Health Promotions Campaigns and Children Obesity - Research Proposal Example

The School Fruit and Vegetable Scheme and Childhood Obesity: Assessing the Effects 2007 Background Childhood obesity has recently turned into one of the major public health concerns and one of the prevalent nutritional diseases in the UK. This dangerous condition is commonly defined as "a chronic condition that develops when energy intake exceeds energy expenditure, resulting in excessive body weight" (Kibbe 2003: 1) or an excessive " accumulation of body fat claiming that obesity is diagnosed when total body weight is more than 25 percent fat in boys and more than 32 percent fat in girls (Lohman 1987: 99). Health consequences of childhood obesity are profound. Asthma, sleep disorders, gall bladder disease, liver disease, and increased intracranial pressure are also associated with childhood obesity. Mental issues include low self esteem, social isolation, and depression (Betz 2000; Drohan 2003). As obese children age, risk of cardiovascular and musculoskeletal problems continues to increase (Feeg 2004). An estimated 11 percent of British children are diagnosed as obese, while 25 percent are considered overweight (Reilly et al 2002). Such disturbing trend brings childhood obesity to the forefront of treatment and prevention research. Childhood obesity has been linked to several factors such as genetics (Garn & Clark 1976: 452), energy imbalance, and physical activity (Kibbe 2002; MacKenzie 2000). Dietary factors have recently moved to the focus of academic research dedicated childhood obesity with many scholars directly linking them to the recent epidemics of obesity. They identify a variety of nutrition factors contributing to childhood obesity: "family meal patterns and food choices, food availability, portion control, fat intake, school food service, sugar beverages, and nutrition products qualifying under the Food Stamp and Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs" (Kibbe 2003: 6). Abundant statistics vividly demonstrates that dietary patterns has transformed greatly over the last decades. Thus, only during one year (from 1997 to 1998) the amount of food income spent outside the home increased by 2 percent: from 36 to 38 percent (Nader et al 1999). This increase, in its turn, led to more calories consumed by children: it is a well-known fact that meals eaten in eating establishments is more saturated with fat and contains more calories than meals eaten at home. Increased availability of cheap and highly nutrient products is also likely to contribute to proliferation of childhood obesity in the UK. Although there is no clarity as for direct relationship between drinking carbonated drinks and accumulation of excessive weight, the chances are that this disturbing relationship exists. The ongoing 5 A DAY health promotion programmes designed and implemented by the Department of Health is meant to address the growing incidence of chronic diseases associated with nutrition, including obesity. The core of the 5 A DAY initiative is increase consumption of the health benefits of fruit and vegetables (DH 2007). Abundant empirical data is available to confirm the positive effect of 5 A DAY in preventing and/or alleviating the consequences of many chronic conditions such as various hart diseases, asthma, diabetes, cardiovascular diseases, etc (Appel, Moore & Obarzanek 1997; Taylor, Jacques & Epstein 1995). However, there is little research exploring the effect of the 5 A DAY initiative on childhood obesity. The Department of Health claims that The School Fruit and Vegetable Scheme (a variation of 5 A DAY initiative for educational institutions) rely upon a solid body of pilot studies confirming its positive effect on children. Unfortunately, the search revealed no credible studies showing any kind of relationship between the programme and childhood obesity though indirect evidences of the positive effects of fruits and vegetables consumption can be found in the dietary factors research (Kibbe 2003). Yet such evidences can hardly be extrapolated on the due to only reason: The School Fruit and Vegetable Scheme not only seeks to increase consumption of fruits and vegetables, but also highlights the importance of educating children about the importance of balanced diet. Therefore, more specific studies are needed justify and assess the effectiveness of The School Fruit and Vegetable Scheme in preventing and fighting childhood obesity. Objective The primary goal of this case-control study is to assess the impact of the concrete health promotion programme on childhood obesity. The basic hypothesis is that participation in the programme is a factor that positively affects childhood obesity helping children effectively fight this dangerous condition by normalizing their diet. Study Design The case-control study design is chosen to test the basic