Obesity Articles Television Viewing and Hypertension in Obese Children and The HIKCUPS Trial - Literature review Example

The two articles ‘Television Viewing and Hypertension in Obese Children’ by Pardee et al. and ‘The HIKCUPS trial: a multi-site randomized controlled trial combined physical activity skill-development and dietary modification program in overweight and obese children’ by Jones et al. are based on the studies conducted on the prevailing problems of childhood obesity. In the recent times, obesity has increasingly become a social problem which has crossed the realm of personal issues that can be resolved individually. This trend has caused concern amongst the medical fraternity and various researches have been undertaken to understand the reasons so that effective measures and programs can be implemented to arrest this rapidly growing tendency amongst the population, especially children. The wide ranging implications of obesity are serious and they need to be addressed at the earliest to promote better health and welfare of the society at large. The paper would critically evaluate the studies to see the issues that have significant impact on the obesity. Article 1 The first article is a research based on the grounded theory that time spent watching television is directly correlated with hypertension in obese children. This area was particularly chosen because no previous studies had explored this dimension in the obese children though one European study had explored the effect TV viewing of children with hypertension and had found no substantial evidence of the same. Since obesity is a serious health hazard and promotes psychological disorders and hypertension, leading to other health problems of heart, diabetes etc., it also becomes pertinent to study the impact of other factors like TV viewing which may directly be responsible for hypertension in obese children. The study has reviewed 39 literatures, related to the topic, spanning twenty one years from 1985 to 2006. The most important feature of the literature review has been that twenty 23 out 39 reviews have been from studies published in the last 10 years thus giving credence to the contemporary trend of obese behavior and its implications. The study and literature review has remained focused on the issue of the obesity and factors correlated with it. It was a quantitative analysis with a total of 556 children, from the age of 4 years to 17 years who were evaluated at pediatrics subspecialty weight management clinic in San Diego CA, San Francisco CA and Dayton OH. With strict watch on the BMI level of all children, they were observed from 2003 to 2005. The information regarding age, gender, race, ethnicity, height, weight, systolic blood pressure, and diastolic blood pressure was maintained at the start of the evaluation. Blood pressure was recorded from the right arm of the children and average TV as per the standard protocol. The viewing time as stated by the parents was recorded meticulously. All the ethical postulates were strictly adhered and the written consent from the parents of children below the age of 8 years was taken. For children 8 years an above, consent from parent and child was both recorded. All the standard parameters of clinical protocols were followed. The ten subjects with missing data were excluded from the evaluation and survey on 546 children was carried out. Pearson’s correlation was used to establish the association between hours of TV watched and the severity of obesity in the children. Difference in BMI1, age and hours of TV watching between children with and without hypertension was calculated with t Test. Hypertension between boys and girls and ethnicity/ race were tested with chi square test. For other multivariate tests, hypertension was considered as dependent variable with BMI score and TV watching as independent variable. SPSS package was used as the statistical package for all calculations. The result of the survey established that there is definite linkage between hours of TV watching and hypertension in the obese children. The hypertension amongst the obese children is significantly increased with the duration of TV watching. The study also showed that the duration of T watching increased with the age of the participant children. The result was true across the various factors like gender, race and ethnicity. The study is highly relevant primarily because hypertension is critical by-product of obesity and factors that may aggravate this condition in obese children are vital factors that need to be addressed urgently. Obesity amongst children and adolescent has become a menacing problem in the contemporary time and this study would go a long way in developing interventional techniques to control hypertension amongst the obese children. Great efforts were made to follow the protocols and precision followed by well established criteria of calculation that gave credence to the result that were achieved. Article 2 The second article by Jones et al. is a Hunter Illawarra Kids Challenge Using Parents Support (HIKCUPS) trial, on the effective methods of intervention in the obese children, based on the experimental model of controlled trial on comparative analysis of 3 interventions: dietary modifications under parental guidance; physical activity and skill development; and combination