summerbell, C. (2011). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 1 (12), 1-214.