hypothesis. The choice of study design is due to the major drawback of using a longitudinal approach to study the causes of such condition as childhood obesity. Considering the ambiguity surrounding the causes of this condition a very large and long-lasting investigation is required to ensure acceptable level of statistical power in finding out whether increased consumption of fruits and vegetables has any positive effect on children suffering from obesity. The case-control design allows avoiding this major problem and completing the study within a relatively small timeframe (6 months). The case-control design implies the following steps identified specifically for this investigation: 1. A brief preliminary survey of schools in order to identify at least one which strictly observes the requirements of The School Fruit and Vegetable Scheme (a variation 5 A DAY programme for educational institutions) and one which does not follow The School Fruit and Vegetable Scheme requirements (e.g. the school is not yet eligible, the region of the school's location has not yet come on stream, etc); 2. Obtaining appropriate permissions to carry out the study from the administration of each school; 3. Identification of two equal samples of obese children aged 8 years old: one sample for each school. Sampling will be done in the following way: Obtaining parental consent for the whole student population of the age of interest (8 years): this will be done individually; parents will be briefed on the objectives, methods and significance of the study and offered to sign a consent form confirming their willingness to take part in the research. Contacting the school paediatricians for help in identifying obese children among the student population whose parents signed the consent form. The process does not imply any procedures directly involving the children: it is assumed that the school paediatrician is able to identify the group of interest based upon the previously conducted examinations and/or anonymous observations. 4. After samples are identified, the researcher will contact the parents of children selected for the study asking them to fill in a specifically designed questionnaire. The same procedure will be repeated in four months 5. Odds ratios will be estimated then on the basis of collected data. Procedure Once the authorisation obtained from the administration of both schools is obtained, participants (parents) will read and sign the consent form which provides a succinct explanation of their participation in the study. Then sampling will be carried out to define the case and control group of children. Thus, the research will involve two groups of children (8 years old) whom clearly suffer from obesity. The sample of children from the pro-5 A DAY school will be considered the case; the sample of children from the school which does not implement the 5 A DAY programme will be considered the control. The major criteria for selection will be regular medical examination taken in the beginning of the school year but not earlier than four weeks prior to the study. Such criteria as sex, age, and socio-economic position will also be considered to reduce the confounding factors to minimum. Parents of the selected children will complete the specially designed questionnaires. After three months they will complete the same questionnaires again Materials (Questionnaire) The questionnaire will be developed with reference to validated research, specifics of the study being conducted, and questionnaires used in similar studies. Several versions of the questionnaire should be designed and preliminary evaluated before the final version is approved an employed as the primary data collection tool in the study. The questionnaire will not be too large: only the relevant data will be retrieved such as physical characteristics of interest (weight, height), socio-economic position, basic nutritional factors, and some additional information to allow for further statistical adjustments of results. Use of interviewing would allow collecting more versatile and in-depth data, but surveying is preferred considering the limited resources and narrow timeframe for the study. Collection and Analysis of Data Data will be collected either via mail (electronic or ordinary) or individually depending upon the preferences of participants. Questionnaires will be sent to parents of those children whom expressed their consent to participate in the study. The collected data will be categorised and analysed using a powerful statistical software (SPSS) to measure the variables of interest and test the basic hypothesis. Use of the advanced statistical instrument analysis of variance (ANOVA) will allow not only simple comparison of mean scores, but also analysis of the variables of interest for statistical significance. Assessment of Confounding Factors Only few confounding factors will be