of first two interventions. The measures of intervention that have most considerable impact on the obesity of children were undertaken and evaluated per se. The qualitative research becomes significant because it was observed that the present intervention techniques were short term measures of control and lost their relevance in the long term. The research has encompassed literature from 1978 to 2006, examining 29 studies undertaken in the area. The most commendable feature of the research is that 23 out of 29 papers were published between 2000 and 2006, thus ensuring that latest trends and factors were considered. While the previous literature greatly facilitated in ensuring that the intervention measures were important imperatives for the research, the study was designed to study and prove the efficacy of the above mentioned interventions in controlling the obese behavior amongst children and adolescents. 200 families with overweight or obese children in the age group of 5-9 years were considered from Hunter and Illawarra region of New South Wales, Australia, three cohorts during 2005 and one cohort in 2006. The methodologies applied for recruitment was through extensive propaganda on the schools newsletter, pamphlets, articles, GP clinics, pediatric dietetic departments at local hospitals etc. and parents encouraged to study the details of the study. Once their consent was recorded in the written form and their agreement for the various inclusive and exclusive criteria taken, random selection process was used to select the final families. The baseline for assessment was 6, 12 and 24 months. To study the efficacy of interventions, the parents were apprised of the conditions and the time they needed to devote on the project. The first dietary modification intervention encouraged parents to introduce dietary modifications in their lifestyle and motivate children to follow the same through various means like making themselves as role model for new diet. The three major components of DM program: parent focused face-to-face group session; homework; and follow up greatly served to motivate the parents and keep them interested in the project. The second intervention promoting child focused physical activity skill development program (PASD) amongst children too had three components: child focused group sessions; homework; and follow-up help evaluate the objectives of the study. Ten session of 2 hours duration on a weekly basis was designed for children where they were encouraged to participate in physical activities which were aimed at improving their mastery of 12 fundamental movement skills (run, jump, leap, hop, slide, gallop, strike, roll, kick, throw, catch, bounce). The various components help persuade them to become proficient in various skills, thus promoting better health. The third intervention measure was a combination of the two previous interventions where parents undertook dietary measures and their children participated in PASD. The research was approved by Universities of Wollongong and Newcastle Human Ethics Research Committee and parents were given full details of the various inclusion/ exclusion criteria and consent recorded before the commencement of the trial experiment. The primary outcome of trial is BMI Z-score and waist circumference amongst the children of the participant families. The secondary outcomes are: metabolic profile vis-à-vis blood pressure, fasting level of total cholesterol, HDL and LDL cholesterol, triglycerides, glucose, insulin and C-reactive protein; dietary intake and child feeding questionnaire; skill proficiency, physical activity detail, sedentary activities; and lifestyle changes. It is assumed that these interventions would inculcate long term habits of lifestyle maintenance that promote healthy living and discourage obese behavior amongst children. The outcomes envisaged in the HIKCUPS trial are designed to make original and effective intervention practices that would discourage obese behavior amongst children. While the objectives and various criteria of the study entailed are commendable for their effectiveness, the rigorous schedule of the trial for children as well as for the parents may promote indifference on long term basis. It is therefore, advisable for the participants and the organizers to relax the schedule after some period to rejuvenate the enthusiasm for the project amongst the parents and children alike. But the most important part of the trial is the 24 months assessment would give strong indication of development of new lifestyle that includes healthy diet and thus bodes well for future. The research is one of the first randomized controlled trials in Australia with a large sample size which would give important indication of the long term intervention practice in the control of obese behavior amongst children. Reference Perrie E. Pardee; Norman, Gregory J.; Lustig, Robert H.; Daniel Preud’homme; and . Schwimmer, Jeffrey B.(2007).Television Viewing and Hypertension in Obese Children. American Journal of Preventive Medicine;33(6):439–443 Jones, Rachel A; Okely, Anthony D.; Collins, Clare E.; Morgan, Philip J; et al. (2007). The HIKCUPS trial: a multi-site randomized controlled trial combined physical activity skill-development and dietary modification program in overweight and obese children. BMC Public Health; 7:15. Read More