investigated within the framework of this study: sex, socio-economic position. One way to improve credibility of the study by addressing the potential confounding factors is to measure them and then make adequate adjustments during statistical analysis of data. This can be done by matching cases and controls either individually (for example by pairing each case with a control of the same sex and socio-economic position) or on the basis of group comparison (for example, by creating similar case and control groups with the same overall sex and socio-economic distribution). Further statistical adjustments can be made depending upon the preliminary results. Evidently, such study will not provide comprehensive data on the relationship between dietary factors and childhood obesity: in fact, it is nothing but a pilot study revealing only short-term consequences of the nutritional programme. A longitudinal prospective case-control study involving larger samples and longer timeframe would be much better in terms of statistical power and comprehensiveness of conclusions. Unfortunately, specifics of the subject of interest does not allow for conducting a randomized control study which is known to be the best alternative in establishing causality. The design of such longitudinal study will differ from the pilot study design on several dimensions: 1. The study will involve several hundreds or even thousands of participants of the same sex, age, and similar socio-economic position: this will allow eliminate some potentially essential confounding factors. 2. More confounding factors will be considered such as physical activity, stress, mental problems, family factors, use of multivitamins and others. 3. After several years of follow up it will be possible to better understand not only the short-term relationship but also the long-term correlation between a specific health promotion campaign (5 A DAY in our case) and childhood obesity in participants categorized by age, body mass index, physical activity and other confounding factors. On the condition of correct follow-up, coupled with accurate statistical analysis, the results of such study seem to have sufficient credibility and no serious biases. Safety and Ethical Considerations Since the study involves human subjects the key ethical issue associated with it is confidentiality. The data collected and analysed within the framework of this study will not be disclosed to anyone. The study does not involve any direct measurements, experiments or interventions with obese or normal children: it only seeks to assess the short-term outcomes of the 5 A DAY initiative in school setting relying primarily upon parental observations. Therefore, considering the age of children selected for the study there is no need to inform them about their participation in the study. Parents will be strongly advised not to do it too in order to avoid any potential consequences of this information. References Appel, L., Moore, T. & E. Obarzanek 1997. 'A clinical trial of the effects of dietary patterns on blood pressure'. New England Journal of Medicine, 336: 1117-23 Betz, L. 2000. 'Childhood obesity: Nursing prevention and intervention approaches are needed'. Journal of Pediatric Nursing: Nursing Care of children & Families, 15(3), 135-136. Department of Health 2007. 5 A DAY. Retrieved April 10, 2007 from http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/FiveADay/index.htm. Drohan, S. H. 2003. 'Managing early childhood obesity in the primary care setting: A behavior modification approach'. Pediatric Nursing, 28(6): 599-610. Feeg, V. D. (2004). Combating childhood obesity: A collective effort. Pediatric Nursing, 30(5): 361-362. Garn S. M, & D.C. Clark 1976. 'Trends in fatness and the origins of obesity'. Pediatrics, 57: 443-456. Kibbe, D. 2003. 'Childhood Obesity - Advancing Effective Prevention and Treatment: An Overview for Health Professionals'. National Institute for Health Care Management Research and Educational Foundation, Issue Paper. Retrieved May 4, 2007 from www.nihcm.org/ChildObesityOverview.pdf. Lohman, T. G. 1987. 'The use of skinfolds to estimate body fatness on children and youth'. Journal of Physical Education, Recreation & Dance, 58(9): 98-102. MacKenzie, N. R. 2000. 'Childhood obesity: strategies for prevention'. Pediatric Nursing. 26(5): 527-530. Nader, P.R., E.J. Stone & L.A. Lytle 1999. 'Three-year maintenance of improved diet and physical activity'. Archives of Pediatric and Adolescent Medicine, 153: 695-704. Reilly, J. J., Wilson, M. L., Summerbell, C. D. & Wilson, D. C. 2002. 'Obesity: diagnosis, prevention, and treatment; evidence based answers to common questions'. Archives of Disease in Childhood, 86: 392-394. Taylor, A., Jacques, P., and E. Epstein 1995. 'Relations among ageing, antioxidant status and cataract'. American Journal of Clinical Nutrition, 62 (supp): 1439-47s Read More